십이지장 궤양 발생과 Helicobacter pylori 균주의 cagA, vacA 및 iceA 유전자형과의 상관관계
Relationship between duodenal ulcers and cagA, vacA, and iceA genotypes of Helicobacter pylori
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목적 : 한국인에서 H. pylori 독성인자의 유전자형을 확인하고, 십이지장 구부와 위 전정부에서 H. pylori를 각각 검출하여 십이지장 궤양 발생과 관련된 균주의 특성과 유형을 조사하고자 하였다. 방법 : 위내시경 검사를 통해 H. pylori 감염이 확인된 십이지장 궤양 28예, 만성 위염 20예를 대상으로 하였다. 십이지장 구부의 조직은 각각 2개씩 세균배양검사와 병리학적 검사를, 위 전정부의 조직은 각각 신속요소분해효소검사와 세균배양검사에 이용하였다. 배양된 균주의 cagA, vacA 및 iceA 유전자형을 분석하였고, RAPD 지문술을 시행하였다. 결과 : 1) 십이지장 궤양의 십이지장 구부와 위 전정부의 H. pylori 배양률은 각각 50% (14/28), 46% (13/28)였다. 2) 십이지장 궤양에서 배양된 H. pylori 균주의 유전자형은 cagA+ vacA s1/m1 iceA1 12예, cagA+ vacA s1/m2 iceA1 4예였다. 3) 십이지장 궤양 중 십이지장 구부와 위 전정부에서 모두 균이 배양된 11예 중 2예에서 RAPD 지문술상 십이지장 구부와 위 전정부의 H. pylori DNA subtype의 차이를 보였다. 4) 십이지장 궤양에서 같은 환자의 십이지장 구부와 위 전정부의 독성인자의 유전자형은 모두 같았다. 5) 대조군의 십이지장 구부와 위 전정부의 H. pylori 배양률은 각각 30% (6/20), 35% (7/20)였다. 6) 대조군의 유전자형은 십이지장 궤양과 유의한 차이는 없었다. 결론 : 1) 십이지장 궤양에서 십이지장 구부와 위 전정부의 H. pylori 유전자형은 모두 같아서 십이지장 내 H. pylori는 위에서 전염된 것으로 판단된다. RAPD 지문술상 2예에서 균주의 DNA subtype이 다른 것은 위 점막에 H. pylori 균주의 중복 감염이 발생할 수 있음을 시사한다. 2) 십이지장 궤양과 만성 위염에서 H. pylori 유전자형과 DNA subtype은 유의한 차이가 없는데 이는 질병 발생의 원인으로 H. pylori 균주의 유형보다 숙주 요인 또는 다른 유전자 등 다른 원인이 더 중요한 역할을 할 가능성이 있음을 시사한다.
Abstract
Background : The aims of this study were to evaluate whether genotypes of Helicobacter pylori are different between the gastric antrum and duodenal bulb in order to assess the roles of duodenal H. pylori strains in development of duodenal ulcer. Methods : Forty-eight H. pylori infected patients (duodenal ulcer 28, chronic gastritis 20) were included for the study. Biopsy specimens were taken separately from the antrum and duodenal bulb for the histologic examination and H. pylori culture. cagA, vacA, and iceA genotypes of H. pylori were examined by polymerase chain reaction and H. pylori DNA subtypes by random amplified polymorphic DNA (RAPD) fingerprinting. Results : H. pylori genotypes were not significantly different between antrum and duodenal bulb of the duodenal ulcer and chronic gastritis. RAPD fingerprinting showed different H. pylori strains between the gastric antrum and duodenal bulb in 2 patients with duodenal ulcer. Most prevalent genotype was cagA+ vacA s1/m1 iceA1 in duodenal ulcer (15/16). Conclusion : The host factor or other genotypes may play the major roles in duodenal ulcerogenesis compared with H. pylori genotype itself.
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