摘要
目的:探讨sIgA在慢性乙型肝炎病毒(hepatitis Bvirus,HBV)感染合并胃黏膜损伤中的变化及意义.方法:选择慢性HBV感染患者40例,排除其他肝病及既往胃病史;慢性胃炎40例,排除既往肝病史;正常对照为9例胃镜检查正常体检者.均行电子胃镜检查,从形态学上了解胃、十二指肠黏膜病变情况,同时抽取胃黏液,采用放射免疫法检测sIgA水平.结果:(1)按McCormick标准,慢性HBV感染组胃黏膜病变占80.0%(32/40),其中慢重肝的重度胃黏膜病变占46.15%(6/13);慢性胃炎组胃黏膜病变占77.5%(31/40);(2)在慢性HBV感染组,肝损伤越重,胃黏膜病变发生率越高,随着胃黏膜病变的加重,胃黏液sIgA水平逐渐降低,差异有统计学意义(P<0.01),并且sIgA水平同胃黏膜病变分度之间呈负相关(r=-0.516,P<0.01);虽然慢乙肝、肝硬化患者的胃黏液sIgA水平均高于正常组(P<0.01,P<0.05),但随着肝病程度的加重,sIgA水平是呈逐渐降低趋势,在慢重肝患者甚至低于正常人;胃黏液sIgA水平还与ALB、PTA呈正相关(r=0.453,P<0.01;r=0.557,P<0.01),而与ALT、TBIL无相关性(r=0.008,P>0.05;r=-1.522,P>0.05);(3)慢性胃炎组重度胃黏膜病变的胃黏液sIgA水平高于其他各组,但各组之间比较差异无统计学意义(F=1.706,P>0.05).结论:慢性HBV感染常伴有胃黏膜病变的发生,肝损伤越重,胃黏膜损害程度越重;慢性HBV感染者胃黏膜病变的发生与多种因素有关,但胃黏液sIgA作为胃黏膜防御因子,其水平的下降,可能参与了慢性肝病胃黏膜病变的形成.
AIM： To analyze the significance of gastric mucosal levels of sIgA in patients with chronic hepatitis B virus （HBV） infection and gastric mucosal lesions. METHODS： Forty patients with chronic HBV infection but without a previous history of liver disease or gastropathy （including 13 cases with chronic hepatitis B, 14 with cirrhosis, and 13 with chronic severe hepatitis B）, 40 patients with chronic gastritis but without a previous history of liver disease and 9 normal controls were included in this study. All subjects underwent electronic gastroscopy to observe the morphology of gastric and duodenal mucosal lesions and take gastric mucosal specimens. The level of sIgA in the gastric mucosa was determined by radioimmunoassay. RESULTS： According to the McCormick standards, gastric mucosal lesions developed in 80% （32/40） of patients with chronic HBV [46.15% （6/13） of patients with chronic severe hepatitis B] and 77.5% （31/40） of patients with chronic gastritis. Gastric mucosal levels of sIgA were significantly higher in patients with chronic hepatitis B or cirrhosis than in normal controls （P〈 0.01, P〈 0.05）, but were lower in patients with chronic severe hepatitis than in normal controls. Gastric mucosal levels of sIgA had a positive correlation with ALB and PTA （r = 0.453, 0.557, both P〈 0.01）, but had no correlation with ALT or TBIL （r = 0.008, -1.522; both P 〈0.05）. Gastric mucosal levels of sIgA gradually decreased with the increase in the severity of gastric mucosal lesions （P 〈0.01） and were negatively correlated with the degree of gastric mucosal lesion in patients with chronic liver disease. The levels of sIgA in the gastric mucosa in patients with severe gastric mucosal lesions in the chronic gastritis group were higher than those in other groups, but the difference was not significant among each group （F = 1.706, P〈0.05）. CONCLUSION： Patients with chronic HBV infection often have concurrent gastric mucosal lesions. The decrease in gastric mucosal levels of sIgA may be involved in the development of gastric mucosal lesions in patients with chronic liver disease.
出处
《世界华人消化杂志》
CAS
北大核心
2013年第3期256-260,共5页
World Chinese Journal of Digestology
基金
贵州省教委科研基金资助项目
黔教高发[2000]518号
