类风湿性关节炎患者根除幽门螺旋杆菌期间实验室指标动态的特殊性

V. Aleksandrov, E. A. Zagorodneva, N. V. Aleksandrova, E. G. Cherkesova, L. N. Shilova, A. Aleksandrov
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Forty women with RA and confirmed chronic H. pylori infection were included in the study (mean age 55.5±8.7 years; mean disease duration 13.9±9.1 years; DAS-28–3.96±0.56). CagA-IgG associated H. pylori infection was diagnosed in 22 (group I, CagA+) and not diagnosed in 18 (group II, CagA-) patients. All RA patients underwent a course of H. pylori eradication therapy.Results. The process of H. pylori eradication had the most significant effect on laboratory parameters of CagA-negative RA patients (group II). In this group the levels of rheumatoid factor (p=0,028), C-reactive protein (CRP, p=0.001), interleukin-6 (IL-6, p=0.002), tumor necrosis factor alpha (p=0,023), angiopoietinlike protein type 3 (p=0.026) and antibodies to cyclic citrullinated peptide (ACCP, p=0,016) decreased significantly. In patients from group I (CagA+) most parameters remained practically unchanged (p>0.05), except for CRP (p=0.01) and IL-6 (p=0.011). 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引用次数: 0

摘要

幽门螺杆菌(H. pylori)能够参与多种自身免疫性疾病的发病机制,积极维持慢性炎症并刺激全身免疫反应。幽门螺杆菌的毒力因子是细胞毒素相关基因 A(CagA),它与更严重的炎症反应、不良临床结果风险增加有关,并能影响类风湿性关节炎(RA)患者的感染根除效果。评估编码细胞毒素相关基因 A 菌株慢性感染的 RA 患者幽门螺杆菌根除效果的实验室参数。研究纳入了 40 名患有 RA 并确诊为慢性幽门螺杆菌感染的女性患者(平均年龄 55.5±8.7 岁;平均病程 13.9±9.1 年;DAS-28-3.96±0.56)。22例(I组,CagA+)患者确诊为CagA-IgG相关幽门螺杆菌感染,18例(II组,CagA-)患者未确诊。所有 RA 患者都接受了一个疗程的幽门螺杆菌根除治疗。结果显示,幽门螺杆菌根除疗法对 CagA 阴性 RA 患者(II 组)的实验室指标影响最大。在该组中,类风湿因子(p=0.028)、C反应蛋白(CRP,p=0.001)、白细胞介素-6(IL-6,p=0.002)、肿瘤坏死因子α(p=0.023)、血管生成素样蛋白3型(p=0.026)和环瓜氨酸肽抗体(ACCP,p=0.016)的水平显著下降。在第一组(CagA+)患者中,除 CRP(p=0.01)和 IL-6(p=0.011)外,大多数参数基本保持不变(p>0.05)。在短期内,CagA+ 患者的根除成功率明显低于 CagA- 患者(p=0.033)。此外,在 CagA+ 和高滴度 ACCP 及改良瓜氨酸波形蛋白抗体的组合中,在既定时间内成功根除幽门螺杆菌的确认极为罕见(p=0.009)。在RA患者中根除幽门螺杆菌的效果取决于编码细胞毒素相关基因A的菌株是否存在慢性感染以及瓜氨酸化蛋白抗体的水平,在选择对该群体幽门螺杆菌的治疗效果时应考虑到这一点。
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Peculiarities of laboratory parameters dynamics during helicobacter pylori eradication in patients with rheumatoid arthritis
Helicobacter pylori (H. pylori) is able to participate in the pathogenesis of a number of autoimmune diseases, actively maintains chronic inflammation and stimulates the systemic immune response. The virulence factor of H. pylori is cytotoxin-associated gene A (CagA) is associated with more severe inflammatory reactions, increased risk of poor clinical outcomes and is able to influence the efficacy of infection eradication in patients with rheumatoid arthritis (RA).Purpose of the study. To evaluate laboratory parameters of H. pylori eradication efficacy in RA patients with chronic infection with the strain encoding cytotoxin-associated gene A.Materials and methods. Forty women with RA and confirmed chronic H. pylori infection were included in the study (mean age 55.5±8.7 years; mean disease duration 13.9±9.1 years; DAS-28–3.96±0.56). CagA-IgG associated H. pylori infection was diagnosed in 22 (group I, CagA+) and not diagnosed in 18 (group II, CagA-) patients. All RA patients underwent a course of H. pylori eradication therapy.Results. The process of H. pylori eradication had the most significant effect on laboratory parameters of CagA-negative RA patients (group II). In this group the levels of rheumatoid factor (p=0,028), C-reactive protein (CRP, p=0.001), interleukin-6 (IL-6, p=0.002), tumor necrosis factor alpha (p=0,023), angiopoietinlike protein type 3 (p=0.026) and antibodies to cyclic citrullinated peptide (ACCP, p=0,016) decreased significantly. In patients from group I (CagA+) most parameters remained practically unchanged (p>0.05), except for CRP (p=0.01) and IL-6 (p=0.011). In the short term, the success of eradication in CagA+ patients was significantly lower than in CagA- patients (p=0.033). Moreover, confirmation of successful eradication of H. pylori within the established period of time was extremely rare (p=0.009) in the combination of CagA+ and high titers of ACCP and antibodies to modified citrullinated vimentin.Conclusions. The effectiveness of H. pylori eradication in RA patients depends on the presence of chronic infection with the strain encoding the cytotoxin-associated gene A and the level of antibodies to citrullinated proteins, which should be taken into account when choosing the therapeutic effect on H. pylori in this group.
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