幽门螺杆菌分型与上消化道疾病及幽门螺杆菌根除效果的研究

郭金芝; 汤胜君; 王德录; 钱立康; 张元瑞

doi:10.7619/jcmp.20220380

幽门螺杆菌分型与上消化道疾病及幽门螺杆菌根除效果的研究

Study on Helicobacter pylori serotypes, upper gastrointestinal diseases and effect of Helicobacter pylori eradication

摘要

摘要:
目的   观察不同上消化道疾病患者的幽门螺杆菌(Hp)血清学分型情况, 并比较不同Hp分型患者的Hp根除效果。
方法   选取因上消化道症状就诊的267例患者作为研究对象，按疾病类型分为慢性胃炎组90例、胃息肉组76例和消化性溃疡组101例。抽取患者静脉血，检测血清Hp抗体表达情况，包括尿素酶A(UreA)、尿素酶B(UreB)、细胞毒素相关蛋白A(CagA)和空泡细胞毒素A(VacA)。比较各组患者的Hp感染率和UreA、UreB、CagA、VacA阳性率。Hp阳性患者均接受四联方案治疗，比较不同Hp分型患者的Hp根除率。
结果   267例患者的Hp总感染率为67.04%, 慢性胃炎组、胃息肉组、消化性溃疡组的Hp感染率分别为61.11%、51.32%、84.16%; 消化性溃疡组的Hp感染率高于慢性胃炎组、胃息肉组，差异有统计学意义(P < 0.05), 慢性胃炎组与胃息肉组的Hp感染率差异无统计学意义(P>0.05)。消化性溃疡组UreA、VacA阳性率高于慢性胃炎组、胃息肉组，差异有统计学意义(P < 0.05); 慢性胃炎组UreA、VacA阳性率与胃息肉组相比，差异无统计学意义(P>0.05)。消化性溃疡组UreB阳性率(93.07%)高于慢性胃炎组(78.89%)、胃息肉组(61.84%), 且慢性胃炎组高于胃息肉组，差异均有统计学意义(P < 0.05)。消化性溃疡组CagA阳性率(66.34%)高于胃息肉组(46.05%), 差异有统计学意义(P < 0.05); 慢性胃炎组CagA阳性率与胃息肉组、消化性溃疡组比较，差异无统计学意义(P>0.05)。慢性胃炎组、胃息肉组和消化性溃疡组的HpⅠ型感染率分别为83.64%、87.18%和77.65%, 均高于HpⅡ型感染率。采用四联方案治疗后, HpⅠ型患者的Hp根除率为86.99%, 高于HpⅡ型患者的69.70%, 差异有统计学意义(P < 0.05)。
结论   慢性胃炎、胃息肉和消化性溃疡患者的HpⅠ型感染率均高于HpⅡ型感染率，消化性溃疡患者的Hp感染率和Hp抗体阳性率均高于慢性胃炎、胃息肉患者，且HpⅠ型患者的Hp根除率高于HpⅡ型患者。

Abstract:
Objective   To observe Helicobacter pylori (Hp) serotypes, and compare eradication effects of different serological typing.
Methods   A total of 267 patients with upper gastrointestinal symptoms were collected as study objects and were divided into chronic gastritis group(n=90), gastric polyps group(n=76) and peptic ulcer group(n=101). Venous blood was drawn from all patients, and expressions of Hp antibodies, including urease A(UreA), urease B (UreB), cytotoxin associated protein A (CagA) and vacuolating toxin associated protein A (VacA)in serum were detected. Hp infection rate and positive rates of UreA, UreB, CagA and VacA were compared in each group. Hp positive patients were treated with quadruple regimen, and Hp eradication rates of patients with different Hp types were compared.
Results   The total Hp infection rate of 267 patients was 67.04%. The Hp infection rates of chronic gastritis group, gastric polyp group and peptic ulcer group were 61.11%, 51.32% and 84.16%, respectively. The Hp infection rate of the peptic ulcer group was higher than that of the chronic gastritis group and the gastric polyp group (P < 0.05). There was no significant difference in Hp infection rate between the chronic gastritis group and the gastric polyp group (P>0.05). The positive rates of UreA and VacA in the peptic ulcer group were higher than those in the chronic gastritis group and the gastric polyp group (P < 0.05). There was no significant difference in the positive rate of UreA and VacA between chronic gastritis group and gastric polyp group (P>0.05). The positive rate of UreB in the peptic ulcer group(93.07%) was higher than that in the chronic gastritis group (78.89%) and gastric polyp group(61.84%), and was higher in the chronic gastritis group than that in the gastric polyp group (P < 0.05). The positive rate of CagA in the peptic ulcer group(66.34%) was higher than 46.05% in the gastric polyp group (P < 0.05). There was no significant difference in CagA positive rate between the chronic gastritis group and gastric polyp group, between the chronic gastritis group and the peptic ulcer group (P>0.05). In the chronic gastritis group, gastric polyp group and peptic ulcer group, the infection rates of Hp type I were 83.64%, 87.18% and 77.65%, respectively, which were higher than that of Hp type Ⅱ. After quadruple regimen, the eradication rate of Hp type I was higher than that of type Ⅱ(86.99%versus 69.70%, P < 0.05).
Conclusion   The infection rates of Hp typeⅠ in patients with chronic gastritis, gastric polyp and peptic ulcer are higher than those with Hp typeⅡ, the infection rate of Hp and positive rate of Hp antibody in patients with peptic ulcer are higher than those of chronic gastritis and gastric polyp, and the eradication rate of Hp type Ⅰ is higher than that of Hp type Ⅱ.

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