不同消化性疾病患者幽门螺杆菌毒力基因类型及意义研究

目的分析用不同消化性疾病来源的幽门螺杆菌(Hp)毒力基因的检测结果及其意义。方法收集该院胃镜室于2015年1月至2016年7月采集的628例患者胃活检标本,分离培养Hp,检测其携带的毒力基因,并探讨Hp与慢性萎缩性胃炎(CAG)、慢性浅表性胃炎(CSG)、消化性溃疡(PUD)的相关性。结果 628份胃活检标本中成功分离出214株Hp,选取其中172株提取DNA,发现Hp携带cagA、vacA、dupA、iceA、oipA、luxS多种毒力基因,其中vacA s1m1是CSG的危险因素,vacA s1m2与iceA1+/iceA2+提高PUD的发生率,dupA+提高十二指肠溃疡危险度。结论不同消化性疾病与Hp感染密切相关,dupA可考虑作为Hp致十二指肠溃疡的标记基因,vacA s1m2与iceA1+/iceA2+增加了发生PUD的危险性。     

广州地区消化道疾病患者中H.pylori ureA和vacA s1基因及cagA基因亚型分布

目的 分析研究广州地区消化道疾病患者中H.pylori ureA、vacA s1基因和cagA基因亚型(ABC、ABD、ABAB、AAD等)的分布状况及其与胃黏膜病理检测结果间的相关性.方法 随机选取227例消化道疾病患者的胃黏膜标本,分别来自病理组织学检测无病理改变者46例,慢性胃炎130例,消化性溃疡29例,萎缩性胃炎15例,胃癌7例.并用实时荧光定量PCR检测H.pylori ureA基因、vacA s1基因,用PCR扩增cagA羧基端EPIYA基序所在区,然后测序确定其亚型.以保守基因ureA的存在判断H.pylori感染.结果 227例消化道疾病患者中,有50.7% (115/227)的患者H.pylori阳性,其中,vacA s1基因阳性91.3%(105/115),cagA基因阳性78.3%(90/115).4种cagA-EPIYA亚型分布为,ABC 17.8%(16/90)、ABD 78.9%(71/90)、AAD 2.2%(2/90)、ABAB 1.1%(1/90).无病理改变组中H.pylori 阳性32.6%(15/46),vacA s1基因阳性28.3%(13/46),cagA基因阳性26.1%(12/46);慢性胃炎组H.pylori 阳性48.5%(63/130),vacA s1基因阳性43.8%(57/130),cagA基因阳性36.2%(47/130);溃疡组H.pylori 阳性72.4%(21/29),vacA s1基因阳性65.5%(19/29),cagA基因阳性55.2%(16/29);萎缩性胃炎组H.pylori 阳性66.7%(10/15),vacA s1基因阳性66.7%(10/15),cagA基因阳性66.7%(10/15);胃癌组H.pylori阳性85.7%(6/7),vacA s1基因阳性85.7%(6/7),cagA基因阳性71.4%(5/7).H.pylori在不同胃黏膜病理组的分布差异有统计学意义(χ2=16.72;P<0.01),溃疡、萎缩性胃炎、胃癌组中H.pylori的分布明显高于无病理改变与炎症组(χ2=16.02;P<0.01).但在H.pylori阳性患者中,强毒力因子vacA s1基因(χ2=2.00;P=0.74)、cagA基因(χ2=3.44;P=0.49)及cagA-EPIYA亚型(χ2=3.66;P=0.45)在无病理改变、炎症、溃疡、萎缩性胃炎及胃癌组中的分布差异均无统计学意义.结论 广州消化道疾病患者中H.pylori的感染与胃黏膜病理改变显著相关,而广州地区消化道疾病患者中H.pylori高毒力亚型的强致病性并不明显,需扩大标本量,再细化疾病种类进一步分析高毒力H.pylori对胃肠道疾病发生的影响.

