中国图书资料分类号R573

摘要

目的探讨慢性胃病患者T细胞亚群、一氧化氮(NO)、氨基己糖含量变化与Hp感染的关系.

方法分别对30例慢性胃炎(CG)、32例消化性溃疡合并慢性胃炎(PU+CG)与20例正常对照分别进行T细胞亚群、NO、氨基己糖含量检测.

结果CG患者外周血CD⁺₃, CD⁺₄, cD⁺₈, CD⁺₄/CD⁺₈(60.7%±2.4%,35.8%±2.5%, 25.2%±2.4%，1.43±0.15)分别较正常对照组(68.3%±3.9%,43.0%±3.8%，26.4%±1.7%,1.64±0.18)明显降低(P＜0.05～0.01)；其Hp⁺组CD⁺₃, cD⁺₄(59.7%±2.5%，34.8%±2.6%)较Hp^-组(62.2%±0.9%，36.9%±2.0%)为低(P＜0.01，0.05)；重度CG患者71%有Hp感染，其CD⁺₃, cD⁺₄, CD⁺₄/ CD⁺₈(59.5%±2.1%，35.4%±2.7%，1.40±0.13)分别均较轻中度患者(62.3%±1.7%，37.4%±1.8%，1.50±0.13)明显减低(P＜0.05～0.01). cG和PU+CG患者Hp感染率分别为60.0%和75.0%，其氨基己糖含量(mg/g，40±6，39±8)较Hp^-组(45±8，51±7)明显减低(P＜0.05，0.01)；重度CG患者氨基己糖含量(mg/g，38±4)明显低于轻中度患者(47±8，P＜0.01). cG和PU+CG组NO含量(μg/L，2514±364, 2824±673)均明显高于正常对照组(μg/L,2227±214, p＜0.05,0.01)；其Hp⁺组NO含量(μg/L,2671±258,3071±398)均明显高于Hp^-组(μg/L，2282±387,2579±668，P＜0.01，0.05)；重度CG和PU伴重度CG患者NO含量(μg/L，2656±251，2880±802)分别较轻中度患者明显增高(2328±413， 2403±284，P＜0.05，0.05).

结论CG尤其是重症患者存在细胞免疫功能紊乱. cG，PU伴Hp感染患者胃粘膜氨基己糖含量随感染发生、发展呈进行性减低，血浆NO含量也随Hp感染、病变程度加重呈进行性升高.

T lymphocyte subsets, nitric oxide, hexosamine and Helicobacter pylori infection in patients with chronic gastric diseases

ZHANG Hui, REN Xi-Ling and YAO Xi-Xian

department of Gastroenterology, Second Hospital of Hebei medical University, Shijiazhuang 050000, Hebei province, China

Subject headingsstomach diseases; chronic diseases; t-lymphocyte subsets; nitric oxide/analysis; hexosamine/analysis; Helicobacter pylori infections

Abstract

aIMTo study the relationship among T lymphocyte subsets, NO, hexosamine and Hp infection in patients with chronic gastric diseases.

mETHODSPeripheral blood T lymphocyte subsets, plasma NO and hexosamine in gastric mucosa were measured respectively in 30 patients with chronic gastritis (CG), 32 patients with peptic ulcer and chronic gastritis (PU+CG) and 20 normal subjects.

rESULTSCD⁺₃, CD⁺₄, cD⁺₈, CD⁺₄/CD⁺₈ in CG patients (60.7%±2.4%, 35.8%±2.5%,25.2%±2.4%，1.43±0.15) were significantly lower than those in normal controls (68.3%±3.9%,43.0%±3.8%，26.4%±1.7%,1.64±0.18,P＜0.05～0.01). cD⁺₃, CD⁺₄ in Hp⁺ group (59.7%±2.5%，34.8%±2.6%) were significantly decreased (Hp^-, 62.2%±0.9%， 36.9%±2.0%，P＜0.01，＜0.05). in addition, the majority (71%) of severe CG had Hp infection, and their CD⁺₃, CD⁺₄, cD⁺₄/ CD⁺₈(59.5%±2.1%，35.4%±2.7%，1.40±0.13) were significantly decreased than that of mild to moderate CG patients (62.3%±1.7%，37.4%±1.8%，1.50±0.13，P＜0.05～0.01). in 30 CG patients and 32 PU+CG patients, Hp infection rate was 61.9% and 75.0%. The hexosamine level (mg/g) in Hp⁺ group (39.5±6.2，38.6±7.5) was significantly lower than that of Hp^- group (45.3±7.7，50.7±7.3，P＜0.05，＜0.01). in severe CG patients, the hexosamine level (mg/g) (38.0±3.8) was significantly lower than that in mild and moderate CG (47.0±7.6，P＜0.01). plasma NO (μg/L) levels in CG and PU+CG (2514±364, 2824±673) were significantly higher than that of normal controls (2227±214,P＜0.05,＜0.01). the NO levels in both Hp⁺ groups (2671±258,3071±398) were significantly higher than that of Hp^- group (2282±387,2579±668,P＜0.01，＜0.05). the NO levels in both groups with severe CG (2656±251， 2880±802) were significantly higher than that of mild to moderate CG (2328±413，2403±284，P＜0.05，＜0.05).

