Helicobacter pylori's virulence and infection persistence define pre-eclampsia complicated by fetal growth retardation

doi:10.3748/wjg.v17.i47.5156

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 17, Issue 47

This Article

Citation of this article

Corresponding Author of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Number of Hits and Downloads for This Article

Total Article Views (6236)

All Articles published online

The chart showing PDF series, HTML series, Figures (1-2) series, Tables (1-6) series.

Item

Count

PDF

472

HTML

5224

Figures (1-2)

246

Tables (1-6)

294

Sum=6236

Dec 21, 2011 (publication date) through Nov 27, 2024

Times Cited of This Article

Times Cited (44)

Journal Information of This Article

Publication Name

World Journal of Gastroenterology

ISSN

1007-9327

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Original Article

World J Gastroenterol. Dec 21, 2011; 17(47): 5156-5165
Published online Dec 21, 2011. doi: 10.3748/wjg.v17.i47.5156

Table 1 Clinical characteristics of study populations (continuous variables)

Variable	Controls (n = 49) Median (25th-75th)	PE-only (n = 17) Median (25th-75th)	PE FGR (n = 32) Median (25th-75th)	FGR-only (n = 13) Median (25th-75th)	P value¹
Maternal age at delivery (yr)	30 (28-33)⁴	29 (24-32)	30 (26-34)⁷	25 (24-26)⁴⁷	⁴< 0.001; ⁷0.002
Gestational age at delivery (wk)	40 (39-41)²³⁴	30 (28-31)²⁵⁶	32 (31-34)³⁵	34 (32-39)⁴⁶	²³⁴< 0.001; ⁵0.045; ⁶0.009
Neonatal weight (g)	3380 (3170-3700)²³⁴	1140 (1045-1570)²	1278 (920-1668)³	1600 (1060-2730)⁴	²³⁴< 0.001
Placental weight (g)	600 (500-650)²³⁴	300 (240-410)²	280 (215-360)³	345 (300-470)⁴	²³⁴< 0.001
Systolic blood pressure (mmHg)	120 (110-120)²³	160 (150-160)²⁶	150 (148-160)³⁷	120 (120-125)⁶⁷	²³⁶⁷< 0.001
Diastolic blood pressure (mmHg)	75 (70-80)²³	100 (100-100)²⁶	100 (95-105)³⁷	77 (75-80) ⁶⁷	²³⁶⁷< 0.001
Proteinuria (g/24 h)	0 (0-0)²³	2.21 (1.52-3)²⁶	1.34 (0.79-2.38)³⁷	0 (0-0)⁶⁷	²³⁶⁷< 0.001

¹P values were calculated by non-parametric Kruskal-Wallis H test, with post-hoc analysis by Mann-Whitney U test.

²Comparison between controls and PE-only group;

³Comparison between Controls and PE FGR group;

⁴Comparison between controls and FGR-only group;

⁵Comparison between PE-only and PE FGR groups;

⁶Comparison between PE-only and FGR-only groups;

⁷Comparison between PE-only and FGR-only groups. PE: Pre-eclampsia; FGR: Fetal growth retardation.

Table 2 Clinical characteristics of study populations (categorical variables) n (%)

