反流性食管炎患者的幽门螺杆菌感染

目的探讨幽门螺杆菌在反流性食管炎发病中的作用.方法选择有典型反流症状的患者并经胃镜检查诊断为反流性食管炎53例作为病例组,无典型反流症状的患者并经胃镜检查诊断为慢性胃炎25例作为对照组,分别取食管下端黏膜及胃窦黏膜各3块,并分别行快速尿素酶试验、病理Hp检查和Hp培养,食管及胃窦黏膜Hp菌株应用PCR方法行cagA基因、vacA基因检测.结果病例组、对照组中食管黏膜的Hp阳性率分别为14/53（26.4%）、8/25（32%）,两者差异无显著性（P＞0.05）;胃窦黏膜的Hp阳性率分别为20/53（37.8%）、16/25（64%）,两者差异有显著性（P＜0.05）;病例组中胃窦黏膜Hp的cagA＋检出率（6/20,30%）明显低于对照组（10/16,62.5%）（P＜0.05）,而vacA＋检出率分别为6/20（30%）、7/16（43.8%）,两者差异无显著性（P＞0.05）.不同程度食管炎中食管黏膜Hp阳性率差异无显著性（P＞0.05）,胃窦黏膜Hp阳性率差异有显著性（P＜0.01）,而cagA＋及vacA＋的Hp菌株的差异无显著性（P＞0.05）,但cagA＋菌株多见于程度轻的食管炎.结论食管黏膜中检测到的Hp可能来源于胃窦黏膜的Hp,胃窦Hp感染、尤其是cagA＋的Hp感染可能在RE的发生中有一定的保护作用.

Role of Helicobacter pylori Infection in Patients with Reflux Esophagitis

Objective To investigate the role of Helicobacter pylori (H. pylori) infection in patients with reflux esophagitis(RE). Methods A total of 53 patients with RE,having typical reflux symptoms and diagnosed by endoscopy, were studied. 25 patients presenting with a normal esophagus, were served as a reference group. All patients underwent upper endoscopies,and the distal esophagus and antral biopsy specimens were taken to detect H. pylori by rapid urease test,histopathology,and culture. H. pylori in distal esophagus and gastric antrum biopsies were taken for determination of cagA gene and vacA gene by using Polymerase Chain Reaction. Results 53 patients with RE had no significant difference in H. pylori prevalence in distal esophagus(26.4%) than that in reference group( 32%)(P>0.05). The prevalence of H. pylori in gastric antrum was 37. 8% in patients with RE,significantly lower than that in the reference group(64% )(P< 0.05). Among H. pylori-positive patients, cagA+ strains of H. pylori were detected in 30% patients with RE versus 62.5% in the reference group(P<0.05). AndvacA+ strains of H. pylori were detected in 30% patients with RE versus 43.8% in the reference group( P > 0.05). There was correlation between the severity of RE and the prevalence of H. pylori in gastric antrum(P<0.01),but there was no correlation between the severity of RE and cagA+ strains or vacA + strains of H. pylori in gastric antrum (respectively, P >0. 05) . However, cagA + strains of H. pylori were detected more in mild RE than in serious RE. Conclusion H. pylori obtained by culture in distal esophagus may come from stomach. H. pylori infection in gastric antrum, especially cagA+ strains,may play a protective role on the formation of RE.