【摘要】：目的：研究幽門螺桿菌感染兩毒力與兒童胃粘膜病理學(xué)改變的關(guān)系。方法：(1)應(yīng)用奧林巴斯GIF-XQ20纖維胃鏡對有上消化道癥狀的175例兒童行胃鏡檢查，確診慢性淺表性胃炎(CSG)124例，胃十二指腸消化性潰瘍(GU)17例，慢性淺表性胃炎合并潰瘍34例。(2)經(jīng)胃粘膜快速尿素酶檢測、Warthin-Starry銀染色和HE染色確認其為幽門螺桿菌感染。（3）采用免疫印跡法檢測其菌株類型，結(jié)合病理組織學(xué)染色及胃鏡檢查結(jié)果，判斷菌株類型與胃粘膜病變是否存在相關(guān)性。 結(jié)果：（1）175例患兒中CagA和VacA抗體總檢出率分別為83.43%(146/175)，86.86%(152/175)，其中CagA在CSG和GU的檢出率分別為76.58%,96.08%,兩者相比有顯著性差異（P0.05）；VacA在CSG和GU檢出率分別為88.61%,90.20%,兩者相比無顯著性差異(P0.05)；（2）175例H. pylori感染患兒， CSG組中CagA、VacA抗體均陽性(I型菌)占130例(82.27%),CagA、VacA抗體均陰性(II型菌)占13例(8.23%),CagA、VacA抗體僅一項陽性(中間型)占15例(9.49%)；GU組中CagA、VacA抗體均陽性(I型菌)占41例(80.39%),CagA、VacA抗體均陰性(II型菌)占6例(11.76%),CagA、VacA抗體僅一項陽性(中間型)占4例(7.84%)；（3）175例患者中，146例CagA抗體陽性患者中，有126例處于急性活動性病變，其中輕度24（19.05%）例，中重度102例（80.95%），兩者差異有統(tǒng)計學(xué)意義(X2=8.62，P0.05)；119例粘膜炎癥病變，，其中表現(xiàn)為輕度的有21（17.65%）例，中重度的有98（82.35%）例（以上數(shù)據(jù)之間有交叉），兩者差異有統(tǒng)計學(xué)意義(X2=6.78，P0.05)。（4）CagA+組146例，LFP發(fā)生率30.82%（45/146）, CagA-組29例，LFP發(fā)生率13.79%(4/29)，兩者比較無統(tǒng)計學(xué)意義（X2=3.48，P0.05）；而CagA+組腸上皮化生發(fā)生率6.16%(9/146)，CagA-組腸上皮化生發(fā)生率3.45(1/29)，兩者比較亦無統(tǒng)計學(xué)意義（X2=0.33，P0.05）。(5)從炎癥的活動性看，175例H.pylori相關(guān)性胃腸道疾病中，無活動性胃炎20例，LFP發(fā)生率0%（0/20），輕度活動性炎癥37例，LFP發(fā)生率13.51%(5/37)，中重度活動性炎癥118例，LFP發(fā)生率37.29%(44/118)。LFP發(fā)生率表現(xiàn)為中重度輕度無活動性炎癥,組間比較差異有統(tǒng)計學(xué)意義，p0.05。 結(jié)論：（1）CagA蛋白與GU有密切的關(guān)系，明顯高于CSG；而VacA蛋白不能作為區(qū)別CSG和GU的特征性指標(biāo)，但CagA和VacA均與CSG及GU疾病的形成有關(guān)。（2）本地區(qū)的兒童，幽門螺桿菌類型主要以I型菌株類型為主，應(yīng)引起臨床重視；（3）CagA蛋白可作為胃粘膜炎癥程度的輔助診斷手段，特別是對于小兒這類特殊群體更具有重要意義；（4）CagA蛋白可能與淋巴濾泡及腸上皮化生無關(guān)。（5）LFP發(fā)生率在H.pylori相關(guān)性胃腸道疾病中，可能與其慢性胃炎急性活動性程度有關(guān)，表現(xiàn)為中重度輕度無活動性炎癥。
[Abstract]:Objective: to study the relationship between Helicobacter pylori infection and pathological changes of gastric mucosa in children. Methods: (1) Olympus GIF-XQ20 fibergastroscopy was performed in 175children with upper digestive tract symptoms. There were 124 cases of chronic superficial gastritis (CSG) and 17 cases of gastroduodenal peptic ulcer (GU). There were 34 cases of chronic superficial gastritis complicated with ulcer. (2) it was confirmed as Helicobacter pylori infection by rapid urease test, Warthin-Starry silver staining and HE staining in gastric mucosa. (3) the type of Helicobacter pylori was detected by immunoblotting. According to the results of histopathological staining and gastroscopy, the relationship between the type of strains and gastric mucosal lesions was evaluated. Results: (1) the total positive rates of CagA and VacA were 83.43% (146 / 175) and 86.86% (152 / 175), respectively. The positive rates of CagA in CSG and GU were 76.58% and 96.08%, respectively. There was significant difference between the two groups (P0.05). The positive rates of VacA in CSG and GU were 88.61% and 90.20%, respectively. There was no significant difference between the two groups (P0.05). (2) among the 175 children with H. pylori infection, 130 cases (82.27%) were positive for CagA,VacA antibody (type I bacteria) and 13 cases (8.23%) were negative for CagA,VacA antibody (type II) (8.23%), CagA,) in CSG group. Only one positive (intermediate type) of VacA antibody was found in 15 cases (9.49%). In GU group, 41 cases (80.39%) were positive for CagA,VacA antibody, 6 cases (11.76%) were negative for CagA,VacA antibody (type II bacteria) and 4 cases (7.84%) were positive for CagA,VacA antibody (intermediate type). (3) among the 175patients with positive CagA antibody, there were 126cases with acute active lesion, of which 24 cases were mild (19.05%) and 102 cases were moderate or severe (80.95%). There was significant difference between the two groups (X 2 / 8 / 62, P < 0.01), but there was no significant difference between the two groups (P < 0.01). (P 0.05); Among 119 cases of mucosal inflammation, 21 (17.65%) were mild, 98 (82.35%) were moderate or severe (the above data were crossed), and the difference was statistically significant (X 2 / 6 78, P < 0.01). The incidence of LFP was 30.82% (45 / 146) in the CagA group and 13.79% (4 / 29) in the CagA- group (). (4). There was no significant difference between the two groups (X2, 3.48, P0.05). The incidence of intestinal metaplasia in CagA group and CagA- group was 6.16% (9 / 146) and 3.45 (1 / 29), respectively. There was no significant difference between the two groups (X 2 / 0.33, P0.05). (5) in the activity of inflammation. Among the 175 cases of H.pylori-associated gastrointestinal diseases, 20 cases were inactive gastritis, the incidence of LFP was 0% (0 / 20), the incidence of mild active inflammation was 37 cases, the incidence of LFP was 13.51% (5 / 37), and the incidence of moderate and severe active inflammation was 118 cases. The incidence of LFP was 37.29% (44 / 118). Conclusion: (1) there is a close relationship between CagA protein and GU, which is significantly higher than that of CSG;. VacA protein can not be used as a characteristic index to distinguish between CSG and GU, but both CagA and VacA are related to the formation of CSG and GU disease. (2) the type of Helicobacter pylori in children in this area is mainly type I, which should be paid attention to in clinical practice. (3) CagA protein can be used as an auxiliary diagnostic method for the degree of gastric mucosal inflammation, especially for this special group of children. (4) CagA protein may not be associated with lymphoid follicles and intestinal metaplasia. (5) the incidence of LFP in H.pylori-associated gastrointestinal diseases may be related to the acute activity of chronic gastritis, showing moderate to severe mild inactive inflammation.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R725.7

