慢性胃炎病情严重程度与幽门螺杆菌抗体分型的相关性

Correlation between the severity of chronic gastritis and Helicobacter pylori antibody typing

目的 分析慢性胃炎病情严重程度与幽门螺杆菌(Hp)抗体分型的相关性。方法 收集496例在本院接受胃镜检查和Hp抗体检测的慢性胃炎患者的临床资料,依据胃黏膜炎症细胞密集和浸润深度、胃黏膜萎缩情况将其进行分级。统计患者的Hp感染情况,并分析Hp抗体分型与患者胃黏膜炎症分级和萎缩分级的关系。结果 慢性胃炎患者Hp阳性检出率为74.60%(370/496),其中Ⅰ型Hp阳性率为88.38%(327/370),Ⅱ型Hp阳性率为11.62%(43/370)。Hp感染组的胃黏膜炎症分级和胃黏膜萎缩分级均显著高于非Hp感染组,差异具有统计学意义(P<0.01)。不同胃黏膜炎症分级和萎缩分级者Ⅰ型Hp阳性率和Hp阴性率比较,差异具有统计学意义(P<0.01);其中重度炎症分级者Ⅰ型Hp感染阳性率>中度者>轻度者(P<0.05);重度炎症者Hp感染阴性率<中度者<轻度者(P<0.05);萎缩分级重度者Ⅰ型Hp感染阳性率>中度者>轻度者>无萎缩者(P<0.05);中度和重度萎缩者Hp感染阴性率明显低于无萎缩者和轻度者,重度者显著低于中度者(P<0.05);不同胃黏膜炎症分级和萎缩分级者Ⅰ型Hp感染阳性率显著高于Ⅱ型Hp感染(P<0.05)。相同胃黏膜炎症分级和萎缩分级者的Ⅰ型Hp抗体细胞空泡毒素基因A(VacA)和细胞毒素相关基因A(CagA)阳性率显著高于仅VacA、CagA阳性抗体,仅VacA抗体阳性率显著高于仅CagA阳性抗体(P<0.05)。结论 Hp感染率与慢性胃炎发生、发展密切相关。Ⅰ型菌株为慢性胃炎的主要致病类型,抗体分型以VacA和CagA双阳性最为常见。

Objective To analyze the correlation between the severity of chronic gastritis and Helicobacter pylori(Hp)antibody typing.Methods The clinical data of 496 patients with chronic gastritis who underwent gastroscopy and Hp antibody detection in our hospital were collected.The patients were divided into grades according to the density and depth of infiltration of inflammatory cells in gastric mucosa and atrophy of gastric mucosa.The Hp infection of patients was counted,and the relationship between Hp antibody typing and the grading of gastric mucosal inflammation and atrophy was analyzed.Results The positive detection rate of Hp in patients with chronic gastritis was 74.60%(370/496),of which the positive rate of typeⅠHp was 88.38%(327/370),and the positive rate of typeⅡHp was 11.62%(43/370).The gastric mucosal inflammation grade and gastric mucosal atrophy grade in the Hp infection group were significantly higher than those in the non-Hp infection group,and the differences were statistically significant(P<0.01).There were significant differences between the positive rate of typeⅠHp and the negative rate of Hp in patients with different grades of inflammation and atrophy of gastric mucosa(P<0.01);among them,the positive rate of typeⅠHp infection in patients with severe inflammatory grade>moderate>mild(P<0.05);the negative rate of Hp infection in patients with severe inflammation<moderate<mild(P<0.05);the positive rate of typeⅠHp infection in patients with severe atrophy>moderate>mild>no atrophy(P<0.05);the negative rate of Hp infection in moderate and severe atrophy was significantly lower than that in non atrophy and mild atrophy,and that in severe atrophy was significantly lower than that in moderate atrophy(P<0.05);the positive rate of typeⅠHp infection was significantly higher than that of typeⅡHp infection in patients with different grades of inflammation and atrophy of gastric mucosa(P<0.05).The positive rates of vacuolating roxin A(VacA)and cytotoxin associated gene A(CagA)of typeⅠHp antibodies in patients with the same level of gastric mucosal inflammation and atrophy were significantly higher than those of VacA and CagA antibodies,and the positive rate of VacA antibodies alone was significantly higher than that of CagA antibodies alone(P<0.05).Conclusion Hp infection rate is closely related to the occurrence and development of chronic gastritis.TypeⅠstrain is the main pathogenic type of chronic gastritis,and the double positive expression of VacA and CagA is the most common antibody typing.