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1、AdvanceinH.Pyloriinfection同济医院消化内科王志荣BarryMarshallandDrRobinWarren2005NobelWinnersH.pyloriEpidemiologyofH.pyloriinfection1997年:Tomb等完成了代码为26695和J99Hp基因组全序列测定分析全基因组大小分别为1667867个和1643831个bp分别包含有1552个和1495个编码蛋白的开放阅读框(orf),编码区分别占全基因组的91.10%和90.18%89个特异的orf仅存在于J99中而26695中不存在,117个特异的o

2、rf仅存在于26695中而J99中不存在框架漂移存在于部分的26695或J99基因中26695和J99菌株基因组中的非编码的重复序列家族分别为8个和2个。LocatedingastricepitheliumNegativeGramstainS-shipped/arc-shipped/spherical（sometime）4-7monopoleflagellaMicroaerobicenvirementBiologicalcharacterofH.pyloriHp球形变的研究球形变诱因：在营养缺乏，有氧胁迫，延期培养，亚致死剂量抗生素，pH值改变等。球形

3、变结构改变：球形Hp缺乏完整细胞结构，菌体表面分泌多聚糖，形成一层黏液样生物膜，彼此黏附；球形变HpDNA指纹图谱不变。球形变转轨：在适当条件下，可恢复螺旋杆状。球形变意义：失去药物作用靶点；逃避免疫攻击。InfectionanColonizationChronicgastritisPepticulcerGastricadenocarcinomaMALTlymphomagastroesophagealrefluxdisease？functionaldyspepsia？idiopathicthrombocytopenicpurpurairon-defic

4、iencyanemiaH.pylori-relateddiseasesHp损害胃黏膜屏障Hp诱导炎症和免疫反应Hp基因片断整合到宿主细胞DNA影响胃酸的分泌Hp致病机制CagA(cytotoxinassociatedproteinVacA(vacuolatingcytotoxin)SabA(sialicacid-bindingadhesin)BabA(Bloodgroupantigen-bindingadhesion)OipA(outerinflammatoryproteinA)InterfernceofmicroRNAexpressionAmmoni

5、a,lipopolysaccharide,inflammatorymediatorPhosphataseA,ureaseH.pylorivirulencefactorsOverviewofH.pylorifactorsthatinterferewithhostcellfunctionsWroblewskiLE,etal.,Targeteddisruptionoftheepithelial-barrierbyH.pylori.CellCommunicationandSignaling2011,9:29DisruptionofEpithelialcellj

6、unction-basedbarrierDisruptionofEpithelialcelljunction-basedbarrierDisruptionofEpithelialcelljunction-basedbarrierBackertS,etal.,MolecularmechanismsofgastricepithelialcelladhesionandinjectionofCagAbyH.pylori.CellCommunicationandSignaling2011,9:28DisruptionofEpithelialcelljunctio

7、n-basedbarrierTLR,NOD,andtheNF-BsignalingpatrwayRegulationofcellcycleprogressionSignalingcascadesthatregulatetheintrinsicandextrinsicpathwayofapoptosisProgressiontogastricadenocarcinomainducedbyH.pyloriinfectionHCO3-－粘液屏障H＋反弥散致密连接破坏离子交换紊乱上皮细胞损伤粘液分泌减少损害因素尿素酶NH3阻断胃酸对胃泌素分泌反馈抑制G细胞敏

8、感性增强炎症直接刺激CCK对G细胞分泌反馈抑制障碍。D细胞旁分泌SS减少SS对G细胞分泌抑制减