Roussos Anastasios, Philippou Nikiforos, Mantzaris Gerassimos J, Gourgoulianis Konstantinos I
A' Gastroenterology Clinic, Evangelismos Hospital, Athens, Greece.
Respiration. 2006;73(5):708-14. doi: 10.1159/000093816. Epub 2006 Jun 7.
Recent studies suggest an epidemiological association between Helicobacter pylori infection and several extra-gastroduodenal pathologies, including cardiovascular, rheumatic, skin and liver diseases. The observed associations might be explained by a role of H. pylori infection in the pathogenesis of certain extra-digestive disorders, as a variety of inflammatory mediators are activated by H. pylori infection. The present review summarizes the current literature, including our own studies, concerning the association between respiratory diseases and H. pylori infection. A small number of epidemiological and serologic case-control studies suggest that patients with chronic obstructive pulmonary disease have an increased seroprevalence of H. pylori. A frequent coexistence of bronchiectasis and H. pylori infection has also been found. Moreover, recent studies have shown an increased prevalence of H. pylori infection in patients with pulmonary tuberculosis and in those with lung cancer. On the other hand, bronchial asthma does not seem to be related to H. pylori infection. At present, there is no definite proof of a causal relationship between H. pylori and respiratory diseases. The primary evidence rests on case-control studies, concerning relatively small numbers of patients. Future studies should be large enough for moderate-sized effects to be assessed or registered reliably. The activation of inflammatory mediators by H. pylori infection might be the pathogenetic mechanism underlying the observed associations. Therefore, the role of genetic predisposition of the infected host, the presence of strain-specific virulence factors and the serum concentration of proinflammatory markers in H. pylori-infected patients with respiratory diseases need further evaluation.
近期研究表明，幽门螺杆菌感染与多种胃十二指肠外病变之间存在流行病学关联，这些病变包括心血管疾病、风湿性疾病、皮肤病和肝脏疾病。观察到的这些关联可能是由于幽门螺杆菌感染在某些消化外疾病的发病机制中发挥了作用，因为幽门螺杆菌感染可激活多种炎症介质。本综述总结了当前包括我们自己的研究在内的有关呼吸系统疾病与幽门螺杆菌感染之间关联的文献。少数流行病学和血清学病例对照研究表明，慢性阻塞性肺疾病患者的幽门螺杆菌血清阳性率有所增加。支气管扩张症与幽门螺杆菌感染并存的情况也很常见。此外，近期研究显示，肺结核患者和肺癌患者的幽门螺杆菌感染率有所上升。另一方面，支气管哮喘似乎与幽门螺杆菌感染无关。目前，尚无确凿证据证明幽门螺杆菌与呼吸系统疾病之间存在因果关系。主要证据基于病例对照研究，涉及的患者数量相对较少。未来的研究应足够大，以便能够可靠地评估或记录中等规模的效应。幽门螺杆菌感染激活炎症介质可能是所观察到的关联背后的发病机制。因此，在感染幽门螺杆菌的呼吸系统疾病患者中，宿主遗传易感性、菌株特异性毒力因子的存在以及促炎标志物的血清浓度所起的作用需要进一步评估。
