中国上消化道疾病患者幽门螺杆菌感染根除前后胃粘膜病理改变与空泡毒素活性的关系

目的：观察幽门螺杆菌（H.pylori)阳性消化性溃疡病和慢性胃炎患者H.pylori根除前后胃粘膜病理改变与空泡毒素（VacA)活性的关系。方法：功能性消化不良伴H.pylori感染的中国患者74例，于H.pylori根除前和4－6周后作胃镜检查，根据新悉尼病理分级法按半定量记分对治疗前后的胃粘膜病理变化程度进行分级。结果：VacA^ 菌检出率为80％（59／74），消化性溃疡病患者的检出率与慢性胃炎患者无明显差别；VacA^ 和VacA^-组患者的H.pylori根除率亦无明显差别。根除治疗前，VacA^ 和VacA^-组患者的胃粘膜慢性炎症、活动性、表面上皮损伤、萎缩、肠化和淋巴滤泡数量无显著差别；治疗后4－6周，两组患者的胃窦粘膜炎症活动性、表面上皮损伤和慢性炎症程度均明显减轻，尤以前者为著（P＜0．0001），VacA^ 组患者的胃窦部淋巴滤泡数量减少亦稍较VacA^-组明显（P＝0．051），两组患者的胃粘膜萎缩和肠化程度均无明显好转。结论：中国上消化道疾病患者H.pylori感染根除前后的胃粘膜病理改变与VacA活性无明显关系。成功根除H.pylori感染并不引起萎缩和肠化的逆转。

Relevance of VacA and Mucosal Pathological Changes among Chinese Patients with Upper Gastrointestinal Diseases after Helicobacter pylori Eradication

Background/ Aims: To investigate the influence of VacA activity on the gastric mucosa prior to and after Helicobacter pylori (H. pylori) eradication in Chinese patients with peptic ulcer disease and chronic gastritis. Methods: Seventy-four consecutive dyspeptic Chinese patients with H. pylori infec- tion were enrolled. The status of H. pylori infection was evaluated by culture and histopathology be- fore and 4-6 weeks after H. pylori eradication therapy. Histologic specimens were examined and graded semiquantitativelv according to the updated S driev classification. Results: VacA H. pylori or- ganisms were isolated from 59 /74 (80%) patients, its prevalence in peptic ulcer disease and chronic gas- tritis was similar, and the eradication rates were also similar in those with VacA and VacA H. pylori strains. Before eradication, the degrees of acute or chronic inflammation. epithelial damage, atrophy, intestinal metaplasia (TM) and the number of lvmphoid follicles were similar in patients with VacA and VacA H. p~lori. Four-six weeks after eradication of H. pylori infection, the degrees of acute and chronic inflammation and epithelial damage in the antrum decreased significantly, particularly in those with VacA H. pylori (P<0.000 1), whereas the number of lvmphoid follicles in the antrum also dimin- ished more in those with VacA H. pylori (P=0.051). However, the degrees of atrophy and IM remained unchanged. Conclusions: There is no specific correlation between VacA and VacA- H. pylori strains and mucosal clinicopathological features among Chinese patients with upper gastrointestinal diseases before and after eradication therapy. Successful eradication of H. pylori infection dose not improve the atrophic and IM lesions of gastric mucosa.