Heikkinen M, Mayo K, Mégraud F, Vornanen M, Marin S, Pikkarainen P, Julkunen R
Dept. of Medicine, Kuopio University Hospital, Finland.
Scand J Gastroenterol. 1998 Jan;33(1):31-8. doi: 10.1080/00365529850166176.
CagA-positive Helicobacter pylori strains have been reported to be associated with peptic ulcer or malignancy more often than cagA-negative strains. Less is known about the relation of H. pylori serology (CagA-negative or CagA-positive) to histologic changes in the stomach of patients with functional upper abdominal complaints. The association of H. pylori status with patient symptoms or with different subgroups of non-organic dyspepsia is also obscure. In the present study patients' symptoms and their relation to H. pylori serology (H. pylori-negative, H. pylori-positive but CagA-negative, and H. pylori-positive and CagA-positive) were evaluated in general practice patients who had functional upper abdominal complaints. The association of H. pylori serology with different symptom-based subgroups of functional upper abdominal complaints was also assessed. The severity and activity of inflammation and the presence of atrophy and intestinal metaplasia in the antrum and body were evaluated and compared with H. pylori status.
Four hundred consecutive unselected dyspeptic patients in primary care were investigated by means of gastroscopy, upper abdominal ultrasound, laboratory screening including H. pylori and CagA serology, and other examinations if needed. Of these patients 193 with functional upper abdominal complaints were enrolled in this study.
Of the study patients 87 (45%) were H. pylori-negative, 70 (36%) were H. pylori- and CagA-positive, and 36 (19%) were H. pylori-positive but CagA-negative. There were no differences in the occurrence of any dyspeptic symptoms between H. pylori-related subgroups. Nor was there an association between H. pylori status and symptom-based subgroups in our study patients. Inflammation of the stomach was related to H. pylori infection, but CagA-seropositive patients did not have moderate or severe inflammation more often than CagA-seronegative ones. CagA-seropositive patients with functional upper abdominal complaints did not have atrophic changes or intestinal metaplasia in the stomach more often than those who were CagA-negative.
H. pylori or more specific CagA serology is not associated with any specific symptom profile of dyspepsia or with any symptom-based subgroups in patients with functional upper abdominal complaints in primary care. The study patients with CagA seropositivity did not have more severe histologic changes in the stomach than the patients who were H. pylori-seropositive but CagA-seronegative.
据报道，与细胞毒素相关基因A（CagA）阴性的幽门螺杆菌菌株相比，CagA阳性的幽门螺杆菌菌株更常与消化性溃疡或恶性肿瘤相关。关于幽门螺杆菌血清学（CagA阴性或CagA阳性）与功能性上腹部不适患者胃组织学变化之间的关系，人们了解较少。幽门螺杆菌感染状态与患者症状或不同亚组的非器质性消化不良之间的关联也不明确。在本研究中，对有功能性上腹部不适的全科患者的症状及其与幽门螺杆菌血清学（幽门螺杆菌阴性、幽门螺杆菌阳性但CagA阴性、幽门螺杆菌阳性且CagA阳性）的关系进行了评估。还评估了幽门螺杆菌血清学与基于不同症状的功能性上腹部不适亚组之间的关联。评估了胃窦和胃体炎症的严重程度和活动度以及萎缩和肠化生的存在情况，并与幽门螺杆菌感染状态进行了比较。
对基层医疗中连续400例未经选择的消化不良患者进行了胃镜检查、上腹部超声检查、包括幽门螺杆菌和CagA血清学在内的实验室筛查以及必要时的其他检查。其中193例有功能性上腹部不适的患者纳入本研究。
在研究患者中，87例（45%）幽门螺杆菌阴性，70例（36%）幽门螺杆菌和CagA阳性，36例（19%）幽门螺杆菌阳性但CagA阴性。幽门螺杆菌相关亚组之间任何消化不良症状的发生率均无差异。在我们的研究患者中，幽门螺杆菌感染状态与基于症状的亚组之间也无关联。胃炎症与幽门螺杆菌感染有关，但CagA血清阳性患者并不比CagA血清阴性患者更常出现中度或重度炎症。有功能性上腹部不适的CagA血清阳性患者与CagA阴性患者相比，胃内萎缩性改变或肠化生并不更常见。
在基层医疗中，幽门螺杆菌或更具特异性的CagA血清学与功能性上腹部不适患者的任何特定消化不良症状谱或基于症状的亚组均无关联。CagA血清阳性的研究患者与幽门螺杆菌血清阳性但CagA血清阴性的患者相比，胃内组织学改变并不更严重。
