The Study Of Association Between H.pylori And Chronic Obstructive Pulmonary Disease

Objective:To explore the role of H.pylori (HP) in the pathogenesis of Chronic obstructive pulmonary disease (COPD) by the establishment of COPD rat model with HP infection.Methods:Specific pathogen-free 11 week of age female 40 Wistar rats were randomly grouped into control group, simple COPD group, simple H. pylori infection group and HP infection COPD. The lung function was observed and cytokines level in serum and bronchial alveolar lavage fluid was tested by ELISA. The genes coding for HP CagA, VacA and UreC in bronchial and lung tissue of COPD rats were detected by PCR technology. Afterwards, Helicobacter pylori or HP strains were isolated and cultured.Results:In simple COPD group and HP infection COPD, the bronchial epithelial was found necrosis of degeneration, goblet cell hyperplasia, inflammatory cell infiltration, the integration part of of alveolar expansion, alveolar space to expand; There was a significant difference between the lung function changes of simple COPD group and HP infection COPD group. But there is not a significant difference between the simple HP infection group and control group. HP colonization density in gastric mucosa of HP infection COPD group was higher than that in simple HP infection group. The more was higher of HP colonization density in gastric mucosa of HP infection COPD group, the more was worse of the lung function of HP infection COPD group; Compared with the control group, the significant changes in serum cytokines level were all observed in simple COPD group, HP infection COPD group and simple HP infection group. There was a significant difference changes in serum and bronchoalveolar lavage fluid cytokines levelof HP infection COPD group than that in the other groups. The genes coding for HP UreC in bronchial and lung tissue of COPD rats were detected by PCR technology in 5 cases HP infection COPD groups.Conclusions:HP infection may affect the serum cytokines level of COPD rat model, which may aggravate inflammation and may directly worsen the lung function of COPD rats. These effects may not function by the directly colonization of HP in the respiratory tract. Objective:To explore the relationship between H.pylori (HP) infection as well as the produced virulence factors and the chronic obstructive pulmonary disease, and to analyze the impact of HP infection on the lung function and serum levels of cytokines.Method:125 patients with stable COPD diagnosed according to GOLD guidelines were recruited, including 70 males and 55 females, with an average age of 58.23±10.3 years old.120 cases of age-and gender-equivalent healthy volunteers were recruited as controls, including 61 males and 59 females, with an average age of 57.50±9.5 years old. Anti-HP-IgG in serum was detected by using ELISA. Among the anti-HP-IgG positive subjects, serum anti-CagA-IgG and anti--VacA-IgG was detected by using Western-Blotting for the survey of HP infection rate. According to the principles of case-control, the differences between COPD patients and healthy control group were analyzed. The relationship between different subtypes of HP virulence and clinical features of COPD was observed.Results:(1) Positive rate of serum anti-HP-IgG in COPD patients was 71.2%, for the control group was 43.3%. There was a significant difference between the two groups (p<0.01). After adjusting other risk factors such as age, sex, smoking and smoking index, significantly increased relative risk of COPD was observed in HP infected patients, the OR value was 1.87, and 95% CI was 1.37-2.02. anti-CagA-IgG and/or anti--VacA-IgG positive rate was higher in COPD group compared with control group (55.2% vs.30.8%). After removing the risk factors of age, sex, smoking and smoking index, the risk of suffering from COPD was significantly higher in anti-CagA-IgG and anti-VacA-IgG infection group. The OR value was 2.74, (95% CI was 1.58-3.21), which was higher than that of HP infected patients (OR=1.87). (2) HP infection in COPD patients with average FEV1% predicted lung function was significantly lower than in patients with COPD no combined HP infection (P<0.05) (3) HP infection rate of severe/very severe COPD group was significantly higher than that in patients with mild to moderate COPD groups (85.0% VS58.46%, p<0.05) especially the CagA+and/or VacA +strains of HP infection rate was even higher, After removing the risk factors of age, sex, smoking and smoking index, the risk of suffering from COPD was