不同类型幽门螺杆菌在慢性胃病中感染情况及对胃泌素-17和胃蛋白酶原的影响

Prevalence of different types of Helicobacter pylori infection in chronic gastric diseases and its influences on gastrin-17 and pepsinogen

目的探讨不同类型幽门螺杆菌(Helicobacter pylori,Hp)感染在慢性胃病中的分布情况及对胃泌素-17(gastrin 17,G-17)、胃蛋白酶原(pepsinogen,PG)的影响。方法523例慢性胃病患者均行13C尿素呼吸试验、血清Hp抗体分型及血清G-17、PG检测和胃镜检查,根据组织病理学诊断分为非萎缩性胃炎组213例,非萎缩性胃炎伴糜烂组96例,慢性萎缩性胃炎组77例,消化性溃疡组94例,胃腺癌组43例;分析5组患者不同状态Hp分布情况及血清G-17和PG水平。结果523例患者Hp阳性率为76.9%,Ⅰ型Hp阳性率(72.4%)高于Ⅱ型(27.6%);消化性溃疡组Hp阳性率(90.4%)高于胃腺癌组(88.4%)、慢性萎缩性胃炎组(83.1%)、非萎缩性胃炎伴糜烂组(78.1%)和非萎缩性胃炎组(65.7%)(P<0.05),胃腺癌组Ⅰ型Hp阳性率(84.2%)高于非萎缩性胃炎伴糜烂组(62.7%)和非萎缩性胃炎组(67.9%)(P<0.05)。Hp阳性患者血清G-17[3.88(1.48,9.75)pmol/L]、PGⅡ[13.60(8.71,20.80)μg/L]水平高于Hp阴性患者[1.44(0.65,4.29)pmol/L、7.93(5.59,11.74)μg/L](P<0.05),PGⅠ/PGⅡ[12.14(9.44,15.31)]低于Hp阴性患者[7.74(5.60,11.24)](P<0.05),PGⅠ水平[109.41(65.31,166.27)μg/L]与阴性患者[97.78(61.70,148.64)μg/L]比较差异无统计学意义(P>0.05);Ⅰ型Hp阳性患者血清PGⅡ水平高于Ⅱ型Hp阳性者(P<0.05),PGⅠ/PGⅡ低于Ⅱ型Hp阳性者(P<0.05),血清G-17、PGⅠ水平与Ⅱ型Hp阳性患者比较差异无统计学意义(P>0.05);胃腺癌组Ⅰ型Hp阳性患者血清G-17、PGⅡ水平高于其他4组(P<0.05),PGⅠ/PGⅡ低于其他4组(P<0.05),血清PGⅠ水平高于非萎缩性胃炎组、非萎缩性胃炎伴糜烂组和慢性萎缩性胃炎组(P<0.05),与消化性溃疡组比较差异无统计学意义(P>0.05)。结论不同类型的Hp感染在慢性胃病的进展中有不同作用,Ⅰ型Hp是导致胃黏膜病变和胃癌发生的高风险菌株,可引起PG和G-17的异常分泌。

Objective To investigate the distributions of different types of Helicobacter pylori(Hp)infection in chronic gastric diseases and its clinical influences on gastrin-17(G-17)and pepsinogen(PG).Methods Totally 523 patients with chronic gastric diseases received 13C-urea breath test,Hp antibody typing,G-17 and PG detection,and endoscopy.According to histopathologic results,these patients were divided into non-atrophic gastritis(NAG)group(n=213),NAG with erosion(NAGE)group(n=96),chronic atrophic gastritis(CAG)group(n=77),peptic ulcers(PU)group(n=94)and gastric cancer(GC)group(n=43).The Hp distribution and the levels of serum G-17 and PG were analyzed in five groups.Results The total Hp positive rate was 76.9%.The typeⅠHp positive rate(72.4%)was higher than typeⅡHp positive rate(27.6%).The Hp positive rate was higher in PU group(90.4%)than that in GC group(88.4%),CAG group(83.1%),NAGE group(78.1%)and NAG group(65.7%)(P<0.05),and the typeⅠHp positive rate was higher in GC group(84.2%)than that in NAGE group(62.7%)and NAG group(67.9%)(P<0.05).The levels of serum G-17 ans PGⅡwere higher in Hp-positive patients(3.88(1.48,9.75)pmol/L,13.60(8.71,20.8)μg/L)than those in Hp-negative patients(1.44(0.65,4.29)pmol/L,7.93(5.59,11.74)μg/L)(P<0.05),PGⅠ/PGⅡratio was lower in Hp-positive patients(12.14(9.44,15.31))than that in Hp-negative patients(7.74(5.60,11.24))(P<0.05),and there was no significant difference in PGⅠlevel(109.41(65.31,166.27)μg/L vs97.78(61.70,148.64)μg/L)(P>0.05).The serum PGⅡlevel was higher and PGⅠ/PGⅡwas lower in typeⅠHp-positive patients than that in typeⅡHp-positive patients(P<0.05),while the levels of G-17 and PGⅠshowed no significant differences(P>0.05).The serum levels of G-17 and PGⅡin typeⅠHp-positive patients in GC group were the highest(P<0.05);PGⅠ/PGⅡratio was the lowest(P<0.05);the serum PGⅠlevel was higher than that in NAG,NAGE and CAG groups,and showed no significant difference compared with PU group(P>0.05).Conclusion Different types of Hp infection have different affects on the progression of chronic gastric diseases.TypeⅠHp is a high-risk strain for gastric mucosal lesions and gastric cancer,and would lead to abnormal secretion of PG and G-17.