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中华实验和临床感染病杂志(电子版) ›› 2024, Vol. 18 ›› Issue (04) : 237 -244. doi: 10.3877/cma.j.issn.1674-1358.2024.04.007

论 著

不同抗体型幽门螺杆菌感染与溃疡性结肠炎患者疾病活动及组织学评分的关系
郭伟仪, 林沛玲()   
  1. 523000 东莞市,东莞市人民医院消化内科
  • 收稿日期:2024-03-03 出版日期:2024-08-08
  • 通信作者: 林沛玲

Relationship between Helicobacter pylori infection with different antibody types and disease activity and histological scores in patients with ulcerative colitis

Weiyi Guo, Peiling Lin()   

  1. Gastroenterology Department, Dongguan People’s Hospital, Dongguan 523000, China
  • Received:2024-03-03 Published:2024-08-08
  • Corresponding author: Peiling Lin
引用本文:

郭伟仪, 林沛玲. 不同抗体型幽门螺杆菌感染与溃疡性结肠炎患者疾病活动及组织学评分的关系[J]. 中华实验和临床感染病杂志(电子版), 2024, 18(04): 237-244.

Weiyi Guo, Peiling Lin. Relationship between Helicobacter pylori infection with different antibody types and disease activity and histological scores in patients with ulcerative colitis[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2024, 18(04): 237-244.

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Ⅱ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(χ2 =13.160、P = 0.041)和组织学评分(χ2 = 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(χ2 = 9.650、P = 0.008)和组织学评分(χ2 = 14.263、P = 0.002)差异有统计学意义;Ⅰ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,Ⅰ型Hp感染者比例增加,Ⅱ型Hp感染者比例降低。Mann-Whitney U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Ⅱ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 ⅠHp 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 groups were compared, respctively. The risk factors for severe disease activity in UC patients were analyzed by multivariate Logistic regression.

Results

The disease activity (χ2 = 13.160, P = 0.041) and histological scores(χ2 = 21.263, P = 0.033) among Hp patients with different antibody types were significantly different. The positive rate of CagA antibody was higher in patients with severe disease activity and histological scores of 4 (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) and hs-CRP (F = 12.174, P < 0.001) were significantly different. The disease activity (χ2 = 9.650, P = 0.008) and histological scores (χ2 = 14.263, P = 0.002) between type Ⅰ Hp infection group and type Ⅱ Hp infection group were significantly 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 higher than those in type Ⅱ Hp infection group, with significant differences. With the aggravation of disease activity and 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) and histological score (Z = 4.231, P < 0.001) of type Ⅰ Hp infected patients were significantly higher than those of type 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) were all independent risk factors for severe disease activity of patients with UC. The structural equation model was used to verify the Logistic regression analysis results, and the RMSEA value was 0.017, suggesting a good fit of 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 all independent risk factors for severe disease activity of patients with UC.

表1 不同抗体型Hp 感染UC 患者病理学特征
表2 Ⅰ型Hp 感染组和Ⅱ型Hp 感染组患者的一般资料和临床指标
图1 不同抗体型Hp感染者疾病活动度和组织学评分 注:A:Ⅰ型Hp感染组和Ⅱ型Hp感染组患者疾病活动度分布图;B:I型Hp感染组和II型Hp感染组患者组织学评分分布图;C:不同抗体型Hp感染者在不同疾病活动度中分布;D:不同抗体型Hp感染者在各组织学评分中分布
图2 不同抗体型Hp感染者的DAI评分和组织学评分箱线图
表3 Ⅰ型Hp 感染组和Ⅱ型Hp 感染组UC 患者DAI 评分和组织学评分[M(P25,P75),分]
表4 轻度组、中度组和重度组UC 患者疾病活动的相关因素
表5 UC 患者重度疾病活动的多因素Logistic 回归分析
图3 UC重度活动的结构方程模型
表6 UC 患者重度疾病活动的结构方程模型参数
表7 UC 患者重度疾病活动的结构方程模型拟合指标
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