慢性肝病胃粘膜乙型肝炎病毒表达及幽门螺杆菌感染

Hepatitis B virus antigen expression and Helicobacter pylori infection in gastric mucosa of patients with chronic liver disease

目的 探讨乙型肝炎病毒（HBV）的泛嗜性及与幽门螺杆菌（Hp）感染的关系。方法选择慢性乙型肝炎（慢肝）28例、乙型肝炎后肝硬化（肝硬化）44例,共72例作为观察组,无肝病的胃病患者30例作为对照组。受检者常规胃镜检查,取胃窦幽门周围3cm以内活体组织3块,除普通病理检查外,分别做乙型肝炎病毒表面抗原（HBsAg）、乙型肝炎病毒核心抗原（HBcAg）检测及快速尿素酶、品红染色和免疫组化法检测Hp。结果 慢肝组有不同程度的胃粘膜慢性炎症者达92.9％（26/28）、肝硬化组达95.5％（42/44）,其中慢肝组以单纯慢性炎症为多,而肝硬化组以伴萎缩和肠化者为多。72例慢性肝病者中有51例胃粘膜HBV阳性,其中HBsAg、HBcAg双阳性16例;肝硬化组HBV抗原表达高于慢肝组,而HBsAg、HBcAg双阳性者低于慢肝组（P均<0.05）。在慢肝和肝硬化组有炎症的胃粘膜中Hp阳性率分别为76.9％（20/26）、69.0％（29/42）,与对照组相比无显著差别。慢性肝病Hp阳性、阴性者胃粘膜HBV抗原表达率分别为69.8％（37/53）、73.7％（14/19）,亦无统计学差异（P>0.05）。结论 （1）HBV在慢肝及肝硬化患者胃粘膜表达明显,应重视其在胃粘膜病变中的作用,加强防护措施。（2）在胃粘膜中HBV与Hp表达未见相关关系。

Objective To investigate the wide tropism of hepatitis B virus (HBV) and its relationship to Helicobacter pylori (Hp) infection. Methods Seventy-two patients were selected , among them 28 with chronic hepatitis B (chronic hepatitis B group) , 44 with hepatitis B associated with cirrhosis (cirrhosis group) ;30 patients with gastritis but without liver disease were used as control . In all patients diagnostic en-doscopy was performed. Three gastric biopsies were taken within 3 cm around the pylorus of gastric antra. U-rease detection, HE, Fuchsin staianing and immunohistochemical analysis of Hp IgG antigen were conducted. Results Different extent of chronic inflammation in cirrhosis group and chronic hepatitis B group was 95.5% (42/44) and 92. 9% (26/28) respectively. It indicated that in chronic hepatitis group most patients were complicated with chronic inflammation, while in cirrhosis group most patients with gland atrophy and intestinal metaplasia. In these two groups the positive rate of Hp in the inflammatory gastric mucosa was 69.0% (29/42) and 76.9% (20/26) respectively . No obvious difference existed between these two groups and control group. The rates of HBV antigen expression in the Hp positive, and Hp negative gastric mucosa were 69.8% (37/53) and 73.7% (14/19) respectively (P >0.05). Conclusions (l)There are obvious expression of HBV antigen in the gastric mucosa of patients with chronic liver disease and cirrhosis . Its role in the pathogenesis of gastric mucosal lesion is the worthful subject to be further studied. (2) No relationship between HBV antigen and Hp antigen expression was observed in this study.