Variable		Controls (n = 49)	PE-only (n = 17)	PE FGR (n = 32)	FGR-only (n = 13)	P value⁵
Cesarean section delivery		15 (30.6)⁶⁷⁸	16 (94.1)⁶	29 (90.6)⁷	9 (69.2)⁸	⁶⁷< 0.001; ⁸0.022
Neonatal sex	Male	19 (38.8)⁷	7 (41.2)	20 (62.5)⁷	6 (46.2)	⁷0.043
	Female	30 (61.2)	10 (58.8)	12 (37.5)	7 (53.8)	NS
Nulliparae		31 (63.3)⁶⁷	16 (94.1)⁶	27 (84.4)⁷	10 (76.9)	⁶0.015; ⁷0.047
Maternal risk factors		4 (8.2)	2 (11.8)¹	8 (25.0)	1 (7.7)	NS
	Autoimmune diseases	1 (2.0)	2 (11.8)	4 (12.5)	0 (0)	NS
	Cardiovascular diseases	3 (6.1)	1 (5.9)	4 (12.5)	1 (7.7)	NS
Family risk factors		20² (40.8)⁶	12³ (70.6)⁶¹⁰	13⁴ (40.6)	2 (15.4)¹⁰	⁶0.049; ¹⁰0.004
	Hypertension	9 (18.4)	8 (47.1)	10 (31.3)	2 (15.4)	NS
	Diabetes	10 (20.4)	3 (17.6)	5 (15.6)	0 (0)	NS
	Cardiovascular diseases	5 (10.2)	2 (11.8)	3 (9.4)	0 (0)	NS
Other complications:	FGR	0 (0.0)⁷⁸	0 (0.0)⁹¹⁰	32 (100)⁷⁹	13 (100)⁸¹⁰	⁷⁸⁹¹⁰< 0.001
	Early onset PE	-	16 (94.1)	29 (90.6)	-	NS
	Severe PE	-	13 (76.5)	19 (59.4)	-	NS
	HELLP syndrome	-	3 (17.6)	2 (6.3)	-	NS

¹One patient presented both maternal risk factors (autoimmune and cardiovascular diseases);

²Four patients presented two family risk factors (3 hypertension and diabetes; 1 diabetes and cardiovascular disease);

³One patient presented two family risk factors (hypertension and diabetes);

⁴Five patients presented two family risk factors (4 hypertension and diabetes; 1 hypertension and cardiovascular disease).

⁵P values were calculated by chi-square test (χ²).

⁶Comparison between controls and PE-only group;

⁷Comparison between controls and PE FGR group;

⁸Comparison between controls and FGR-only group;

⁹Comparison between PE-only and PE FGR groups;

¹⁰Comparison between PE-only and FGR-only groups. NS: Non significant; PE: Pre-eclampsia; FGR: Fetal growth retardation; HELLP: Hemolysis-elevated liver enzymes-low platelets.

Table 3 Leukocytes, platelets and liver enzymes in normal and pathological pregnancies

