幽门螺杆菌相关胃外疾病研究进展

刘晋阳 陈峥宏 马牧溪 林永帅 谭伟伟

摘要：幽门螺杆菌（Hp）是一种常见的胃肠道感染的革兰氏阴性杆菌，主要存在于胃上皮细胞表面和黏液中，与胃溃疡、胃癌和胃黏膜等相关淋巴瘤有关。研究表明Hp可诱发或加重某些胃外疾病，还与新型冠状病毒感染发生有关，因此Hp可能通过刺激机体产生炎症因子或发生交叉免疫反应，间接或直接地参与胃外疾病的发生和发展，同时Hp还可进入念珠菌内，持续释放毒素，且发挥躲避免疫系统识别和药物杀菌作用。本文总结近年国内外对Hp相关胃外疾病的研究报道，旨在引起临床工作者对Hp相关胃外疾病的重视，积极地掌握Hp的感染相关学科知识，从而科学制订避免Hp加重或诱发其他疾病的对策。

关键词：幽门螺杆菌；胃外疾病；交叉免疫反应；新型冠状病毒感染

中图分类号： R573  文献标识码： A  文章编号：1000-503X（2024）03-0414-11

DOI：10.3881/j.issn.1000-503X.15698

Research Progress of Helicobacter pylori-Associated Extragastric Diseases

LIU Jinyang 2，CHEN Zhenghong3，4，MA Muxi5，LIN Yongshuai 2，TAN Weiwei 2

1Clinical Medicine School，Guizhou Medical University，Guiyang 55000 China

2Department of Urology，The Affiliated Hospital of Guizhou Medical University，Guiyang 55000 China

3Helicobacter pylori and Intestinal Microecology Joint Laboratory/Department of Urology，The Affiliated Hospital of Guizhou Medical University，Guiyang 55000 China

4Key Laboratory of Pathogenic Biology Characteristics，Guizhou Provincial Department of Education，Guiyang 55000 China

5Central Hospital of Yicheng District in Zhumadian，Zhumadian，Henan 463000，China

Corresponding author：CHEN Zhenghong Tel：13985006815，E-mail：chenzhenhong@gmc.edu.cn

ABSTRACT：Helicobacter pylori （Hp） is a common Gram-negative bacillus causing gastrointestinal infections.It mainly exists on the surface of gastric epithelial cells and in mucus and is associated with gastric ulcers，gastric cancer，and gastric mucosa-associated lymphomas.Studies have shown that Hp can induce or exacerbate certain extragastric diseases and is associated with the occurrence of coronavirus disease 2019.It is hypothesized that Hp may be indirectly or directly involved in the occurrence and development of diseases by stimulating the production of inflammatory cytokines or inducing cross-immune reactions.In addition，Hp can enter Candida to release toxins continuously and play a role in escaping the recognition of the host immune system and the bactericidal effect of drugs.This article reviews the research progress in Hp-associated extragastric diseases in recent years，aiming to draw the attention of clinical workers to Hp-associated extragastric diseases and enrich the knowledge about Hp infection for formulating countermeasures to avoid the aggravation or triggering of other diseases by Hp.

Key words：Helicobacter pylori；extragastric diseases；cross-immune reaction；coronavirus disease 2019

Acta Acad Med Sin，2024，46（3）：414-424

幽门螺杆菌（Helicobacter pylori，Hp）在全球范围内的感染率超过50%，尤其是在发展中国家的感染率明显高于发达国家［1-2］。除了胃内疾病，越来越多的证据表明，Hp的感染与心血管系统、免疫系统和神经系统等系统疾病相关，有研究报道Hp与新型冠状病毒肺炎和阿尔茨海默病（Alzheimers disease，AD）等有关［3-7］。Hp的感染使得治疗某些疾病变得较为复杂，而医务工作者在患者感染Hp早期又会忽略Hp与某些胃外疾病的关系，可造成感染Hp患者原有某些疾病加重。

近日有研究指出：Hp能与念珠菌形成原核-真核共生物，即Hp内化念珠菌，不仅在念珠菌内的Hp可持续释放毒力因子于胞外，对局部组织或全身产生致炎作用，并且念珠菌内的Hp还具有躲避抗生素的作用［8-9］。……