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目的:探讨淮南地区幽门螺杆菌感染个体菌株基因多态性及其与感染结局的影响。方法:选取125例幽门螺杆菌(H.pylori,HP)感染的慢性胃炎、消化性溃疡患者,常规获取胃窦、胃体部粘膜,进行HP分离、培养,提取HP基因组DNA,采用随机扩增多态性DNA(RAPD)指纹分析法检测菌株基因多态性;125例患者均给予质子泵抑制、H2受体拮抗剂、铋剂为基础的三联或四联疗法治疗,治疗后4~6周进行14C-尿素呼气试验评估Hp根除情况;获取HP根除失败患者的胃窦、胃体黏膜进行HP分离、培养、鉴定,并采用RAPD指纹分析法检测菌株来源,评估HP基因多态性对治疗结局的影响。结果:cagA、iceA1、iceA2、vacAs1、vacAm1、babA2阳性率分别为92.80%、36.00%、93.60%、93.60%、29.50%、53.50%,cagA、iceA2、vacAs阳性率均高于其他基因类型阳性率(P<0.05或P<0.01),其他基因类型阳性率比较差异无统计学意义(P>0.05)。经治疗后HP根除率为86.4%(107/125),14.4%(18/125)根除失败;18例根除失败患者中,15例患者治疗前后的菌株具有相同的指纹图谱,证实为原菌株复发,其中cagA、iceA1、iceA2、vacAs1、vacAm1、babA2阳性率分别为93.33%、13.33%、86.67%、93.33%、6.67%、20.00%,cagA、iceA2、vacAs阳性率均高于其他基因类型阳性率(P<0.05或P<0.01)。结论:cagA+、vacAs+、iceA2+为淮南地区HP感染的优势基因型,该基因型易导致HP根除失败;未发现babA2与HP感染结局存在相关性。
Objective: To investigate the genetic polymorphism of Helicobacter pylori isolates in Huainan area and its effect on the infection outcome. Methods: 125 patients with chronic gastritis and peptic ulcer infected with H. pylori were randomly divided into gastric mucosa, gastric mucosa and gastric mucosa. The HP genomic DNA was extracted and purified by random amplification Polymorphic DNA (RAPD) fingerprinting was used to detect the polymorphism of the strains. 125 patients were treated with proton pump inhibition, H2 receptor antagonist and bismuth-based triple or quadruple therapy. After 4 to 6 weeks of treatment The 14C-urea breath test was used to evaluate the eradication of Hp. The gastric mucosa of gastric antrum and gastric mucosa of patients with failed eradication of HP were isolated, cultured and identified. The origin of the strains was detected by RAPD fingerprinting. The impact of the outcome. Results: The positive rates of cagA, iceA1, iceA2, vacAs1, vacAm1 and babA2 were 92.80%, 36.00%, 93.60%, 93.60%, 29.50% and 53.50% respectively, and the positive rates of cagA, iceA2 and vacAs were higher than those of other genotypes (P <0.05 or P <0.01). There was no significant difference in the positive rates of other gene types (P> 0.05). After treatment, the eradication rate of HP was 86.4% (107/125) and 14.4% (18/125), respectively. Of the 18 patients who failed to eradication, 15 patients had identical fingerprints before and after treatment, which confirmed that the original strains were relapsed , The positive rates of cagA, iceA1, iceA2, vacAs1, vacAm1 and babA2 were 93.33%, 13.33%, 86.67%, 93.33%, 6.67%, 20.00% respectively, and the positive rates of cagA, iceA2 and vacAs were higher than those of other genotypes (P <0.05 or P <0.01). CONCLUSION: cagA +, vacAs +, iceA2 + are the predominant genotypes of HP infection in Huainan. The genotype is likely to lead to the failure of HP eradication. There is no correlation between babA2 and HP infection.