本文選題：幽門螺桿菌 + 萎縮性胃炎��； 參考：《沈陽醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的探討幽門螺桿菌(H.pylori)vacA基因型與萎縮性胃炎、胃黏膜腸上皮化生(IM)的關(guān)系,為鑒別IM相關(guān)高致病性H.pylori菌株及識別H.pylori感染高危人群,臨床阻斷萎縮性胃炎IM進(jìn)程,進(jìn)行因型施治提供依據(jù)。方法本研究選取2011～2014年沈陽醫(yī)學(xué)院附屬中心醫(yī)院和沈陽醫(yī)學(xué)院附屬第二醫(yī)院胃鏡活檢的石蠟包埋標(biāo)本396例。經(jīng)檢測271例為H.pylori陽性病例,后者中攜帶vacA基因者共計(jì)233例。233例H.pylori陽性病例包括,淺表性胃炎(GS)71例、萎縮性胃炎(GA)49例、胃潰瘍(GU)113例;伴IM者82例(GS=18、GA=35、GU=29),不伴 IM 者 151 例(GS=53、GA=14、GU=84)。利用HE染色和亞甲藍(lán)染色對所取標(biāo)本進(jìn)行組織病理學(xué)診斷;利用試劑盒法提取石蠟包埋胃鏡組織中的DNA;利用PCR技術(shù)和組織學(xué)染色相結(jié)合的方法對H.pylori進(jìn)行判定;同時利用巢式PCR方法對H.pylori vacA進(jìn)行分型;利用免疫組化技術(shù)對黏蛋白MUC2和MUC5AC進(jìn)行檢測;利用HID-ABpH2.5-PAS黏蛋白染色對IM進(jìn)行分型。統(tǒng)計(jì)分析采用統(tǒng)計(jì)軟件spss16.0進(jìn)行χ2或Fisher精確檢驗(yàn),P0.05差異具有統(tǒng)計(jì)學(xué)意義。結(jié)果比較vacA基因亞型在不同胃疾病中的分布,在GS中vacAs1m-亞型組合的構(gòu)成比最高;GU中vacAs1m1m2亞型的構(gòu)成比最高;GA中vacAs1m2亞型的構(gòu)成比最高。在GA中m2亞型的構(gòu)成比為38.8%(19/49)高于同組m1、m1m2和m-亞型,高于GS和GU組;vacAs1m2亞型組合的構(gòu)成比為38.8%(19/49),高于同組胃疾病的其他亞型組合,高于GS和GU組。差異均有統(tǒng)計(jì)學(xué)意義。比較不同vacA基因亞型與IM間的關(guān)系,在IM組,m2亞型的構(gòu)成比為42.7%(35/82),高于同組其他亞型,其中明顯高于m1亞型;同時IM組中m2亞型的構(gòu)成比亦明顯高于非IM組;在IM組s1m2亞型的構(gòu)成比為41.5%(34/82),高于同組其他亞型基因型組合,其中明顯高于s1m1亞型;同時IM組中s1m2亞型的構(gòu)成比亦明顯高于非IM組。在非IM組m1亞型的構(gòu)成比為33.8%(51/151)明顯高于IM組,高于同組其他m亞型;在非IM組s1m1亞型的構(gòu)成比為29.1%(44/151)明顯高于IM組,高于同組其他亞型基因型組合。在IM組中的GA病例中,m2亞型的構(gòu)成比為54.3%(19/35)明顯高于其他m亞型,同時高于IM組中的GS和GU;在IM組中的GA病例中,s1m2亞型的構(gòu)成比為54.3%(19/35),明顯高于其他基因型組合,同時亦高于IM組的GS和GU。比較不同vacA基因亞型與黏蛋白MUC2表達(dá)間的關(guān)系,經(jīng)過免疫組化染色MUC2陽性病例107例,陰性病例126例。在MUC2陽性組中,m2亞型的構(gòu)成比為36.4%(39/107),明顯高于m1亞型且高于陰性組的m2亞型;s1m2亞型組合的構(gòu)成比為35.5%(38/107),高于MUC2陰性組中s1m2亞型。差異均有統(tǒng)計(jì)學(xué)意義。比較不同vacA基因亞型與黏蛋白MUC5AC表達(dá)間的關(guān)系,經(jīng)過免疫組化染色MUC5AC陽性病例89例,陰性病例144例。在MUC5AC陽性組中,m2亞型的構(gòu)成比為14.6%(13/89),明顯低于m1亞型;且明顯低于陰性組的m2亞型。在MUC5AC陽性組中,s1m2亞型的構(gòu)成比為14.6%,明顯低于s1m1亞型;且明顯低于陰組中s1m2亞型。不同vacA基因亞型與IM分型間的關(guān)系經(jīng)過HID-AB-PAS-PH2.5染色,在82例IM中,完全性IM 23例,不完全性IM 59例。m2亞型在不完全性IM組中的構(gòu)成比為50.8%(30/59),高于同組的m1亞型,且高于完全性IM;vacAs1m2亞型在不完全性IM組中的構(gòu)成比為49.2%(29/59),高于同組s1m1亞型,且高于完全性IM。差異均有統(tǒng)計(jì)學(xué)意義。結(jié)論1.vacA m2亞型和vacA s1m2亞型組合為GA中感染H.pylori的優(yōu)勢基因型;vacA m2基因亞型和s1m2亞型組合的H.pylori可能與GA發(fā)生有關(guān)。2.vacA m2亞型和vacA s1m2亞型組合為IM病變中感染H.pylori的優(yōu)勢基因型,尤以GA中的為突出;vacA m2基因亞型和s1m2亞型組合的H.pylori可能與IM發(fā)生有關(guān)。3.與完全性IM相比,不完全性IM中感染H.pylori,其vacA基因型以m2亞型和s1m2亞型組合為優(yōu)勢,與不完全性IM的發(fā)生有關(guān)
[Abstract]:Objective to investigate the relationship between Helicobacter pylori (H.pylori) vacA genotype and atrophic gastritis and intestinal metaplasia (IM) in the gastric mucosa, in order to identify the high pathogenic H.pylori strain of IM and identify the high-risk group of H.pylori infection, to block the IM process of atrophic gastritis, and to provide the basis for the type of treatment for 2011~2014 years in Shenyang. There were 396 cases of paraffin embedded specimens of gastroscope biopsy in the Affiliated Hospital of the college and the Second Affiliated Hospital of Shenyang Medical College. 271 cases of H.pylori positive were detected, and 233 cases of H.pylori positive in the latter included 233.233 cases, 71 cases of superficial gastritis (GS), 49 cases of atrophic gastritis (GA), 113 cases of gastric ulcer (GU) and 82 cases of IM (GS). =18, GA=35, GU=29), 151 cases without IM (GS=53, GA=14, GU=84). Histopathological diagnosis of specimens were obtained by HE staining and methylene blue staining, and DNA in paraffin embedded gastroscope was extracted with kit method, and H.pylori was determined by the method of combining PCR technique with histological staining, and the nested PCR method was used. Ylori vacA was typed; immunohistochemical technique was used to detect the MUC2 and MUC5AC of mucin; IM was classified by HID-ABpH2.5-PAS mucin staining. Statistical analysis was carried out by statistical software SPSS16.0 for the exact test of chi 2 or Fisher. The difference of P0.05 was statistically