Abstract：

Objective To detect the distribution of H.pylori ureA, vacA s1 gene and cagA subtype(ABC, ABD, ABAB, AAD, et al) in patients with digestive diseases in Guangzhou and investigate the relationship with the pathological findings of gastric mucosa.Methods A total of 227 randomly selected gastric mucosa from patients with digestive diseases were enrolled in the research, including 46 without pathological changes, 130 with chronic gastritis, 29 with peptic ulcer, 15 with atrophic gastritis and 7 with gastric cancer.Real-time PCR assay were used to detect Helicobacter pylori ureA gene and vacA s1 gene.EPIYA motifs in the 3′ region of cagA were amplified by conventional PCR followed by subtype sequencing. The conserved gene ureA was used to detect H.pylori infection.Results Among the 227 patients with digestive diseases, 50.7% (115/227) patients were H.pylori positive, in which 91.3%(105/115) carried vacA s1 and 78.3% (90/115) carried cagA. Four types of cagA-EPIYA subtype were detected, including ABC 17.8%(16/90), ABD 78.9%(71/90), AAD 2.2%(2/90) and ABAB 1.1%(1/90).In the non-pathological change group, 32.6% (15/46) were H.pylori positive, in which 28.3% (13/46) carried vacA s1 and 26.1% (12/46) carried cagA;in chronic gastritis group, it was 48.5% (63/130), 43.8% (57/130) and 36.2% (47/130), respectively;in ulcer group, it was 72.4% (21/29), 65.5% (19/29) and 55.2% (16/29), respectively;in atrophic gastritis group, it was 66.7% (10/15), 66.7% (10/15) and 66.7% (10/15), respectively;in gastric cancer group, it was 85.7% (6/7), 85.7% (6/7) and 71.4% (5/7), respectively.The distribution of H.pylori among the 4 groups had statistical significance (χ2=16.72;P<0.01). H.pylori was more prevalent in ulcer, atrophic gastritis and cancer group than in inflammation group and non-pathological change group (χ2=16.02;P<0.01).In patients infected by H.pylori, there was no significant difference in the distribution of vacA s1 gene as high virulence factors among non-pathological change, inflammation, ulcer, atrophic gastritis and cancer group (χ2=2.00;P=0.74), as well as cagA (χ2=3.44;P=0.49) and EPIYA subtypes (χ2=3.66;P=0.45).Conclusions H.pylori infection is significantly associated with the pathological change of gastric mucosa for patients with digestive diseases in Guangzhou, while the relationship with the pathogenicity of H.pylori with high virulence genotype is not significant.More samples and diseases reclassification are needed to make an advanced analysis of the effect of H.pylori with high virulence in gastrointestinal diseases development.     

幽门螺杆菌细胞毒素相关蛋白A、细胞毒素相关蛋白E、细胞空泡毒素A基因型与上消化道疾病的关系

目的分析幽门螺杆菌(Hp)的细胞毒素相关蛋白A(cagA)、细胞毒素相关蛋白E(cagE)、细胞空泡毒素A(vacA)基因型与上消化道疾病的关系。方法选取112例上消化道疾病患者,对其胃黏膜组织中Hp菌株的cagA、cagE、vacA基因型进行检测和分析。结果所有患者胃黏膜样本中的Hp菌株均为cagA基因和cagE基因阳性表达,阳性率均为100%。患者的vacAs1/m~2表型的阳性率最高,分别为54.1%和60.5%,其次为vacAs1/mlb表型和vacAs1/m~-表型,阳性率分别为13.2%~21.1%。消化性溃疡患者和慢性胃炎患者的Hp基因各表型的阳性率的差异均无统计学意义(P0.05)。结论上消化道疾病患者胃黏膜组织中的Hp菌株呈现cagA、cagE、vacAs1/m~2等基因亚型的优势表达,说明这些毒力因子表型在Hp引发和促进上消化道疾病的过程中具有重要的作用,但与上消化道疾病类型缺乏相关性。     

Characteristics of clinical Helicobacter pylori strains from Ecuador

In Ecuador, Helicobacter pylori infections are highly prevalent. A total of 42 H. pylori clinical isolates from 86 patients attending the outpatient clinic of the gastroenterology department of the university hospital of Guayaquil in Ecuador were characterized. Their susceptibility, and cagA and vacA status were determined. Resistance to metronidazole and clarithromycin was found in 80.9% and 9.5% of strains, respectively. Neither amoxicillin- nor tetracycline-resistant strains were found. The most prevalent genotype was the cagA(+), vacA s1b,m1 type. This genotype was associated with gastric cancer and peptic ulcer. Typing by random amplified polymorphic DNA showed no genetic relationship among the strains.     

