ЭТИОЛОГИЧЕСКИЕ ФАКТОРЫ ХРОНИЧЕСКИХ ГАСТРИТОВ У ДЕТЕЙ

  • View
    216

  • Download
    2

Embed Size (px)

Transcript

  • 15

    : , , : 125412, , . , . 2, . (495) 487B46B81 22.10.2005 ., 14.03.2006 .

    ..

    145 . 40% . HELICOBACTER PYLORI (H. PYLORI) 44,8% . 27,6% . . H. PYLORI( ) ( ). : , , , , , , HELICOBACTER PYLORI.

    Etiological factors of chronicgastritis in children

    G.V. Volynets

    Moscow Research Institute of Pediatrics and Children'sSurgery, the Federal Agency for Healthcare and SocialDevelopment (Roszdrav)

    IN THE ARTICLE THE DATA ON THE STUDY OF THE ETIOLOGICAL FACTORS OFVARIOUS TYPES OF CHRONIC GASTRITIS IN CHILDREN ARE PRESENTED.BASED ON REVEALING OF THE AUTOANTIBODIES TO PARIETAL GASTRICCELLS IN 40,0% OF CHILDREN AUTOIMMUNE GASTRITIS (A TYPE GASTRITIS)IS DIAGNOSED. HELICOBACTER PYLORI INFECTION IS REVEALED IN 44,8% OFCHILDREN. IN 27,6% OF CHILDREN TYPE C GASTRITIS IS DIAGNOSED.AUTOIMMUNE GASTRITIS IN CHILDREN HAS BEEN LINKED TO THE ACTIVEPHASE OF CHRONIC EPSTEINBBARR VIRUS INFECTION. THE ETIOLOGICALFACTORS OF NONAUTOIMMUNE GASTRITIS ARE HELICOBACTER PYLORIINFECTION (TYPE B GASTRITIS) AND MULTIPLE DUODENOGASTRIC REFLUXES(TYPE C GASTRITIS).KEY WORDS: CHILDREN, CHRONIC GASTRITIS, ETIOLOGICAL FACTORS,AUTOIMMUNE GASTRITIS, NONAUTOIMMUNE GASTRITIS, ACTIVE PHASEOF CHRONIC EPSTEINBARR VIRUS INFECTION, HELICOBACTER PYLORIINFECTION.

    . : ( B); , H. pylori ( ), (, B , , B, , ) [1, 2]. , H. pylori B , B B [35]. , H. pylori B [6, 7]. B B , . H. pylori, B , , . , , B, , B [812]. B B [1316]. B [1]. McIntyre et al. 1965 . . B , [17]. ,

  • 16

    , 13 14% [18, 19]. B B , [1, 2026]. B . B [27]. B , [28]. 30% H+/K+B, . B [21,29]. B , B H+/K+B B [21, 30, 31]. . , , B , B . B , B [28]. BB , B [30]. B , B [3235]. , B [36]. 36% B , B, [37]. B , [36]. B B H. pylori 6,5%. [37]. B B, , B . , B [21, 38]. B , B, 11 12 [39]. B , B , B, I , , B. , , B [38, 40]. , B [41]. H. pylori B . , H. pylori [42, 43]. H. pylori B

    , . , 3050% B . H. pylori [23, 4446]. B, , , H. pylori, [47]. , 27,7% H. pyloriB H+/K+B. , , , B [4850]. H. pyloriB S. Eight et al. 1996 . B B , . ylori [51]. [52]. M. Stolte et al. (1998) . ylori [53]. , B H. pylori B , B [54, 55]. , B , B .

    2002 . 2006 . 145 (79 66 ) 3 17 ( 10,1 0,3 ) . 3 . 70 (37 33 ) 3 17 ( 10,1 0,5 ). , 6 , 2 B , B . B H. pylori B 2 . B 30 , B H. pyloriB. 40 H. pyloriB. 58 (35 23 B) 4 17 ( 10,8 0,5 ). B . H. pylori 2 . B 23 , H. pylori ( ). 35 H. pylori ( +). B ( B, , , B , B

  • 17

    / 2

    00

    6/

    5/

    3

    ), , B . ( ) 17 7,0 0,8 B, B . B H. pylori, . B B OLYMPUS VB160 (B). BB H. pylori H. pylori (, ). B H. pylori Helicobacter pylori ( , ). , B IgG H. pylori (). B B 1:20 B B . B 1:10 , B . B B (IgM, IgG) 12 , IgM, IgG (), B HUMAN (B), BioRad (), B (). 1 2 , B , B . B BB . 290 .. BB100BR (. N VB9B100BR), B 1000 B / (B BB B ). B B B . .. B . .. . B, B B B. : IgG B

    1015 ..;

    IgM ;

    IgG B ;

    .

    : IgG B

    1015 ..;

    IgG /

    IgM B /

    / .

    B B BB5 B (). B , B B B B ().

    1 2 , IgM B. IgG 1 2 B 1:800 1:12800 16 (11,1%); 14 (9,7%) 1:1600. 12 . B 2 (1,4%) . , IgM 6 (4,2%); IgG 1:800 1:6400 21 (14,6%) , 11 (7,6%) 1:1600. , B 4 (2,1%) . B B 1 (0,7%) . B IgM IgG. B 111 (76,6%). 35 (31,5%), 76 (68,5%) . 44 B . H. pylori , B IgG H. pylori 65 (44,8%) . B, B 117 145 (80,7%). B 93 (64,1%) 145 , B 73 (50,3%) 145. B 49 (33,8%) 145 .

