胆结石病人胆汁中幽门螺杆菌细胞毒素相关蛋白的检测及意义
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摘要
目的:探讨幽门螺杆菌(HP)与胆结石形成的相关性,寻找HP在胆汁中存在的证据,同时对胆汁中细菌检测方法进行研究分析。
方法:选择36例胆结石患者,其中28例采用胆管穿刺、8例采用内镜下选择性胆管插管抽取胆汁,用酶联免疫吸附法(ELISA)定量检测胆汁中HP-CagAIgG,同时与对照组(非结石组)16例进行比较,对照组中8例采用胆管穿刺、8例采用内镜下选择性胆管插管抽取胆汁。
结果:结石组与对照组胆管内胆汁中HP-CagA IgG检出阳性率有显著性差异(P<0.05),伴有和不伴有急性胆管炎的胆结石患者胆管内胆汁中HP-CagA IgG检出阳性率亦有显著性差异(P<0.05),而术中胆管穿刺与内镜下选择性胆管插管抽取的胆汁中HP-CagA IgG检出阳性率无显著性差异(P>0.05)。
结论:HP可能存在于胆道,并与胆结石的形成有一定的关系;经内镜下选择性胆管插管抽取胆汁进行HP-CagAIgG的检测是可行的。
Objective:To study the relationship between the Helicobacter pylori infection and the formation of gallstones. To collect the evidence of HP existing in biliary tract, and to study the detective methods of bacteria in biliary tract.
Methods:Twenty-eight cases of patients with gallstone collected bile by direct puncture during operation and other eight cases with gallstone by ERCP operation. HP CagA immunoglobulin G detected by enzyme - linked immunosorbent assays(ELISA). Sixteen cases of patients without gallstone was the control group. Eight cases collected bile by direct puncture during operation and other eight cases by ERCP operation.
Result:The detection of HP-CagA IgG of the two groups has significant difference. There was also significant difference with/without acute cholangitis in biliary tract of the patients with gallstone. However, there was no significant difference between the direct puncture group and ERCP group.
Conclusions: HP exists possibly in biliary tract and has some relationship with the formation of gallstone. It’s feasible to detect Helicobacter pylori CagAIgG through ERCP.
方法:选择36例胆结石患者,其中28例采用胆管穿刺、8例采用内镜下选择性胆管插管抽取胆汁,用酶联免疫吸附法(ELISA)定量检测胆汁中HP-CagAIgG,同时与对照组(非结石组)16例进行比较,对照组中8例采用胆管穿刺、8例采用内镜下选择性胆管插管抽取胆汁。
结果:结石组与对照组胆管内胆汁中HP-CagA IgG检出阳性率有显著性差异(P<0.05),伴有和不伴有急性胆管炎的胆结石患者胆管内胆汁中HP-CagA IgG检出阳性率亦有显著性差异(P<0.05),而术中胆管穿刺与内镜下选择性胆管插管抽取的胆汁中HP-CagA IgG检出阳性率无显著性差异(P>0.05)。
结论:HP可能存在于胆道,并与胆结石的形成有一定的关系;经内镜下选择性胆管插管抽取胆汁进行HP-CagAIgG的检测是可行的。
Objective:To study the relationship between the Helicobacter pylori infection and the formation of gallstones. To collect the evidence of HP existing in biliary tract, and to study the detective methods of bacteria in biliary tract.
Methods:Twenty-eight cases of patients with gallstone collected bile by direct puncture during operation and other eight cases with gallstone by ERCP operation. HP CagA immunoglobulin G detected by enzyme - linked immunosorbent assays(ELISA). Sixteen cases of patients without gallstone was the control group. Eight cases collected bile by direct puncture during operation and other eight cases by ERCP operation.
Result:The detection of HP-CagA IgG of the two groups has significant difference. There was also significant difference with/without acute cholangitis in biliary tract of the patients with gallstone. However, there was no significant difference between the direct puncture group and ERCP group.
Conclusions: HP exists possibly in biliary tract and has some relationship with the formation of gallstone. It’s feasible to detect Helicobacter pylori CagAIgG through ERCP.
