血清CD47水平与幽门螺杆菌感染及慢性萎缩性胃炎进展的关系

Relationship between serum CD47 level and helicobacter pylori infection and progression of chronic atrophic gastritis

目的 分析血清CD47水平与幽门螺杆菌(Hp)感染及慢性萎缩性胃炎(CAG)进展的关系。方法 选择2018年10月至2021年2月在儋州市人民医院消化内科就诊的273例CAG患者,采用14C-尿素呼气试验(14C-UBT)和抗Hp抗体检测了解Hp感染情况,将患者分为Hp阳性组和Hp阴性组。利用酶免疫分析法(EIA)检测血清胃泌素-17(G-17)、胃蛋白酶原(PG)水平;进一步分析血清CD47、G-17、PGⅠ、PGⅡ水平与Hp分型、慢性炎性反应、疾病活动度和慢性胃炎OLGA分期的关系。结果 Hp阳性组的血清CD47、G-17、PGⅠ、PGⅡ水平均较Hp阴性组明显升高(P均<0.001);HpⅠ型组的血清CD47、G-17、PGⅠ、PGⅡ水平均明显高于HpⅡ型组(P均<0.001)。在慢性炎性反应严重程度为2级或3级的患者中,HpⅠ型感染患者占比均明显高于HpⅡ型感染患者,且其血清CD47、G-17、PGⅡ水平也高于0级患者(P<0.05);尤其是3级患者,血清CD47、G-17、PGⅡ水平升高较1级和2级患者更明显(P<0.05)。在炎性反应活动度为1级、2级或3级的患者中,HpⅠ型感染患者占比均明显高于HpⅡ型感染患者,且炎性反应活动度≥2级的患者的血清CD47、G-17、PGⅡ水平亦高于0级患者(P<0.05);尤其是3级患者,血清CD47、G-17、PGⅡ水平升高较1级和2级患者更明显(P<0.05)。OLGA分期≥Ⅲ期患者的血清CD47、G-17、PGⅡ水平高于Ⅰ期患者(P<0.05);尤其是Ⅳ期患者,血清CD47、G-17、PGⅡ水平升高较Ⅱ期和Ⅲ期患者更明显(P<0.05)。Spearman相关系数分析结果显示,血清CD47与血清G-17、PGⅠ、PGⅡ均呈正相关性(r=0.723,r=0.213,r=0.820,P均<0.001)。结论 Hp(尤其是HpⅠ型)感染可能导致血清CD47表达水平升高,进而在CAG进展中发挥关键作用。CD47有望成为CAG患者诊治的重要生物标志物。

Objective This paper intends to analyze the relationship between the serum CD47 level and Helicobacter pylori(Hp) infection and the progression of chronic atrophic gastritis(CAG).Methods Two hundred and seventy-three CAG patients who were treated in the Department of Gastroenterology,Danzhou People’s Hospital from October 2018 to February 2021 were selected and assigned to the Hp positive group and the Hp negative group based on 14 C-urea breath test(14 C-UBT) and anti-Hp antibody detection.The serum gastrin-17(G-17) and pepsinogen(PG) levels were detected by enzyme immunoassay(EIA).The relationship between serum CD47,G-17,PGⅠ,PGⅡ levels and Hp typing,chronic inflammatory response,disease activity,and OLGA stage of chronic gastritis was further analyzed.Results The levels of serum CD47,G-17,PGⅠ,and PGⅡ in the Hp positive group are found to be significantly higher than those in the Hp negative group(P<0.001),while those in the Hp typeⅠgroup are significantly higher than those in the Hp typeⅡ group(P<0.001).Among patients with grade 2 or 3 chronic inflammatory response severity,the proportion of Hp typeⅠinfection patients is significantly higher than that of Hp type Ⅱ infection patients,and their serum CD47,G-17,and PGⅡ levels are also higher than those of grade 0 patients(P<0.05);especially in patients with grade 3,the levels of serum CD47,G-17,and PGⅡ increase more significantly than those in patients with grades 1 and 2(P<0.05).Among patients with inflammatory reaction activity of grade 1,2,or 3,the proportion of Hp typeⅠinfection patients is significantly higher than that of Hp type Ⅱ infection patients,and the serum CD47,G-17,and PGⅡ levels of patients with inflammatory reaction activity≥grade 2 are also higher than those of grade 0 patients(P<0.05);especially in patients with grade 3,the levels of serum CD47,G-17,and PGⅡ increase more significantly than patients with grade 1 and 2(P<0.05).The serum levels of CD47,G-17,and PGⅡ in patients with OLGA stage≥Ⅲ are higher than those in patients with stageⅠ(P<0.05);especially in patients with stage Ⅳ,the levels of serum CD47,G-17,and PGⅡ increase more significantly than patients with stages Ⅱ and Ⅲ(P<0.05).The Spearman correlation coefficient analysis shows that serum CD47 is positively correlated with serum G-17,PGⅠ,and PGⅡ(r=0.723,r=0.213,r=0.820,P<0.001).Conclusions Hp(especially Hp typeⅠ) infection may lead to increased expression of serum CD47,which in turn plays a key role in the progression of CAG.CD47 is expected to become an important biomarker for the diagnosis and treatment of CAG patients.