慢性萎缩性胃炎胃粘膜病理改变与细胞毒素相关蛋白及空泡细胞毒素的关系

The relationship between the pathological changes of gastric mucosa and the virulence factors CagA,VacA of Helicobacter pylori in chronic atrophic gastritis

目的 研究慢性萎缩性胃炎时胃粘膜不同的病理变化与幽门螺杆菌 (Hp)致病因子细胞毒素相关蛋白 (CagA)和空泡细胞毒素 (VacA)之间的关系。 方法 12 0例Hp阳性的慢性萎缩性胃炎患者按粘膜炎症和粘膜萎缩的程度以及有无肠化生进行分组 ,并抽取血清 ,用Westernblot法测定血清中特异性抗体CagA( 116KD)和VacA( 89KD)。 结果 ( 1)慢性萎缩性胃炎粘膜炎症的程度与CagA检出的阳性率显著相关 ,炎症程度严重患者的CagA抗体阳性率显著高于轻度炎症病例 ( 85 .1%vs 5 3 .2 8%,P <0 .0 0 5 ) ;( 2 )胃粘膜重度萎缩者VacA抗体阳性率显著高于胃粘膜轻度萎缩者 ( 77.8%vs 3 8.7%,P <0 .0 0 5 ) ;( 3 )慢性萎缩性胃炎患者VacA抗体阳性者多有肠化生 ,其肠化生的发生率显著高于VacA抗体阴性患者 ( 84.1%vs 3 0 .3 %,P <0 .0 0 5 )。结论 CagA的表达同慢性萎缩性胃炎的严重程度密切相关 ,高阳性率患者的胃粘膜炎症活动度较重 ,而VacA的表达则同胃粘膜的萎缩及肠化密切相关 。

Objective To study the relationship between the pathological changes of gastric mucosa and the virulence factors CagA,VacA of Helicobacter pylori in chronic atrophic gastritis.Methods The sera from 120 cases with chronic atrophic gastritis which Helicobacter pylori was positive were sampled,and the specific antibody CagA,VacA was tested by Western blotting.The 120 cases were divided into different groups according to the mucosa inflammatory degree,the mucosa atrophic degree and the metaplasia degree.Results (1)The mucosa inflammatory degree in chronic atrophic gastritis was significantly associated with Cag A,the positive rate of CagA in severe mucosa inflammatory cases is significantly higher than that in mild mucosa inflammatory cases(85.1% vs 53.28%, P <0.005).(2)The VacA positive rate in severe gastric mucosal atrophy cases is significantly higher than that in mild atrophy cases(77.8% vs 38.7%, P <0.005).(3)The rate of metaplasia in VacA positive cases is significantly lower than that in VacA negative cases(84.1% vs 30.3%, P <0.005).Conclusions The expression of CagA is closely related to the inflammatory severity of the chronic atrophic gastritis;the higher the CagA positive rate is,the more severe the gastric mucosa inflammatory degree is.The expression of VacA is closely related to the gastric mucosa atrophy and metaplasia,the expression of VacA in severe atrophy and metaplasia cases is significantly higher than that in mild atrophy and metaplasia cases.