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目的 :探讨幽门螺杆菌 (Helicobacterpylori,HP)诱导胃上皮细胞凋亡的机制及细胞凋亡在HP相关性消化性溃疡 (PU)中的作用。方法 :内镜下胃粘膜活检取材 ,应用TUNEL法检测胃上皮细胞凋亡 ,免疫组化法检测凋亡调控蛋白bak、bcl 2的表达。结果 :HP阳性胃溃疡 (GU)和十二指肠溃疡 (DU)患者细胞凋亡指数 (AI)明显高于HP阴性非溃疡性消化不良 (NUD)患者 (P <0 0 1)。根除HP后 ,AI在DU明显下降 (P <0 .0 1) ,在GU无明显改变 (P >0 0 5 )。HP阳性DU溃疡活动期AI明显高于愈合期和瘢痕期 (P <0 0 5 ) ,而HP阳性GU溃疡三期AI无差异 (P >0 0 5 )。bak蛋白表达在HP阳性PU明显高于HP阴性NUD患者 (P <0 0 5 )。根除HP后 ,DU患者bak蛋白表达明显降低 (P <0 0 5 ) ,GU患者虽有下降 ,但无统计学差异。bcl 2蛋白表达在HP阳性PU与HP阴性NUD之间无显著差异 ,HP根除前后亦无明显改变。结论 :HP诱导胃上皮细胞凋亡在十二指肠溃疡发病中起更重要的作用 ,HP诱导胃上皮细胞凋亡可能是通过bak路径实现的
Objective: To investigate the mechanism of Helicobacter pylori (HP) -induced gastric epithelial cell apoptosis and the role of apoptosis in HP-associated peptic ulcer (PU). Methods: Gastric mucosa biopsy was taken by endoscopy. The apoptosis of gastric epithelial cells was detected by TUNEL method. The expression of apoptosis-modifying protein bak and bcl-2 were detected by immunohistochemistry. Results: The apoptosis index (AI) in HP positive gastric ulcer (GU) and duodenal ulcer (DU) patients was significantly higher than that in HP negative non - ulcer dyspepsia (NUD) patients (P <0.01). After eradication of HP, AI was significantly decreased in DU (P <0.01), but not in GU (P> 0.05). The AI of HP-positive DU ulcer was significantly higher than that of healing and scarring (P <0.05), while there was no difference in AI of HP-positive GU ulcer (P> 0.05). bak protein expression was significantly higher in HP-positive PU than in HP-negative NUD patients (P <0.05). After eradication of HP, the expression of bak protein in DU patients was significantly lower (P <0.05), although there was a decrease in GU patients, but there was no significant difference. There was no significant difference in bcl 2 protein expression between HP-positive PU and HP-negative NUD, and no significant change was observed before and after HP eradication. Conclusion: HP induced gastric epithelial cell apoptosis play a more important role in the pathogenesis of duodenal ulcer. HP induced gastric epithelial cell apoptosis may be achieved through the bak pathway