幽门螺杆菌不同抗体与新疆地区胃癌、消化性溃疡和慢性胃炎的关系

王新国李莉高峰*

新疆维吾尔自治区人民医院消化科(830001)

背景：幽门螺杆菌(Hp)是公认的慢性胃炎(CG)的主要原因，CagA和VacA为Hp的重要致病因子。最近研究发现VacA抗体、CagA抗体与胃癌(GC)、消化性溃疡(PU)相关。目的：探讨Hp不同抗体与新疆地区GC、PU和CG的关系。方法：收集2014年1月—2014年8月84例GC、108例PU、196例CG患者，以14C-尿素呼气试验检测Hp感染，免疫印迹技术检测Hp分型，分析入选患者与Hp不同抗体的关系。结果：GC组Hp Ⅰ型感染率为47.6%，PU组为37.0%，CG组为21.4%，呈递减趋势。GC、PU和CG组间CagA-128 kDa、VacA-110 kDa和UreB-66 kDa的感染率差异有统计学意义(P=0.013，P=0.011，P=0.002)；GC与CagA-128 kDa、VacA-110 kDa、VacA-90 kDa、UreB-66 kDa相关(P<0.05)，PU与VacA-110 kDa、UreB-66 kDa相关(P<0.05)；UreB-66 kDa为PU和GC发生的危险因素(P<0.05)。结论：GC与CagA-128 kDa、VacA-110 kDa、VacA-90 kDa、UreB-66 kDa相关，PU与VacA-110 kDa、UreB-66 kDa相关，UreB-66 kDa为PU和GC发生的危险因素。

关键词胃肿瘤；消化性溃疡；胃炎；幽门螺杆菌；CagA抗体；VacA抗体；尿素酶抗体；危险因素

Investigation on Relationship between Different

HelicobacterpyloriAntibodies and Gastric Cancer, Peptic Ulcer and Chronic Gastritis in Xinjiang AreaWANGXinguo,LILi,GAOFeng.DepartmentofGastroenterology,People’sHospitalofXinjiangUygurAutonomousRegion,Urumqi(830001)

Correspondence to: GAO Feng, Email: xjgf@sina.com

Background:Helicobacterpylori(Hp) is the main cause of chronic gastritis (CG), and CagA and VacA are important pathogenic factors of Hp. Recent studies have indicated that CagA and VacA antibodies of Hp have close relationship with gastric cancer (GC) and peptic ulcer (PU). Aims: To investigate the relationship between different antibodies of Hp and GC, PU and CG in Xinjiang area. Methods: Eighty-four GC, 108 PU and 196 CG patients from Jan. 2014 to Aug. 2014 were enrolled.14C-urea breath test was used to determine Hp infection. Hp was typed by immunoblotting technique. Relationship between different Hp antibodies and patients with GC, PU and CG was analyzed. Results: Type Ⅰ Hp-positive rate in GC, PU and CG groups was decreased stepwisely (47.6%, 37.0%, 21.4%, respectively). The positive rates of Hp strains (CagA-128 kDa, VacA-110 kDa and UreB-66 kDa) differed significantly among GC, PU, and CG groups (P=0.013,P=0.011,P=0.002); GC was associated with CagA-128 kDa, VacA-110 kDa, VacA-90 kDa and UreB-66 kDa (P<0.05), PU was associated with VacA-110 kDa, UreB-66 kDa (P<0.05). UreB-66 kDa was the risk factor of PU and GC (P<0.05). Conclusions: GC is associated with CagA-128 kDa, VacA-110 kDa, VacA-90 kDa and UreB-66 kDa, PU is associated with VacA-110 kDa, UreB-66 kDa, and UreB-66 kDa is the risk factor of PU and GC.

Key wordsStomach Neoplasms;Peptic Ulcer;Gastritis;Helicobacterpylori;CagA Antibody;

VacA Antibody;Urease Antibody;Risk Factors

幽门螺杆菌(Hp)为慢性胃炎(chronic gastritis, CG)的主要原因。流行病学研究显示，Hp感染亦与严重的胃炎相关性疾病相关[1]。1994年国际癌症研究机构将Hp感染列为Ⅰ类致癌原[2]。胃癌(gastric cancer, GC)是目前世界上死亡率位列第二的恶性肿瘤，尽管过去10年GC发病总例数呈下降趋势，但发展中国家的发病率依然很高[3]。CagA和VacA是Hp的重要致病因子，可能与消化性溃疡(peptic ulcer, PU)和GC的发生密切相关[4]。

近年多项研究对CagA和VacA抗体与胃十二指肠疾病的关系进行分析。黄品川等[5]对76例PU患者(18~74岁)、31例GC患者(43~75岁)、33例CG患者(24~56岁)进行研究，发现VacA和CagA抗体与PU、GC关系密切。Shiota等[6]的研究发现，GC与CagA抗体有关。GC是包括Hp在内的多种致病因素长期反复作用的结果，故患者年龄较其他消化性疾病偏大，发病年龄中位数约为55岁[7]。因此，有必要排除年龄因素对研究结果的影响。目前国内少见排除年龄因素后研究GC、PU和CG与Hp感染关系的报道。……