慢性乙型肝炎和乙型肝炎肝硬化患者胃粘膜病变研究

目的 了解慢性乙型肝炎(CHB)和肝硬化患者胃粘膜病变发生率及其特征表现。方法 2017年1月～2019年1月海南医学院附属海南医院收治的70例慢性乙型肝炎、56例乙型肝炎肝硬化和同期在该院体检的50例健康人,接受胃镜检查,采用ELISA法检测血清胃蛋白酶原(PG)I和PGII水平,使用流式细胞仪检测外周血CD3⁺、CD4⁺和CD8⁺细胞百分比。结果 乙型肝炎肝硬化组血清PGI水平(93.8±28.3)μg/L,显著低于健康人【(135.7±21.6)μg/L,P<0.05】或CHB患者【(116.3±32.4)μg/L,P<0.05】,血清PGII水平为(13.3±5.7)μg/L,显著高于健康人【(9.2±2.4)μg/L,P<0.05】,血清PGI/PGII比例为(7.1±2.3),显著低于健康人【(14.8±3.4),P<0.05】或CHB患者【(9.6±2.9),P<0.05】;健康人、CHB和肝硬化组浅表性胃炎发生率分别为68.0%、32.9%和19.6%,差异显著(P<0.05),肝硬化组轻、中、重度萎缩性胃炎发生率分别为37.5%、25.0%和17.9%,与健康人(分别为8.0%、6.0%和2.0%,P<0.05)或CHB组(分别为37.1%、11.4%和5.7%,P<0.05)比,差异显著;肝硬化组外周血CD3⁺细胞百分比为(62.4±7.9)%,显著低于健康人【(68.3±5.8)%,P<0.05】或CHB组【(66.4±7.4)%,P<0.05】,CD4⁺细胞百分比为(35.7±7.4)%,显著低于健康人【(50.3±6.6)%,P<0.05】或CHB组【(45.4±6.4)%,P<0.05】,而CD8⁺细胞百分比为(34.4±4.7)%,显著高于健康人【(27.2±4.3),P<0.05】,CD4⁺/CD8⁺细胞比值为(1.8±0.3),显著低于健康人【(2.8±0.9),P<0.05】。结论 乙型肝炎肝硬化患者慢性萎缩性胃炎发生率高,血清PGI和PGII水平变化明显,其发生机制需要进一步探讨。

Observation of gastric mucosal lesions in patients with hepatitis B liver cirrhosis

Objective The aim of this study was to investigate gastric mucosal lesions in patients with hepatitis B and hepatitis B-induced liver cirrhosis. Methods 70 patients with chronic hepatitis B (CHB), 56 patients with liver cirrhosis and 50 healthy persons were enrolled in our hospital between January 2017 and January 2019, and all underwent gastroscopy. Serum PGI and PGII levels were detected by ELISA, and peripheral blood CD3⁺, CD4⁺ and CD8⁺ cells were detected by FCM. Results Serum PGI level in patients with hepatitis B-induced liver cirrhosis was(93.8±28.3)μg/L, significantly lower than (135.7±21.6)μg/L, P<0.05] in healthy persons or (116.3±32.4)μg/L, P<0.05] in patients with CHB, serum PGII level was (13.3±5.7)μg/L, significantly higher than (9.2±2.4)μg/L, P<0.05] in healthy persons, and the ratio of serum PGI/PGII was (7.1±2.3), significantly lower than (14.8±3.4), P<0.05] in healthy persons or (9.6±2.9), P<0.05] in patients with CHB; the prevalences of chronic superficial gastritis in healthy persons, in patients with CHB and in patients with cirrhosis were 68.0%, 32.9% and 19.6%(P<0.05), and the incidences of mild, moderate and severe chronic atrophic gastritis in patients with cirrhosis were 37.5%, 25.0% and 17.9%, significantly different compared to 8.0%, 6.0% and 2.0% (P<0.05) in healthy persons or 37.1%, 11.4% and 5.7% (P<0.05) in patients with CHB; the percentage of peripheral blood CD3⁺ cells in patients with cirrhosis was (62.4±7.9)%, significantly lower than (68.3±5.8)%, P<0.05] in healthy persons or (66.4±7.4)%, P<0.05] in patients with cirrhosis, the percentage of CD4⁺ cells was (35.7±7.4)%, significantly lower than (50.3±6.6)%, P<0.05] in healthy persons or (45.4±6.4)%, P<0.05] in patients with CHB, while the percentage of CD8⁺ cells was (34.4±4.7)%, significantly higher than (27.2±4.3), P<0.05] and the ratio of CD4⁺/CD8⁺ cells was (1.8±0.3), significantly lower than (2.8±0.9), P<0.05] in healthy persons. Conclusion The chronic atrophic gastritis in patients with hepatitis B cirrhosis is common, serum PGI and PGII levels change obviously, and the mechanism involved needs further investigation.