| Background: Helicobacter pylori(Hp)infection is believed to be closely related to chronic gastritis,peptic ulcer,gastric cancer and other gastric and duodenal diseases,and its pathogenicity is mainly related to A variety of virulence factors,such as vacuolar toxin A(vac A)and cytotoxic-related protein A(cag A).According to the expression of cag A and vac A,Helicobacter pylori can be divided into type Ⅰ(Urease antibody positive,cag A and/or vac A antibody positive),type Ⅱ(Urease antibody positive,cag A and vac A antibody negative)and type Ⅲ(Urease,cag A and vac A antibody negative).At present,there are few reports on the correlation between serotyping of Hp and clinical diseases,and its clinical significance remains to be discussed.Objective: Hp typing in chronic gastritis,peptic ulcer,gastric cancer and initial eradication losers was detected by immunofluorescence method,and the relationship between Hp typing and the above diseases was further analyzed,so as to explore its clinical significance,providing clinical basis for precise eradication of Hp and reducing the application of antibiotics.Methods: Patients admitted and admitted to the Department of Gastroenterology,the Second Affiliated Hospital of Dalian Medical University from July 2022 to December2022 were randomly selected.Data on gender,age and Hp infection-related gastric and duodenal diseases were collected.Serum of all patients meeting the inclusion criteria were collected and Hp typing was detected by immunofluorescence method.To explore the relationship between gender,age,different diseases and Hp serotyping,and to analyze the Hp serotyping of the losers of initial eradication treatment,so as to provide a theoretical basis for accurate eradication of Hp.Results:1.General information of the subjects: A total of 180 patients were included,including98 males(54.4%)and 82 females(45.6%);37 patients(20.6%)aged < 50 years old and143 patients(79.4%)aged ≥50 years old.There were 50 cases in the chronic nonatrophic gastritis group,27.8% in the chronic atrophic gastritis group,and 30 cases in the gastric cancer group(16.6%).2.Gender and age analysis of gastric and duodenal diseases associated with Hp infection:(1)Gender: there were significant differences in the proportions of the four kinds of gastric and duodenal diseases between the male group and the female group(P< 0.05);(2)Age: the prevalence rate of patients ≥50 years old was higher than that of patients < 50 years old,with gastric cancer accounting for the highest proportion.In the age group < 50 years old and ≥50 years old,there were significant differences in the proportions of 4 kinds of gastric and duodenal diseases(P < 0.05).3.Serotyping analysis of Helicobacter pylori:(1)The Hp types of all subjects were as follows: 134 cases(74.5%)of Hp type Ⅰ,40 cases(22.2%)of Hp type Ⅱ,6 cases(3.3%)of Hp type Ⅲ;(2)The expression of Hp serotype in different diseases: chronic non-atrophic gastritis group(Ⅰ : 35/50,Ⅱ : 9/50,Ⅲ : 6/50),chronic atrophic gastritis group(Ⅰ : 41/50,Ⅱ : 9/50,Ⅲ : 0),peptic ulcer group(Ⅰ : 40/50,Ⅱ : 10/50,Ⅲ : 0)and gastric cancer group(type Ⅰ : 18/30,type Ⅱ : 12/30,type Ⅲ : 0)were mainly dominated by Hp type Ⅰ;(3)The expression of Hp serotype in gender,age and gastric and duodenal diseases:(1)There were 134 infected patients with Hp type Ⅰ,including76 males(56.7%)and 58 females(43.3%);26 cases(19.4%)were younger than 50 years old,108 cases(80.6%)were older than 50 years old.There were 35 cases(26.1%)of chronic non-atrophic gastritis,41 cases(30.6%)of chronic atrophic gastritis,40 cases(29.9%)of peptic ulcer and 18 cases(13.4%)of gastric cancer.(2)Hp type Ⅱ : A total of 40 patients were infected,including 20 males(50.0%)and 20 females(20%).9 cases(22.5%)were younger than 50 years old and 31 cases(77.5%)were older than 50 years old.There were 9 cases(22.5%)of chronic non-atrophic gastritis and chronic atrophic gastritis,10 cases(25.0%)of peptic ulcer and 12 cases(30.0%)of gastric cancer.(3)Hp type Ⅲ : 6 patients were infected with chronic non-atrophic gastritis,including 2 males(33.3%)and 4 females(66.7%).There were 2 cases(33.3%)aged < 50 years old and 4cases(66.7%)aged ≥50 years old.In other words,the proportion of type Ⅰ Hp was the highest among all infected men,women and ≥50 years old,and there was no statistical significance among all groups(P > 0.05).Hp type I infection was the main cause of the above 4 diseases,and the difference between groups was statistically significant(P <0.05).(P < 0.05);(4)Analysis of the changes of Hp serotype in different diseases with age:(1)Hp type Ⅰ : In the four groups,the infection rate of Hp type I increased with age;(2)Hp type Ⅱ : The infection rate of Hp type Ⅱ in the 4 groups did not change with the increase of age.(5)The expression of Hp serotype in the losers of initial eradication therapy: Among the 19 patients who received bismuth potassium citrate/tinidazole tablets/clarithromycin tablets +PPI eradication therapy,there were 4males(21.1%)and 15 females(78.9%);There were 7 cases(36.8%)younger than 50 years old and 12 cases(63.2%)older than 50 years old.There were 9 cases(47.4%)of chronic non-atrophic gastritis and 10 cases(52.6%)of chronic atrophic gastritis.There were 15 cases(78.9%)of Hp type I infection and 4 cases(21.1%)of Hp type II infection.Conclusion: 1.The patients with chronic gastritis,peptic ulcer and gastric cancer were mainly infected with Hp type Ⅰ.Hp type III was not detected in precancerous disease and gastric cancer group,suggesting that its pathogenicity was weak.2.The infection rate of Hp type Ⅰ increased with age.3.The failure of initial eradication of Hp was mainly type Ⅰ Hp;Therefore,attention and active treatment should be paid to Hp type I patients,especially those over 50 years of age,and a better regimen should be selected in the initial treatment to avoid nitroimidazole in order to improve the eradication rate of Hp. |
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