幽门螺杆菌毒力基因分型与消化性溃疡患者早期肾损伤相关性研究

doi:10.3969/j.issn.1673-8640.2022.01.003

摘要/Abstract

摘要：

目的探讨幽门螺杆菌（Hp）不同毒力基因分型与消化性溃疡患者早期肾损伤的相关性。方法选取504例消化性溃疡患者,根据是否出现Hp感染分为Hp（-）组和Hp（+）组;另选取100名健康体检者作为健康对照组。分析不同组别肾功能指标变化情况,探讨Hp毒力基因、炎症因子、免疫应答因子与早期肾脏病变的关系。采用Logistic回归分析评估消化性溃疡患者早期肾损伤的影响因素。采用受试者工作特征（ROC）曲线评价各项指标诊断消化性溃疡患者早期肾损伤的效能。结果 Hp（+）组尿视黄醇结合蛋白（RBP）、尿β₂-微球蛋白（β₂-MG）、尿α₁-微球蛋白（α₁-MG）、尿转铁蛋白（TF）、胱抑素C（CysC）、高敏C反应蛋白（hs-CRP）、免疫球蛋白（Ig）A1、蚕豆凝集素（VVL）-IgA1结合力与Hp（-）组、健康对照组比较,差异均有统计学意义（P<0.05）。Hp（+）组早期肾损伤患者cagA+vacA检出率高于无肾损伤患者（P<0.05）。Logistic回归分析结果显示,病程、α₁-MG、RBP、Cys C、hs-CRP、IgA1、VVL-IgA1结合力、cagA+vacA阳性表达为Hp感染消化性溃疡患者早期肾损伤的影响因素。IgA1和VVL-IgA1结合力诊断Hp感染消化性溃疡患者早期肾损伤的曲线下面积分别为0.792和0.773。cagA+vacA阳性Hp感染伴早期肾损伤患者与非cagA+vacA阳性患者比较,α₁-MG、RBP、Cys C、hs-CRP、VVL-IgA1结合力差异均有统计学意义（P<0.05）。结论部分Hp感染消化性溃疡患者存在早期肾损伤,cagA和vacA共表达患者早期肾损伤更明显,其原因可能与炎症反应、机体免疫应答有关。

关键词: 幽门螺杆菌, 消化性溃疡, 早期肾损伤, 尿白蛋白, 免疫球蛋白A1

Abstract:

Objective To investigate the relationship between Helicobacter pylori（Hp） virulence genotypes and early renal damage in patients with peptic ulcers. Methods A total of 504 patients with peptic ulcer were enrolled and classified into Hp（-） group and Hp（+） group according to the presence or absence of Hp infection,and 100 healthy subjects were enrolled as healthy control group. The changes of renal function indicators in different groups were analyzed. The relationship between Hp virulence genes,inflammatory factors and immune response factors and early renal damage was evaluated. Logistic regression analysis was used to evaluate the influence factors for early renal damage in patients with peptic ulcers. Receiver operating characteristic（ROC） curve was used to evaluate the efficiency of these indicators for the diagnosis of early renal damage in patients with peptic ulcers. Results Retinol binding protein（RBP）,urinary beta₂-microglobulin（β₂-MG）,urinary alpha₁-microglobulin（α₁-MG）,urinary transferrin（TF）,cystatin C（Cys C）,high-sensitivity C-reactive protein（hs-CRP）,immunoglobulin（Ig） A1 and vicia vilosa lectin（VVL）-IgA1 binding capacity in Hp（+） group had statistical significance compared with Hp（-） group and healthy control group（P<0.05）. The determination rate of cagA+vacA in patients with early renal damage in Hp（+） group was higher than that without early renal damage（P<0.05）. Logistic regression analysis showed that the course of disease,α₁-MG,RBP,Cys C,hs-CRP,IgA1,VVL-IgA1 binding capacity and the positive expression of cagA+vacA were influence factors for early renal damage in patients with peptic ulcer infected with Hp. The areas under curves of IgA1 and VVL-IgA1 binding capacity in the diagnosis of Hp-positive peptic ulcer with early renal damage were 0.792 and 0.773,respectively. The α₁-MG,RBP,Cys C,hs-CRP and VVL-IgA1 binding capacity in cagA+vacA group with Hp infection and early renal damage had statistical significance compared to that in non-cagA+vacA group（P<0.05）. Conclusions There is a certain proportion of early renal damage in patients with Hp infection and peptic ulcer,while the early renal damage is obvious in patients with cagA+vacA co-expression,which may be caused by inflammation and immune response.

Key words: Helicobacter pylori, Peptic ulcer, Early renal damage, Urinary albumin, Immunoglobulin A1

中图分类号:

R378.99

延喜胜, 雷磊, 王剑. 幽门螺杆菌毒力基因分型与消化性溃疡患者早期肾损伤相关性研究[J]. 检验医学, 2022, 37(1): 16-22.

YAN Xisheng, LEI Lei, WANG Jian. Relationship between Helicobacter pylori virulence genotypes and early renal damage in patients with peptic ulcer[J]. Laboratory Medicine, 2022, 37(1): 16-22.

