胃镜下病理改变与血清幽门螺杆菌抗体分型的关系分析

Relationship between pathological changes under gastroscopy and Helicobacter pylori antibody groups in serum

目的:探讨血清幽门螺杆菌(Helicobacter pylori,Hp)感染在该地区的流行状况及Hp抗体分型与胃镜下病理改变的关系。方法:选取2018年8月至2020年1月在山东第一医科大学第二附属医院行胃镜检查并同期进行Hp抗体检测的患者705例,其中男性389例,女性316例,年龄13~88岁。采用免疫印迹法检测Hp的4种抗体,根据性别和每10岁为一个年龄段分组(≤30、31~≤40、41~≤50、51~≤60、61~≤70、≥71岁组)两两比较HpⅠ型和Ⅱ型的感染率。根据胃镜诊断结果分为浅表性胃炎、浅表性胃炎伴糜烂、食管炎、慢性萎缩性胃炎、胃溃疡和胃癌组,比较各组间抗体检测的阳性率;统计胃镜下各病理改变的HpⅠ型中毒素相关蛋白A(cytotoxin-associated protein,CagA)、空泡毒素基因(vacuolating cytotoxin gene,VacA)、CagA+VacA抗体的表达情况。结果:Hp总感染率为60.6%,且Ⅰ型Hp感染率高于Ⅱ型(χ^(2)=188.686,P=0.000)。男性Hp感染率(59.4%)与女性(62.0%)相比差异无统计学意义(χ^(2)=0.510,P=0.475);同年龄组内HpⅠ型感染率与Ⅱ型感染率比较差异均有统计学意义(均P<0.05);胃癌组Ⅰ型阳性率最高(60.0%),食管炎组Ⅱ型阳性率最高(17.5%),同组Ⅰ型阳性率与Ⅱ型阳性率比较差异均有统计学意义(均P<0.05);胃镜下病理改变的Ⅰ型感染中CagA、VacA抗体的表达,胃癌组CagA抗体阳性率最高(70.6%),浅表性胃炎伴糜烂组VacA抗体阳性率最高(17.0%),食管炎组CagA+VacA抗体阳性率最高(52.0%)。结论:Hp感染是导致大部分胃部疾病的关键原因,Ⅰ型感染率更高,致病性更强,是目前临床上最常见的Hp感染类型。

Objective To investigate the prevalence of serum Helicobacter pylori(Hp)infection in the patients with upper gastrointestinal symptoms and the relationship between Hp antibody groups and pathological changes under gastroscopy.Methods A total of 705 patients including 389 males and 316 females underwent gastroscopy from August 2018to January 2020(age between 13 and 88 years).Four Hp antibodies were detected by immunoblotting,and the infection rates of typeⅠand typeⅡHp were multiple compared by sex and age groups(every 10 years old,which were≤30,31~≤40,41~≤50,51~≤60,61~≤70,≥71 years).Divided into superficial gastritis,superficial gastritis with erosion,esophagitis,chronic atrophic gastritis,gastric ulcer and gastric cancer groups through gastroscopy.The positive rates of HP antibodies detected between groups were compared,and the data of detected antibodies including toxin-related protein cytotoxin-associated protein(CagA),vacuolating cytotoxin gene(VacA)and CagA+VacA were collected and analyzed.Results The total HP infection rate was 60.6%,and the infection rate of Hp typeⅠin was higher than that of Hp typeⅡ.The HP infection rates in male were 59.4%(231)and 62.0%(196)in female,and didn’t show difference(χ^(2)=0.510,P=0.475).Age into 6 groups with Hp infection rate(P<0.05),HpⅠinfection rate within each age group(P<0.05).The gastric cancer group had highest positive rate of HpⅠ(60.0%),while the esophagitis group had highest rate of HpⅡ(17.5%),significant difference between typeⅠpositive rate(P<0.05).In the cases with positive HpⅠ,the Cag A positive rate in gastric cancer was 70.6%,the Vac A positive rate in superficial and erosive gastritis was 17.0%,and the positive rate of Cag A+Vac A in esophagitis was 52.0%.Conclusions Hp infection is a key cause of the most gastric diseases.HpⅠis currently the most common type of Hp infection in the clinic,which is more pathogenic.