Annibale B, Lahner E, Bordi C, Martino G, Caruana P, Grossi C, Negrini R, Delle Fave G
Gastroenterology Department, University of Rome La Sapienza, Italy.
Dig Liver Dis. 2000 Dec;32(9):756-62. doi: 10.1016/s1590-8658(00)80351-5.
Pernicious anaemia is associated with atrophic body gastritis and considered an autoimmune disease. Whether Helicobacter pylori is involved in the induction of pernicious anaemia is uncertain.
To investigate the prevalence of Helicobacter pylori infection in pernicious anaemia patients and to ascertain whether the Helicobacter pylori-positive patients had distinctive clinical and gastric morphofunctional characteristics.
A series of 81 consecutive pernicious anaemia patients underwent serological, functional and endoscopic/histological investigations.
A total of 49 (60.5%) patients were Helicobacter pylori-positive (males 61.2% vs females 38.8%). No difference was observed in clinical and morphofunctional characteristics between Helicobacter pylori-positive and negative patients, whereas distinctive functional/histological features between histologically Helicobacter pylori-positive (n=8) and serologically Helicobacter pylori-positive (n=41) cases were detected. In the histologically Helicobacter pylori-positive group, Pepsinogen I was higher [13 (058) vs 5 (0-26) ng/ml; p=0.0025)] and positivity for anti-parietal cell antibodies was lower [42.9% vs 76.9, p=0.0867]. Antral histological variables of the gastritis score were significantly higher in the histologically Helicobacter pylori-positive than in the serologically Helicobacter pylori-positive patients, but this latter group had a higher score of body atrophy (2.63+/-0.12 vs 1.71+/-0.29; p=0.0051). Body inflammation was also significantly higher in the histologically Helicobacter pylori-positive group (chronic inflammation: 1.43+/-0.2 vs 1.05+/-0.06; p=0.0271; inflammation acitivity: 0. 57+/-0.3 vs 0.15+/-0.06, p=0.0220). Antral mucosa was normal in 24/41 (58.5%) of the serologically Helicobacter pylori-positive patients, but only in 1/8 (12.5%) of the histologically Helicobacter pylori-positive patients (p=0.0232).
Almost two thirds of pernicious anaemia patients have evidence of Helicobacter pylori, but only those with an active Helicobacter pylori infection have distinctive functional and histological features. These findings support the hypothesis that Helicobacter pylori infection could play a triggering role in a subgroup of pernicious anaemia patients.
恶性贫血与萎缩性胃体炎相关，被认为是一种自身免疫性疾病。幽门螺杆菌是否参与恶性贫血的诱发尚不确定。
调查恶性贫血患者中幽门螺杆菌感染的患病率，并确定幽门螺杆菌阳性患者是否具有独特的临床和胃形态功能特征。
连续81例恶性贫血患者接受了血清学、功能及内镜/组织学检查。
共有49例（60.5%）患者幽门螺杆菌阳性（男性61.2%，女性38.8%）。幽门螺杆菌阳性和阴性患者在临床及形态功能特征方面未观察到差异，然而，在组织学幽门螺杆菌阳性（n = 8）和血清学幽门螺杆菌阳性（n = 41）的病例之间检测到了独特的功能/组织学特征。在组织学幽门螺杆菌阳性组中，胃蛋白酶原I较高[13（0 - 58）对5（0 - 26）ng/ml；p = 0.0025]，抗壁细胞抗体阳性率较低[42.9%对76.9%，p = 0.0867]。组织学幽门螺杆菌阳性患者的胃炎评分胃窦组织学变量显著高于血清学幽门螺杆菌阳性患者，但后一组的胃体萎缩评分较高（2.63±0.12对1.71±0.29；p = 0.0051）。组织学幽门螺杆菌阳性组的胃体炎症也显著更高（慢性炎症：1.43±0.2对1.05±0.06；p = 0.0271；炎症活动度：0.57±0.3对0.15±0.06，p = 0.0220）。血清学幽门螺杆菌阳性患者中有24/41（58.5%）胃窦黏膜正常，但组织学幽门螺杆菌阳性患者中只有1/8（12.5%）胃窦黏膜正常（p = 0.0232）。
近三分之二的恶性贫血患者有幽门螺杆菌感染证据，但只有那些有活动性幽门螺杆菌感染的患者具有独特的功能和组织学特征。这些发现支持幽门螺杆菌感染可能在一部分恶性贫血患者中起触发作用这一假说。
