胃癌高发地区慢性萎缩性胃炎血清幽门螺杆菌抗体分型情况以及癌变风险的差异

Differences in serum Hp antibody typing and cancer risk in chronic atrophic gastritis in areas with a high prevalence of gastric cancer

目的分析胃癌高发地区慢性萎缩性胃炎(CAG)病人血清幽门螺杆菌(Hp)抗体分型情况以及癌变风险的差异。方法纳入2019年12月至2021年1月合肥市第二人民医院就诊的168例CAG病人作为研究对象,采用蛋白质印迹法检测血清Hp抗体分型(CagA、VacV、Ure),分为Ⅰ型Hp组、Ⅱ型Hp组和阴性组;酶联免疫吸附测定(ELISA)检测胃黏膜功能[胃蛋白酶原(PG)Ⅰ、PGⅡ、胃蛋白酶原比值(PRG)、胃泌素17(G17)],采用“改良ABC法”进行癌变风险分层,参考“木村-竹本”分类法对萎缩范围分级,根据萎缩部位和程度进行OLGA分期。结果168例CAG病人中Ⅰ型Hp组83例,Ⅱ型Hp组39例,Hp阴性46例;单纯胃窦萎缩病人,I型Hp病人G17低于Ⅱ型和Hp阴性组[3.61(2.57,5.04)pmol/L比5.85(3.91,7.32)pmol/L,6.01(4.55,8.39)pmol/L,P<0.05];胃窦+胃体萎缩病人,I型Hp病人PGⅠ[82.66(61.00,101.28)μg/L比100.27(66.59,124.28)μg/L,98.04(70.22,121.43)μg/L]、PRG[8.55(7.16,11.02)比10.13(8.94,12.31),10.71(9.08,13.16)]低于Ⅱ型和Hp阴性组(P<0.05);三组“改良ABC”癌变风险分层差异有统计学意义(P<0.05),其中Ⅰ型Hp病人高危层占比最高,达33.74%;三组“木村-竹本”分类法“C型”和“O型”的比例差异无统计学意义[18.72%(15/83)比23.07%(9/39),13.04%(6/46),P>0.05];三组OLGA分期差异有统计学意义(P<0.05),I型Hp病人Ⅲ期和Ⅳ期共19例,占比最高(22.89%),但三组间对比显示,I型和Ⅱ型Hp病人间OLGA分组差异无统计学意义(P>0.017),I型Hp病人OLGA高危组占比高于Hp阴性病人(P<0.017)。结论胃癌高发地区CAG病人以Ⅰ型Hp感染多见,不同分型Hp感染的CAG病人PG、PGR、G17水平存在差异,Ⅰ型Hp感染的CAG病人癌变风险相对较高。

Objective To analyze the differences in serum Helicobacter pylori(Hp)-antibody typing and cancer risk in patients with chronic atrophic gastritis(CAG)in areas with s high prevalence of gastric cancer.Methods A total of 168 patients with CAG who attended the Second People's Hospital of Hefei from December 2019 to January 2021 were enrolled in the study,and serum Hp antibody typing(CagA,VacV,Ure)was detected by Western blotting and divided into a type Ⅰ Hp group,a type Ⅱ Hp group and a negative group.Enzyme-linked immunosorbent assay(ELISA)was used to detect gastric mucosal function[pepsinogen(PG)Ⅰ,PGⅡ,pepsinogen ratio(PRG),gastrin 17(G17)].The"modified ABC method"was used to stratify the risk of cancer,and the extent of atrophy was graded according to the"Kimura-Takemoto"classification,and OLGA staging was performed according to the site and extent of atrophy.Results Among 168 CAG patients,83 were in the type Ⅰ Hp group,39 in the type Ⅱ Hp group and 46 in the Hp-negative group.In patients with simple sinus atrophy,typeⅠHp patients had lower G17 than the type Ⅱ and Hp-negative groups[3.61(2.57,5.04)pmol/L vs.5.85(3.91,7.32)pmol/L,6.01(4.55,8.39)pmol/L,P<0.05].In patients with gastric sinus+gastric body atrophy,PGⅠ[82.66(61.00,101.28)μg/L vs.100.27(66.59,124.28)μg/L,98.04(70.22,121.43)μg/L],PRG[8.55(7.16,11.02)vs.10.13(8.94,12.31),10.71(9.08,13.16)]were lower than those in the type Ⅱ and Hp-negative groups(P<0.05).The difference between the three groups of"modified ABC method"cancer risk stratification was statistically significant(P<0.05),with the highest percentage of type Ⅰ Hp patients in the high-risk stratum(33.74%).The differences in the proportions of"C"and"O"types in the three groups according to the"Kimura-Takemoto"classification were not statistically significant[18.72%(15/83)vs.23.07%(9/39),13.04%(6/46),P>0.05].The difference in OLGA stage between the three groups was statistically significant(P<0.05),and the highest percentage(22.89%)was found in 19 cases of stage Ⅲ and Ⅳ Hp patients with type Ⅰ Hp,but the comparison results between the three groups showed that the difference in OLGA grouping between type Ⅰ and type Ⅱ Hp patients was not statistically significant(P>0.017),and the percentage of OLGA high-risk patients was higher in typeⅠHp patients than in Hp-negative patients(P<0.017).Conclusion Patients with CAG in regions with high incidence of gastric cancer are more frequently infected with type Ⅰ Hp.The levels of PG,PGR and G17 in CAG patients with different subtypes of Hp infection differed,and the risk of cancer was relatively higher in CAG patients with type Ⅰ Hp infection.