胃粘膜幽门螺杆菌抗原的分布及其意义

Distribution of H.pylori antigens in gastric mucosa and its clinical significance

目的 探讨幽门螺杆菌(Hp)感染患者Hp抗原分布部位及其与胃癌的关系。方法 收集经病理学检查证实的Hp 阳性胃病患者共84例 ,用免疫组织化学技术检测胃上皮细胞的Hp 抗原。结果 慢性浅表性胃炎、癌前变化和胃癌患者Hp抗原阳性者分别为12例、22例和13例 ;三者胃上皮细胞胞浆Hp 抗原阳性率依次升高 ,分别为0、63.6 %和84.6% (χ2=19.76,P<0.001) ;12例浅表性胃炎患者Hp抗原位于粘液层及腺颈部以上粘膜9例 (75.0% ) ,22例癌前变化患者Hp抗原位于腺颈部及峡部12例 (54.5% ) ,13例胃癌患者Hp抗原位于峡部以下粘膜9例 (69.2% ,χ2=25.30,P<0.001)。结论 在慢性浅表性胃炎→癌前变化→胃癌的变化过程中 ,Hp抗原逐渐由细胞外向细胞内、由浅表粘膜向深部粘膜迁移。

Objective To investigate the distribution of H.pylori antigens in the gastric mucosa in patients with H.pylori infection, and the relationship between the H.pylori distribution and gastric cancer.Methods H.pylori antigens in the gastric mucosa were detected by immunohistochemistry in 84 patients with chronic superficial gastritis, precancerous changes (chronic atrophic gastritis, intestinal metaplasia or atypical hyperplasia) and gastric cancer.Results Among 84 cases H.pylori was detected in 12 cased of chronic superficial gastritis, 22 precancerous lesions and 13 gastric cancers. The positive rates of H.pylori antigens in the cytoplasm of chronic superficial gastritis, precancerous changes and gastric cancer were at 0(0/12), 63.6% (14/22) and 84.6% (11/13) respectively (χ2=19.76, P<0.001). H.pylori antigens were located in the mucus layer and above the neck of the gland in 9 of 12 (75.0%) cases with chronic superficial gastritis, at the neck of the gland and the isthmus in 12 of 22 (54.5%) cases with precancerous changes, below the isthmus in 9 of 13 (69.2%) cases with gastric cancer (χ2=25.30,P<0.001).Conclusion With the progression of chronic superficial gastritis to precancerous changes and to gastric cancer, H.pylori antigens progressively migrated from the outside to inside of the cell, and from the superficial to the deep gastric mucosa.