罗伟 朱志超 徐宝宏 罗振华

[摘要] 目的 研究唾液幽门螺杆菌（Hp）与胃癌发展各阶段的相关性。 方法 选取2016年1月～2017年10月首都医科大学附属北京潞河医院201例病理诊断为浅表性胃炎、萎缩性胃炎、不典型增生及胃癌的患者唾液，应用幽门螺杆菌唾液检测板（HPS）检测法对唾液Hp进行检测，同时根据年龄、性别、牙周状况及胃内不同病变分组，分析口腔Hp感染率及其相关性。 结果 纳入试验的患者中，男性Hp感染率（75.5%）高于女性（54.5%），差异有统计学意义（P < 0.05）；青年组Hp感染率为42.9%，中年组为69.9%，老年组为75.4%，三组间比较差异有统计学意义（P < 0.05）；萎缩性胃炎组、不典型增生组、胃癌组口腔Hp感染率分别为64.5%、76.0%、75.0%，明显高于浅表性胃炎组（44.4%），差异均有统计学意义（P < 0.05）；牙龈炎组、牙周炎组患者的口腔Hp感染率与牙周健康组比较明显增高，差异均有统计学意义（P < 0.05）；牙周炎组与牙龈炎组Hp感染率比较明显增高，差异有统计学意义（P < 0.05）。 结论 幽门螺杆菌在口腔中存在高感染率现象，口腔幽门螺杆菌感染率与年龄、性别因素及牙周炎有关。口腔Hp感染率与胃癌前病变和胃癌的病变有关，可能是胃癌前病变和胃癌的重要危险因素。

[关键词] 幽门螺杆菌；唾液；胃癌前病变；胃癌；牙周炎

[中图分类号] R735.2 [文献标识码] A [文章编号] 1673-7210（2018）08（a）-0088-04

[Abstract] Objective To investigate the correlation between salivary Helicobacter pylori （Hp） and various stages of gastric cancer development. Methods Saliva was collected from 201 patients with pathologically diagnosed superficial gastritis， atrophic gastritis， dysplasia， and gastric cancer in Beijing Luhe Hospital， Capital Medical University from January 2016 to October 2017. The HPS test was used to detect Hp in saliva. The incidence and correlation of Hp infection were analyzed according to age， sex， periodontal status， and different gastric lesions. Results Among all patients included in the trial， the male infection rate （75.5%） was higher than that of female （54.5%） （P < 0.05）. The Hp infection rates of middle-aged and elderly patients were 69.9% and 75.4% respectively， which were significantly different from the younger ones （42.9%） （P < 0.05）. The positive rates of oral Hp in the atrophic gastritis group， atypical hyperplasia group， and gastric cancer group were 64.5%， 76.0%， and 75.0%， respectively， which were significantly higher than superficial gastritis group （44.4%）， and the differences were statistically significant （P < 0.05）. The infection rates of gingivitis group and periodontitis group were higher than periodontal health group， and the differences were statistically significant （P < 0.05）. Conclusion Oral Hp infection rate is higher in the oral cavity， and related to age， gender and periodontal disease. The oral Hp infection rate is related to the precancerous lesions and gastric cancer. The presence of oral Hp may be an important risk factor for gastric precancerous lesions and gastric cancer.

[Key words] Helicobacter pylori； Saliva； Gastric precancerous lesions； Gastric cancer； Periodontitis

幽門螺杆菌（Helicobacter pylori，Hp）自20世纪80年代由Warren和Marshall培养成功并公开报道以来，相关实验室及临床研究均获得突破性进展。前期研究发现Hp感染不仅是消化性溃疡、各种胃炎的主要致病因素，同时还促进了胃癌前病变及胃癌的发生发展[1-2]，且所造成的慢性感染性炎症在浅表性胃炎向胃癌发生发展过程中起到了重要作用。以往的观点认为，Hp主要在胃内定植，而自从1989年Krajden成功从牙菌斑中分离出Hp后，口腔作为Hp的另一重要储存地的观点逐渐被广大学者所接受[3]。目前多数试验研究支持胃内和口腔Hp具有形态和生物学的同源性[4-5]。研究表明，口腔内Hp的存在不仅与多种口腔疾病有关[6]，而且Hp随吞咽进入胃是胃内Hp传播和反复感染的主要原因[7]。目前，Hp唾液检测板（H.pylori saliva test cassette，HPS）作为一种新的免疫检测法，可以定性检测口腔幽门螺杆菌尿素酶抗原，具有敏感性高、特异性强的优点，显示出了良好的应用前景。……