摘要
目的探讨不同抗体型幽门螺杆菌(Hp)感染与溃疡性结肠炎(UC)患者疾病活动及组织学评分的关系。方法选择东莞市人民医院2019年10月至2023年1月收治的285例UC患者作为研究对象,其中男性141例,女性144例;平均年龄(41.09±9.37)岁。分析Hp感染血清学抗体与UC患者病理特点的关系,根据Hp抗体类型将患者分为I型Hp感染组(211例)和I型Hp感染组(74例),比较两组患者疾病活动度和组织学评分分布、DAI评分和组织学评分,并应用多因素Logistic回归分析UC患者重度疾病活动的危险因素。结果不同抗体型Hp感染者的疾病活动度(χ^(2)=13.160、P=0.041)和组织学评分(χ^(2)=21.263、P=0.033)差异有统计学意义;抗-CagA在疾病活动为重度(73.33%)、组织学评分为4分(76.27%)和5分(75.76%)患者中阳性率最高。抗-CagA、抗-VacA、抗-UreA及抗-UreB型Hp感染UC患者IL-6(F=14.372、P<0.001)、IL-1β(F=3.476、P=0.022)、TNF-α(F=23.785、P<0.001)和hs-CRP(F=12.174、P<0.001)水平差异均有统计学意义。I型Hp感染组和II型Hp感染组患者疾病活动度(χ^(2)=9.650、P=0.008)和组织学评分(χ^(2)=14.263、P=0.002)差异有统计学意义;型Hp感染组患者IL-6(t=2.183、P=0.030)、IL-1β(t=2.032、P=0.043)、TNF-α(t=3.167、P=0.002)和hs-CRP(t=7.820、P<0.001)水平显著高于II型Hp感染组患者。随疾病活动加重和组织学评分的增加,型Hp感染者比例增加,I型Hp感染者比例降低。Mann-WhitneyU检验分析显示,I型Hp感染者DAI评分(Z=6.527、P<0.001)和组织学评分(Z=4.231、P<0.001)均显著高于I型Hp感染者。多因素Logistics回归分析显示,I型Hp感染(OR=3.284、95%CI:1.429~5.124、P<0.001)、组织学评分(OR=2.168,95%CI 1.537~2.734、P<0.001)、IL-6(OR=1.826、95%CI:1.351~2.423、P=0.008)和hs-CRP(OR=2.037、95%CI:1.283~1.683、P<0.001)水平均为UC患者重度疾病活动的独立危险因素,利用结构方程模型验证Logistic回归分析结果,RMSEA值为0.017,提示模型的拟合度良好。结论随着疾病活动度和组织学评分的升高,I型Hp感染者比例随之增加;I型Hp感染、组织学评分、IL-6及hs-CRP水平的升高均为UC患者重度疾病活动的独立危险因素。
Objective To investigate the relationship between Helicobacter pylori(Hp)infection of different antibody types and disease activity and histological scores of ulcerative colitis(UC)patients.Methods Total of 285 patients with UC admitted to Dongguan People's Hospital from October 2019 to January 2023 were selected,with an average age of(41.09±9.37)years old,among whom,141 cases were male and 144 cases were female.The relationship between serological antibodies to Hp infection and pathological characteristics of UC patients was analyzed,and the patients were divided into type I Hp infection group(211 cases)and type II Hp infection group(74 cases)according to the results of Hp antibody-type.The distribution of general data,clinical indicators,disease activity and histological scores of the two groups were compared,while DAI scores and histological scores of UC patients in both groupswere compared,respctively.The risk factors for severe disease activity in UC patients were analyzed bymultivariate Logistic regression.Results The disease activity(?=13.160,P=0.041)and histological scores(=21.263,P=0.033)among Hp patients with different antibody types were significantly different.Thepositive rate of CagA antibody was higher in patients with severe disease activity and histological scores of4(76.27%)and 5(75.76%).Among patients with UC infected by anti-CagA,anti-VacA,anti-UreA and anti-UreB Hp,levels of IL-6(F=14.372,P<0.001),IL-1β(F=3.476,P=0.022),TNF-α(F=23.785,P<0.001)andhs-CRP(F=12.174,P<0.001)were significantly different.The disease activity(=9.650,P=0.008)and histologicalscores(=14.263,P=0.002)between type I Hp infection group and type II Hp infection group weresignificantly different.The levels of IL-6(t=2.183,P=0.030),IL-1β(t=2.032,P=0.043),TNF-α(t=3.167,P=0.002)and hs-CRP(t=7.820,P<0.001)in type I Hp infection group were significantly higherthan those in type II Hp infection group,with significant differences.With the aggravation of disease activityand increasing histological score,the proportion of type I Hp infection increased and the proportion of typeII Hp infection decreased.Mann-Whitney U test analysis showed that DAI score(Z=6.527,P<0.001)andhistological score(Z=4.231,P<0.001)of type I Hp infected patients were significantly higher than those oftype II Hp infected patients.Multivariate Logistic regression analysis showed that type I Hp infection(OR=3.284,95%CI:1.429-5.124,P<0.001),histological score(OR=2.168,95%CI:1.537-2.734,P<0.001),IL-6(OR=1.826,95%CI:1.351-2.423,P=0.008)and hs-CRP(OR=2.037,95%CI:1.283-1.683,P<0.001)wereall independent risk factors for severe disease activity of patients with UC.The structural equation model wasused to verify the Logistic regression analysis results,and the RMSEA value was 0.017,suggesting a good fitof the model.Conclusions With the increase of disease activity and histological score,the proportion of typeI Hp infected patients increased.Type I Hp infection,histological score,IL-6 and hs-CRP levels were allindependent risk factors for severe disease activity of patients with UC.
作者
郭伟仪
林沛玲
Guo Weiyi;Lin Peiling(Gastroenterology Department,Dongguan People's Hospital,Dongguan 523000,China)
出处
《中华实验和临床感染病杂志（电子版）》
CAS
2024年第4期237-244,共8页
Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)
关键词
幽门螺杆菌
抗体类型
溃疡性结肠炎
疾病活动
组织学评分
Helicobacter pylori
Antibody type
Ulcerative colitis
Disease activity
Histological score
作者简介
通信作者:林沛玲,Email:402041923@qq.com。