Variable	Normal values in Italian female population range	Controls (n = 49) Median (25th-75th)	All PE (n = 49) Median (25th-75th)	PE-only (n = 17) Median (25th-75th)	PE FGR (n = 32) Median (25th-75th)	FGR-only (n = 13) Median (25th-75th)	P value²
Total leukocyte count (1 × 10³/μL)	4.00-11.00	10.56 (9.21-11.65)³⁷⁵⁶	12.03 (10.69-14.1)³	12.34 (10.71-13.83)⁵	11.83 (10.2-14.51)⁶	12.27 (11.21-13.47)⁷	³0.004; ⁷0.045
							⁵0.007; ⁶0.024
Neutrophils (1 × 10³/μL)		8.27 (7.45-9.19)	10.09 (7.30-11.6)	10.15 (7.81-12.10)	9.92 (7.30-11.51)	9.34 (6.27-9.48)	NS
(%)	45.0-73.0	75.8 (68.1-78.8)	76.7 (68.37-87.1)	80 (72.5-90.1)	72.1 (68.2-83.6)	64.4 (57.3-77.3)	NS
Lymphocytes (1 × 10³/μL)		2.02 (1.68-2.26)	2.08 (1.3-3.06)	1.86 (1.22-2.34)	2.08 (1.31-3.07)	3.15 (2.13-3.79)	NS
(%)	19.0-47.0	18.7 (14-23.5)	17.4 (10.8-22.43)	14.55 (8.9-18.15)⁸	18.8 (11.1-23.2)	25.9 (17.4-34.3)⁸	⁸0.047
Monocytes (1 × 10³/μL)		0.54 (0.47-0.74)	0.59 (0.3-0.85)	0.61 (0.25-0.81)	0.58 (0.3-0.88)	0.89 (0.54-1.05)	NS
(%)	3.0-9.0	5.4 (4.5-6)	5.3 (3-7.3)	4.15 (2.15-7.75)	5.4 (3.5-7.3)	6.1 (4.9-7.9)	NS
Eosinophils (1 × 10³/μL)		0.15 (0.09-0.19)³	0.05 (0.02-0.1)³	0.04 (0.02-0.11)	0.05 (0.03-0.1)	0.17 (0.03-0.33)	³0.028
(%)	0.2-4.4	1.2 (0.9-1.8)³	0.5 (0.2-0.8)³	0.35 (0.1-0.8)	0.5 (0.2-0.8)	1.7 (0.2-2.4)	³0.020
Basophils (1 × 10³/μL)		0.02 (0.01-0.03)	0.02 (0.01-0.03)	0.03 (0.01-0.03)	0.02 (0.01-0.03)	0.01 (0-0.04)	NS
(%)	0.1-1.3	0.2 (0.1-0.3)	0.2 (0.1-0.3)	0.2 (0.15-0.25)	0.2 (0.1-0.3)	0.1 (0-0.3)	NS
Platelets (1 × 10³/μL)	150-400	219 (170-240)⁵	187 (126-228)	170 (111-214)⁵⁸	191 (143-234)	235 (177-285)⁸	⁵0.024; ⁸0.031
Platelets¹ (1 × 10³/μL)	150-400	219 (170-240)	191 (161-234)	180.5 (154-228)	191 (165-242)	235 (177-285)	NS
ALT (U/L)	< 34	15 (10-19)³⁵	23 (14-46)³	26 (19-150)⁵⁸	19.5 (13.5-35)	14 (10-21.5)⁸	³0.006; ⁵0.002; ⁸0.026
ALT¹ (U/L)	< 34	15 (10-19)³	20 (14-31)³	25 (15-46)	18 (13-27)	14 (10-21.5)	³0.023
AST (U/L)	< 31	17.5 (14-19)³	21 (16-39)³⁴	25 (16-123)⁸	20 (16-35.5)⁹	14 (12-18)⁴⁸⁹	³0.029; ⁴0.018; ⁸0.031; ⁹0.026
AST¹ (U/L)	< 31	17.5 (14-19)	19 (15.5-33)	19 (15-39)	18.5 (16-32)	14 (12-18)	NS

¹Hemolysis-elevated liver enzymes-low platelets cases excluded;

²P values were calculated by non-parametric Kruskal-Wallis H test, with post-hoc analysis by Mann-Whitney U test.

³Comparison between controls and all PE group;

⁴Comparison between all PE and FGR-only groups;

⁵Comparison between controls and PE-only group;

⁶Comparison between controls and PE FGR group;

⁷Comparison between controls and FGR-only group;

⁸Comparison between PE-only and FGR-only groups;

⁹Comparison between PE-only and FGR-only groups. ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; NS: Non significant; PE: Pre-eclampsia; FGR: Fetal growth retardation.

Table 4 Seropositivity against Helicobacter pylori, cytotoxin-associated antigen A, vacuolating cytotoxin A, ureases A, C, E and H, heat shock protein B and flagellin A n (%)