引文
1. Maki T,et a1. Pathogenesis of calcium bilirubinate gallstone:role of E. colo, betaglucuronidase and coagulation by inorganic ions, polyelectrolytes and agitation. Ann Surg, l966;l64:90-100.
2. Swidsinski A, Ludwig W, Pahlig H,et a1.Molecular genetic evidence of bacterial colonization of cholesterol gallstones. Gastroenterology,1995; 108:860-864.
3. 杨玉龙,谭文翔,付维利,等.胆系感染的菌群结构分析及临床意义.肝胆胰外科杂志,2004; 16(1):26-28.
4. 胡伏莲,周殿元,主编.幽门螺杆菌感染的基础与临床.修订版.北京:中国科学技术出版社,2002;30.
5. Kuroki T, Fukuda K, Yamanouchi K, et al. Helicobacter pylori accelerates The biliary epithelial cell proliferation activity in hepatolithiasis. Hepatogastroenterology, 2002;49(45):648-651.
6. 陈思峰,吴中立.体液和组织磷脂酶A2简便快速测定法.第二军医大学学报,1989;10:254-256.
7. Sung JY,et a1.Dig Dis Sci, 1991;36:943-948.
8. 方驰华,杨继震,康惠广,等.胆囊结石胆汁、结石幽门螺杆菌与结石核心形成的关系[J].世界华人消化杂志,1999;(7):233-235.
9. Figura N,Cetta F,Angelico M ,et a1.Most Helicobacter pylori infectedpatients have specificantibodies and some also have H.pylori antigens and genomic material in bile.Dig Dis Sci,1998;43:854-862.
10. 郭吕,唐俐,郭新瑛,等.胆结石患者血清和胆汁幽门螺杆菌相关蛋白免疫印迹检测〔J〕.临床消化病杂志,2002;14:168-170.
11. Offner GD, Gong D, Afdhal NH. Identification of a 130一kilodalton human biliary concanavalin A binding protein as aminopeptidase N[J].Gastroenterology, 1994;106:755-762.
12. Nakano T,Yanagisawa J,Nakayama F.Phospholipase activity in human bile. Hepatology,1988;8:1560-1564.
13. Crabtree JE, Covaccia,Farmery SM, et al. Helicobacter pylori induced interleukin-8 expression in gastric epithelial cells is associated with CagA positive[J].J Clin Pathol ,1995;48(1):41-45.
14. 陈晓文,智发朝,武金宝,等.聚合酶链式反应和常规培养检测胆总管结石中细菌及其意义的研究.临床肝胆病杂志,2005;21(3):173-175.
1. Steward l,Smith AL,Pellegrini CA,et a1.Pigment gallstones form as a composite of bacterial microcolonies and pigment solids[J].AnnSurg,1987;206(3):242-250.
2. Tabata M , Nakayama F . Bacteria and gallstones: Etiological significance[J].Dig Dis Sci,1981;26(3):218-224.
3. Sung JY,et a1.Dig Dis Sci 1991;36:943- 948.
4. 方驰华,杨继震,康惠广,等.胆囊结石胆汁、结石幽门螺杆菌与结石核心形成的关系[J].世界华人消化杂志,1999;(7):233-235.
5. Fox JG,Dewhirst FE,Shen Z,et a1.Hepatic heficobacter species identified in bile and gallbladder tissue from Chileans with chronic cholecystitis. Gastroenterology,1998;44:755-763.
6. Myung SJ, Kim MH, Shim KN,et al. Detection of Helicobacter pylori DNA in human biliary tree and its association with hepatolithiasis.Dig Dis Sci, 2000; 45(7):1405-1412.
7. 陈晓文,智发朝,武金宝,等.聚合酶链式反应和常规培养检测胆总管结石中细菌及其意义的研究.临床肝胆病杂志,2005;21(3):173-175.
8. Figura N,Cetta F,Angelico M ,et a1.Most Helicobacter pylori infected patients have specific antibodies and some also have H.pylori antigens and genomic material in bile.Dig Dis Sci,1998;43:854-862.
9. 郭吕,李民,郭新瑛,等.胆石症病人胆囊粘膜中HP的免疫组化检测及意义[J].外科理论与实践,2002;7:305-307.