significant. The distribution of the vacA gene subtypes in different gastric diseases was compared. In GS, the composition ratio of the vacAs1m- subtype is the highest; the constituent ratio of the vacAs1m1m2 subtype in GU is the highest; the constituent ratio of the vacAs1m2 subtype in GA is the highest. In GA, the constituent ratio of the M2 subtype is 38.8% (19/49) higher than the same group of M1, m1m2 and m- subtypes; the constituent ratio of the subtype is 38.8%, higher than the other subgroups of the same group of gastric diseases. Type combination, higher than group GS and GU. The difference was statistically significant. In the IM group, the constituent ratio of M2 subtypes was 42.7% (35/82), higher than that of the other subtypes in the IM group, which was higher than the M1 subtype, and the constituent ratio of the M2 subtype in the IM group was also higher than that in the non IM group. The constituent ratio of the M2 subtype in the IM group was 41.5%. 2), higher than the group of other subtypes of the same group, which was significantly higher than the s1m1 subtype, and the constituent ratio of s1m2 subtypes in the group IM was also significantly higher than that in the non IM group. The constituent ratio of the M1 subtype in the non IM group was significantly higher than that of the IM group, higher than the other m subgroups, and the constituent ratio of the s1m1 subtype in the non IM group was 29.1% (44/151) higher than that of the same group, higher than the same group. In group GA cases in group IM, the constituent ratio of M2 subtype was 54.3% (19/35) significantly higher than the other M subtypes, and was higher than the GS and GU in the IM group. In the GA cases in the IM group, the constituent ratio of the s1m2 subtype was 54.3% (19/35), which was significantly higher than that of the other group. The relationship between the subtype and the expression of MUC2 was 107 cases of MUC2 positive and 126 negative cases by immunohistochemistry. In the MUC2 positive group, the constituent ratio of the M2 subtype was 36.4% (39/107), obviously higher than the M1 subtype and higher than the negative group M2 subtype; the constitution ratio of the s1m2 subtype was 35.5% (38/107), which was higher than the s1m2 subtype in the MUC2 negative group. The difference was higher than that of the s1m2 subtype in the MUC2 negative group. The relationship between different vacA gene subtypes and the expression of mucin MUC5AC was compared, and 89 cases of MUC5AC positive and 144 negative cases were stained by immunohistochemistry. In the MUC5AC positive group, the constituent ratio of M2 subtype was 14.6% (13/89), obviously lower than the M1 subtype, and obviously lower than the negative group M2 subtype. In the MUC5AC positive group, s1m2, s1m2. The constituent ratio of the subtype was 14.6%, obviously lower than the s1m1 subtype, and obviously lower than the s1m2 subtype in the negative group. The relationship between the subtypes of the vacA gene and the IM typing was HID-AB-PAS-PH2.5 staining, 23 cases of complete IM in 82 cases of IM, and the constituent ratio of the incomplete IM in the incomplete IM group was 50.8% (30/59), and was higher than the same group of M1 subtype. Higher than complete IM; the constituent ratio of vacAs1m2 subtype in incomplete IM group was 49.2% (29/59), higher than that of the same group s1m1 subtype, and higher than that of complete IM.. Conclusion 1.vacA M2 subtype and vacA s1m2 subtype are the dominant genotype of H.pylori in GA. The.2.vacA M2 subtype and the vacA s1m2 subtype are the dominant genotype of H.pylori in IM lesions, especially in GA. The H.pylori may be associated with the occurrence of the vacA M2 gene subtype and the s1m2 subtype. For the advantage, it is related to the occurrence of incomplete IM
【學(xué)位授予單位】：沈陽醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R573

【參考文獻(xiàn)】

相關(guān)期刊論文 前5條

1 薄威;王旭光;張忠;王翠芳;吳t，

本文編號：1903805