Arents N L, van Zwet A A, Thijs J C, Kooistra-Smid A M, van Slochteren K R, Degener J E, Kleibeuker J H, van Doorn L J
Regional Public Health Laboratory, Groningen/Drenthe, The Netherlands.
Am J Gastroenterol. 2001 Sep;96(9):2603-8. doi: 10.1111/j.1572-0241.2001.04104.x.
To study the relationship between the presence of H. pylori virulence factors and clinical outcome in H. pylori infected patients.
DNA was isolated from an antral biopsy sample and vacA, cagA, and iceA genotype were determined by PCR and a reverse hybridization technique in 183 patients with culture-proven H. pylori infection: 51 with peptic ulcer disease (PUD), 62 with gastroesophageal reflux disease (GERD), and 70 with a normal endoscopy (gastritis only; GO).
Forty-four samples (24%) showed more than one allelic variant in the vacA s- or in-region and/or both iceA1 and iceA2 genotypes, indicating multiple strain infection. These were excluded from statistical analysis. vacA s1 and cagA were significantly more common in PUD than in GERD and GO. Logistic regression analysis showed that GERD patients were more often infected with strains lacking both cagA and iceA than GO patients (OR = 0.36; CI = 0.15-0.89). Trend analysis showed that GERD patients were most often infected with less virulent strains (p < 0.002).
Multiple strain infection is common. H. pylori strains possessing the vacA s1 genotype and/or cagA are associated with PUD. GERD patients, infected with H. pylori, mostly carry less virulent strains possessing neither cagA nor iceA1. Our findings support the hypothesis that virulent strains protect against the development of GERD.
研究幽门螺杆菌毒力因子的存在与幽门螺杆菌感染患者临床结局之间的关系。
从胃窦活检样本中提取DNA，采用聚合酶链反应（PCR）和反向杂交技术，对183例经培养证实幽门螺杆菌感染的患者进行vacA、cagA和iceA基因型检测，其中51例患有消化性溃疡疾病（PUD），62例患有胃食管反流病（GERD），70例内镜检查正常（仅为胃炎；GO）。
44个样本（24%）在vacA s区或i区显示出不止一种等位基因变异，和/或同时存在iceA1和iceA2基因型，表明存在多菌株感染。这些样本被排除在统计分析之外。vacA s1和cagA在PUD患者中比在GERD和GO患者中更为常见。逻辑回归分析显示，GERD患者比GO患者更常感染同时缺乏cagA和iceA的菌株（比值比=0.36；可信区间=0.15-0.89）。趋势分析显示，GERD患者最常感染毒力较低的菌株（p<0.002）。
多菌株感染很常见。具有vacA s1基因型和/或cagA的幽门螺杆菌菌株与PUD相关。感染幽门螺杆菌的GERD患者大多携带既不具有cagA也不具有iceA1的低毒力菌株。我们的研究结果支持毒力菌株可预防GERD发生这一假说。
