乙、丙型肝炎病毒及幽门螺杆菌在慢性肝炎、肝硬化患者胃黏膜的表达

Hepatitis B and Cantigen expression and Helicobacter pylori in gastric mucosa of patients with chronic liver disease

目的 探讨乙、丙型肝炎病毒(HBV、HCV)的泛嗜性及幽门螺杆菌(Helicobacter pylori)感染的关系。方法 选择慢性乙型肝炎(慢肝)28例、乙型肝炎后肝硬化(肝硬化)44例,共72例作为观察组,无肝病的胃病患者30例作为对照组。受检者常规胃镜检查,取胃窦幽门周围3cm以内活体组织3块,除普通病理检查外,分别做乙型肝炎病毒表面抗原(HBsAg)、乙型肝炎病毒核心抗原(HBcAg)、丙型肝炎病毒抗原(HCVAg)检测及快速尿素酶、品红染色和免疫组化法检测H.pylori抗原(HPAg)。结果 慢肝组有不同程度的胃黏膜慢性炎症者达92.9％(26/28)、肝硬化组为95.5％(42/44)。排除年龄影响因素外,慢肝组以单纯慢性炎症为多,而肝硬化组以伴萎缩和肠化者多。72例慢性肝病者中有51例胃黏膜HBVAg阳性,其中HBsAg、HBcAg双阳性31例。肝硬化组HBsAg或HBcAg表达及HBsAg、HBcAg双阳性者均高于慢肝组(P均<0.05)。51例慢性肝病胃黏膜中有33例占64.7％有HCVAg表达;其中22例占52.4％与HBsAg或(和)HBcAg同时表达。在慢肝和肝硬化组有炎症的胃黏膜中H.pylori阳性率分别为67.9％(20/26)、69.0％(29/42),与对照组相比无显著差别。慢性肝病H.Pylori阳性、阴性者胃黏膜HBV抗原表达率分别为69.8％(37/53)、73.7％(14/19),亦无统计学差异(P>0.05)。结论 (1)HBV。

Objective To investigate the wide tropism of hepatitis B and C virus (HBV and HCV) and their relationship with Helicobacter pylori (H. pylori) infection. Methods Seventy-two patients were selected, among them 28 with chronic hepatitis (chronic hepatitis group) and 44 with hepatitis B associated cirrhosis (cirrhosis group) ; 30 patients with gastritis but without liver disease were used as control. In all patients diagnostic endoscopy was performed. Three gastric biopsies were taken within 3cm around the pylorus of gastric antra. Uresase detection, HE, Fuchsin staianing and immunohistochemical analysis of H. pylori IgG antigen were conducted . Results Different extent of chronic gastric inflammation in cirrhosis group and chronic hepatitis B group was 95 .5 % (42/44) and 92 .9 % (26/28) respectively . It indicated that in chronic hepatitis group most patients were accompanied with chronic inflammation, while in cirrhosis group most patients with gland atrophy and intestinal metaplasia. The positive rate of HBVAg in these two groups is 81.8 % (36/44) and 53 .6 % (15/28) respectively ( P <0.05), and HCVAg is 70.97% (22/31) and 55% (11/20) . In these two groups the positive rate of H. pylori in the inflammatory gastric mucosa was 69.0% (29/42) and 67.9% (20/26) respectively. No obvious difference existed between these two groups and control group. The rate of HBV antigen expression in the H. pylori positive group was 69. 8% (37/53) but 91.7%(33/36) in H. pylori negative group( P > 0 . 05 ) . Conclusions (1)There were obvious expression of HBV,HCV antigen in the gastric mucosa of patients with chronic liver disease. Its role in the pathogenesis of gastric mucosal lesion is the worthful subject to be further studied . (2) No relationship between HBV and HCV antigen expression. (3)The role of H. pylori is an early factor to cause the chronic inflammation which can progress to gastric cancer. In later stage, after severe multi-focal atrophic gastritis intestinal metaplasia has developed. The eradication of H. pylori may not be sufficient to reverse the malignant process. Thus the author suggests that early detection and early eradication of the antigen of H, pylori in the gastric mucosa is of the utmost importance to the prevention of gastric cancer, irrespective of the antigen of HBV and HCV in the gastric mucosa being controlled or not.