significantly higher in the CagA+and/or VacA+strains infection group. The OR value was 2.89 (95%CI was 1.43-3.87). (5) There was a significant difference in serum levels of cytokines between HP-positive and HP-negative COPD patients. Furthermore, the serum levels of cytokines of the CagA-and/or VacA-strains infected COPD patients was significantly higher than that of CagA- VacA -strains infected COPD patients.Conclusions:(1) the rate of HP infection in patients with COPD was significantly higher than that of the non-COPD patient, especially cagA+vacA+ strains of HP infection rate was even higher. (2) HP infection rate of severe/very severe COPD group was significantly higher than that in patients with mild to moderate COPD groups, especially the cagA+vacA+trains of HP infection rate was even higher. (3) An average FEV1% predicted value of Lung function of COPD patients merging HP infection compared with COPD patients of unincorporated HP infection significantly reduce. (4) The serum levels of cytokines of COPD patients merging HP infection compared with COPD patients of unincorporated HP infection significantly increased, especially cagA+and/or vacA+strains of HP infection in COPD patients are more obvious. Objective:To explore the eradication rate of HP efficacy by different treatments of stable COPD positive for HP infection. In order to observe the pulmonary function and health status improvement after the HP eradication.Methods:A randomized case control study,89 HP infective stable COPD patients clinically diagnosed according to GOLD guidelines were enrolled and randomly assigned to HP eradication therapy group and without HP eradication therapy group. HP eradication therapy group 62 cases, male 32, female 30, mean age of 57.48±12.80years, Further divided into the EACB with clarithromycin group 31 patients, male 17, female 14 cases, the average age of 57.38±11.70 years old, The EAMB group with moxifloxacin 31 patients, male 15 cases,16 females, mean age of 57.39±11.80 years; not eradicate HP group of 27 cases, male 12, female 15 cases, the average age of 58.00±9.25 years. Different treatment programs for HP infection eradication rate of COPD patients were compared. After eradication therapy were observed the pulmonary function and health status changes in two groups.Results:(1) The HP eradication rate(48.4%) of containing Clarithromycin regimen group (EACB group) is higher than that of the containing EAMB moxifloxacin group (87.0%), p<0.05, while the EACB group did not eradicate the HP, The overall eradication program rate after applications with moxifloxacin regimen 83.9% is no significant difference from EAMB group (87.0%), p> 0.05. (2) FEV1% predicted value of not eradicate HP group after the 3 month, the 6 month, the 9 month and 12 month, was a slight downward trend than that of HP eradication therapy group, but there was no significantly difference. (2) 6min walking distance of COPD patients with HP eradication therapy compared with themselves before eradication therapy were increased, the difference was significant,6min walking distance of COPD patients with not eradicate HP group was no significant changed compared themselves before therapy. (3) Borg dyspnea score was no significant difference between HP eradication therapy group and not eradicate HP group before treatment. But Borg dyspnea score of HP eradication therapy group was significant difference after treatment and Borg dyspnea score of not eradicate HP group was no significant difference after treatment.(4) SGRQ score was no significant difference between HP eradication therapy group and not eradicate HP group before treatment. But SGRQ score of HP eradication therapy group was significant difference after treatment and SGRQ score of not eradicate HP group was no significant difference after treatment. (5) The number of acute attack of patients of HP eradication herapy group after treatment was decreased significantly than those of not eradicate HP group.Conclusion:(1)The HP eradication rate or HP infection patients with COPD using EACB eradication programs is lower than that of using EAMB eradication programs.(2)HP infection eradication interference therapy in HP infection patients with COPD can delay the degree of decline in lung function, but can not hinder lung function decline in COPD patients. (3) HP infection patients with COPD treated with eradication interference therapy can reduce the number of acute attacks, and the same can improve exercise tolerance, reduce dyspnea and improve quality of life.