幽门螺杆菌的表型特征及其分型的临床意义

Characteristic of Helicobacter Pylori Phenotypes and Clinical Significance of Its Typing

目的 研究幽门螺杆菌 (H .pylori,Hp)的表型特征并评价Hp表型分型的临床意义。 方法 以被确诊感染Hp的 2 18例胃十二指肠疾病患者和 36例无症状健康志愿者作为研究对象。 2 18例患者经胃镜和组织学检查确诊为慢性胃炎 (CG) (n =12 4 )、消化性溃疡 (PU) (n =5 1)和胃癌 (GC) (n =4 3)。用免疫印迹法检测Hp细胞毒素相关蛋白 (CagA)、空泡毒素 (VacA)、尿素酶 (Urease)、鞭毛蛋白 (Flagellin)及其亚型。 结果 ①Hp存在比较明显的表型多态性。②除 30KDUreA在CG组中的表达率 (83 6 % )低于在PU组中的表达率 (98.0 % ) (P =0 .0 2 6 )外 ,Hp表型CagA、VacA、Urease、Flagellin及亚型 12 8KDCagA、116KDCagA、95KDVacA、91KDVacA、6 6KDUreB、5 4KDFla和5 0KDFla ,无一在CG、PU和GC组中的表达率差异有显著性意义 (P >0 .0 5 )。③I型菌株在CG、PU和GC组中的表达率分别为 76 .6 %、84 .3%和 93.0 % ;CG组与PU组比较 ,P =0 .2 5 7;CG组与GC组比较 ,P =0 .0 18;GC组与PU组比较 ,P =0 191;GC组与非GC(CG和PU)组比较 ,P =0 .0 32。④I型在不同年龄组和性别组中的表达率差异均无显著性意义 (P >0 .0 5 )。结论 ①Hp的表型多态性可能与其毒力和感染结局的多样性有关。

objective To study the characteristic of Helicobacter pylori (H. pylori) phenotypes and evaluate the clinical significance of its phenotype typing. Methods 218 patients with gastroduodenal diseases and 36 volunteers without symptoms were observed. 218 patients were diagnosed as chronic gastritis (CG) (n=124), peptic ulcer (PU) (n=51) and gastric cancer (GC) (n=43) by endoscopy and histology. Western blotting was used to detect phenotypes of H. pylori Cytotoxin-associated protein (CagA), vacuolating cytotoxin (VacA), Urease, Flagellin and their sub-phenotypes. Results (1) There exists obvious phenotype polymorphism on H. pylori. (2) Except that the expression rate of phenotype 30KDUreA in group CG was lower than that in group PU (P=0.026), among the expression rates of phenotype CagA, VacA, Urease, Flagellin and their sub-phenotype 128KDCagA, 116KDVacA, 95KDVacA, 91KDVacA, 66KDUreB, 54KDFla and 50KDFla in group CG, PU and GC, no significant difference was observed (P>0 05). (3) The expression rate of type I strain in group CG, group PU and group GC was 76 6%、84.3% and 93.0%,respectively; group CG vs group PU,P=0.257;group CG vs group GC,P=0.018; group GC vs group PU,P=0.191; and group GC vs group of patients without GC(i.e. CG and PU), P=0.032. (4) No significant difference was observed between the expression rate of type I strain in different group of age or sex (P>0.05). Conclusion(1) The polymorphisms of H. pylori may be related to it’s virulence and the diversity of infection outcomes. (2) It is not clear why the expression rate of phenotype 30KDUreA in group CG was lower than that in group PU; And none of the rest of phenotypes and sub-phenotypes seems itself to play an independent role of pathopoiesia, indicating that H. pylori probably cause formation of GC by comprehensive effect of many phenotypes and others not mentioned in present paper. (3) Type I strain may increase more risk for developing gastric cancer than type II. (4) The result of H. pylori phenotype typing is not associated with age and sex.