Analysis of the vacA,cagA, cagE,iceA, and babA2 genes in Helicobacter pylori from sixty-one pediatric patients from the Midwestern United States

This study was designed to characterize H. pylori from pediatric gastric biopsy specimens in terms of several genes (vacA, cagA, cagE, iceA1, iceA2, and babA2) proposed to be involved in the pathogenesis of this organism. Many of these genes have been studied in adult H. pylori isolates, however, these genes have not been well characterized in H. pylori from children. Using PCR we observed that 44% of the H. pylori in our biopsies shared two common genotypes (vacA s1b m1, cagA, cagE, iceA2 +/- babA2). While 26% of the H. pylori had unique genotypes. The cag pathogenicity island associated genes, cagA and cagE, were found together in 64% or our H. pylori, while 84% were iceA2 positive. The presence of the babA2 gene has been proposed to be associated with a higher risk of H. pylori related diseases, however, we found that only 36% of our H. pylori contained this gene.     

幽门螺杆菌感染与胃粘膜林巴滤泡关系探讨

目的：为了探讨含有细胞毒素相关基因A（cagA）菌株感染与胃粘膜淋巴滤泡形成之间的关系,并对胃粘膜淋巴滤泡的发生与幽门螺杆菌（Hp）感染状况的关系等进行观察。方法：我们对655例慢性胃炎,消化性溃疡的患者进行胃镜检查,取胃窦粘膜组织作Hp检测和组织病理检查,并选择70份Hp培养阳性的临床分离菌,用PCR扩增法进行cagA基因的检测。结果：Hp感染患者中胃粘膜淋巴滤泡的发生率（60.14%）显著高于非Hp感染者（17.06%）;胃粘膜淋巴滤泡在活动性胃炎比非活动性胃炎中更易检测到;在Hp相关性胃肠病中,慢性胃炎、胃溃疡、十二指肠球溃这三者之间胃粘膜淋巴滤泡的发生率无显著性差异;另外,还观察到含cagA基因的Hp菌株与胃粘膜淋巴滤泡的增生两者之间无相关性。结论：胃粘膜淋巴滤泡的发生直接与Hp感染相关,并可作为一种Hp感染相关性胃肠病中一个较为恒定的形态特征;Hp作为一种抗原刺激胃粘膜产生淋巴滤泡的作用与Hp菌株的毒力（cagA基因）无关,任何Hp感染均可刺激胃粘膜产生淋巴滤泡。     

Genotyping of Helicobacter pylori strains from gastric biopsies by multiplex polymerase chain reaction. How advantageous is it?

Recent application of multiplex polymerase chain reaction (PCR) for genotyping Helicobacter pylori direct from biopsies revealed variable results (detection of amplicons from DNA extracted by boiling biopsies, variable size amplicons and deletions, uniform intensity of amplicon bands). We aimed to look at how applicable the technique is for determining cagA and vacA genotypes and to correlate the results with the severity of the disease. H. pylori strains from 52 patients (35 duodenal ulcers [DUs], 7 gastric ulcers [GUs], 10 gastritis) were included. Three antral biopsies were obtained for Campylobacter-like organism (CLO) and PCR. Primers for cagA, vacA s1s2, and m1m2 alleles were used. No PCR amplicons were detected from boiling biopsies; thus, DNA was extracted by QIAamp kit. H. pylori was positive in 84.6% of the patients (85.7% DU, 100% GU, and 70% gastritis). The cagA gene was detected in 86.6% DU, 71.4% GU, and 57.0% gastritis patients. The vacA allelic distribution among cagA-positive strains was 80.7% s1m1 in DU and 60.0% in GU patients, whereas 75.0% of gastritis had s1m2. No variability in the amplicon sizes was found, and the intensity of the amplicon bands was not uniform. A deleted band of approximately 420 bp below the m1 band was detected in strains from 2 DU and 1 GU patients. Although the multiplex PCR is a rapid and an effective tool for detecting several genes in a single-step system, one has to adjust for optimization of the technique when genotyping H. pylori direct from biopsies. A significant association was found between the cagA-positive vacA-s1m1 genotype and peptic ulcers.     

