Tovey Frank I, Hobsley Michael, Holton John
World J Gastroenterol. 2006 Jan 7;12(1):6-9. doi: 10.3748/wjg.v12.i1.6.
Reports from countries with a high prevalence of Helicobacter pylori (H pylori) infection do not show a proportionately high prevalence of duodenal ulceration, suggesting the possibility that H pylori cannot be a primary cause of duodenal ulceration. It has been mooted that this discrepancy might be explained by variations in the prevalence of virulence factors in different populations. The aim of this paper is to determine whether the published literature gives support to this possibility. The relevant literature was reviewed and analyzed separately for countries with a high and low prevalence of H pylori infection and virulence factors. Although virulent strains of H pylori were significantly more often present in patients with duodenal ulcer than without the disease in countries with a low prevalence of H pylori infection in the population, there was no difference in the prevalence of virulence factors between duodenal ulcer, non - ulcer dyspepsia or normal subjects in many countries, where the prevalence of both H pylori infection and of virulence factors was high. In these countries, the presence of virulence factors was not predictive the clinical outcome. To explain the association between virulence factors and duodenal ulcer in countries where H pylori prevalence is low, only two papers were found that give little support to the usual model proposed, namely that organisms with the virulence factors are more likely than those without them to initiate a duodenal ulcer. We offer an alternative hypothesis that suggests virulence factors are more likely to interfere with the healing of a previously produced ulcer. The presence of virulence factors only correlates with the prevalence of duodenal ulcer in countries where the prevalence of H pylori is low. There is very little evidence that virulence factors initiate duodenal ulceration, but they may be related to failure of the ulcer to heal.
幽门螺杆菌（H pylori）感染率高的国家的报告显示，十二指肠溃疡的患病率并未相应地高，这表明幽门螺杆菌不太可能是十二指肠溃疡的主要病因。有人提出，这种差异可能是由于不同人群中毒力因子患病率的差异所致。本文的目的是确定已发表的文献是否支持这种可能性。分别对幽门螺杆菌感染和毒力因子患病率高和低的国家的相关文献进行了综述和分析。虽然在人群中幽门螺杆菌感染率低的国家，十二指肠溃疡患者中有毒力的幽门螺杆菌菌株比无十二指肠溃疡患者中明显更常见，但在许多幽门螺杆菌感染率和毒力因子患病率都高的国家，十二指肠溃疡、非溃疡性消化不良或正常受试者中毒力因子的患病率没有差异。在这些国家，毒力因子的存在并不能预测临床结果。为了解释幽门螺杆菌患病率低的国家中毒力因子与十二指肠溃疡之间的关联，仅发现两篇论文，它们几乎不支持通常提出的模型，即有毒力因子的生物体比没有毒力因子的生物体更有可能引发十二指肠溃疡。我们提出了另一种假说，即毒力因子更有可能干扰先前产生的溃疡的愈合。毒力因子的存在仅与幽门螺杆菌患病率低的国家中十二指肠溃疡的患病率相关。几乎没有证据表明毒力因子会引发十二指肠溃疡，但它们可能与溃疡愈合失败有关。
