幽门螺杆菌vacA基因型与胃黏膜肠上皮化生关系

发布时间：2018-05-18 01:32

  本文选题：幽门螺杆菌 + 萎缩性胃炎　； 参考：《沈阳医学院》2017年硕士论文

【摘要】：目的探讨幽门螺杆菌(H.pylori)vacA基因型与萎缩性胃炎、胃黏膜肠上皮化生(IM)的关系,为鉴别IM相关高致病性H.pylori菌株及识别H.pylori感染高危人群,临床阻断萎缩性胃炎IM进程,进行因型施治提供依据。方法本研究选取2011～2014年沈阳医学院附属中心医院和沈阳医学院附属第二医院胃镜活检的石蜡包埋标本396例。经检测271例为H.pylori阳性病例,后者中携带vacA基因者共计233例。233例H.pylori阳性病例包括,浅表性胃炎(GS)71例、萎缩性胃炎(GA)49例、胃溃疡(GU)113例;伴IM者82例(GS=18、GA=35、GU=29),不伴 IM 者 151 例(GS=53、GA=14、GU=84)。利用HE染色和亚甲蓝染色对所取标本进行组织病理学诊断;利用试剂盒法提取石蜡包埋胃镜组织中的DNA;利用PCR技术和组织学染色相结合的方法对H.pylori进行判定;同时利用巢式PCR方法对H.pylori vacA进行分型;利用免疫组化技术对黏蛋白MUC2和MUC5AC进行检测;利用HID-ABpH2.5-PAS黏蛋白染色对IM进行分型。统计分析采用统计软件spss16.0进行χ2或Fisher精确检验,P0.05差异具有统计学意义。结果比较vacA基因亚型在不同胃疾病中的分布,在GS中vacAs1m-亚型组合的构成比最高;GU中vacAs1m1m2亚型的构成比最高;GA中vacAs1m2亚型的构成比最高。在GA中m2亚型的构成比为38.8%(19/49)高于同组m1、m1m2和m-亚型,高于GS和GU组;vacAs1m2亚型组合的构成比为38.8%(19/49),高于同组胃疾病的其他亚型组合,高于GS和GU组。差异均有统计学意义。比较不同vacA基因亚型与IM间的关系,在IM组,m2亚型的构成比为42.7%(35/82),高于同组其他亚型,其中明显高于m1亚型;同时IM组中m2亚型的构成比亦明显高于非IM组;在IM组s1m2亚型的构成比为41.5%(34/82),高于同组其他亚型基因型组合,其中明显高于s1m1亚型;同时IM组中s1m2亚型的构成比亦明显高于非IM组。在非IM组m1亚型的构成比为33.8%(51/151)明显高于IM组,高于同组其他m亚型;在非IM组s1m1亚型的构成比为29.1%(44/151)明显高于IM组,高于同组其他亚型基因型组合。在IM组中的GA病例中,m2亚型的构成比为54.3%(19/35)明显高于其他m亚型,同时高于IM组中的GS和GU;在IM组中的GA病例中,s1m2亚型的构成比为54.3%(19/35),明显高于其他基因型组合,同时亦高于IM组的GS和GU。比较不同vacA基因亚型与黏蛋白MUC2表达间的关系,经过免疫组化染色MUC2阳性病例107例,阴性病例126例。在MUC2阳性组中,m2亚型的构成比为36.4%(39/107),明显高于m1亚型且高于阴性组的m2亚型;s1m2亚型组合的构成比为35.5%(38/107),高于MUC2阴性组中s1m2亚型。差异均有统计学意义。比较不同vacA基因亚型与黏蛋白MUC5AC表达间的关系,经过免疫组化染色MUC5AC阳性病例89例,阴性病例144例。在MUC5AC阳性组中,m2亚型的构成比为14.6%(13/89),明显低于m1亚型;且明显低于阴性组的m2亚型。在MUC5AC阳性组中,s1m2亚型的构成比为14.6%,明显低于s1m1亚型;且明显低于阴组中s1m2亚型。不同vacA基因亚型与IM分型间的关系经过HID-AB-PAS-PH2.5染色,在82例IM中,完全性IM 23例,不完全性IM 59例。m2亚型在不完全性IM组中的构成比为50.8%(30/59),高于同组的m1亚型,且高于完全性IM;vacAs1m2亚型在不完全性IM组中的构成比为49.2%(29/59),高于同组s1m1亚型,且高于完全性IM。差异均有统计学意义。结论1.vacA m2亚型和vacA s1m2亚型组合为GA中感染H.pylori的优势基因型;vacA m2基因亚型和s1m2亚型组合的H.pylori可能与GA发生有关。2.vacA m2亚型和vacA s1m2亚型组合为IM病变中感染H.pylori的优势基因型,尤以GA中的为突出;vacA m2基因亚型和s1m2亚型组合的H.pylori可能与IM发生有关。3.与完全性IM相比,不完全性IM中感染H.pylori,其vacA基因型以m2亚型和s1m2亚型组合为优势,与不完全性IM的发生有关
[Abstract]:Objective to investigate the relationship between Helicobacter pylori (H.pylori) vacA genotype and atrophic gastritis and intestinal metaplasia (IM) in the gastric mucosa, in order to identify the high pathogenic H.pylori strain of IM and identify the high-risk group of H.pylori infection, to block the IM process of atrophic gastritis, and to provide the basis for the type of treatment for 2011~2014 years in Shenyang. There were 396 cases of paraffin embedded specimens of gastroscope biopsy in the Affiliated Hospital of the college and the Second Affiliated Hospital of Shenyang Medical College. 271 cases of H.pylori positive were detected, and 233 cases of H.pylori positive in the latter included 233.233 cases, 71 cases of superficial gastritis (GS), 49 cases of atrophic gastritis (GA), 113 cases of gastric ulcer (GU) and 82 cases of IM (GS). =18, GA=35, GU=29), 151 cases without IM (GS=53, GA=14, GU=84). Histopathological diagnosis of specimens were obtained by HE staining and methylene blue staining, and DNA in paraffin embedded gastroscope was extracted with kit method, and H.pylori was determined by the method of combining PCR technique with histological staining, and the nested PCR method was used. Ylori vacA was typed; immunohistochemical technique was used to detect the MUC2 and MUC5AC of mucin; IM was classified by HID-ABpH2.5-PAS mucin staining. Statistical analysis was carried out by statistical software SPSS16.0 for the exact test of chi 2 or Fisher. The difference of P0.05 was statistically significant. The distribution of the vacA gene subtypes in different gastric diseases was compared. In GS, the composition ratio of the vacAs1m- subtype is the highest; the constituent ratio of the