上海崇明地区幽门螺杆菌cagA基因多态性与感染临床结局的关系

目的探讨上海崇明地区幽门螺杆菌（Helicobacter pylori,Hp）的cagA基因的多态性与感染临床结局的关系。方法采用PCR法检测100株临床分离株cagA基因亚型,获得东亚型和西方型2种基因型。分析cagA基因亚型与消化道疾病间的关系。结果100株Hp中72株检出cagA基因,其中81．9％为cagA基因东亚型,15．3％为西方型,2．8％为同时存在着2种基因型。胃癌与慢性萎缩性胃炎患者中cagA基因东亚型菌株均显著高于胃溃疡、十二指肠溃疡患者,而十二指肠溃疡cagA基因西方型菌株的比率显著高于其余4种疾病类型。结论本地区感染Hp以cagA基因东亚型为主,cagA基因东亚型菌株与胃癌、慢性萎缩性胃炎密切相关,而cagA基因西方型菌株与十二指肠溃疡密切相关。推测cagA基因多态性对由Hp引起的感染性疾病的发病机制可能起一定的作用。     

Helicobacter pylori associated antral gastritis in peptic ulcer disease patients and normal healthy population of kashmir, India

Aim: To study the association of Helicobacter pylori infection with chronic antral gastritis in peptic ulcer disease patients and healthy population of Kashmir.Methods: 50 peptic ulcer patients (duodenal ulcer = 46, gastric ulcer = 2 and combined duodenal and gastric ulcer = 2) and 30 asymptomatic healthy volunteers were included in this study. Peptic ulcer was diagnosed on endoscopic examination. 4-6 punch biopsies were taken from gastric antrum in all the individuals and in case of gastric ulcer an additional biopsy was taken from the edge of the ulcer to exclude its malignant nature. Helicobacter pylori (H. pylori) organism was diagnosed using three different test methods, viz. Histology (using Giemsa Stain), Microbiology (Gram Stain) and Biochemistry (using one minute Endoscopy Room Test). Histological diagnosis of H. pylori was taken as the "gold standard" for the presence of H. pylori organism. Histological diagnosis of gastritis was made using Hematoxylin and Eosin Stain and the gastritis was classified as active chronic gastritis and superficial chronic gastritis.Results: Out of 30 peptic ulcer disease patients with associated antral gastritis, 27 (90%) were positive for H. pylori on histological examination (13 superficial chronic gastritis and 14 active chronic gastritis) whereas out of 8 healthy volunteers with histological evidence of chronic antral gastritis, H. pylori was observed in 7 individuals (87.50%) (4 active chronic gastritis and 3 superficial chronic gastritis).Conclusion: A highly significant association between H. pylori infection with chronic antral gastritis both in peptic ulcer disease patients and healthy volunteers of Kashmir was found in this study. Association between H. pylori infection and chronic gastritis was 90% in peptic ulcer group and 87.50% in healthy population (P<0.005).     

儿童胃黏膜白细胞介素mRNA水平与幽门螺旋杆菌感染的研究

目的分析儿童胃黏膜白细胞介素(IL-1β)水平与幽门螺旋杆菌(H.pylori)及其高毒力亚型感染间的相关性。方法实时定量聚合酶链(real-time PCR)检测H.pylori的保守基因ure以判断H.pylori的感染,高毒力亚型基因vacA s1用real-time PCR检测,用PCR扩增另一高毒力基因cagA羧基端EPIYA基序所在区,然后测序确定其亚型。IL-1βmRNA使用PCR-荧光探针法检测,比较循环CT法分析。结果患儿中无论是低毒力还是高毒力的H.pylori感染都与胃黏膜IL-1βmRNA水平无显著相关性。结论 H.pylori对儿童胃黏膜IL-1β表达的影响作用并不明显,可能还有其他一些环境、遗传因素如IL-1基因簇多态性与H.pylori共同作用调节胃黏膜IL-1β的表达。     

Association between Helicobacter pylori genotypes and gastric disorders in relation to the cag pathogenicity island

