中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2012年
4期
318-321
,共4页
贾犇黎%孟翔凌%汪正广%祁义军
賈犇黎%孟翔凌%汪正廣%祁義軍
가분려%맹상릉%왕정엄%기의군
胆管肿瘤%螺杆菌,幽门%基因型
膽管腫瘤%螺桿菌,幽門%基因型
담관종류%라간균,유문%기인형
Bile duct neoplasms%Helicobacter pylori%Genotype
目的 研究胆管癌中幽门螺杆菌( Helicobacter pylori,HP)感染情况及其基因型表达,并分析其临床病理参数与预后间的关系.方法 采用PCR法对80例手术切除的胆管癌标本及30例对照标本进行HP检测,对所有阳性结果用PCR方法进一步检测细胞毒素相关蛋白基因(Cag A)、空泡细胞毒素(VacA)的三个基因亚型sla、m1和m2的表达,结合临床、病理资料对结果进行分析.连续性变量采用t检验,分类变量采用x2检验法或Fisher精确计算法,应用多元Logistic分析模型进行相关危险因素分析.结果 80例胆管癌中HP阳性检出率(71％),显著高于对照组(20％)(x2=23.418,P＜0.05)；57例HP阳性胆管癌中CagA、VacA sla、VacA m1和VacA m2阳性分别为30例、40例、5例和43例；HP的感染与肿瘤的位置相关(x2=27.580,P＜0.05),与肿瘤的分期无关(x2=1.204,P=0.548)；多元Logistic回归分析显示HP感染阳性的患者发生胆管癌的可能性为阴性者的10倍之多( OR=10.531)；Cox比例风险模型分析显示,HP的感染(HR =8.105,P=0.032)、TNM分期(Ⅱ/Ⅲ期HR =9.141,P=0.040,Ⅳ期HR=29.071,P=0.040)、手术根治情况(HR =9.531,P=0.015)均为胆管癌的独立预后因素,寿命表分析显示HP的感染对胆管癌术后生存时间存在影响(u=10.074,P=0.002),HP感染阳性的中位数生存时间较HP阴性者短7.25个月.结论 胆管癌患者中可能存在HP的感染,其感染的主要基因型为VacA sla/m2型；HP的感染与胆管癌的发生有关,对胆管癌预后存在不利影响.
目的 研究膽管癌中幽門螺桿菌( Helicobacter pylori,HP)感染情況及其基因型錶達,併分析其臨床病理參數與預後間的關繫.方法 採用PCR法對80例手術切除的膽管癌標本及30例對照標本進行HP檢測,對所有暘性結果用PCR方法進一步檢測細胞毒素相關蛋白基因(Cag A)、空泡細胞毒素(VacA)的三箇基因亞型sla、m1和m2的錶達,結閤臨床、病理資料對結果進行分析.連續性變量採用t檢驗,分類變量採用x2檢驗法或Fisher精確計算法,應用多元Logistic分析模型進行相關危險因素分析.結果 80例膽管癌中HP暘性檢齣率(71％),顯著高于對照組(20％)(x2=23.418,P＜0.05)；57例HP暘性膽管癌中CagA、VacA sla、VacA m1和VacA m2暘性分彆為30例、40例、5例和43例；HP的感染與腫瘤的位置相關(x2=27.580,P＜0.05),與腫瘤的分期無關(x2=1.204,P=0.548)；多元Logistic迴歸分析顯示HP感染暘性的患者髮生膽管癌的可能性為陰性者的10倍之多( OR=10.531)；Cox比例風險模型分析顯示,HP的感染(HR =8.105,P=0.032)、TNM分期(Ⅱ/Ⅲ期HR =9.141,P=0.040,Ⅳ期HR=29.071,P=0.040)、手術根治情況(HR =9.531,P=0.015)均為膽管癌的獨立預後因素,壽命錶分析顯示HP的感染對膽管癌術後生存時間存在影響(u=10.074,P=0.002),HP感染暘性的中位數生存時間較HP陰性者短7.25箇月.結論 膽管癌患者中可能存在HP的感染,其感染的主要基因型為VacA sla/m2型；HP的感染與膽管癌的髮生有關,對膽管癌預後存在不利影響.
목적 연구담관암중유문라간균( Helicobacter pylori,HP)감염정황급기기인형표체,병분석기림상병리삼수여예후간적관계.방법 채용PCR법대80례수술절제적담관암표본급30례대조표본진행HP검측,대소유양성결과용PCR방법진일보검측세포독소상관단백기인(Cag A)、공포세포독소(VacA)적삼개기인아형sla、m1화m2적표체,결합림상、병리자료대결과진행분석.련속성변량채용t검험,분류변량채용x2검험법혹Fisher정학계산법,응용다원Logistic분석모형진행상관위험인소분석.결과 80례담관암중HP양성검출솔(71％),현저고우대조조(20％)(x2=23.418,P＜0.05)；57례HP양성담관암중CagA、VacA sla、VacA m1화VacA m2양성분별위30례、40례、5례화43례；HP적감염여종류적위치상관(x2=27.580,P＜0.05),여종류적분기무관(x2=1.204,P=0.548)；다원Logistic회귀분석현시HP감염양성적환자발생담관암적가능성위음성자적10배지다( OR=10.531)；Cox비례풍험모형분석현시,HP적감염(HR =8.105,P=0.032)、TNM분기(Ⅱ/Ⅲ기HR =9.141,P=0.040,Ⅳ기HR=29.071,P=0.040)、수술근치정황(HR =9.531,P=0.015)균위담관암적독립예후인소,수명표분석현시HP적감염대담관암술후생존시간존재영향(u=10.074,P=0.002),HP감염양성적중위수생존시간교HP음성자단7.25개월.결론 담관암환자중가능존재HP적감염,기감염적주요기인형위VacA sla/m2형；HP적감염여담관암적발생유관,대담관암예후존재불리영향.
Objective To survey the status of Helicobacter pylori (HP) infection in cholangiocarcinoma,and its relation to clinical and pathological parameters and prognosis. Methods HP infection in 80 cholangiocarcinoma samples and 30 controls was detected by PCR,in those with positive results the expression of Cag A and its subtypes of Vac A sla,m1 and m2 was further tested by PCR.Results Chi-square test showed that the detection rate of in HP ( + ) in cholangiocarcinoma group is 71％,higher than 20％ in control group.The positive cases of CagA and VacA sla,m1,m2 in cholangiocarcinoma group was respectively 30,40,5 and 43 cases.HP infection in cholangiocarcinoma was correlated with the location of the tumor (x2 =27.580,P ＜ 0.05 ). Multivariate Logistic analysis showed that cholangiocarcinoma is over 10 times more likely in HP ( + ) patients than HP ( - ) ( OR =10.531 ).Cox regression analyses showed that the infection of HP(HR =8.105,P =0.032),the staging of TNM( Ⅱ/ⅢHR=9.141,P=0.040,Ⅳ HR =29.071,P=0.040) and surgery (HR=9.531,P =0.015) are all independent prognostic factors of cholangiocarcinoma. Life table analyses showed HP infection negatively affects the survival time of cholangiocarcinoma after a surgery ( u =10.074,P =0.002),and the median survival time is 7.25 months shorter than HP( - ) patients. Conclusions It is common that HP infection complicating cholangiocarcinoma,usually with the genotype of VacA sla/m2,HP infection is a risk factor for cholangiocarcinoma,and negatively affects oatients survival after surgery.
