Đặc điểm các yếu tố độc lực cagA, vacA của vi khuẩn Helicobacter pylori và tính đa hình của Enzym CYP2C19 trên bệnh nhân viêm loét dạ dày tá tràng do nhiễm H.pylori chưa từng điều trị

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Tác giả: Nhật Huy Âu, Hồng Thanh Nguyễn, Thị Khánh Tường Trần, Thị Mai Thảo Trần

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y Dược học Phạm Ngọc Thạch, 2024

Mô tả vật lý: tr.147

Bộ sưu tập: Metadata

ID: 286476

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Đặt vấn đề: Helicobacter pylori là tác nhân gây ung thư nhóm 1. Gen cagA và vacA được quan tâm nhiều nhất vì đây là hai yếu tố độc lực quan trọng liên quan đến khả năng gây bệnh của vi khuẩn này. Bên cạnh đó, tính đa hình của Enzym CYP2C19 làm thay đổi sự chuyển hóa của nhóm thuốc ức chế bơm proton từ đó ảnh hưởng đến kết quả điều trị ở bệnh nhân viêm loét dạ dày tá tràng cũng như ảnh hưởng đến kết quả điều trị tiệt trừ H.pylori. Mục tiêu: Khảo sát tỷ lệ các yếu tố độc lực Cag A, Vac A của vi khuẩn H.pylori và tỷ lệ các kiểu hình của Enzym CYP2C19 trên bệnh nhân viêm loét dạ dày tá tràng chưa từng được điều trị. Đối tượng và phương pháp nghiên cứu: Nghiên cứu mô tả cắt ngang thực hiện trên 216 bệnh nhân viêm loét dạ dày tá tràng bệnh viện Quốc Tế Mỹ từ tháng 10/2019 - 9/2022. Kiểu gene cagA, vacA và kiểu gen mã hóa cho Enzym CYP2C19 được xác định bằng kỹ thuật PCR. Kết quả: Có 216 BN, tuổi trung bình 42,85 ± 11,76. Chủng H. pylori có độc lực Cag A (+) chiếm 72,69%, các chủng H. pylori có độc lực Cag A (-) chiếm 27,31%. Không có sự khác biệt phân bố Cag A theo giới tính (p = 0,488). Chủng H. pylori mang độc lực Vac A chiếm 100% ở nhóm bệnh nhân viêm loét dạ dày tá tràng, trong đó kiểu s1m1 chiếm tỷ lệ cao nhất là 50%, kiểu s-m1 chiếm tỷ lệ thấp nhất là 0,46%. Không có sự khác biệt có ý nghĩa giữa kiểu phân bố độc lực Vac A và giới tính (p = 0,78). Có sự khác biệt về phân bố của độc lực Vac A theo nhóm Cag A (+) và Cag A (-). Những bệnh nhân viêm loét dạ dày tá tràng có kiểu hình CYP2C19 chuyển hóa thuốc PPI trung bình chiếm tỷ lệ cao nhất là 49,07%, kiểu hình chuyển hóa mạnh chiếm 39,35%, kiểu hình chuyển hóa kém chiếm tỷ lệ thấp nhất là 11,58%. Không có sự khác biệt giữa kiểu hình chuyển hóa của Enzym CYP2C19 giữa nam và nữ với p = 0,454. Kết luận: Ở những BN viêm loét dạ dày tá tràng có nhiễm H.pylori chưa từng được điều trị, kiểu gen độc lực Cag A (+) và kiểu gen VacA s1m1 chiếm ưu thế. Đây là những chủng có mức độ tổn thương nặng và mức độ hoạt động mạnh hơn các chủng khác. BN có kiểu hình chuyển hóa thuốc trung bình, và chuyển hóa thuốc mạnh chiếm tỷ lệ khá cao. Ở những bệnh nhân này có thể bị thay đổi sự chuyển hóa của nhóm thuốc ức chế bơm proton từ đó ảnh hưởng đến kết quả điều trị bệnh viêm loét dạ dày tá tràng cũng như ảnh hưởng đến kết quả điều trị tiệt trừ H.pylori. Abstract Introduction: Helicobacter pylori is a group 1 carcinogen. The genes cagA and vacA are the most studied, as they are crucial virulence factors linked to the pathogenicity of this bacterium. In addition, the polymorphism of the Enzyme CYP2C19 alters the metabolism of proton pump inhibitors (PPIs), thereby affecting treatment outcomes in patients with peptic ulcer disease (PUD) and the eradication of H. pylori. Objective: To investigate the prevalence of H. pylori virulence factors cagA, vacA and the phenotypes of CYP2C19 Enzyme polymorphism in patients with peptic ulcer disease who have not been eradicated H.pylori. Methods: A cross-sectional descriptive study was conducted on 216 patients with peptic ulcer disease at American International Hospital from October 2019 to September 2022. The cagA, vacA genes, and CYP2C19 Enzyme - encoding genes were identified using PCR techniques. Results: Among 216 patients, the mean age was 42.85 ± 11.76. H. pylori strains with CagA (+) virulence factor accounted for 72.69%, while CagA (-) strains accounted for 27.31%. There was no significant gender difference in CagA distribution (p = 0.488). All patients with peptic ulcer disease harbored H. pylori strains with VacA virulence, with the s1m1 type being the most common (50%) and s-m1 the least (0.46%). No significant difference in the distribution of VacA virulence by gender was observed (p = 0.78). There was a significant difference in VacA distribution between CagA (+) and CagA (-) groups. Patients with intermediate CYP2C19 metabolism phenotypes had the highest prevalence at 49.07%, followed by strong metabolizers (39.35%) and poor metabolizers (11.58%). There was no significant difference in CYP2C19 Enzyme metabolism phenotypes between males and females (p = 0.454). Conclusions: In untreated patients with H. pylori - induced peptic ulcer disease, CagA (+) genotype and VacA s1m1 genotype were predominant. These strains are associated with more severe tissue damage and higher activity levels compared to others. Patients with intermediate and strong CYP2C19 metabolizer phenotypes were relatively common. These patients may experience altered metabolism of proton pump inhibitors, which could impact treatment outcomes for peptic ulcer disease and H. pylori eradication. DOI: 10.59715/pntjmp.3.4.18

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