幽门螺旋杆菌中CagA、VacA毒素与糜烂性胃炎的关系及其临床应用价值

目的探讨血清幽门螺旋杆菌中细胞毒素(CagA)、空泡毒素(VacA)与糜烂性胃炎的危险因素关系及其临床应用价值。方法选取2020年1-12月于该院治疗的56例糜烂性胃炎患者作为糜烂性胃炎组,54例慢性胃炎患者作为慢性胃炎组,另选同期体检健康者60例作为健康对照组。运用免疫印迹法对幽门螺旋杆菌(HP)进行抗体分型检测,采用受试者工作特征(ROC)曲线分析对糜烂性胃炎的预测价值,采用多元Logistic回归分析对糜烂性胃炎的危险因素进行预测分析。结果(1)健康对照组与慢性胃炎组、糜烂性胃炎组3组年龄、性别、吸烟史及糖尿病史比较,差异无统计学意义(P>0.05);3组饮酒史、高血压史、HP-Ⅰ、HP-Ⅱ型及¹⁴C呼气试验比较,差异有统计学意义(均P<0.05)。(2)多元Logistic回归分析显示:¹⁴C呼气试验、饮酒史、HP-Ⅰ型抗体是影响糜烂性胃炎的独立危险因素,差异有统计学意义(P<0.05),其中HP-Ⅰ型抗体相对危险度(OR)高达8.126。(3)ROC曲线分析显示:HP-Ⅰ型的曲线下面积(AUC)最高,为0.761,约登指数也是最高,为0.523。(4)糜烂性胃炎组中两项CagA+和VacA+阳性率显著高于慢性胃炎组、健康对照组,差异有统计学意义(χ²=33.106,P<0.05),糜烂性胃炎组中单项CagA+、VacA+阳性率与慢性胃炎组、健康对照组比较,差异无统计学意义(χ²=3.298、2.290,P>0.05)。结论HP-Ⅰ型中CagA和VacA阳性感染与糜烂性胃炎密切相关,是影响糜烂性胃炎发病的独立危险因素,可为其临床早期防治提供理论依据,且具有重要临床应用价值。

Relationship between CagA,VacA toxin in Helicobacter pylori and erosive gastritis and its clinical value

Objective To investigate the relationship between serum cytotoxin(CagA)and vacuolar toxin(VacA)of Helicobacter pylori and risk factors of erosive gastritis in elderly patients and its clinical application value.Methods Fifty six patients with erosive gastritis in Suzhou Hospital of Anhui Medical University were selected as the observation group from January 2020 to December 2020,54 patients with chronic gastritis in the same period were selected as the benign control group,and 60 healthy people were selected as the normal control group.Immunoblotting was used to detect the antibody types of Helicobacter pylori,and the receiver operating characteristic(ROC)was analyzed by SPSS22.0 software.In addition,multivariate Logistic regression was used to predict the risk factors of erosive gastritis.Results(1)there were no significant differences in age ratio,sex ratio,smoking history and diabetes history between normal control group and chronic gastritis group and erosive gastritis group,the difference were statistically significant(all P>0.05);there were significant differences in drinking history,hypertension history,HP-Ⅰ,HP-Ⅱand 14 C breath test among three groups,the difference were statistically significant(all P<0.05).(2)Multivariate Logistic regression analysis showed that 14 C breath test,drinking history and HP-Ⅰantibody were the independent risk factors of erosive gastritis,and the differences were statistically significant(P<0.05).The relative risk of HP-Ⅰantibody was 8.126.(3)ROC curve showed that area under curve(AUC)of HP-Ⅰwas the highest,which was 0.761,and Youden index was also the highest,which was 0.523.(4)The positive rates of CagA+and VacA+in erosive gastritis group were significantly higher than those in chronic gastritis group and normal control group,the differences were statistically significant(χ2=33.106,P<0.05).The positive rates of single CagA+and VacA+in erosive gastritis group were not significantly different from those in chronic gastritis group and normal control group,the differences were not statistically significant(χ2=3.298,2.290,P>0.05).Conclusion CagA and VacA positive infection in HP-Ⅰis closely related to erosive gastritis in elderly patients,which is an independent risk factor for the onset of erosive gastritis in elderly patients,and provides theoretical basis and important clinical application value for its early clinical prevention and treatment.