图/表 8

参考文献 14

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基因名称	引物序列（5'~3'）	产物长度/bp
cagA	R：CTGAGCATTAACTAGCCCTTACGGTC	349
	F：GTCGTTTGCGTCACGTGGCAATGCTG
vacA	R：TGCGTCCGCATAACCGTGTAGTGCGG	678
	F：GCTTGAGTCCCGTTGCAATGCTATCA
ureA	R：CTGACGTGTATTAGTTTGATACGT	411
	F： GCTGGACGTTGTGGCGTAGTACG

基因名称	引物序列（5'~3'）	产物长度/bp
cagA	R：CTGAGCATTAACTAGCCCTTACGGTC	349
	F：GTCGTTTGCGTCACGTGGCAATGCTG
vacA	R：TGCGTCCGCATAACCGTGTAGTGCGG	678
	F：GCTTGAGTCCCGTTGCAATGCTATCA
ureA	R：CTGACGTGTATTAGTTTGATACGT	411
	F： GCTGGACGTTGTGGCGTAGTACG

组别	例数	年龄/岁	性别		病程/月	吸烟史/例	酗酒史/例	BMI/（kg/m²）
组别	例数	年龄/岁	男性/例	女性/例	病程/月	吸烟史/例	酗酒史/例	BMI/（kg/m²）
Hp（+）组	315	41.97±8.69	201	114	9.23±5.88	204	189	21.19±1.85
Hp（-）组	189	42.18±9.05	114	75	9.18±5.72	114	99	21.87±1.96
健康对照组	100	41.26±8.92	61	39		56	52	22.78±2.13
统计值		0.886	0.639		0.277	2.771	3.684	1.043
P值		0.501	0.707		0.821	0.250	0.159	0.474
组别	Urea/ （mmol/L）		UACR/ （mg/g）		GFR/ [mL/（min·1.73m²）]	RBP/（mg/L）	α₁-MG/ （mg/L）	β₂-MG/ （mg/L）
Hp（+）组	4.49±0.94		12.08±3.96		103.25±6.04	79.69±13.58^**##	14.09±5.94^**##	3.11±0.80^*#
Hp（-）组	3.87±0.76		11.29±3.92		108.94±6.92	59.36±10.26^*	10.46±2.82^*	2.26±0.49^*
健康对照组	3.74±0.71		9.23±1.61		112.34±7.66	49.58±9.28	7.31±2.79	1.89±0.52
统计值	3.362		2.965		2.447	8.662	9.032	7.741
P值	0.097		0.102		0.132	0.012	0.008	0.018
组别		TF/（mg/L）		Cys C/（mg/L）		hs-CRP/（mg/L）	IgA1/（g/L）	VVL-IgA1结合力/（AU/mg）
Hp（+）组		3.02±0.78^*#		1.84±0.29^**##		12.26±3.65^**##	2.39±0.99^**##	4.36±1.22^**##
Hp（-）组		1.18±0.37		1.12±0.21^*		8.67±1.93^**	1.82±0.81^*	2.73±0.94^*
健康对照组		1.21±0.26		0.65±0.22		4.77±1.34	1.29±0.64	1.44±0.58
统计值		8.437		9.325		8.271	11.092	19.094
P值		0.012		0.003		0.009	0.000	0.000

组别	例数	年龄/岁	性别		病程/月	吸烟史/例	酗酒史/例	BMI/（kg/m²）
组别	例数	年龄/岁	男性/例	女性/例	病程/月	吸烟史/例	酗酒史/例	BMI/（kg/m²）
Hp（+）组	315	41.97±8.69	201	114	9.23±5.88	204	189	21.19±1.85
Hp（-）组	189	42.18±9.05	114	75	9.18±5.72	114	99	21.87±1.96
健康对照组	100	41.26±8.92	61	39		56	52	22.78±2.13
统计值		0.886	0.639		0.277	2.771	3.684	1.043
P值		0.501	0.707		0.821	0.250	0.159	0.474
组别	Urea/ （mmol/L）		UACR/ （mg/g）		GFR/ [mL/（min·1.73m²）]	RBP/（mg/L）	α₁-MG/ （mg/L）	β₂-MG/ （mg/L）
Hp（+）组	4.49±0.94		12.08±3.96		103.25±6.04	79.69±13.58^**##	14.09±5.94^**##	3.11±0.80^*#
Hp（-）组	3.87±0.76		11.29±3.92		108.94±6.92	59.36±10.26^*	10.46±2.82^*	2.26±0.49^*
健康对照组	3.74±0.71		9.23±1.61		112.34±7.66	49.58±9.28	7.31±2.79	1.89±0.52
统计值	3.362		2.965		2.447	8.662	9.032	7.741
P值	0.097		0.102		0.132	0.012	0.008	0.018
组别		TF/（mg/L）		Cys C/（mg/L）		hs-CRP/（mg/L）	IgA1/（g/L）	VVL-IgA1结合力/（AU/mg）
Hp（+）组		3.02±0.78^*#		1.84±0.29^**##		12.26±3.65^**##	2.39±0.99^**##	4.36±1.22^**##
Hp（-）组		1.18±0.37		1.12±0.21^*		8.67±1.93^**	1.82±0.81^*	2.73±0.94^*
健康对照组		1.21±0.26		0.65±0.22		4.77±1.34	1.29±0.64	1.44±0.58
统计值		8.437		9.325		8.271	11.092	19.094
P值		0.012		0.003		0.009	0.000	0.000

组别	例数	cagA+vacA/[例（%）]	cagA/[例（%）]	vacA/[例（%）]	ureA/[例（%）]
无肾损伤组	256	91（30.95）	27（10.85）	68（26.56）	70（33.67）
早期肾损伤组	59	30（57.14）	5（8.47）	15（25.42）	9（19.04）
χ²值		5.945	0.226	0.032	3.196
P值		0.015	0.653	0.858	0.074