Helicobacter pylori is a bacterium associated with upper gastrointestinal diseases in humans. However, only a small proportion of infected people become sick. Although several studies have tried to establish an association between known virulence markers and clinical outcomes, in many cases the results have been conflicting. The aim of this study was to investigate the importance of virulence markers to predict clinical outcome in Brazil. Mixed infections by genetically unrelated strains detected by vacA genotyping were found in 18% of the patients. The cagA and cagE genes and the vacAs1 genotype were associated with the development of peptic ulcer disease (PUD). The cagAvacAs1m1 genotype was associated with PUD and duodenal ulcer (DU). Conversely, jhp947 was not associated with DU or PUD, indicating that this gene is not a universal virulence marker. These results also show that a high proportion of the patients were simultaneously infected by cag-positive and cag-negative H. pylori types. This finding suggests the existence of a dynamic equilibrium between the loss and gain of the cag pathogenicity island, probably depending on the physiologic conditions of the patient's stomach. To the best of our knowledge, this is the first study that has documented this finding in Brazil.     

Virulence factors of Helicobacter pylori responsible for gastric diseases in Mongolian gerbil

Helicobacter pylori infection induces various gastroduodenal diseases. We examined the role of two genes, vacA and cagE, in the gastric pathogenesis induced by H. pylori using a long-term (62 wk) animal model. Reportedly, both genes are associated with the virulence of H. pylori: vacA encodes vacuolating cytotoxin, and cagE, with other genes in the cag pathogenicity islands, encodes a type IV secretion system. Mongolian gerbils were challenged in this study by a wild-type TN2 strain and its isogenic mutants of cagE or vacA. The wild-type and vacA mutants induced severe gastritis, whereas cagE mutants induced far milder changes. Gastric ulcer was induced at the highest rate (22/23) by the wild-type TN2, followed by the vacA mutant (19/28). No ulcer was found in the gerbils infected with the cagE mutant (0/27) or in controls (0/27). Intestinal metaplasia was also found in the gerbils infected with the wild-type (14/23) or vacA mutant (15/28). Gastric cancer developed in one gerbil with wild-type infection and in one with vacA mutant infection. In conclusion, the knocking out of the cagE gene deprived wild-type H. pylori of the pathogenicity for gastritis and gastric ulcer, suggesting that the secretion system encoded by cag pathogenicity island genes plays an essential role.     

幽门螺杆菌cagA、vacA、iceA基因与儿童结节性胃炎的关系

目的：探讨幽门螺杆菌（HP）cagA、VaCA、iceA基因与儿童结节性胃炎的关系。方法：收集2007年5月-2008年1月行胃镜检查确诊Hp感染的22例结节性胃炎和22例非结节性胃炎患儿的胃粘膜组织,分别用聚合酶链反应（PCR）检测cagA、vacA和iceA基因。病理检查了解胃窦粘膜炎症程度。结果：结节性胃炎组中cagA基因单独检出率为68．2％,VaCAs1／ml单独捡出率为13．6％,vacAs1／m2单独检出率为45．5％,iceA1单独检出率为72．7％,iceA2单独检出率为18．2％．非结节性胃炎组中cagA基因单独检出率为68．2％,vacAs1／ml单独检出率为22．7％,vacAs1／m2单独检出率为27．3％。iceA1单独检出率为63．6％．iceA2单独检出率为22．7％。不同基因型菌株在结节性胃炎和非结节性胃炎中的检出率无统计学意义（P〉0．05）。在轻度、轻一中度、中度慢性结节性胃炎中,cagA型茵株检出率分别为66．7％、50％、75Voo,vacA s1／ml型菌株检出率分别为11．1％、0%、25%,VaCAs1／m2型菌株检出率分别为55．6％、25％、37．5％,iceA1型菌株检出率分别为88．9%、50％、75%．iceA2型菌株在轻度、轻一中度、中度慢性结节性胃炎中的检出率分别为0％、50％、25％,不同基因型菌株与结节性胃炎胃窦粘膜炎症的严重程度无关（P〉0．05）。结论：cagA、vacA、iceA基因与结节性胃炎、胃粘膜的炎症严重程度无关。提示除菌株因素外．宿主因素、环境因素在结节性胃炎的形成过程中可能发挥了重要作用。     

