Casswall Thomas H, Németh Antal, Nilsson Ingrid, Wadström Torkel, Nilsson Hans-Olof
Department of Pediatric Gastroenterology, Hepatology and Nutrition, Astrid Lindgren's Children's Hospital at Karolinska University Hospital, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
Scand J Gastroenterol. 2010;45(2):160-7. doi: 10.3109/00365520903426915.
Enterohepatic Helicobacter species (EHS) have previously been found in adults with hepatobiliary diseases. Here, we report the prevalence of Helicobacter pylori and EHS in liver and gastric tissue in children and adolescents with chronic liver disease (CLD).
Seventy-seven consecutive children and adolescents with CLD with or without ulcerative colitis or Crohn's disease (UC/CD) were investigated. Tissue samples were analysed using a Helicobacter genus-specific 16S rDNA polymerase chain reaction (PCR) assay and DNA-sequence analysis. Sera from 61 subjects were also analysed using enzyme immunoassay and immunoblotting.
The Helicobacter PCR was positive in 3/23 (13%) livers from patients with primary sclerosing cholangitis and UC, and in 1/2 livers from patients with autoimmune hepatitis (AIH) and UC. Sequenced PCR products matched the 16S rDNA of H. hepaticus, H. muridarum, H. canis, and H. pylori, respectively. H. ganmani and H. bilis were detected in gastric tissues from two AIH patients. H. hepaticus and H. pullorum were found in livers from two patients with acute liver failure and intrahepatic cholestasis. Antibody reactivity to Helicobacter cell-surface proteins was negative.
H. pylori and EHS can be detected in the livers of some patients with UC and concomitant liver disease, as well as in other children with liver diseases. Multicentre studies from different locations are needed to find out whether these bacteria play a pathogenetic role or whether their presence is an epiphenomenon.
此前已在患有肝胆疾病的成人中发现肠肝螺杆菌属（EHS）。在此，我们报告慢性肝病（CLD）儿童和青少年的肝脏及胃组织中幽门螺杆菌和EHS的流行情况。
对77例连续性CLD儿童和青少年进行调查，这些患者伴有或不伴有溃疡性结肠炎或克罗恩病（UC/CD）。使用螺杆菌属特异性16S rDNA聚合酶链反应（PCR）检测法和DNA序列分析对组织样本进行分析。还使用酶免疫测定法和免疫印迹法对61名受试者的血清进行分析。
在原发性硬化性胆管炎合并UC患者的3/23（13%）肝脏中，以及自身免疫性肝炎（AIH）合并UC患者的1/2肝脏中，幽门螺杆菌PCR检测呈阳性。测序后的PCR产物分别与肝螺杆菌、鼠螺杆菌、犬螺杆菌和幽门螺杆菌的16S rDNA匹配。在两名AIH患者的胃组织中检测到甘氏螺杆菌和胆汁螺杆菌。在两名急性肝衰竭和肝内胆汁淤积患者的肝脏中发现了肝螺杆菌和鸡螺杆菌。对螺杆菌细胞表面蛋白的抗体反应性为阴性。
在一些合并UC及肝脏疾病的患者肝脏中，以及其他患有肝脏疾病的儿童中，可检测到幽门螺杆菌和EHS。需要来自不同地区的多中心研究，以确定这些细菌是否发挥致病作用，或者它们的存在是否只是一种附带现象。
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