摘要
背景胆石症发病与胆道系统动力学、胆汁成分改变、幽门螺杆菌(Helicobacter pylori,H.pylori)感染等因素有关.H.pylori感染一方面能引起胆汁中磷脂酶A2(phospholipaseA-2,PLA-2)释放增加,可促进胆固醇沉淀,引发结石;另一方面,H.pylori感染可对机体免疫反应产生刺激作用,导致免疫功能下降.胆石症合并H.pylori感染抗H.pylori治疗,能否降低PLA-2活性、改善免疫功能,目前并不确切.本研究初步探讨抗H.pylori治疗与胆汁H.pylori DNA、PLA-2、免疫功能关系.目的探讨胆石症患者实施抗H.pylori治疗对其胆汁H.pyloriDNA、PLA-2活性以及免疫功能的影响.方法选取粤北人民医院2014-06/2018-03因胆石症行经内镜逆行性胰胆管造影术胆总管取石+鼻胆管引流术或外科胆管取石行T管引流术合并H.pylori感染患者80例.通过随机数字法分为两组,40例予以抗H.pylori治疗者为研究组,40例常规施予质子泵抑制剂治疗者为对照组.回顾性对比分析两组胆汁H.pylori DNA转阴率、PLA-2活性、免疫功能变化.结果研究组胆汁H.pylori DNA转阴率为92.50%,较对照组的67.50%高,差异有统计学意义(P<0.05);研究组治疗后PLA-2低于对照组,差异存在统计学意义(P<0.05);两组治疗后免疫球蛋白A、免疫球蛋白M差异无统计学意义(P>0.05);治疗后免疫球蛋白G较治疗前升高,差异有统计学意义(P<0.05),且两组免疫球蛋白G差异有统计学意义(P<0.05);研究组CD4+、CD8+水平优于对照组,差异有统计学意义(P<0.05).结论抗H.pylori治疗可通过提升H.pylori DNA转阴率、降低胆汁PLA-2水平,达到改善患者免疫功能.
BACKGROUND The pathogenesis of cholelithiasis is related to many factors including the dynamics of the biliary system,the change of bile content,the infection with bacteria like Helicobacter pylori(H.pylori)and so on.H.pylori infection,on the one hand,may result in the increase of phospholipase A2(PLA2)in bile,which could promote cholesterol precipitation and later cause bile stone formation.On the other hand,H.pylori infection could stimulate the body’s immune response and then lead to the decline of immune function.It is still unknown whether anti-H.pylori therapy in patients with cholelithiasis complicated with H.pylori infection could reduce PLA2 activity and improve immune function.The objective of this study was to investigate the effect of anti-H.pylori therapy on bile H.pylori DNA and PLA2 and immune function in patients with cholelithiasis.AIM To investigate the effect of anti-H.pylori therapy on bile H.pylori DNA and PLA2 and immune function in patients with cholelithiasis.METHODS A total of 80 patients who were treated by endoscopic retrograde cholangiopancreatography choledocholithotomy plus endoscopic nasobiliary drainage for cholelithiasis or who underwent surgical bile duct stone removal combined with T tube drainage and had H.pylori infection were selected.They were randomly divided into either a study group or a control group(n=40 each).The study group was treated with anti-H.pylori therapy,and the control group underwent proton pump inhibitor treatment.Changes in the negative conversion rate of bile H.pylori DNA,PLA2 activity,and immune function were compared between the two groups.RESULTS The negative conversion rate of bile H.pylori DNA in the study group was significantly higher than that in the control group(92.50%vs 67.50%,P<0.05).PLA-2 activity in bile in the study group was significantly lower than that in the control group after treatment(P<0.05),but there was no significant difference in immunoglobulin A or immunoglobulin M between the two groups(P>0.05).Immunoglobulin G was increased after treatment(P<0.05),and there was a significant difference in immunoglobulin G between the two groups(P<0.05).The levels of CD4+and CD8+T lymphocytes in the study group were better than those the control group(P<0.05).CONCLUSION Anti-H.pylori therapy can improve the immune function in patients with cholelithiasis possibly by improving the negative conversion rate of H.pylori DNA and lowering the level of bile PLA2.
作者
朱蔓然
宁雪莲
姚卫民
郭勇杭
何丽娟
卢如相
Man-Ran Zhu;Xue-Liang Ning;Wei-Min Yao;Yong-Hang Guo;Li-Juan He;Ru-Xiang Lu(Department of Gastroenterology,Yuebei People’s Hospital,Shaoguan 512025,Guangdong Province,China;Clinical Research Center of Affiliated Hospital of Guangdong Medical University,Zhanjiang 524000,Guangdong Province,China)
出处
《世界华人消化杂志》
CAS
2019年第14期883-888,共6页
World Chinese Journal of Digestology
基金
韶关市科技计划项目,No.2014CX/K2~~