幽门螺杆菌cagA、vacA抗体与胃十二指肠疾病的相关性研究

目的：探讨幽门螺杆菌（Hp)毒力基因cagA,vacA抗体与胃十二指肠疾病之间的关系。方法：采用免疫印迹法检测440例胃十二指肠疾病患者血清中的cagA,vacA抗体。结果：cagA,vacA抗体在440例患者中的检出率分别为73%，37.0%。在慢性胃炎（CG），十二指肠肠球部溃疡（DU），胃癌（GC）患者专利号，cagA,vacA抗体摄影性率分别为62.9%,76.1%,96.9%与33.0%,31.0%,62.5%；经u检验显示；慢性胃炎组与十二指肠球部溃疡组比较，无明显差异。胃癌组与慢性胃炎组，十二指肠球部溃疡组比较，有显著性差异。结论：本文通过患者血清中Hp抗体（cagA和vacA)的检测。推知其cagA和vacA抗体的表达状况，可为胃十二指肠疾病的诊断提供血清中Hp抗体（cagA和vacA)的检测，推知其cagA和vacA抗体的表达状况，可为胃十二指肠疾病的诊断提供依据。但不能作为区分Hp感染所致胃十二指肠疾病的单一指标。     

Phospholipase C activity of Helicobacter pylori is not associated with the presence of the cagA gene

BACKGROUND: Knowledge about the possible role of phospholipase C (PLC) activity of microbial pathogens in the development of disease is increasing. Recently attention has focused on investigating PLC activity elaborated by Helicobacter pylori, but the role of this enzyme in H. pylori pathogenesis is still unknown. The aim of this study was to correlate PLC-activity of H. pylori on the basis of the cagA status with the clinical diagnosis of the patients. MATERIALS AND METHODS: Helicobacter pylori was isolated from patients with gastritis (G; n = 38), duodenal ulcer (DU; n = 15), gastric ulcer (GU; n = 11) and gastric cancer (GC; n = 12). Polymerase chain reaction primers DZ3/R009 which amplified a 1350-bp fragment were used to detect the cagA gene. PLC activity was determined using p-nitrophenylphosphorylcholine as substrate. RESULTS: Of the strains, 60% were cagA(+) and 40% were cagA(-). All strains showed PLC activity (2.20 +/- 0.91 U mg(-1) protein). PLC activity showed no association with the cagA status: cagA(+) (2.21 +/- 1.03 U mg(-1) protein), cagA(-) (2.18 +/- 0.79 U mg(-1) protein). Patients with GU had the highest PLC activity (2.77 +/- 1.26 U mg(-1) protein) and patients with GC had the lowest activity (1.8 +/- 0.57 U mg(-1) protein). CONCLUSIONS: Although PLC activity was present in all strains tested, it may only have pathological importance in patients with GU. However, the extent of PLC activity was independent of the presence of the cagA gene.     

老年人消化性溃疡与慢性萎缩性胃炎的相关性研究

目的研究老年人消化性溃疡与慢性萎缩性胃炎的相关性。方法对十二指肠溃疡（DU）、胃溃疡（GU）和复合性溃疡（CU）的老年患者胃窦、胃窦胃体交界处和胃体黏膜以及慢性胃炎（CG）患者胃窦黏膜活检标本进行组织学检查,统计各自胃黏膜的萎缩、肠化生、慢性炎症、活动性和幽门螺杆菌（Hp）感染的发生率。结果 DU患者胃窦、胃窦胃体交界处和胃体黏膜的萎缩发生率分别为54.0%、8.0%和16.0%,肠化生发生率分别为19.0%、6.0%和4.0%。其胃窦黏膜肠化生的发生率明显低于相应的GU、CU或CG者。3种消化性溃疡和CG患者均存在胃窦部慢性炎症,且老年消化性溃疡患者胃体部炎症的发生率较高,其胃炎活动性以胃窦部为主,且均较CG者高。结论老年人消化性溃疡均可有胃窦部灶性萎缩和肠化生发生,但DU胃窦黏膜肠化发生率最低,这可能是老年DU患者罹患胃癌危险性较低的原因之一。     