vacAs1m1m2 subtype in GU is the highest; the constituent ratio of the vacAs1m2 subtype in GA is the highest. In GA, the constituent ratio of the M2 subtype is 38.8% (19/49) higher than the same group of M1, m1m2 and m- subtypes; the constituent ratio of the subtype is 38.8%, higher than the other subgroups of the same group of gastric diseases. Type combination, higher than group GS and GU. The difference was statistically significant. In the IM group, the constituent ratio of M2 subtypes was 42.7% (35/82), higher than that of the other subtypes in the IM group, which was higher than the M1 subtype, and the constituent ratio of the M2 subtype in the IM group was also higher than that in the non IM group. The constituent ratio of the M2 subtype in the IM group was 41.5%. 2), higher than the group of other subtypes of the same group, which was significantly higher than the s1m1 subtype, and the constituent ratio of s1m2 subtypes in the group IM was also significantly higher than that in the non IM group. The constituent ratio of the M1 subtype in the non IM group was significantly higher than that of the IM group, higher than the other m subgroups, and the constituent ratio of the s1m1 subtype in the non IM group was 29.1% (44/151) higher than that of the same group, higher than the same group. In group GA cases in group IM, the constituent ratio of M2 subtype was 54.3% (19/35) significantly higher than the other M subtypes, and was higher than the GS and GU in the IM group. In the GA cases in the IM group, the constituent ratio of the s1m2 subtype was 54.3% (19/35), which was significantly higher than that of the other group. The relationship between the subtype and the expression of MUC2 was 107 cases of MUC2 positive and 126 negative cases by immunohistochemistry. In the MUC2 positive group, the constituent ratio of the M2 subtype was 36.4% (39/107), obviously higher than the M1 subtype and higher than the negative group M2 subtype; the constitution ratio of the s1m2 subtype was 35.5% (38/107), which was higher than the s1m2 subtype in the MUC2 negative group. The difference was higher than that of the s1m2 subtype in the MUC2 negative group. The relationship between different vacA gene subtypes and the expression of mucin MUC5AC was compared, and 89 cases of MUC5AC positive and 144 negative cases were stained by immunohistochemistry. In the MUC5AC positive group, the constituent ratio of M2 subtype was 14.6% (13/89), obviously lower than the M1 subtype, and obviously lower than the negative group M2 subtype. In the MUC5AC positive group, s1m2, s1m2. The constituent ratio of the subtype was 14.6%, obviously lower than the s1m1 subtype, and obviously lower than the s1m2 subtype in the negative group. The relationship between the subtypes of the vacA gene and the IM typing was HID-AB-PAS-PH2.5 staining, 23 cases of complete IM in 82 cases of IM, and the constituent ratio of the incomplete IM in the incomplete IM group was 50.8% (30/59), and was higher than the same group of M1 subtype. Higher than complete IM; the constituent ratio of vacAs1m2 subtype in incomplete IM group was 49.2% (29/59), higher than that of the same group s1m1 subtype, and higher than that of complete IM.. Conclusion 1.vacA M2 subtype and vacA s1m2 subtype are the dominant genotype of H.pylori in GA. The.2.vacA M2 subtype and the vacA s1m2 subtype are the dominant genotype of H.pylori in IM lesions, especially in GA. The H.pylori may be associated with the occurrence of the vacA M2 gene subtype and the s1m2 subtype. For the advantage, it is related to the occurrence of incomplete IM
【学位授予单位】：沈阳医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R573

【参考文献】

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