【參考文獻】

相關(guān)期刊論文 前10條

1 周穎;黃瑛;邵彩虹;王小卉;張冰峰;;上海地區(qū)部分兒童幽門螺桿菌cagA、vacA、iceA基因型別分析[J];中國當(dāng)代兒科雜志;2010年04期

2 袁明;張遠平;郭才晟;謝啟海;劉世玉;;缺鐵性貧血與幽門螺桿菌感染的關(guān)系[J];贛南醫(yī)學(xué)院學(xué)報;2007年01期

3 焦健華,文怡,蔣理;幽門螺桿菌感染及其毒力因子對胃黏膜病理學(xué)改變影響的觀察[J];南京醫(yī)科大學(xué)學(xué)報(自然科學(xué)版);2004年06期

4 李暉;丁甫月;劉玲;許瓊;;幽門螺桿菌感染與兒童過敏性紫癜的關(guān)系[J];實用兒科臨床雜志;2006年20期

5 胡伏蓮;;幽門螺桿菌耐藥研究進展[J];現(xiàn)代消化及介入診療;2005年04期

6 李文秀;;根除治療幽門螺桿菌感染對小兒缺鐵性貧血療效的影響[J];中國醫(yī)藥導(dǎo)報;2009年18期

7 孫淑蘭;楊佳麗;趙劍鋒;;兒童反復(fù)腹痛與幽門螺桿菌感染的探討[J];中國婦幼保健;2011年02期

8 許春娣,鄭潔,奚容平,陳舜年,徐家裕;具有cagA、vacA基因的幽門螺桿菌感染及其與胃十二指腸疾病的關(guān)系[J];中華兒科雜志;2002年03期

9 陳肖肖,尚世強,來慶和,歐弼悠,陳黎勤,吳秀英,章許平;具有cagA、vacA基因的幽門螺桿菌及其表達產(chǎn)物的研究[J];中華兒科雜志;2003年01期

10 葛娟,郭祥,朱永生;白細胞介素6在特發(fā)性血小板減少性紫癜患兒血清中的變化[J];中華兒科雜志;1999年01期

本文編號：2435338