cONCLUSIONThe cellular immunity is impaired in CG patients especially severe cG with Hp infection. The hexosamine level in gastric mucosa is decreased in CG and PU+CG patients. The severer the gastric mucosa is impaired by Hp infection, the lower the hexosamine level. The plasma NO levels in CG and PU+CG patients were increased to varying extent. The severer the gastric mucosa is impaired by hp infection, the higher the NO level.

0引言

慢性胃炎(CG)和消化性溃疡(PU)是常见多发病，Hp感染是CG的主要致病因子，并与PU的发病有关.为此我们对30例CG，32例PU合并CG患者进行了T淋巴细胞亚群、NO、氨基己糖含量检测，藉以探讨慢性胃病患者Hp感染与NO、氨基己糖含量及其免疫功能的关系.

1材料和方法

1.1材料1997-10/1998-01经我院内镜病理检查证实PU合并CG32例，男23例，女9例，年龄20岁～68岁，平均43.2岁；CG 30例，男18例，女12例，年龄24岁～66岁，平均44.3岁.并以相当年龄健康献血员20例为正常对照组.病例选择均除外内分泌及肝脏等其他脏器疾患.

1.2方法外周血T-淋巴细胞标本的采取为空腹静脉血1mL，肝素抗凝，待测.胃粘膜组织采取位于胃窦部距幽门口3cm内小弯、前壁组织各2块. t细胞亚群测定采用FCM方法. 应用美国Becton-Dickinson公司生产的FACS420型流式细胞仪.激光光源为2W氩离子激光，波长488nm，FITC发出的绿色荧光以520nm的长通滤片用于荧光检测.测量数值和图形输入Hp-300 Consort 30微机，应用相应程序进行资料处理. hp检测：①尿素酶试验：采用中外合资三强生物有限公司出品的Hp快速诊断试剂盒.②胃粘膜活检标本涂片Gram染色. 按Monshoy分级法：0级为无菌；Ⅰ级为认真寻找可见；Ⅱ级为在多数高倍视野下可见；Ⅲ级为很多或成堆.③Warthin-Starry染色组织学检查. 上述检查2项以上阳性确定为Hp感染.病理：HE染色用于观察粘膜炎症变化，按炎性细胞浸润范围分为3级：①轻度：炎性细胞浸润于胃小凹或肠绒毛底部以上；②中度：炎性细胞浸润达腺体固有层；③重度：炎性细胞浸润深达粘膜肌层^［1］.氨基己糖测定：将胃粘膜组织2块，用人工组织研磨器将洗净的粘膜组织研磨成匀浆1mL，离心取上清液，-20℃保存备检.①测定上清液蛋白含量：取上清液和标准液各20μL，考马斯亮蓝G250试剂500μL、波长600nm，Cobas mira自动分析仪(瑞士Roche公司生产)测定. ②取粘膜匀浆上清液0.5mL，加浓HCl0.5mL，混匀，高压(147kPa) 30min后加8.3mol/L的NaOH和乙酰丙酮溶液各0.5mL，并置沸水浴中15min，冷却后Cobas mira全自动生化分析仪测定，结果以mg/L表示. ③氨基己糖计算：氨基己糖(mg/g)=上清液氨基己糖mg/L/上清液蛋白质g/L. nO测定：①前处理过程：取血浆200μL，加等量乙腈，摇匀后离心10min(5000r/min)，此步骤重复1次，取上清液10μL，进样.②仪器：美国Waters公司产Baseline810高效液相仪，486紫外检测器.③色谱条件：流动相2.5mmol/L LiOH水溶液+50g/L乙腈，流速1.2mL/min，柱温40℃，检测波长214nm，分析IC-Pak anion, 4.6mm×5cm(美国Waters公司)，检测时间10min.

统计学处理各种数据均用±s表示，两样本均数采用t检验，P＜0.05有显著差异性.