Interaction between infection of different subtypes of Helicobacter pylori and pathological progression of gastric intraepithelial neoplasia of gastric polyps

LI Zhongfeng; MENG Min; XU Ye; WU Xiaochen; LU Huihui

doi:10.3969/j.issn.1007-8134.2025.01.013

Abstract：Objective To analyze the interaction between different subtypes of Helicobacter pylori(Hp)infection and pathological progression of gastric polyps in gastric intraepithelial neoplasia(GIN).Method A total of 200 GIN patients admitted to our hospital from January 2021 to January 2024 were enrolled,including 118 cases of low-grade intraepithelial neoplasia(LGIN)and 82 cases of high-grade intraepithelial neoplasia(HGIN).General patient data were collected,and the levels of IL-6,IL-8,TNF-α,CD4+T lymphocytes,and CD8+T lymphocytes in local gastric immune status were analyzed.Gastric lesions were examined via electronic gastroscopy,mucosal tissue biopsies were performed,and Hp infection was assessed by taking different parts and different types of polyp biopsies or background mucosa under gastroscopy.Hp positive cases were further divided into HP-type Ⅰ positive and HP-typeⅡ positive according to the results of Hp antibody detection.Multivariate Logistic regression was used to analyze the factors affecting the pathological progression of GIN.To analyze the effects of Hp infection and gastric polyps on the pathological progression of GIN.The generalized multifactor dimensionality reduction(GMDR)method was used to analyze the multi-factor interaction.Results(1)There were 118 cases with LGIN,82 cases with HGIN,41 cases with LGIN and 52 cases with HGIN.There were 93 cases(46.50％)with pathological upgrade and 107 cases(53.50％)with no pathological upgrade.(2)HP-type Ⅰ infection rate was higher than HP-Ⅱ infection rate in HGIN and GC;Compared with HGIN group,HP-type Ⅰ infection rate was increased in GC group.There was no significant difference in the distribution of HP-Ⅰ and HP-type Ⅱ infection rates in HGIN and GC(P＞0.05).(3)Multivariate Logistic regression analysis showed that history of gastric ulcer,gastric polyp,lesion size,heterotype of blood vessels,gastric mucosal lesions and Hp infection were independent risk factors for the pathological progression of GIN(P＜0.05).(4)The rate of Hp infection and gastric polyp in HGIN group increased significantly compared with the group without pathological upgrade.In pathological upgrade group,the rate of Hp infection and gastric polyp in GC group was significantly higher than that in HGIN group(P＜0.001).It was still statistically significant after adjusting for Gin-related factors(P＜0.001).Trend analysis showed that the infection rate of Hp and the OR value of gastric polyps increased with the severity of GIN lesion(P＜0.001).(5)Gastric local immune status was detected in the 5 groups,and the results showed that compared with the HP-negative group,the levels of IL-6,IL-8 and TNF-αwere significantly increased in the HP-type Ⅰ positive group and the HP-type Ⅱ positive group,while CD4+T lymphocytes and CD8+T lymphocytes were significantly decreased(P＜0.05).Compared with the group without gastric polyps,the levels of IL-6,IL-8 and TNF-α were significantly increased in the group with gastric polyps,and CD4+T lymphocytes and CD8+T lymphocytes were significantly decreased(P＜0.05).(6)The levels of IL-6,IL-8 and TNF-α in the gastric area in the pathological upgrade group were significantly higher than those in the group without pathological upgrade,and CD4+T lymphocytes and CD8+T lymphocytes were significantly lower than those in the group without pathological upgrade(P＜0.05).(7)The results of multi-factor analysis were introduced into GMDR model analysis,and the result of substitution test showed that the sixth-order interaction model was the best model,and the substitution test had statistical significance(P＜0.05).Conclusion Different subtypes of Hp infection and gastric polyp are not only independent risk factors affecting the pathological upgrading of GIN,but also the combination of the 2 has an interactive effect on the pathological upgrading of GIN.Focusing on different subtypes of Hp infection and gastric polyp is conducive to the early diagnosis and treatment of GIN.