Utjecaj eradikacije Helicobacter pylori i čimbenika virulencije na promjenu premalignih obilježja sluznice želuca

doctoral thesis

• Author: Tajana Filipec Kanižaj; MBZ: 272175
• Mentor: Miroslava Katičić (mentor)
• Committee member: nije dostupno (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2009-10-16, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences
• Universal decimal classification (UDC): 61 - Medical sciences

Abstract

Uvod: Dosadašnja istraživanja nisu odgovorila na pitanje reverzibilnosti H. pylori pozitivnog atrofičnog gastritisa i intestinalne metaplazije sluznice želuca te uloge eradikacijske terapije i čimbenika virulencije. ----- Cilj: utvrditi utjecaj uspješnosti eradikacijske terapije i čimbenika virulencije H. pylori na dinamičnost premalignih promjena: atrofije i intestinalne metaplazije u 5 godišnjem vremenskom intervalu. Usporediti rezultate serološkog određivanja razine enzima PGI, PGII, PGI/II i G17 i nalaza pojedinih stupnjeva patohistoloških promjena. ----- Materijali i metode: U istraživanje je uključeno 186 bolesnika s infekcijom bakterijom H. pylori i u početnom histološkom nalazu prisutnim atrofičnim gastritisom i/ili intestinalnom metaplazijom na jednoj ili obje od anatomskih lokalizacija u želucu. Bioptati želuca analizirani su (prema Sydney i OLGA sistemu) na početnom i kontrolnom (u 5. godina) pregledu. Kod oba pregleda ELISA metodom određena razina enzima PGI, PGII i G17 u serumu. Western blot metodom određena je prisutnost antitijela na p120 (CagA), p95(VacA), p 29 (OMP), p26 i p19 (OMP). Rezultati uspjeha eradikacijske terapije testirani histološki na kontroli u 5-oj godini. ----- Rezultati: Statistički značajna dinamičnost rezultata u petogodišnjem intervalu utvrđena je za obje ispitivane histološke varijable i na obje anatomske lokalizacije te razinu svih ispitivanih enzima. Kod bolesnika s prisutnim patohistološkim parametrom u početnom nalazu utvrđena je statistički značajna regresija stupnja ili stadija u većine (do 98%) bolesnika. U manje od 17% bolesnika prisutna je progresija stupnja ili stadija histološkog parametra. Neuspjeh eradikacijske terapije značajni je prediktor progresije stupnja ili stadija atrofičnog gastritisa korpusa i antruma te intestinalne metaplazije (prema OLGA sistemu). P 120 (cagA) i p 26 serološki negativitet 178 prediktori su progresije atrofičnog gastritisa korpusa te stadija intestinalne metaplazije. Razina enzima G17 statistički značajno korelira stupnjevima intestinalne metaplazije u korpusu želuca. ----- Zaključak: ovisno o bazičnom nalazu, uspješna eradikacija H. pylori u značajnog dijela bolesnika s atrofičnim gastritisom i intestinalnom metaplazijom dovodi do regresije stupnjeva ili nepromjenjivosti prisutnih promjena. Neuspjeh eradikacijske terapije prediktor je progresije histoloških parametara. Razina enzima G17 u prvom pregledu pozitivno korelira s stupnjevima intestinalne metaplazije u korpusu želuca.

Abstract (english)

Introduction: Up till now there is no answer on reversibility of H. pylori positive atrophic gastritis and intestinal metaplasia regarding eradication therapy success and presence of virulence antigens. ----- Aim: of the study was to investigate the role of eradication therapy success and presence of virulence antigens on dynamics of premalignant histological changes (atrophic gastritis and intestinal metaplasia) in 5 year period. Additionally, to correlate results of PGI, PGII, PGI/II and G17 enzyme levels with different grades of histological parameters. ----- Materials and methods: study was performed on 186 H. pylori positive patients with atrophic gastritis and/or intestinal metaplasia in basic bioptic specimens of antrum or corpus. Specimens were analyzed according to Sydney and OLGA protocol in basic and control (5th year). On both examinations serum levels of enzymes was recorded by ELISA method. Western blot was used in order to detect antigens to p120 (CagA), p95 (VacA), p 29 (OMP), p26 and p19 (OMP). All patients received eradication therapy and success was evaluated according to 5th year histological finding. ----- Results: all tested histological parameters revealed statistically significant changes in grade and stage on both anatomical localizations. The same is observed for levels of all tested enzymes. Most (up to 98%) basically positive patients to histological 180 parameters showed significant regression in grade and stage of all parameters. In less than 17% of patients progression of grade or stage of histological parameters was observed. Unsuccessful eradication therapy was predictor of progression of stage and grade of corpus atrophic gastritis and stage of intestinal metaplasia. Negative results to p120 (CagA) and p26 were predictors of corpus atrophic gastritis grade and intestinal metaplasia stage progression respectively. Level of G17 enzyme was positively correlated with higher grades of corpus intestinal metaplasia in basic examination. ----- Conclusions: depending on basic finding, successful H. pylori eradication in related with regression or no change of grade or stage of atrophic gastritis and intestinal metaplasia. Unsuccessful eradication therapy was predictor of progression of stage and grade of histological parameters. Level of G17 enzyme was positively correlated with higher grades of corpus intestinal metaplasia in basic examination.

• Keywords: medicina
• Keywords (english): medicine
• Language: croatian
• URN:NBN: urn:nbn:hr:105:223795
• Study programme: Title: Biomedicine and Health Sciences; Study programme type: university; Study level: postgraduate; Academic / professional title: doktor/doktorica znanosti, područje biomedicine i zdravstva (doktor/doktorica znanosti, područje biomedicine i zdravstva)
• Type of resource: Text
• Extent: 181 str.
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-05-05 08:55:43