Rannsókn á tengslum Helicobacter pylori í magaslímhúð við vefjaflokka og magabólgur

Abstract

This pilot study was performed at the National University Hospital in Reykjavik in late 1987. Blood samples and biopsies from the gastric mucosa were taken from 47 patients (27 females and 20 males aged 14-75 years, median age 51 year), chosen randomly from a group of 224 patients undergoing endoscopy at the time of the study. Two biopsies were taken from each of the following sites; pylorus, angulus and minor curvature, one for bacterial culture and the other for histopathological examination. Blood was taken for HLA-typing by microlymphocytotoxicity test. Patients who had received antibiotics within two weeks of the endoscopy and patients on anticoagulation therapy or having bleeding diathesis were excluded. Culture, HLA-typing and histological examination were performed without knowledge of results from the other parts of the study. H. pylori was found in 29 patients (61.7%), 17 females and 12 males aged 19-74 years. Median age was 56 years. Bacterial cultures for H. pylori, and histological examination after Warthin-Starry staining, gave identical results in 94.3% of the samples. When the HLA groups of H. pylori positive and negative patients were compared by Fisher exact test no statistical significance was found. The relative risk of patients, with positive H. pylori cultures, to have HLA antigen Aw-19 or belonging to the group where HLA-B-typing was unsuccessful, was statistically significant (P<0.05) when compared to a control group. When H. pylori negative patients were compared to the control group they also had a relative risk of belonging to the same untyped HLA B group (P<0.05). All 47 patients had gastritis according to histology even though only 21 were diagnosed as such at endoscopy. Of 29 patients infected with H. pylori 21 (72.4%) had chronic active gastritis and 8 had chronic gastritis. Only one patient had chronic active gastritis and negative culture for H. pylori. Of 18 patients not infected with H. pylori, 17 had chronic gastritis (94.4%) (Yates' correction P<0.001).

Gerð var rannsókn á sambandi Helicobacter pylori í magaslímhúð, annars vegar við vefjaflokka en hins vegar við útlit og meingerð magaslímhúðarinnar. A þeim tíma sem rannsóknin stóð yfir komu 224 sjúklingar til magaspeglunar á Landspítalanum. Í úrtakinu voru 47 þeirra, 27 konur og 20 karlar á aldrinum 14-75 ára. Miðgildi aldurs var 51 ár. Tekin voru vefjasýni úr maga og blóð til vefjaflokkunar. Útilokaðir frá þátttöku voru allir þeir sem höfðu tekið sýklalyf síðustu tvær vikurnar fyrir speglun, höfðu blæðingartilhneigingu eða voru á blóðþynningarmeðferð. Ræktun, vefjaflokkun og vefjaskoðun var gerð án vitneskju um niðurstöður úr öðrum hlutum rannsóknarinnar. H. pylori ræktaðist frá 29 (61.7%), þar af voru 17 konur og 12 karlar. Aldursdreifing þeirra var 19-74 ár. Miðgildi aldurs var 56 ár. Samræmi milli ræktunar og vefjarannsóknar með Warthin-Starry litun var 94.3%. Miðað við samanburðarhóp sýndu einungis vefjaflokkur Aw-19 og þeir seiii ekki sýndu svörun í B vefjaflokki marktæka fylgni við jákyæða ræktun af H. pylori. Þeir sem ekki sýndu svörun í B vefjaflokki höfðu einnig fylgni við neikvæða ræktun af H. pylori. Allir 47 höfðu magabólgur þrátt fyrir að magaslímhúð væri talin eðlileg við speglun hjá 21. Af 29 með jákvæða ræktun fyrir H. pylori hafði 21 (72.4%) virka, hægfara magabólgu (gastritis chronica activa) en átta höfðu hægfara magabólgu (gastritis chronica). Af 18 með neikvæða ræktun fyrir H. pylori, höfðu 17 (94.4%) hægfara magabólgu og einn virka, hægfara magabólgu (leiðrétting Yates, P<0.001).