摘要
目的探讨消化性溃疡出血严重程度与H.pylori血清抗体分型的相关性。方法纳入2009年1月1日至2018年12月31日在广州市第一人民医院确诊为消化性溃疡出血并同期进行H.pylori血清抗体检测的1444例患者,按照Forrest分级将其分为高危组(324例)和低危组(1120例),根据是否再出血分为再出血组(32例)和非再出血组(1412例)。采用蛋白质芯片法对H.pylori特异性抗体细胞毒素相关蛋白A(CagA)、细胞空泡毒素A(VacA)和尿素酶进行血清学检测。分析H.pylori阳性率、H.pylori分型与消化性溃疡出血和再出血的相关性。采用卡方检验和logistic回归分析进行统计学分析。结果1444例消化性溃疡出血患者中,胃溃疡出血709例,十二指肠溃疡出血735例。既往有消化性溃疡病史(OR=1.501,P=0.006)、溃疡最大径≥2 cm(OR=2.484,P<0.01)和H.pylori感染(OR=1.508,P=0.005)是消化性溃疡出血严重程度的独立危险因素。H.pylori总阳性率为68.49%(989/1444),以H.pyloriⅠ型为主,其中61.34%(549/895)为CagA和VacA双阳性菌株,31.73%(284/895)为VacA单阳性菌株,CagA单阳性菌株仅占6.93%(62/895)。高危组H.pylori阳性率高于低危组[75.31%(244/324)比66.52%(745/1120)],差异有统计学意义(χ2=8.999,P=0.004),且Forrest分级越严重H.pylori检出率越高,差异有统计学意义(χ2=11.840,P=0.037)。再出血组H.pylori阳性率与非再出血组比较[81.25%(26/32)比68.20%(963/1412)],差异无统计学意义(χ2=2.469,P>0.05)。根据H.pylori抗体分型,高、低危组均以H.pyloriⅠ型感染为主,高危组H.pyloriⅠ型阳性率高于低危组[67.28%(218/324)比60.45%(677/1120)],差异有统计学意义(χ2=4.986,P=0.026)。胃溃疡出血患者H.pylori阳性率与十二指肠溃疡出血患者比较[68.41%(485/709)比68.57%(504/735)],差异无统计学意义(χ2=0.005,P>0.05)。结论H.pylori感染与消化性溃疡出血严重程度相关,但与早期溃疡再出血不相关;H.pyloriⅠ型菌株是胃溃疡出血和十二指肠溃疡出血的主要致病菌株,且均以CagA和VacA双阳性最常见。
Objective To investigate the correlation between the severity of peptic ulcer bleeding(PUB)and the serum antibody typing of Helicobacter pylori(H.pylori).Methods From January 1,2009 to December 31,2018,at Guangzhou First People′s Hospital,1444 patients diagnosed with PUB and received H.pylori serum antibody test at the same time were enrolled and divided into high-risk group(324 cases)and low-risk group(1120 cases)according to Forrest classification,and according to recurrent bleeding,the patients were divided into recurrent bleeding group(32 cases)and non-rebleeding group(1412 cases).Serum H.pylori specific antibodies cytotoxin-associated gene A(CagA),vacuolating cytotoxin A(VacA)and urease were detected by protein array.The correlation between H.pylori positive rate,H.pylori type,PUB and rebleeding were analyzed.Chi-square test and logistic regression analysis were used for statistical analysis.Results Among 1444 PUB patients,there were 709 patients with gastric ulcer bleeding(GUB)and 735 patients with duodenal ulcer bleeding(DUB).Previous history of peptic ulcer disease(odds ratio(OR)=1.501,P=0.006),the maximum diameter of ulcer over 2 cm(OR=2.484,P<0.01)and H.pylori infection(OR=1.508,P=0.005)were independent risk factors of the severity of PUB.The total H.pylori positive rate was 68.49%(989/1444),H.pylori typeⅠwas the main type.Of which,61.34%(549/895)were CagA and VacA double positive strains,31.73%(284/895)were VacA single positive bacteria and CagA single positive bacteria was only 6.93%(62/895).The positive rate of H.pylori of high-risk group was higher than that of low-risk group(75.31%,244/324 vs.66.52%,745/1120),and the difference was statistically significant(χ2=8.999,P=0.004).In addition,the more serious Forrest classification,the higher the detection rate of H.pylori,and the difference was statistically significant(χ2=11.840,P=0.037).There was no significant difference in the positive rate of H.pylori between recurrent bleeding group and non-rebleeding group(81.25%,26/32 vs.68.20%,963/1412;χ2=2.469,P>0.05).According to H.pylori antibody type,H.pylori typeⅠinfection was mainly in both high-risk group and low-risk group.The positive rate of H.pylori typeⅠstrain of high-risk group was higher than that of low-risk group(67.28%,218/324 vs.60.45%,677/1120),and the difference was statistically significant(χ2=4.986,P=0.026).There was no statistically significant difference in the positive rate of H.pylori between GUB group and DUB group(68.41%,485/709 vs.68.57%,504/735;χ2=0.005,P>0.05).Conclusions The infection of H.pylori is positively correlated with the severity of PUB,but not correlated with early ulcer rebleeding.H.pylori typeⅠis the main pathogenic strain of GUB and DUB,and CagA and VacA double positive strain is the most common strain.
作者
何媛
林泳
聂玉强
周永健
李瑜元
He Yuan;Lin Yong;Nie Yuqiang;Zhou Yongjian;Li Yuyuan(Department of Gastroenterology,Guangzhou First People′s Hospital Affiliated to Guangzhou Medical University,Guangzhou Center of Digestive Diseases,Guangzhou 510180,China)
出处
《中华消化杂志》
CAS
CSCD
北大核心
2019年第11期735-740,共6页
Chinese Journal of Digestion