  • 18

    58 (40,0%) B , B . B , B, , B , B . B (1:201:40) B (.), B B B . , , B . 26 H. pylori, B . 17 65,4%) B ( B , B . 9 (34,6%) BB . B B , H. pylori B . 1. , B B

    (55 111 49,5% 3 34 8,8% ; 2 = 16,330; p < 0,001). B (5 35 14,3%) (2 = 0,111; p = 0,740) . . B 50 (65,8%) 76, , (2 = 23,411; p < 0,001). B , B (40 44 90,9%). H. pylori B . H. pylori B 4 24 (16,7% B). H. pylori 31 (75,6%) 41, (2 = 18,858; p < 0,001). H. pylori 19 (54,3%) 35. ,

    (n = 145) 22 (15,2%)

    (n = 58) 10 (17,2%)

    (n = 70) 9 (12,9%)

    3 (17,6%), (n = 17)

    .

    20 (13,8%)

    12 (20,7%)

    5 (7,1%)

    3 (17,6%)

    19 (13,1%)

    9 (15,5%)

    9 (12,9%)

    1 (5,9%)

    8 (5,5%)

    2 (3,4%)

    7 (10,0%)

    1 (5,9%)

    . 1. ( %) B (), H. pylori

  • 19

    / 2

    00

    6/

    5/

    3

    H. pylori, 31 (75,6%) 41, B B (2 = 2,926; p = 0,087) B B H. pylori, . B H. pylori 57 (51,4%) 111, 32 (56,1%) B 57. H. pylori 54 (48,6%) 111, 22 (40,7%) 54. (2 = 2,1; p = 0,152) B . B , B H. pylori. H. pylori 26 (89,7%) 29, H. pylori 14 (93,3%) 15; 2 = 0,023;p = 0,880. , B , , B H. pylori. , 23 (39,7%) 58 H. pylori, 5 (8,6%) B B , B , + (B , B ). 23 B , B (. 2). 35 (60,3%) 58 H. pylori, 32 . + ( , B , H. pylori ). 6 (10,3%) B . B B ++ ( ,

    , H. pylori B B ). , 55(94,8%) 58 B . 35(60,3%) 58 B H. pylori. H. pylori B 31 (88,6%) 35, B 4 (11,4%) B 35; 2 = 42,299; < 0,001. B H. pylori 19 (32,8%) 58, B H. pylori 4 (6,9%) 58; 2 = 10,629; < 0,001. 70 B . , 70 40 (57,1%) B ( ). 30 (42,9%) B H. pylori B . 15 B B . + ( B , B )( 3).

    B 56 (80,0%) 70. (2 = 23,411;p < 0,001) (30 B 56 53,6%), (5 55 9,1%). (4 56 7,1%) B , (40 55 72,7%); 2 = 47,179; p < 0,001. , 26 (37,1%) 70,

    . 2.

    . 3.

  • 20

    44 (62,9%) 70. 30 (42,9%) 70 B H. pylori. H. pylori B 10 (14,3%) 70, 20 (28,6%) 70. B 16 (40,0%) 40, 24 (60,0%) 40. B ( ) B , H. pylori, B B B . , ( ), B H. pylori ( +). , B , ( ) (. 4). B

    ( ), H. pylori( ). , B , B B ( +). B , B (. 4). [12, 13]. B B BB , , B , B B . , :1. B 40% B , . 86,2% B , 60,3% H. pylori. B 6,9% . 2. B 48,3% 42,9% H. pyloriB, 57,1% B B . B .

    . 4. (n = 145)

    1. .. // , , . 1997. . YIII. 3. . 8285.2. Stolte M., Meining A. The updated Sydney system: classificationand grading of gastritis as the basis of diagnosis and treatment //Can. J. Gastroenterol. 2001. V. 15, 9. . 591598.3. .. . / ..,.., ... ., 2002. 592 .4. Helicobacter pylori, B ( B 2122 2000 .) // B , , . 2000. 6. . 79.5. Malfertheiner P., Megraud F., O'Morain C. Guidelines for themanagement of Helicobacter pylori infection. Summary of theMaastrichtB3 2005 Consensus Report.6. .., .. 22000 // . 2002. 2 (B). . 58.7. .. // . 2003. . 11, 3. . 107112.8. .., .., .. B // B. 2004. 89. . 68.

    9. .. // . B 2 , B 50B . . ., 2004. . 126135.10. .., .. :, , , // . . B . 1998. 3. . 713.11. Kangro H.O., Chong S.K.F., Hardiman A. et al. A prospective studyof viral and mycoplasma infection in chronic inflammatory bowel disBcase // Gastroenterol. 1990. V. 98. P. 549553.12. Yarilin D.A., Valiando J., Posnett D.N. A mouse herpesvirusinduces relapse of experimental autoimmune arthritis by infection ofthe inflammatory target tissue // Jurnal of Immunologi. 2004. V. 173. P. 52385246.13. Grinstein S., Preciado M.V., Gattuso P., Chabay P.A., Warren W.H., DeMatteo E., Gould V.E. Demonstration of EpsteinBBarr virus in carcinomas ofvarious sites // Cancer Res. 2002. V. 62, 17. . 48764878.14. Tajima M., Komuro M., Okinaga K. Establishment of EpsteinBBarrvirusBpositive human gastric epithelial cell lines // Jpn. J. Cancer Res. 1998. Mar. 89 (3). . 262268.15. Takasaka N., Tajima M., Okinaga K., Satoh Y., Hoshikawa Y.,Katsumoto T., Kurata T., Sairenji T. Productive infection of EpsteinBBarr virus (EBV) in EBVBgenomeBpositive epithelial cell lines (GT38

  • 21

    / 2

    00

    6/

    5/

    3

    and GT39) derived from gastric tissues // Virology. 1998. Aug. 247 (2). . 152159.16. Zhang Y