Aim: To study the occurrence of L-forms of H. pylori infection in patients with peptic ulcers and its association with possible changes of cellular immune function in the patients.
Methods: Endoscopic biopsy specimens of gastric antrum and gastric corpus were taken from 228 patients with peptic ulcers and inoculated into Skirrow selective medium for H. pylori vegetative forms and special medium for H. pylori L-forms, followed by bacterial isolation and identification. And peripheral venous blood of the patients was taken to detect the percentage of CD3(+), CD4(+) and CD8(+) with biotin-streptavidin (BSA) and the level of IL-2, IL-6 and IL-8 with ELISA.
Results: (1) The detection rates of H. pylori L-forms and vegetative forms in the patients were 50.88 % (116/228) and 64.91 % (148/228) respectively, and the co-infection rate of H. pylori L-forms and vegetative forms was 78.38 % (116/148). To be more exact, the detection rates of H. pylori L-forms in male and female patients were 57.04 % (77/135) and 41.94 % (39/93) respectively, and statistics found significant difference between them (P<0.05). Furthermore, the detection rates of H. pylori L-forms in patients aged 14 years-, 30 years-, 40 years- and 50 years- were 31.91 % (15/47), 42.86 % (24/56), 56.94 % (41/72) and 67.92 % (36/53) respectively, and there was significant difference between them (P<0.01). (2) The percentages of CD3(+), CD4(+), CD8(+), the ratio of CD4(+)/CD8(+), and the level of IL-2, IL-6, IL-8 in H. pylori-positive patients were (52.59+/-5.44) %, (35.51+/-5.74) %, (27.77+/-8.64) %, (1.56+/-0.51), (2.66+/-0.47) mg/L, (108.62+/-5.85) ng/L and (115.79+/-7.18) ng/L respectively, compared with those in H. pylori-negative patients, the percentages of CD3(+), CD4(+) and the ratio of CD4(+)/CD8(+) decreased, but the level of IL-2, IL-6 increased, and the difference was significant (P<0.001-P<0.01). Moreover, the percentages of CD3(+), CD4(+), CD8(+), the ratio of CD4(+)/CD8(+), and the level of IL-2, IL-6, IL-8 in the patients with mixed infection of both H. pylori L-forms and vegetative forms were (51.69+/-5.28) %, (34.75+/-5.89) %, (27.15+/-7.45) %, (1.48+/-0.47), (2.16+/-0.38) mg/L, (119.45+/-5.44) ng/L and (123.64+/-6.24) ng/L respectively, compared with those in patients with simple infection of H. pylori vegetative forms, the percentage of CD4(+), the ratio of CD4(+)/CD8(+) and the level of IL-2 increased, but the level of IL-6 and IL-8 decreased, statistical difference was found between them (P<0.001-P<0.05).
Conclusion: L-forms variation often occurs in patients with peptic ulcers who are infected by H. pylori, which is commonly found in male patients and related to ages. The L-forms variation of H. pylori can be an important factor causing disorder of cellular immune function in the patients with peptic ulcers who are infected by H. pylori.