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首页> 外文期刊>The Internet Journal of Tropical Medicine >The Role Of Helicobacter Pylori And Cag A Antibody Titers In The Pathology Of Chronic Gastritis
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The Role Of Helicobacter Pylori And Cag A Antibody Titers In The Pathology Of Chronic Gastritis

机译：幽门螺杆菌和Cag抗体滴度在慢性胃炎病理中的作用

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Chronic gastritis is a multifactorial disorder, which is influenced primarily by the bacterium Helicobacter pylori. In addition to the density of the organism, the CagA pathogenicity island (PAI) of H pylori is thought to be a primary factor contributing to the antral inflammation. Endoscopic findings are believed to be non contributory in the diagnosis. In this study, we have shown that endoscopic features like erythema, erosions and nodularity maybe contributory in predicting the presence of H pylori in the biopsy specimen. The primary factor influencing the degree of inflammation in gastritis appears to be the density of H pylori in the antrum. The CagA pathogenicity island does not appear to have a role in influencing the severity of the antral inflammation. The role of other H pylori antigens remains undetermined. Introduction Although gastritis was first interpreted to be due to ageing and lifelong exposure to various insults, it is now clear that the most common cause of this inflammatory condition is infection with Helicobacter pylori (1). It has been shown that this organism is strongly associated with chronic active gastritis as well as gastric adenocarcinoma and MALT (Mucosal Associated Lymphoid Tissue) lymphomas (2). Although H pylori infection is extremely common, only a small proportion of those infected develop chronic gastritis. Thus the clinical outcome is dependant on a complex interplay between the bacterium and the host. Several bacterial virulence factors have been implicated in influencing the severity of gastritis. The CagA island which encodes a high molecular weight antigen (CagA) is believed to stimulate gastric mucosal cells to produce high levels of interleukin 8 that has a pivotal role in the inflammatory responses to infection (3,4,5). H pylori strains that express the CagA protein are considered to be endowed with increased pathogenecity. Studies have shown that the prevalence of antibodies to the CagA protein is higher in patients with peptic ulcer disease than in H pylori gastritis without ulcer (6,7,8,9). However it is not clear if increased titres of Cag A antibodies are associated with a severe phenotype of chronic gastritis.The endoscope has been used extensively in visualizing antral gastritis but histopathological examination remains the gold standard for the diagnosis. (10,11). Various gastroscopic features may be interpreted as signs of gastritis. These include erythema (diffuse, spotty, linear), erosions, absence of rugae in the gastric corpus, and presence of visible vessels (12). It remains uncertain if any of the endoscopic features are a predictor for the presence of H pylori or any particular histological features of gastritis.The Sydney system for grading and classifying chronic gastritis was devised to provide a standardised approach to the histological interpretation of biopsies in 1990 (13) and it was later upgraded in 1994 (14). Several parameters are assessed in this system including the density of H pylori. The parameters are graded on a visual analogue scale as normal, mild, moderate and marked. This system remains an excellent predictor for evaluating the presence of H pylori and the severity of gastritis.In this study, we gauged if the density of H pylori in biopsy specimens and the presence of anti CagA antibodies were significantly associated with the severity of gastritis as evaluated by histopathology. We also studied the role of endoscopy in predicting the severity of gastritis. The aim of the study was two fold; Firstly, we wished to evaluate the role of H pylori and its main antigen in the pathogenesis of the disease. Secondly, we attempted to assess if a careful endoscopic examination would obviate the need of histopathological examination in assessing for the presence of H pylori and the severity of the disease. Materials And Methods Patients Between August 2004 and August 2005, 120 patients with non ulcer dyspepsia who underwent upper gastrointestinal endoscopy
机译：慢性胃炎是一种多因素疾病，主要受幽门螺杆菌感染。除生物体的密度外，幽门螺杆菌的CagA致病岛（PAI）被认为是导致肛门炎的主要因素。内镜检查结果被认为对诊断无贡献。在这项研究中，我们表明内窥镜特征（如红斑，糜烂和结节）可能有助于预测活检标本中是否存在幽门螺杆菌。影响胃炎炎症程度的主要因素似乎是胃窦中幽门螺杆菌的密度。 CagA致病岛似乎不影响肛窦炎症的严重性。其他幽门螺杆菌抗原的作用仍未确定。引言尽管胃炎最初被解释为是由于衰老和终生暴露于各种侮辱所致，但现在清楚的是，这种炎症性疾病的最常见原因是幽门螺杆菌感染（1）。研究表明，这种生物与慢性活动性胃炎以及胃腺癌和MALT（粘膜相关淋巴组织）淋巴瘤密切相关（2）。尽管幽门螺杆菌感染非常普遍，但只有一小部分感染者会发展为慢性胃炎。因此，临床结果取决于细菌和宿主之间复杂的相互作用。几种细菌毒力因子与胃炎的严重程度有关。据信，编码高分子量抗原（CagA）的CagA岛刺激胃粘膜细胞产生高水平的白介素8，白介素8在感染的炎症反应中起关键作用（3,4,5）。表达CagA蛋白的幽门螺杆菌菌株被认为具有增加的致病性。研究表明，与消化性溃疡患者相比，消化性溃疡患者中抗CagA蛋白抗体的患病率更高（6、7、8、9）。然而，尚不清楚Cag A抗体滴度升高是否与慢性胃炎的严重表型有关。内窥镜已广泛用于可视化胃窦炎，但组织病理学检查仍是诊断的金标准。 （10,11）。各种胃镜特征可以解释为胃炎的体征。这些症状包括红斑（弥漫性，斑点，线状），糜烂，胃体无皱纹和可见血管（12）。尚不确定内窥镜检查是否可作为幽门螺杆菌的存在或胃炎的任何特殊组织学特征的预测指标.1990年，悉尼对慢性胃炎进行分级和分类的系统旨在为活检组织学的组织学解释提供标准化方法。 （13），后来在1994年进行了升级（14）。在该系统中评估了几个参数，包括幽门螺杆菌的密度。以视觉模拟量表将参数分为正常，轻度，中度和标记等级。该系统对于评估幽门螺杆菌的存在和胃炎的严重程度仍然是一个很好的预测指标。在这项研究中，我们评估了活检标本中幽门螺杆菌的密度和抗CagA抗体的存在是否与胃炎的严重程度显着相关。通过组织病理学评估。我们还研究了内镜在预测胃炎严重程度中的作用。研究的目的是双重的。首先，我们希望评估幽门螺杆菌及其主要抗原在疾病发病机理中的作用。其次，我们试图评估在评估幽门螺杆菌的存在和疾病严重程度时是否进行仔细的内镜检查是否可以避免进行组织病理学检查。材料和方法患者2004年8月至2005年8月之间，接受上消化道内窥镜检查的120例非溃疡性消化不良患者

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