Moss Steven F, Sood Shivani
Division of Gastroenterology, Department of Medicine, Rhode Island Hospital, 593 Eddy Street, APC 4, Providence, RI 02903, USA.
Curr Opin Infect Dis. 2003 Oct;16(5):445-51. doi: 10.1097/00001432-200310000-00011.
Helicobacter pylori is an important human pathogen, responsible for most peptic ulcer disease, gastritis and gastric malignancies. H. pylori has several unique features: it is highly adapted for gastric colonization, yet it produces clinical consequences in a small minority, its genome is known, and it is the only bacterium strongly associated with cancer. H. pylori is therefore of great interest to clinicians and researchers of many, often disparate, disciplines. We highlight recent advances in this fast changing field from many different areas.
The major contentious clinical issues relate to the synergistic gastrotoxic interactions of H. pylori with non-steroidal anti-inflammatory drugs, and a possible association of H. pylori with atherosclerotic events. Accumulating evidence implicates genetic variation in the inflammatory response to H. pylori in the etiology of the increased risk of gastric cancer after H. pylori infection. Studies of pathogenesis have been aided by increasingly sophisticated murine models. The effects in gastric epithelial cells of two of the major virulence factors (genes within the cag pathogenicity island and the vacuolating cytotoxin, VacA) of H. pylori illustrate the complex network of cellular reactions activated by H. pylori. The metabolism of H. pylori is dependent on the availability of hydrogen.
Basic science research into H. pylori continues to elucidate the mechanisms by which H. pylori infection causes disease. These findings have implications for the design of novel therapies and for improving clinical strategies to identify at-risk individuals. Many are also worthy of consideration for other epithelial-microbial interactions.
幽门螺杆菌是一种重要的人类病原体，是大多数消化性溃疡疾病、胃炎和胃癌的病因。幽门螺杆菌具有几个独特的特征：它高度适应在胃内定植，但仅在少数人中引发临床后果；其基因组已知；它是唯一与癌症密切相关的细菌。因此，幽门螺杆菌引起了许多不同学科的临床医生和研究人员的极大兴趣。我们重点介绍了这个快速变化领域中许多不同方面的最新进展。
主要有争议的临床问题涉及幽门螺杆菌与非甾体抗炎药的协同胃毒性相互作用，以及幽门螺杆菌与动脉粥样硬化事件之间可能存在的关联。越来越多的证据表明，幽门螺杆菌感染后胃癌风险增加的病因中，对幽门螺杆菌炎症反应的基因变异起到了作用。越来越复杂的小鼠模型有助于发病机制的研究。幽门螺杆菌的两种主要毒力因子（cag致病岛中的基因和空泡毒素VacA）对胃上皮细胞的影响，说明了幽门螺杆菌激活的复杂细胞反应网络。幽门螺杆菌的代谢依赖于氢气的供应。
对幽门螺杆菌的基础科学研究不断阐明幽门螺杆菌感染导致疾病的机制。这些发现对新型疗法的设计以及改进识别高危个体的临床策略具有重要意义。其中许多发现对于其他上皮-微生物相互作用也值得考虑。
