幽门螺杆菌基因型与慢性胃炎、消化性溃疡病严重程度及胃黏膜白细胞介素-8 水平的关系：来自中东地区的研究证据。
Association between Helicobacter pylori genotypes and severity of chronic gastritis, peptic ulcer disease and gastric mucosal interleukin-8 levels: Evidence from a study in the Middle East.
机构信息
Department of Medicine, Faculty of Medicine, Kuwait University, P. O. Box 24923, 13110 Safat, Kuwait ; Thunayan Al-Ghanim Gastroenterology Center, Al-Amiri Hospital, Sharq, Kuwait.
Department of Pathology, Faculty of Medicine, Kuwait University, Jabriya, Kuwait.
出版信息
Gut Pathog. 2014 Sep 26;6(1):41. doi: 10.1186/s13099-014-0041-1. eCollection 2014.
BACKGROUND
The varied clinical presentations of Helicobacter pylori (H. pylori) infection are most likely due to differences in the virulence of individual strains, which determines its ability to induce production of interleukin-8 (IL-8) in the gastric mucosa. The aim of this study was to examine association between cagA, vacA-s1 and vacA-s2 genotypes of H. pylori and severity of chronic gastritis and presence of peptic ulcer disease (PUD), and to correlate these with IL-8 levels in the gastric mucosa.
METHODS
Gastric mucosal biopsies were obtained from patients during esophagogastroduodenoscopy. The severity of chronic gastritis was documented using the updated Sydney system. H. pylori cagA and vacA genotypes were detected by PCR. The IL-8 levels in the gastric mucosa were measured by ELISA.
RESULTS
H. pylori cagA and/or vacA genotypes were detected in 99 patients (mean age 38.4±12.9; 72 males), of whom 52.5% were positive for cagA, 44.4% for vacA-s1 and 39.4% for vacA-s2; and 70.7% patients had PUD. The severity of inflammation in gastric mucosa was increased with vacA-s1 (p=0.017) and decreased with vacA-s2 (p=0.025), while cagA had no association. The degree of neutrophil activity was not associated with either cagA or vacA-s1, while vacA-s2 was significantly associated with decreased neutrophil activity (p=0.027). PUD was significantly increased in patients with cagA (p=0.002) and vacA-s1 (p=0.031), and decreased in those with vacA-s2 (p=0.011). The level of IL-8 was significantly increased in patients with cagA (p=0.011) and vacA-s1 (p=0.024), and lower with vacA-s2 (p=0.004). Higher levels of IL-8 were also found in patients with a more severe chronic inflammation (p=0.001), neutrophil activity (p=0.007) and those with PUD (p=0.001).
CONCLUSIONS
Presence of vacA-s1 genotype of H. pylori is associated with more severe chronic inflammation and higher levels of IL-8 in the gastric mucosa, as well as higher frequency of PUD. Patients with vacA-s2 have less severe gastritis, lower levels of IL-8, and lower rates of PUD. The presence of cagA genotype is not associated with the severity of gastritis or IL-8 induction in the gastric mucosa. The association of cagA with PUD may be a reflection of its presence with vacA-s1 genotype.
背景
幽门螺杆菌（H. pylori）感染的临床表现多种多样，很可能是由于各菌株毒力的差异所致，而菌株毒力决定了其诱导胃黏膜产生白细胞介素-8（IL-8）的能力。本研究旨在探讨 H. pylori 的 cagA、vacA-s1 和 vacA-s2 基因型与慢性胃炎严重程度和消化性溃疡病（PUD）的发生之间的关系，并与胃黏膜中 IL-8 水平相关联。
方法
在胃镜检查期间从患者中获取胃黏膜活检标本。使用更新的悉尼系统记录慢性胃炎的严重程度。通过 PCR 检测 H. pylori 的 cagA 和 vacA 基因型。通过 ELISA 测量胃黏膜中的 IL-8 水平。
结果
在 99 例患者（平均年龄 38.4±12.9；72 名男性）中检测到 H. pylori cagA 和/或 vacA 基因型，其中 52.5%为 cagA 阳性，44.4%为 vacA-s1 阳性，39.4%为 vacA-s2 阳性；70.7%的患者有 PUD。胃黏膜炎症的严重程度随 vacA-s1 增加（p=0.017），随 vacA-s2 减少（p=0.025），而 cagA 则没有关联。中性粒细胞活性程度与 cagA 或 vacA-s1 均无关，而 vacA-s2 与中性粒细胞活性降低显著相关（p=0.027）。cagA（p=0.002）和 vacA-s1（p=0.031）阳性患者的 PUD 明显增加，而 vacA-s2 阳性患者的 PUD 则减少（p=0.011）。cagA（p=0.011）和 vacA-s1（p=0.024）阳性患者的 IL-8 水平显著升高，而 vacA-s2 阳性患者的 IL-8 水平较低（p=0.004）。更严重的慢性炎症（p=0.001）、中性粒细胞活性（p=0.007）和 PUD（p=0.001）患者的 IL-8 水平也更高。
结论
H. pylori 的 vacA-s1 基因型与胃黏膜中更严重的慢性炎症和更高水平的 IL-8 以及更高频率的 PUD 相关。vacA-s2 基因型患者的胃炎程度较轻，IL-8 水平较低，PUD 发生率较低。cagA 基因型与胃黏膜的炎症严重程度或 IL-8 诱导无关。cagA 与 PUD 的关联可能反映了其与 vacA-s1 基因型的存在。
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