摘要
目的比较不同胃黏膜病变患者血清幽门螺杆菌(Hp)毒力因子细胞毒素A(Cag A)、空泡细胞毒素A(Vac A)阳性率和定量水平,并观察四联疗法治疗前后的变化,为胃黏膜病变的精准诊治提供参考。方法选取2021年5月至2024年4月在该院因上消化道症状就诊的186例患者作为研究对象,所有患者均通过胃镜和活检组织病理检查确诊,其中慢性浅表性胃炎(CSG)65例(CSG组)、慢性萎缩性胃炎(CAG)52例(CAG组)、胃溃疡41例(胃溃疡组)、胃癌28例(胃癌组)。使用R-Biopharm Cag A和Vac A酶联免疫吸附试验(ELISA)试剂盒对所有患者进行血清Hp毒力因子Cag A、Vac A定性和定量检测,比较不同胃黏膜病变患者血清Cag A、Vac A水平及阳性率。对所有患者进行^(14)C尿素呼气试验(^(14)C-UBT),并对Hp阳性的患者给予四联疗法治疗,比较治疗前和治疗后患者血清Cag A、Vac A水平及阳性率。统计^(14)C-UBT及Cag A、Vac A检测费用。结果不同胃黏膜病变组性别、BMI及饮食不规律、饮食结构不合理、有吸烟史、有饮酒史、有消化道肿瘤家族史比例比较,差异均无统计学意义(P>0.05)。胃癌组年龄明显大于CSG组、CAG组和胃溃疡组(P<0.05),CAG组年龄明显大于CSG组和胃溃疡组(P<0.05)。胃癌组和胃溃疡组血清Cag A、Vac A水平均明显高于CSG组和CAG组(P<0.05);CAG组血清Cag A、Vac A水平明显高于CSG组(P<0.05);胃癌组和胃溃疡组血清Cag A、Vac A水平比较,差异均无统计学意义(P>0.05)。胃癌组和胃溃疡组血清Cag A阳性率均明显高于CSG组和CAG组(P<0.05);CAG组血清Cag A阳性率明显高于CSG组(P<0.05);胃癌组和胃溃疡组血清Cag A阳性率比较,差异均无统计学意义(P>0.05);胃癌组和胃溃疡组血清Vac A阳性率均明显高于CSG组(P<0.05),胃癌组血清Vac A阳性率明显高于CAG组(P<0.05)。186例患者治疗前^(14)C-UBT检测结果显示为Hp阳性105例,Hp总阳性率为56.45%(105/186)。经四联疗法治疗后,CSG组、CAG组、胃溃疡组、胃癌组血清Cag A、Vac A水平及阳性率均低于治疗前(P<0.05)。^(14)C-UBT平均检测费用明显高于Cag A、Vac A检测费用(P<0.001)。结论Hp毒力因子血清Cag A、Vac A水平及阳性率在胃癌、胃溃疡中明显升高,Hp阳性患者在接受四联疗法治疗后血清CagA、VacA水平及阳性率均明显降低。
Objective To compare the positive rates and quantitative levels of serum Helicobacter pylori(Hp)virulence factors cytotoxin A(CagA)and vacuolating cytotoxin A(VacA)among the patients with different gastric mucosal lesions,and to observe their changes before and after quadruple therapy treatment,so as to provide referrence for the precise diagnosis and treatment of gastric mucosal lesions.Methods A total of 186 patients who visited the hospital due to upper gastrointestinal symptoms from May 2021 to April 2024 were selected as the research subjects.All patients were diagnosed through gastroscopy and biopsy histopathological examination.Among them,there were 65 cases of chronic superficial gastritis(CSG group),52 cases of chronic atrophic gastritis(CAG group),41 cases of gastric ulcer(gastric ulcer group)and 28 cases of gastric cancer(gastric cancer group).The R-Biopharm CagA and VacA enzyme-linked immunosorbent assay(ELISA)kits were used to qualitatively and quantitatively detect serum CagA and VacA in all patients.The levels and positive rates of serum CagA and VacA were compared among the patients with different gastric mucosal lesions.All patients underwent ^(14) C urea breath test(^(14) C-UBT),and the quadruple therapy was given to the patients with Hp positive.The levels and positive rates of serum CagA and VacA in the patients were compared between before and after treatment.The costs of ^(14) C-UBT and CagA and VacA detection were statistically analyzed.Results There were no statistically significant differences in gender,BMI,the proportions of irregular diet,unreasonable diet structure,smoking history,drinking history and family history of digestive tract tumors among different gastric mucosal lesion groups(P>0.05).The age of the gastric cancer group was significantly higher than that of the CSG group,CAG group and gastric ulcer group(P<0.05),and the age of the CAG group was significantly greater than that of the CSG group and gastric ulcer group(P<0.05).The levels of serum CagA and VacA in the gastric cancer group and gastric ulcer group were significantly higher than those in the CSG group and CAG group(P<0.05);the levels of serum CagA and VacA in the CAG group were significantly higher than those in the CSG group(P<0.05);there were no statistically significant differences in the levels of serum CagA and VacA between the gastric cancer group and gastric ulcer group(P>0.05).The positive rates of serum CagA in the gastric cancer group and gastric ulcer group were significantly higher than those in the CSG group and CAG group(P<0.05);the positive rate of serum CagA in the CAG group was significantly higher than that in the CSG group(P<0.05);there was no statistically significant difference in the positive rate of serum CagA between the gastric cancer group and gastric ulcer group(P>0.05);the positive rate of serum VacA in the gastric cancer group and gastric ulcer group was significantly higher than that in the CSG group(P<0.05),and the positive rate of serum VacA in the gastric cancer group was significantly higher than that in the CAG group(P<0.05).The ^(14) C-UBT test results of 186 patients before treatment showed that 105 cases were positive for Hp,and the total positive rate of Hp was 56.45%(105/186).After quadruple therapy,the levels and positive rates of serum CagA and VacA in the CSG group,CAG group,gastric ulcer group and gastric cancer group were all significantly lower than before treatment(P<0.05).The average detection cost of ^(14) C-UBT was significantly higher than that of CagA and VacA detection(P<0.001).Conclusion The levels and positive rates of Hp virulence factors serum CagA and VacA in gastric cancer and gastric ulcer are significantly elevated.After receiving the quadruple therapy in Hp-positive patients,the levels and positive rates of serum CagA and VacA are significantly reduced.
作者
陈风娟
杨晓军
赵恩
花静
王征球
刘鹏飞
CHEN Fengjuan;YANG Xiaojun;ZHAO En;HUA Jing;WANG Zhengqiu;LIU Pengfei(Department of Gastroenterology,Xishan People's Hospital,Wuxi,Jiangsu 214105,China)
出处
《检验医学与临床》
2026年第4期457-464,共8页
Laboratory Medicine and Clinic
基金
江苏省无锡市卫生健康委科研项目(Z202316,M202542)
江苏省无锡市科技局“太湖之光”科技攻关项目(Y20212010)。
关键词
幽门螺杆菌毒力因子
细胞毒素A
胃黏膜病变
空泡细胞毒素A
四联疗法
Helicobacter pylori virulence factor
cytotoxin A
gastric mucosal lesions
vacuolating cytotoxin A
quadruple therapy