	Controls (n = 49)	All PE (n = 49)	PE-only (n = 17)	PE FGR (n = 32)	FGR-only (n = 13)	P value¹²	Odds ratio¹ (95% CI)
Helicobacter pylori	21 (42.9)³⁵	42 (85.7)³	12 (70.6)	30 (93.8)⁵	6 (46.2)	³⁵< 0.001	³9.22 (2.83-30.04)
							⁵35.56 (5.22-242.43)
CagA	11 (22.4)³⁴⁵	40 (81.6)³	11 (64.7)⁴	29 (90.6)⁵	5 (38.5)	³⁵< 0.001	³17.66 (5.25-59.49)
						⁴0.038	⁴5.20 (1.09-24.69)
							⁵54.97 (9.24-326.88)
VacA	20 (40.8)³⁵	37 (75.5)³	9 (52.9)	28 (87.5)⁵	6 (46.2)	³0.005	³4.89 (1.62-14.73)
						⁵< 0.001	⁵19.64 (3.75-102.98)
HspB	15 (30.6)	21 (42.9)	5 (29.4)	16 (50.0)	6 (46.2)	NS
FlagA	13 (26.5)	22 (44.9)	6 (35.3)	16 (50.0)	5 (38.5)	NS
UreA	10 (20.4)	13 (26.5)	4 (23.5)	9 (28.1)	3 (23.1)	NS
UreC	13 (26.5)³⁵	19 (38.8)³	4 (23.5)	15 (46.9)⁵	4 (30.8)	³0.042	³2.84 (1.04-7.75)
						⁵0.018	⁵4.02 (1.27-12.80)
UreE	12 (24.5)³⁵	26 (53.1)³	8 (47.1)	18 (56.3)⁵	3 (23.1)	³0.004	³4.41 (1.59-12.26)
						⁵0.003	⁵6.29 (1.88-21.04)
UreH	8 (16.3)	13 (26.5)	5 (29.4)	8 (25.0)	4 (30.8)	NS

¹Adjusted for maternal age at delivery, pre-pregnancy body mass index, parity, and presence of maternal and family risk factors;

²P values were calculated by χ² test;

³Comparison between controls and all PE group;

⁴Comparison between controls and PE-only group;

⁵Comparison between controls and PE FGR group. CI: Confidence intervals; NS: Non significant; PE: Pre-eclampsia; FGR: Fetal growth retardation; CagA: Cytotoxin-associated antigen A; VacA: Vacuolating cytotoxin A; HspB: Heat shock protein B; FlagA: Flagellin A; Ure: Ureases.

Table 5 Cytotoxin-associated antigen A/vacuolating cytotoxin A dual seropositivity n (%)

	Controls (n = 49)	All PE (n = 49)	PE-only (n = 17)	PE FGR (n = 32)	FGR-only (n = 13)	P value¹²	Odds ratio¹ (95% CI)
CagA+VacA+	11 (22.4)³⁴	37 (75.5)³	9 (52.9)	28 (87.5)⁴	5 (38.5)	³< 0.001	12.10 (3.76-38.91)
						⁴0.001	45.44 (7.79-265.18)
CagA-VacA+	9 (18.4)	0 (0)	0 (0)	0 (0)	1 (7.7)	NS
CagA+VacA-	0 (0.0)	3 (6.1)	2 (11.8)	1 (3.1)	0 (0.0)	NS
CagA-VacA-	29 (59.2)³⁴	9 (18.4)³	6 (35.3)	3 (9.4)⁴	7 (53.8)	³0.001	0.13 (0.04-0.42)
						⁴< 0.001	0.04 (0.01-0.22)

¹Adjusted for maternal age at delivery, pre-pregnancy body mass index, parity, and presence of maternal and family risk factors;

²P values were calculated by chi-square test (χ²);

³Comparison between controls and all PE group;

⁴Comparison between controls and PE FGR group. CI: Confidence intervals; NS: Non significant; CagA: Cytotoxin-associated antigen A; VacA: Vacuolating cytotoxin A; PE: Pre-eclampsia; FGR: Fetal growth retardation.

