Helicobacter pylori, parietal cell antibodies and autoimmune gastropathy in type 1 diabetes mellitus
Helicobacter pylori, parietal cell antibodies and autoimmune gastropathy in type 1 diabetes mellitus
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DOI：
10.1046/j.1365-2036.2002.01186.x
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发表时间：
2002-02-01
影响因子：
7.6
通讯作者：
Van Gaal, LF
中科院分区：
文献类型：
--
作者：
De Block, CEM;De Leeuw, IH;Van Gaal, LF
背景：15% 至 20% 的 1 型糖尿病患者表现出壁细胞抗体（PCA），其与自身免疫性胃炎、胃酸过少、缺铁和恶性贫血有关。目的：探讨幽门螺杆菌感染是否可以解释糖尿病中 PCA 和自身免疫性胃病的高患病率。如果是这样，根除幽门螺杆菌可以预防自身免疫性胃炎。方法：对 229 名 1 型糖尿病患者（男/女：135/94；年龄：41 +/- 12 岁）的 PCA 进行了测量。通过血清学、尿素呼气试验和组织学（更新的悉尼系统）对 88 名受试者进行幽门螺杆菌感染评估。对 42 名患者进行了五肽胃泌素检测。结果：69 名患者 PCA 阳性。 72名患者中存在幽门螺杆菌感染，并且与HLA-DQA1*0103-B1*0603呈负相关（OR=0.12，P=0.015），与DQA1*0501-B1*0201呈正相关（OR=1.9，P=0.032）。 PCA-阳性与HLA-DQA1*0501-B1*0301相关(OR=3.9，P=0.017)。当 PCA 阳性被定义为滴度大于或等于 1/20（OR = 2.0，P = 0.03）时，观察到幽门螺杆菌和 PCA 之间存在关联，但如果大于或等于 1/40 为截止点，则观察不到关联。 PCA 阳性而非幽门螺杆菌感染与缺铁性贫血（OR = 2.7，P = 0.008）、恶性贫血（OR = 33.5，P < 0.0001）、胃酸过少（OR = 12.1，P = 0.0008）和自身免疫性胃炎（OR = 12.5，P < 0.0001）相关。 0.0001).结论：HLA结合敏感性 幽门螺杆菌和 PCA 有所不同。 PCA 阳性但不持续的幽门螺杆菌感染与自身免疫性胃炎相关。 PCA 滴度低可能反映幽门螺杆菌感染，而不是自身免疫性胃病。
Background: Fifteen to 20% of type 1 diabetic patients exhibit parietal cell antibodies (PCA), which are associated with autoimmune gastritis, hypochlorhydria, iron deficiency and pernicious anaemia.Aim: To examine whether Helicobacter pylori infection could explain the high prevalence of PCA and autoimmune gastropathy in diabetes. If so, H. pylori eradication could prevent autoimmune gastritis.Methods: In 229 type 1 diabetics (M/F: 135/94; age: 41 +/- 12 years) PCA were measured. H. pylori infection was assessed by serology, urea breath test in all and by histology (updated Sydney system) in 88 subjects. Pentagastrin tests were performed in 42 patients.Results: Sixty-nine patients were PCA-positive. H. pylori infection was present in 72 patients and was negatively associated with HLA-DQA1*0103-B1*0603 (OR = 0.12, P = 0.015) and positively with DQAl*0501-B1*0201 (OR = 1.9, P = 0.032). PCA-positivity was linked to HLA-DQAl*0501-B1*0301 (OR = 3.9, P = 0.017). A link between H. pylori and PCA was observed when PCA-positivity was defined as a titre greater than or equal to 1/20 (OR = 2.0, P = 0.03), but not if greater than or equal to 1/40 was the cut-off point. PCA-positivity, but not H. pylori infection, was associated with iron deficiency anaemia (OR = 2.7, P = 0.008), pernicious anaemia (OR = 33.5, P < 0.0001), hypochlorhydria (OR = 12.1, P = 0.0008) and autoimmune gastritis (OR = 12.5, P < 0.0001).Conclusions: The HLA-bound susceptibility of H. pylori and PCA differed. PCA-positivity but not ongoing H. pylori infection is associated with autoimmune gastritis. Low titres of PCA might reflect H. pylori infection rather than autoimmune gastropathy.