幽门螺杆菌血清分型与上消化道疾病的关系

目的 探讨幽门螺杆菌(helicobacter pylori,Hp or H.pylori)分型与消化道不同疾病的关系。方法 入选198例Hp阳性的胃镜检查患者，采用免疫印迹法进行Hp的血清学分型，并取胃窦黏膜经HE染色观察胃窦黏膜病理组织学变化。结果 198例患者中检出HpI型菌株173例(87．4％)，Ⅱ型菌株25例(12．6％)。I型较II型Hp感染者胃镜下消化性溃疡、胃癌的比例更高，P=0.012；与胃炎组比较，十二指肠球部溃疡组、胃癌组的I型感染者更高（P值分别为0.026、0.048），而与胃溃疡组无显著差别(P=0.125)。病理组织学改变I型较II型Hp感染者的结果更为严重（P=0.038）。结论 临床上消化道疾病患者Hp感染以I型菌株最为多见。Hp感染的分型诊断有助于对胃、十二指肠疾病类型及病情的判断，I型菌株感染者需要更为积极的治疗。     

长春地区慢性胃病患者幽门螺杆菌感染状况调查

目的通过对本地区慢性胃病患者幽门螺杆菌（H.pylori）感染状况调查,了解本地区流行病学特点,为进一步阐明其与慢性胃病发生发展的关系提供理论依据。方法采用ELISA方法测定血清H.pyloriIgG抗体及CagA抗体;采取胃粘膜活检组织进行快速尿素酶试验,调查H.pylori感染情况,分析其与各种疾病的关系。结果1180例慢性胃病患者H.pylori感染率为67.11%,复合性溃疡、十二指肠溃疡、胃溃疡及慢性萎缩性胃炎感染率分别为90.9%、84.57%、83.96%和80.24%。与慢性浅表性胃炎相比差异有显著性。消化性溃疡、慢性萎缩性胃炎、胃癌和胃息肉患者血清Hp-CagA抗体的阳性率明显高于慢性浅表性胃炎（P〈0.05）。结论本地区慢性胃病患者H.pylori感染率高与多数地区的普通人群,H.pylori感染者尤其是CagA阳性者,更易发生慢性萎缩性胃炎、消化性溃疡及胃癌。     

胆汁反流和幽门螺杆菌感染在胆汁反流性胃炎和消化性溃疡发病中的作用

目的探讨胆汁反流和幽门螺杆菌感染在胆汁反流性胃炎和消化性溃疡发病中的作用。方法采用病理组织学检查和快速尿素酶试验对76例胆汁反流性胃炎及22例兼有胆汁反流性胃炎和消化性溃疡的患者行幽门螺杆菌检测,并与29例消化性溃疡患者作对照。结果胆汁反流性胃炎组幽门螺杆菌阳性率为31.6%(24/76例),兼有胆汁反流性胃炎和消化性溃疡组幽门螺杆菌阳性率为59.0%(13/22例),消化性溃疡组幽门螺杆菌阳性率为72.4%(21/29例),前二组比较,差异有显著意义(P<0.05),后二组比较,差异无显著意义(P>0.05)。结论胆汁反流在胆汁反流性胃炎的发病中起主要作用,幽门螺杆菌感染在消化性溃疡的发病中起主要作用。胆汁反流和幽门螺杆菌感染在胆汁反流性胃炎和消化性溃疡的共同发病中互不明显影响,幽门螺杆菌感染所起的作用可能更大一些。     

Causal relationship between Helicobacter pylori infection and upper gastroduodenal diseases

Helicobacter pylori infection causes chronic gastritis (nonatrophic gastritis), which progresses to atrophic gastritis and intestinal metaplasia over a period of decades. Atrophy may result from inflammation and apoptosis caused by H. pylori infection. H. pylori is an important risk factor for peptic ulcer disease. Duodenitis in the gastric metaplasia of the duodenum, hypergastrinemia, and impaired proximal duodenal mucosal bicarbonate secretion are considered causal factors for duodenal ulcer disease. Low-grade B-cell gastric lymphoma of mucosa-associated lymphoid tissue (MALT) develops in response to H. pylori infection. Studies of Mongolian gerbil model demonstrated that H. pylori had an initiator or promoter effect on gastric carcinogenesis.