Table 6 Hematological values and cytotoxin-associated antigen A/vacuolating cytotoxin A antigens

Variables	Normal values in Italian female population range	CagA-VacA- (n = 45) Median (25th-75th)	CagA-VacA+ (n =10) Median (25th-75th)	CagA+VacA- (n = 3) Median (25th-75th)	CagA+VacA+ (n = 53) Median (25th-75th)	P value²
Total leukocyte count (1 × 10³/μL)	4.00-11.00	12.02 (10.6-13.13)³	8.95 (7.75-10.5)³⁵⁶	14.1 (12.4-16.34)⁵	11.27 (9.62-13.64)⁶	³0.003; ⁶0.012; ⁵0.014
Neutrophils (1 × 10³/μL)		10.02 (8.88-11.40)	7.45 (4.87-9.48)	12.75 (11.03-14.48)	8.43 (6.9-10.5)	NS
(%)	45.0-73.0	78.8 (67.05-88.85)	71.9 (68.1-77.3)	83.4 (78.2-88.6)	72.05 (67.4-80)	NS
Lymphocytes (1 × 10³/μL)		1.72 (1.11-2.85)	2.13 (1.68-2.13)	1.61 (0.93-2.28)	2.34 (1.63-3.07)	NS
(%)	19.0-47.0	15.3 (8.9-23.2)	20.6 (17.4-23.5)	10.95 (5.7-16.2)	18.75 (14-23.3)	NS
Monocytes (1 × 10³/μL)		0.57 (0.26-0.89)	0.54 (0.43-0.6)	0.78 (0.68-0.88)	0.6 (0.44-0.84)	NS
(%)	3.0-9.0	4.75 (2.15-6.85)	5.2 (4.9-6)	5.1 (4.8-5.4)	5.81 (4.3-7.4)	NS
Eosinophils (1 × 10³/μL)		0.05 (0.02-0.18)	0.09 (0.03-0.21)	0.06 (0.03-0.08)	0.06 (0.03-0.15)	NS
(%)	0.2-4.4	0.55 (0.1-1.45)	1.2 (0.2-2)	0.4 (0.2-0.6)	0.58 (0.3-1.17)	NS
Basophils (1 × 10³/μL)		0.01 (0-0.02)	0.03 (0.01-0.03)	0.02 (0.02-0.03)	0.03 (0.01-0.04)	NS
(%)	0.1-1.3	0.1 (0-0.2)	0.2 (0.2-0.3)	0.15 (0.1-0.2)	0.2 (0.2-0.3)	0.002
Platelets¹ (1 × 10³/μL)	150-400	222 (169-249)	175 (154-209.5)	214 (210-228)	191 (166-242)	NS
ALT¹ (U/L)	< 34	16 (12.5-26)⁴	11 (9-12)⁵	32 (30-178)⁴⁵⁷	17 (11.5-24)⁷	⁴0.020; ⁵0.025; ⁷0.023
AST¹ (U/L)	< 31	18 (15.5-23.5)	13 (12-19)	58 (15-143)	18 (14.5-26)	NS

¹Hemolysis-elevated liver enzymes-low platelets cases excluded;

²P values were calculated by non-parametric Kruskal-Wallis H test, with post-hoc analysis by Mann-Whitney U test;

³Comparison between CagA-VacA- and CagA-VacA+ groups;

⁴Comparison between CagA-VacA- and CagA+VacA- groups;

⁵Comparison between CagA-VacA+ and CagA+VacA- groups;

⁶Comparison between CagA-VacA+ and CagA+VacA+ groups;

⁷Comparison between CagA+VacA- and CagA+VacA+ groups. CagA: Cytotoxin-associated antigen A; VacA: Vacuolating cytotoxin A; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; NS: Non significant.

Citation: Cardaropoli S, Rolfo A, Piazzese A, Ponzetto A, Todros T. Helicobacter pylori's virulence and infection persistence define pre-eclampsia complicated by fetal growth retardation. World J Gastroenterol 2011; 17(47): 5156-5165
URL: https://www.wjgnet.com/1007-9327/full/v17/i47/5156.htm
DOI: https://dx.doi.org/10.3748/wjg.v17.i47.5156