Erzin Y, Koksal V, Altun S, Dobrucali A, Aslan M, Erdamar S, Dirican A, Kocazeybek B
Department of Gastroenterology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey.
Helicobacter. 2006 Dec;11(6):574-80. doi: 10.1111/j.1523-5378.2006.00461.x.
Distinct virulence factors of Helicobacter pylori have been associated with clinical outcome of the infection; however, considerable variations have been reported from different geographic regions and data on genotypes of Turkish H. pylori isolates are sparse.
To determine the prevalence of specific genotypes of H. pylori in Turkish patients with dyspepsia.
Ninety-three H. pylori-positive patients [30 with non-ulcer dyspepsia (NUD), 30 with duodenal ulcer (DU), and 33 with gastric cancer (GC)] who were admitted to our endoscopy unit due to dyspepsia were enrolled in the study. H. pylori infection was confirmed in all patients by histology and rapid urease test (RUT). The presence of vacA alleles, cagA, cagE, iceA, and babA2 genotypes were determined by polymerase chain reaction (PCR). Chi-squared test and Fisher's exact test were used for statistical comparisons and multivariate regression analysis was performed to find out independent predictors of different clinical outcomes.
Turkish strains examined predominantly possessed the vacA s1,m2 (48.4%) and s1,m1 (40.7%) genotypes. The vacA s1a genotype was detected in 66.7, 96.4, and 87.9% of isolates from patients with NUD, DU, and GC, respectively, and its presence was significantly associated with that of DU (p = .004), GC (p = .043), and cagA gene (p = .021). None of the cases was found to harbor the s1c genotype. The frequencies of the cagA and cagE genes among studied isolates were 73.6 and 59.3%, respectively. The cagA gene was significantly associated with the presence of DU (p = .004) and GC (p = .003), and the cagE gene, too, was significantly associated with the presence of DU (p = .002) and GC (p = .000). All H. pylori isolates possessed the iceA gene. In all, 68 isolates (74.7%) were positive for iceA1 and 23 (25.3%) for iceA2. The frequency of icea1 gene was significantly higher in cases with GC (85%) than in cases with NUD (60%) (p = .026). The frequency of babA2 gene was 23.3, 46.4, and 87.9% in isolates of patients with NUD, DU, and GC, respectively. When compared to cases with NUD (p = .000) and DU (p = .000), the presence of babA2 gene was significantly higher in cases with GC. Multivariate regression analysis disclosed cagE (p = .006) and vacA s1a (p = .027) genotypes to be independent predictors of DU and babA2 (p = .000) and cagE (p = .013) genotypes to be independent predictors of GC.
H. pylori vacA s1a, cagA, cagE genotypes have significant relations with the presence of DU and GC, and iceA1, babA2 with GC in Turkish patients with dyspepsia, whereas cagE and vacA s1a genotypes are independent predictors of DU, and babA2 and cagE genotypes are independent predictors of GC.
幽门螺杆菌不同的毒力因子与感染的临床结局相关；然而，不同地理区域报道的情况存在相当大的差异，关于土耳其幽门螺杆菌分离株基因型的数据也很稀少。
确定土耳其消化不良患者中幽门螺杆菌特定基因型的流行情况。
93例因消化不良入住我们内镜科的幽门螺杆菌阳性患者[30例非溃疡性消化不良（NUD）、30例十二指肠溃疡（DU）和33例胃癌（GC）]纳入本研究。所有患者均通过组织学和快速尿素酶试验（RUT）确诊幽门螺杆菌感染。通过聚合酶链反应（PCR）确定vacA等位基因、cagA、cagE、iceA和babA2基因型的存在情况。采用卡方检验和Fisher精确检验进行统计学比较，并进行多因素回归分析以找出不同临床结局的独立预测因素。
检测的土耳其菌株主要具有vacA s1,m2（48.4%）和s1,m1（40.7%）基因型。vacA s1a基因型在NUD、DU和GC患者的分离株中分别检出66.7%、96.4%和87.9%，其存在与DU（p = 0.004）、GC（p = 0.043）和cagA基因（p = 0.021）显著相关。未发现任何病例携带s1c基因型。研究分离株中cagA和cagE基因的频率分别为73.6%和59.3%。cagA基因与DU（p = 0.004）和GC（p = 0.003）的存在显著相关，cagE基因也与DU（p = 0.002）和GC（p = 0.000）的存在显著相关。所有幽门螺杆菌分离株均具有iceA基因。总共68株（74.7%）iceA1阳性，23株（25.3%）iceA2阳性。icea1基因在GC患者中的频率（85%）显著高于NUD患者（60%）（p = 0.026）。babA2基因在NUD、DU和GC患者分离株中的频率分别为23.3%、46.4%和87.9%。与NUD（p = 0.000）和DU（p = 0.000）患者相比，babA2基因在GC患者中的存在显著更高。多因素回归分析显示cagE（p = 0.006）和vacA s1a（p = 0.027）基因型是DU的独立预测因素，babA2（p = 0.000）和cagE（p = 0.013）基因型是GC的独立预测因素。
在土耳其消化不良患者中，幽门螺杆菌vacA s1a、cagA、cagE基因型与DU和GC的存在显著相关，iceA1、babA2与GC显著相关，而cagE和vacA s1a基因型是DU的独立预测因素，babA2和cagE基因型是GC的独立预测因素。
