Kang Hae Yeon, Kim Nayoung, Park Young Soo, Hwang Jin-Hyeok, Kim Jin-Wook, Jeong Sook Hyang, Lee Dong Ho, Jung Hyun Chae, Song In Sung
Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Dig Dis Sci. 2006 Dec;51(12):2310-5. doi: 10.1007/s10620-006-9276-0. Epub 2006 Nov 1.
This study was performed to evaluate the implication of anti-H. pylori IgG positivity when CLOtest, histological test, and culture in the antrum and body are all negative, and to find out the specific disease category that is more affected by the hostile relationship of atrophic gastritis and intestinal metaplasia (IM) with H. pylori. Four hundred thirty-six patients (84 controls, 69 with duodenal ulcer, 96 with benign gastric ulcer, 43 with dysplasia, 144 with gastric cancer), who had not received any eradication therapy, were divided into three groups according to H. pylori test: CLOtest or histological H. pylori-positive group (group A; 294 cases), only anti-H. pylori IgG-positive group (group B; 62 cases), and anti-H. pylori IgG-negative group (group C; 80 cases). The grade of neutrophil and monocyte infiltration, atrophic gastritis, and IM was compared according to the updated Sydney system classification. Neutrophil and monocyte infiltrations were significantly severe in the group A. In contrast, the grade of atrophic gastritis and IM in the antrum was significantly higher in group B than the other two groups, A or C. When patients were divided according to the disease outcome in each group, the grade of IM in the body was statistically higher only in the patients with cancer or dysplasia in group B. These results suggest that anti-H. pylori IgG positivity with all negative invasive H. pylori tests represents past infection with H. pylori rather than a false negative, especially in the case of dysplasia and gastric cancer.
本研究旨在评估当胃窦和胃体的CLO检测、组织学检测及培养均为阴性时，抗幽门螺杆菌IgG阳性的意义，并找出萎缩性胃炎和肠化生（IM）与幽门螺杆菌的敌对关系更易影响的特定疾病类别。436例未接受过任何根除治疗的患者（84例对照、69例十二指肠溃疡患者、96例良性胃溃疡患者、43例发育异常患者、144例胃癌患者）根据幽门螺杆菌检测结果分为三组：CLO检测或组织学检测幽门螺杆菌阳性组（A组；294例）、仅抗幽门螺杆菌IgG阳性组（B组；62例）和抗幽门螺杆菌IgG阴性组（C组；80例）。根据更新后的悉尼系统分类比较中性粒细胞和单核细胞浸润程度、萎缩性胃炎及IM的程度。A组中性粒细胞和单核细胞浸润明显更严重。相比之下，B组胃窦萎缩性胃炎和IM的程度显著高于A组和C组。当根据每组的疾病结局对患者进行分组时，仅B组中患有癌症或发育异常的患者胃体IM程度在统计学上更高。这些结果表明，侵入性幽门螺杆菌检测均为阴性时抗幽门螺杆菌IgG阳性代表幽门螺杆菌既往感染而非假阴性，尤其是在发育异常和胃癌的情况下。
