幽门螺杆菌毒力与儿童胃粘膜病理学改变关系的研究

发布时间：2019-03-06 07:49

【摘要】：目的：研究幽门螺杆菌感染两毒力与儿童胃粘膜病理学改变的关系。方法：(1)应用奥林巴斯GIF-XQ20纤维胃镜对有上消化道症状的175例儿童行胃镜检查，确诊慢性浅表性胃炎(CSG)124例，胃十二指肠消化性溃疡(GU)17例，慢性浅表性胃炎合并溃疡34例。(2)经胃粘膜快速尿素酶检测、Warthin-Starry银染色和HE染色确认其为幽门螺杆菌感染。（3）采用免疫印迹法检测其菌株类型，结合病理组织学染色及胃镜检查结果，判断菌株类型与胃粘膜病变是否存在相关性。结果：（1）175例患儿中CagA和VacA抗体总检出率分别为83.43%(146/175)，86.86%(152/175)，其中CagA在CSG和GU的检出率分别为76.58%,96.08%,两者相比有显著性差异（P0.05）；VacA在CSG和GU检出率分别为88.61%,90.20%,两者相比无显著性差异(P0.05)；（2）175例H. pylori感染患儿， CSG组中CagA、VacA抗体均阳性(I型菌)占130例(82.27%),CagA、VacA抗体均阴性(II型菌)占13例(8.23%),CagA、VacA抗体仅一项阳性(中间型)占15例(9.49%)；GU组中CagA、VacA抗体均阳性(I型菌)占41例(80.39%),CagA、VacA抗体均阴性(II型菌)占6例(11.76%),CagA、VacA抗体仅一项阳性(中间型)占4例(7.84%)；（3）175例患者中，146例CagA抗体阳性患者中，有126例处于急性活动性病变，其中轻度24（19.05%）例，中重度102例（80.95%），两者差异有统计学意义(X2=8.62，P0.05)；119例粘膜炎症病变，，其中表现为轻度的有21（17.65%）例，中重度的有98（82.35%）例（以上数据之间有交叉），两者差异有统计学意义(X2=6.78，P0.05)。（4）CagA+组146例，LFP发生率30.82%（45/146）, CagA-组29例，LFP发生率13.79%(4/29)，两者比较无统计学意义（X2=3.48，P0.05）；而CagA+组肠上皮化生发生率6.16%(9/146)，CagA-组肠上皮化生发生率3.45(1/29)，两者比较亦无统计学意义（X2=0.33，P0.05）。(5)从炎症的活动性看，175例H.pylori相关性胃肠道疾病中，无活动性胃炎20例，LFP发生率0%（0/20），轻度活动性炎症37例，LFP发生率13.51%(5/37)，中重度活动性炎症118例，LFP发生率37.29%(44/118)。LFP发生率表现为中重度轻度无活动性炎症,组间比较差异有统计学意义，p0.05。结论：（1）CagA蛋白与GU有密切的关系，明显高于CSG；而VacA蛋白不能作为区别CSG和GU的特征性指标，但CagA和VacA均与CSG及GU疾病的形成有关。（2）本地区的儿童，幽门螺杆菌类型主要以I型菌株类型为主，应引起临床重视；（3）CagA蛋白可作为胃粘膜炎症程度的辅助诊断手段，特别是对于小儿这类特殊群体更具有重要意义；（4）CagA蛋白可能与淋巴滤泡及肠上皮化生无关。（5）LFP发生率在H.pylori相关性胃肠道疾病中，可能与其慢性胃炎急性活动性程度有关，表现为中重度轻度无活动性炎症。
[Abstract]:Objective: to study the relationship between Helicobacter pylori infection and pathological changes of gastric mucosa in children. Methods: (1) Olympus GIF-XQ20 fibergastroscopy was performed in 175children with upper digestive tract symptoms. There were 124 cases of chronic superficial gastritis (CSG) and 17 cases of gastroduodenal peptic ulcer (GU). There were 34 cases of chronic superficial gastritis complicated with ulcer. (2) it was confirmed as Helicobacter pylori infection by rapid urease test, Warthin-Starry silver staining and HE staining in gastric mucosa. (3) the type of Helicobacter pylori was detected by immunoblotting. According to the results of histopathological staining and gastroscopy, the relationship between the type of strains and gastric mucosal lesions was evaluated. Results: (1) the total positive rates of CagA and VacA were 83.43% (146 / 175) and 86.86% (152 / 175), respectively. The positive rates of CagA in CSG and GU were 76.58% and 96.08%, respectively. There was significant difference between the two groups (P0.05). The positive rates of VacA in CSG and GU were 88.61% and 90.20%, respectively. There was no significant difference between the two groups (P0.05). (2) among the 175 children with H. pylori infection, 130 cases (82.27%) were positive for CagA,VacA antibody (type I bacteria) and 13 cases (8.23%) were negative for CagA,VacA antibody (type II) (8.23%), CagA,) in CSG group. Only one positive (intermediate type) of VacA antibody was found in 15 cases (9.49%). In GU group, 41 cases (80.39%) were positive for CagA,VacA antibody, 6 cases (11.76%) were negative for CagA,VacA antibody (type II bacteria) and 4 cases (7.84%) were positive for CagA,VacA antibody (intermediate type). (3) among the 175patients with positive CagA antibody, there were 126cases with acute active lesion, of which 24 cases were mild (19.05%) and 102 cases were moderate or severe (80.95%). There was significant difference between the two groups (X 2 / 8 / 62, P < 0.01), but there was no significant difference between the two groups (P < 0.01). (P 0.05); Among 119 cases of mucosal inflammation, 21 (17.65%) were mild, 98 (82.35%) were moderate or severe (the above data were crossed), and the difference was statistically significant (X 2 / 6 78, P < 0.01). The incidence of LFP was 30.82% (45 / 146) in the CagA group and 13.79% (4 / 29) in the CagA- group (). (4). There was no significant difference between the two groups (X2, 3.48, P0.05). The incidence of intestinal metaplasia in CagA group and CagA- group was 6.16% (9 / 146) and 3.45 (1 / 29), respectively. There was no significant difference between the two groups (X 2 / 0.33, P0.05). (5) in the activity of inflammation. Among the 175 cases of H.pylori-associated gastrointestinal diseases, 20 cases were inactive gastritis, the incidence of LFP was 0% (0 / 20), the incidence of mild active inflammation was 37 cases, the incidence of LFP was 13.51% (5 / 37), and the incidence of moderate and severe active inflammation was 118 cases. The incidence of LFP was 37.29% (44 / 118). Conclusion: (1) there is a close relationship between CagA protein and GU, which is significantly higher than that of CSG;. VacA protein can not be used as a characteristic index to distinguish between CSG and GU, but both CagA and VacA are related to the formation of CSG and GU disease. (2) the type of Helicobacter pylori in children in this area is mainly type I, which should be paid attention to in clinical practice. (3) CagA protein can be used as an auxiliary diagnostic method for the degree of gastric mucosal inflammation, especially for this special group of children. (4) CagA protein may not be associated with lymphoid follicles and intestinal metaplasia. (5) the incidence of LFP in H.pylori-associated gastrointestinal diseases may be related to the acute activity of chronic gastritis, showing moderate to severe mild inactive inflammation.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R725.7

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