10. Rudi J, Rudy A, Maiwald M,et al.Helicobacter sp.are not detectable in bile from German patients with biliary disease[J].Gastroenterology, 1999; 116: 1016-1067.
11. 朱玉娟,谢健,周卫东,等.幽门螺杆菌感染与胆囊结石形成的相关性分析.重庆医科大学学报,2005;30(5):694-696.
12. Nakano T,Yanagisawa J,Nakayama F.Phospholipase activity in humanbile. Hepatology,1988;8:1560-1564.
13. Kano M ,et a1.Hepatology 1998;28:302- 313.
14. Shoda J, Kano M, Asano T, et al. Secretory low molecular weight phospholipases A2 and their specific receptor in bile ducts of patients with intrahepatic calculi: factors of chronic proliferative cholangitis.Hepatology, 1999;29(4):1026-1036.
15. Kuroki T, Fukuda K, Yamanouchi K, et al. Helicobacter pylori accelerates The biliary epithelial cell proliferation activity in hepatolithiasis.Hepatogastroenterology, 2002;49(45):648-651.
16. 别平,黄志强,韩本立,等.人体胆囊结石时胆囊组织PGE、PGⅠ2、LTC4的含量.中华消化杂志,1995;15(5):262-264.
17. 祁义军,孟翔凌,徐阿曼,等.胆囊结石与胆囊粘膜及胆汁幽门螺杆菌、磷脂酶A2的关系.中华实验外科杂志,2005;22(11):1299-1300.
18. 包文中,孟翔凌.幽门螺杆菌与原发性肝内胆管结石形成的关系.安徽医科大学学报,2006;41(2):199-201.
19. Crabtree JE, Covaccia,Farmery SM, et al. Helicobacter pylori induced interleukin-8 expression in gastric epithelial cells is associated with CagA positive[J].J Clin Pathol ,1995;48(1):41-45.
20. Sipos P . Gamal EM , Blazovics A. Free radical reactions in the gallbladder.Acta Chit Hung,1997;36:329-330.
21. 何鑫,孙权.肝内胆管结石患者胆管粘膜和胆汁的 HP、IL 活性及自由基、PLA2的检测与意义. 医学新知杂志,2006;16(3): 135-136,139.
2. Swidsinski A, Ludwig W, Pahlig H,et a1.Molecular genetic evidence of bacterial colonization of cholesterol gallstones. Gastroenterology,1995; 108:860-864.
3. 杨玉龙,谭文翔,付维利,等.胆系感染的菌群结构分析及临床意义.肝胆胰外科杂志,2004; 16(1):26-28.
4. 胡伏莲,周殿元,主编.幽门螺杆菌感染的基础与临床.修订版.北京:中国科学技术出版社,2002;30.
5. Kuroki T, Fukuda K, Yamanouchi K, et al. Helicobacter pylori accelerates The biliary epithelial cell proliferation activity in hepatolithiasis. Hepatogastroenterology, 2002;49(45):648-651.
6. 陈思峰,吴中立.体液和组织磷脂酶A2简便快速测定法.第二军医大学学报,1989;10:254-256.
7. Sung JY,et a1.Dig Dis Sci, 1991;36:943-948.
8. 方驰华,杨继震,康惠广,等.胆囊结石胆汁、结石幽门螺杆菌与结石核心形成的关系[J].世界华人消化杂志,1999;(7):233-235.
9. Figura N,Cetta F,Angelico M ,et a1.Most Helicobacter pylori infectedpatients have specificantibodies and some also have H.pylori antigens and genomic material in bile.Dig Dis Sci,1998;43:854-862.
10. 郭吕,唐俐,郭新瑛,等.胆结石患者血清和胆汁幽门螺杆菌相关蛋白免疫印迹检测〔J〕.临床消化病杂志,2002;14:168-170.
11. Offner GD, Gong D, Afdhal NH. Identification of a 130一kilodalton human biliary concanavalin A binding protein as aminopeptidase N[J].Gastroenterology, 1994;106:755-762.
12. Nakano T,Yanagisawa J,Nakayama F.Phospholipase activity in human bile. Hepatology,1988;8:1560-1564.
13. Crabtree JE, Covaccia,Farmery SM, et al. Helicobacter pylori induced interleukin-8 expression in gastric epithelial cells is associated with CagA positive[J].J Clin Pathol ,1995;48(1):41-45.
