Anti-Helicobacter pylori therapy in India: differences in eradication efficiency associated with particular alleles of vacuolating cytotoxin (vacA) gene.
Anti-Helicobacter pylori therapy in India: differences in eradication efficiency associated with particular alleles of vacuolating cytotoxin (vacA) gene.
复制标题
印度的抗幽门螺杆菌治疗：与空泡细胞毒素（vacA）基因特定等位基因相关的根除效率差异。
DOI：
10.1046/j.1440-1746.2003.02944.x
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发表时间：
2003
影响因子：
4.1
通讯作者：
Berg,DouglasE
中科院分区：
文献类型：
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作者：
Chaudhuri,Sujit;Chowdhury,Abhijit;Datta,Simanti;Mukhopadhyay,AsishK;Chattopadhya,Santanu;Saha,DhiraR;Dhali,Gopal;Santra,Amal;Nair,GBalakrish;Bhattacharya,Sujit;Berg,DouglasE
背景和目的：幽门螺杆菌根除的效率因地域而异，包括细菌基因型在内的许多可能影响治疗效率的参数也是如此。本研究的目的是确定效率ofH. pylori根除使用10天的质子泵抑制剂为基础的三联疗法方案（奥美拉唑，克拉霉素和阿莫西林）在印度东部的患者人群，并找出关系，如果有的话，成功或失败的治疗已知功能的细菌genotype.MethodsHelicobacter pylori感染进行了分析，在66个十二指肠溃疡患者的上消化道内镜检查，快速尿素酶试验，组织学和文化。 通过聚合酶链反应研究了培养菌株的细胞毒素相关基因（cagA）和空泡细胞毒素（vacA）基因状态。结果：60例（96.77%）患者溃疡愈合，66例十二指肠溃疡患者中41例（62.12%意向治疗，66.13%符合方案）幽门螺杆菌根除，其余25例未根除。 对47例患者的细菌进行了基因分型。唯一显著的疾病相关性差异是vacA m1等位基因在根除失败的患者中的比例（68%）高于成功根除的患者（39%）（P <0.05）。vacAs 1（信号序列等位基因）或cag致病岛状态与持续性无显著相关性。结论：本研究强调了发展中国家公共卫生对更便宜、更具成本效益的抗幽门螺杆菌治疗的需求，并表明细菌基因型的细微特征会影响治疗效率。 特殊的vacAmid区等位基因影响持久性的可能性，也许是通过对特定胃细胞类型的毒素作用，值得进一步研究。
Background and Aims:The efficiency ofHelicobacter pylorieradication varies geographically, as do many parameters that might affect therapeutic efficiency, including bacterial genotype. The aim of the present study was to determine the efficiency ofH. pylorieradication using a 10‐day proton pump inhibitor‐based triple‐therapy regimen (omeprazole, clarithromycin and amoxycillin) in an eastern Indian patient population, and to find out the relationship, if any, of the success or failure of the therapy to known features of bacterial genotype.MethodsHelicobacter pyloriinfections were analyzed in 66 duodenal ulcer patients by upper gastrointestinal endoscopy, rapid urease tests, histology and culture. The cytotoxin‐associated gene (cagA) and vacuolating cytotoxin(vacA)gene status of cultured strains were studied by polymerase chain reaction. Treatment was given for 10 days and endoscopy was repeated at 4 and 12 weeks post therapy to monitor ulcer healing andH. pylorieradication.Results:Ulcer healing was observed in 60 patients (96.77%).Helicobacter pyloriwas eradicated in 41 (62.12% intention to treat, 66.13% per protocol) of the 66 duodenal ulcer patients, but not in the other 25. The bacteria from 47 patients were genotyped. The only significant disease‐associated difference in patterns observed was that thevacA m1allele was represented more disproportionately among patients with eradication failures (68%) than in those with successful eradication (39%) (P< 0.05) No significant association ofvacAs1(signal sequence allele) orcagpathogenicity island status with persistence was detected.Conclusions:This study highlights the public health need for cheaper, more cost‐effective anti‐H. pyloritherapies for developing countries, and suggests that subtle features of bacterial genotype can influence therapeutic efficiency. The possibility that particularvacAmid region alleles affect persistence, perhaps through toxin action on particular gastric cell types, merits further study.