抑酸治疗期间的非幽门螺杆菌菌群：胃液和胃黏膜中的不同发现
Non-Helicobacter pylori bacterial flora during acid-suppressive therapy: differential findings in gastric juice and gastric mucosa.
作者信息
Sanduleanu S, Jonkers D, De Bruine A, Hameeteman W, Stockbrügger R W
机构信息
Department of Gastroenterology/Hepatology, University Hospital Maastricht, The Netherlands.
出版信息
Aliment Pharmacol Ther. 2001 Mar;15(3):379-88. doi: 10.1046/j.1365-2036.2001.00888.x.
BACKGROUND
Intragastric growth of non-Helicobacter pylori bacteria commonly occurs during acid-suppressive therapy. The long-term clinical consequences are still unclear.
AIM
To investigate the luminal and mucosal bacterial growth during gastric acid inhibition, in relation to the type and duration of acid-inhibitory treatment, as well as to concomitant H. pylori infection.
METHODS
A total of 145 patients on continuous acid inhibition with either proton pump inhibitors (n=109) or histamine2-receptor antagonists (H(2)RAs, n=36) for gastro-oesophageal reflux disease, and 75 dyspeptic patients without acid inhibition (control group) were included. At endoscopy, fasting gastric juice was obtained for pH measurement and bacteriological culture. Gastric biopsy specimens were examined for detection of H. pylori (immunohistochemistry) and of non-H. pylori bacteria (modified Giemsa stain-positive and immunohistochemistry-negative at the same location).
RESULTS
Non-H. pylori flora was detected in the gastric juice of 92 (41.8%) patients and in the gastric mucosa of 109 (49.6%) patients. In gastric juice, prevalence rate for non-H. pylori bacteria was higher in patients taking proton pump inhibitors than controls and those taking H(2)RAs (58.7% vs. 22.6% and vs. 30.6%, P < 0.0001 and P < 0.003, respectively), but did not differ statistically between H(2)RAs and controls. In gastric mucosa, prevalence rates for non-H. pylori bacteria were higher in patients taking proton pump inhibitors and H(2)RAs than in the controls (antrum: 46.9% and 48.6% vs. 25%, P < 0.05 for both; corpus: 52.2% and 56.8% vs. 23.7%, P < 0.001 for both), but did not differ between proton pump inhibitors and H(2)RAs. Both luminal and mucosal growth of non-H. pylori bacteria were significantly greater in H. pylori-positive than -negative patients taking proton pump inhibitors (P < 0.05 for both). Luminal growth of non-H. pylori flora increased with the intragastric pH level, whilst mucosal bacterial growth increased with the duration of acid inhibition.
CONCLUSIONS
Non-H. pylori flora not only contaminates the gastric juice but also colonizes the gastric mucosa of a large proportion of patients treated long-term with acid inhibition. The relationship between H. pylori and non-H. pylori bacteria in the pathogenesis of atrophic gastritis and gastric cancer needs further elucidation.
背景
在抑酸治疗期间，非幽门螺杆菌在胃内的生长较为常见。其长期临床后果仍不明确。
目的
研究胃酸抑制期间胃腔内和黏膜的细菌生长情况，以及与抑酸治疗的类型、持续时间和同时存在的幽门螺杆菌感染的关系。
方法
纳入145例因胃食管反流病持续接受质子泵抑制剂（n = 109）或组胺2受体拮抗剂（H₂RAs，n = 36）抑酸治疗的患者，以及75例未接受抑酸治疗的消化不良患者（对照组）。在内镜检查时，获取空腹胃液进行pH测量和细菌培养。对胃活检标本进行幽门螺杆菌检测（免疫组织化学法）和非幽门螺杆菌检测（改良吉姆萨染色阳性且同一部位免疫组织化学阴性）。
结果
在92例（41.8%）患者的胃液和109例（49.6%）患者的胃黏膜中检测到非幽门螺杆菌菌群。在胃液中，服用质子泵抑制剂的患者中非幽门螺杆菌的患病率高于对照组和服用H₂RAs的患者（分别为58.7%、22.6%和30.6%，P < 0.0001和P < 0.003），但H₂RAs组与对照组之间无统计学差异。在胃黏膜中，服用质子泵抑制剂和H₂RAs的患者中非幽门螺杆菌的患病率高于对照组（胃窦：分别为46.9%和48.6% vs. 25%，两者P < 0.05；胃体：分别为52.2%和56.8% vs. 23.7%，两者P < 0.001），但质子泵抑制剂组与H₂RAs组之间无差异。在服用质子泵抑制剂的幽门螺杆菌阳性患者中，非幽门螺杆菌在胃腔和黏膜的生长均显著高于阴性患者（两者P < 0.05）。非幽门螺杆菌菌群在胃腔内的生长随胃内pH值升高而增加，而黏膜细菌生长随抑酸持续时间增加而增加。
结论
非幽门螺杆菌菌群不仅污染胃液，还在很大一部分长期接受抑酸治疗的患者胃黏膜中定植。幽门螺杆菌与非幽门螺杆菌在萎缩性胃炎和胃癌发病机制中的关系需要进一步阐明。
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