幽門螺旋桿菌暴露與攝護腺發炎性疾病關連之統計及生物學證據
郭萌享，陳志碩，林威宇，何東儒，黃雲慶，林健煇，黃國財，邱國雄
嘉義長庚醫院 外科部 泌尿外科
Statistical and Biological Evidences of Link between Helicobacter pylori Exposure and Prostate Inflammatory Diseases
Meng-Hsiang Kuo, Chih-Shou Chen, Wei-Yu Lin, Dong-Ru Ho, Yun-Chin Huang,
Pey-Jium Chang, Jian-Hui Lin, Kuo-Tsai Huang, Kuo-Hsiung Chiu
Division of Urology, Department of Surgery Chang Gung Memorial Hospital, Chia-Yi, Taiwan
Purpose: Previous studies had implied that Helicobacter pylori (H.pylori) exposure may initiate systemic inflammation and result in prostate diseases. We designed this retrospective cohort study utilizing a population-based dataset to examine the association of Helicobacter pylori (H. pylori) infection with prostate diseases. A simple non-bacterial prostatitis rat model was designed to evaluate effect of H.pylori protein exposure on arising of prostatitis
Materials and Methods: In the statistical part, we used data sourced from the Taiwan Longitudinal Health Insurance Database. The cases comprised 12,439 subjects with H. pylori infection and 12,439 randomly matched subjects without H. pylori infection as controls. We used a conditional logistic regression to calculate the odds ratio (OR) for benign prostate disease (BPD) between subjects with and without H. pylori infection. In animal study, subcutaneous dorsal H. pylori protein extract injection in time sequential manner was used to induce chronic reaction. Systemic and prostate inflammation were evaluated by checking splenic tumor necrosis factor alpha (TNF-a), interleukin-1 beta (IL-1b), and prostatic nuclear factor-kappa B (NF-kB) respectively. Prostate was stained to confirm the location of these responses
Results: Of the 24878 sampled subjects, 3688 (14.8%) had developed BPD after the index date; BPD was found in 2008 (16.1%) cases and 1680 (13.5%) controls (p<0.001). Regression analysis revealed, the OR for BPD among cases was 1.215 (95% CI = 1.130-1.306, p<0.001) after adjusting for diabetes, hypertension, hyperlipidemia, coronary artery disease, urinary tract infection, and urolithiasis. In rats with protein extract injection, increased tactile hypersensitivity in scrotal base was found 15 days after injection. There were Increased TNF-a and IL-1b. Prostate inflammation was also confirmed by NF-kb and Caspase 1 staining, which was compatible with physiological changes in rats.
Conclusion: There may be some link between H.pylori protein exposure and prostate inflammation. Our analysis may be only a part of the whole picture. Local prostatic inflammation may be induced by distant antigen-related systemic response