Hp感染血清学抗体与胃镜下胃溃疡病理特征的关系研究

目的检测幽门螺杆菌(Hp)感染血清学抗体水平与胃镜下胃溃疡病理特征的关系。方法选取2015年1月至2016年10月在该院经胃镜活检确诊为胃溃疡的患者228例,其中良性胃溃疡180例,恶性胃溃疡48例,入组对象均行14 C-尿素呼气试验,应用免疫印迹法测定血清细胞毒素相关蛋白A(CagA)、尿素酶A(UreA)、尿素酶B(UreB)、空泡毒素A(VacA)及鞭毛蛋白抗体水平,分析Hp感染相关血清学抗体水平与胃镜下胃溃疡病理特征的关系。结果恶性胃溃疡组Hp阳性率及Ⅰ型Hp阳性率显著高于良性胃溃疡组(P0.05)。与良性胃溃疡组比较,恶性胃溃疡组血清CagA、UreA、UreB、VacA及鞭毛蛋白抗体阳性率均显著升高(P0.05)。CagA在胃溃疡面积2.0cm2、重度黏膜炎性反应、重度炎性反应活动性患者中的阳性率较高(P0.05),UreA、UreB、VacA及鞭毛蛋白抗体在胃溃疡面积2.0cm2患者中的阳性率高于胃溃疡面积≤2.0cm~2患者(P0.05)。结论胃溃疡的发生及病情进展与Hp多种毒力因子共同作用有关,通过测定Hp血清学抗体有助于对Hp阳性胃溃疡患者分型及临床制定针对性的防治方案。

Relationship between serum antibody detection of Hp infection and pathologic features of gastric ulcer

Objective To investigate the relationship between the detection of serological antibodies of Helicobacter pylori(HP) infection and the pathological features of gastric ulcer.Methods 228 cases of patients with gastric ulcer diagnosed by endoscopic biopsy(180 cases of benign ulcer and 48 cases of malignant ulcer) were enrolled in this study from January 2015 to October 2016.All subjects were given 14C-urea breath test.The positive rates of cytotoxin associated gene A(CagA),urease A(UreA),urease B(UreB),vacuolating toxin A(VacA) and flagellin antibodies in serum were determined by immunoblotting.The relationship between serum antibody level of Hp infection and pathologic features of gastric ulcer patients were analyzed.Results HP positive rate and type Ⅰ HP positive rate in malignant gastric ulcer group were significantly higher than those in benign gastric ulcer group(P<0.05).The positive rates of CagA,UreA,UreB,VacA and flagellin antibodies were significantly higher in patients with malignant gastric ulcer than those in benign gastric ulcer group(P<0.05).The positive rates of UreA,UreB,VacA and flagellin antibodies in patients with gastric ulcer area>2.0 cm2,severe mucosal inflammatory reaction and severe inflammatory reaction activity were higher(P<0.05).Conclusion The occurrence of gastric ulcer and progression of the disease could be related to the interaction of HP virulence factors.HP serological antibodies detection could help to classify patients with HP-positive gastric ulcer and formulate targeted prevention and treatment plan.