14. 陈晓文,智发朝,武金宝,等.聚合酶链式反应和常规培养检测胆总管结石中细菌及其意义的研究.临床肝胆病杂志,2005;21(3):173-175.
1. Steward l,Smith AL,Pellegrini CA,et a1.Pigment gallstones form as a composite of bacterial microcolonies and pigment solids[J].AnnSurg,1987;206(3):242-250.
2. Tabata M , Nakayama F . Bacteria and gallstones: Etiological significance[J].Dig Dis Sci,1981;26(3):218-224.
3. Sung JY,et a1.Dig Dis Sci 1991;36:943- 948.
4. 方驰华,杨继震,康惠广,等.胆囊结石胆汁、结石幽门螺杆菌与结石核心形成的关系[J].世界华人消化杂志,1999;(7):233-235.
5. Fox JG,Dewhirst FE,Shen Z,et a1.Hepatic heficobacter species identified in bile and gallbladder tissue from Chileans with chronic cholecystitis. Gastroenterology,1998;44:755-763.
6. Myung SJ, Kim MH, Shim KN,et al. Detection of Helicobacter pylori DNA in human biliary tree and its association with hepatolithiasis.Dig Dis Sci, 2000; 45(7):1405-1412.
7. 陈晓文,智发朝,武金宝,等.聚合酶链式反应和常规培养检测胆总管结石中细菌及其意义的研究.临床肝胆病杂志,2005;21(3):173-175.
8. Figura N,Cetta F,Angelico M ,et a1.Most Helicobacter pylori infected patients have specific antibodies and some also have H.pylori antigens and genomic material in bile.Dig Dis Sci,1998;43:854-862.
9. 郭吕,李民,郭新瑛,等.胆石症病人胆囊粘膜中HP的免疫组化检测及意义[J].外科理论与实践,2002;7:305-307.
10. Rudi J, Rudy A, Maiwald M,et al.Helicobacter sp.are not detectable in bile from German patients with biliary disease[J].Gastroenterology, 1999; 116: 1016-1067.
11. 朱玉娟,谢健,周卫东,等.幽门螺杆菌感染与胆囊结石形成的相关性分析.重庆医科大学学报,2005;30(5):694-696.
12. Nakano T,Yanagisawa J,Nakayama F.Phospholipase activity in humanbile. Hepatology,1988;8:1560-1564.
13. Kano M ,et a1.Hepatology 1998;28:302- 313.
14. Shoda J, Kano M, Asano T, et al. Secretory low molecular weight phospholipases A2 and their specific receptor in bile ducts of patients with intrahepatic calculi: factors of chronic proliferative cholangitis.Hepatology, 1999;29(4):1026-1036.
15. Kuroki T, Fukuda K, Yamanouchi K, et al. Helicobacter pylori accelerates The biliary epithelial cell proliferation activity in hepatolithiasis.Hepatogastroenterology, 2002;49(45):648-651.
16. 别平,黄志强,韩本立,等.人体胆囊结石时胆囊组织PGE、PGⅠ2、LTC4的含量.中华消化杂志,1995;15(5):262-264.
17. 祁义军,孟翔凌,徐阿曼,等.胆囊结石与胆囊粘膜及胆汁幽门螺杆菌、磷脂酶A2的关系.中华实验外科杂志,2005;22(11):1299-1300.
18. 包文中,孟翔凌.幽门螺杆菌与原发性肝内胆管结石形成的关系.安徽医科大学学报,2006;41(2):199-201.
19. Crabtree JE, Covaccia,Farmery SM, et al. Helicobacter pylori induced interleukin-8 expression in gastric epithelial cells is associated with CagA positive[J].J Clin Pathol ,1995;48(1):41-45.
20. Sipos P . Gamal EM , Blazovics A. Free radical reactions in the gallbladder.Acta Chit Hung,1997;36:329-330.
21. 何鑫,孙权.肝内胆管结石患者胆管粘膜和胆汁的 HP、IL 活性及自由基、PLA2的检测与意义. 医学新知杂志,2006;16(3): 135-136,139.