Features of cytokine balance with the progression of structural changes in the gastric mucosa in patients with atrophic gastritis

Abstract

Background. Until now, the issue of the correlation between the cytokine balance and the progression of structural changes in the gastric mucosa remain completely uncertain. At the same time, the determination of the role of cytokine ba­lance as a component of gastric carcinogenesis will make it possible to substantiate new approaches to managing patients with atrophic gastritis. The purpose was to assess the level of pro- and anti-inflammatory cytokines, vascular endothelial growth factor (VEGF) at the stages of progression of structural changes in the gastric mucosa of patients with atrophic gastritis. Materials and methods. The study included 79 individuals with atrophic gastritis who underwent narrow band imaging endoscopic examination. The patients were divided into groups taking into account the revealed structural changes in the gastric mucosa: group I — 7 people with gastric mucosal atrophy without intestinal metaplasia (IM); group II — 16 individuals with gastric mucosal atrophy with IM limited by the antrum; group III — 45 people with diffuse IM against the background of gastric mucosal atrophy; group IV — 10 individuals with gastric mucosal dysplasia. In all patients, we assessed the level of interleukins (IL-8, IL-10, IL-18), tumor necrosis factor alpha (TNF-α), VEGF. Results. In patients of group IV, the concentration of IL-8 in the blood serum was 18.6 (11.3; 23.9) pg/ml that was significantly higher than in group I (by 5.0 times, p < 0.05), group II (by 3.6 times, p < 0.05) and group III (by 3.4 times, p < 0.05). According to the results of the Kruskal-Wallis test, the probability of a difference in the IL-8 level between the groups was 0.0260. The level of VEGF in the blood serum of patients with gastric mucosal dysplasia was significantly increased compared to that in people with gastric mucosal atrophy without IM (by 1.8 times, p < 0.05) and those with gastric mucosal atrophy with IM (by 1.7 times, p < 0.05). Changes in the cytokine balance towards proinflammatory cytokines were most pronounced in patients of groups III and IV; according to the results of the Kruskal-Wallis test, the probability of a difference in the IL-8/IL-10 ratio between the groups was 0.0207. Conclusions. With the progression of structural changes in the gastric mucosa of patients with atrophic gastritis, an increase in the level of proinflammatory cytokines (IL-8, IL-18 and TNF-α) in the blood serum does not induce the secretion of anti-inflammatory cytokines (IL-10). According to the results of the ROC analysis, the diagnostic criteria for the formation of the risk group for detecting dysplastic changes in the gastric mucosa are VEGF level of more than 341.4 mU/ml (sensitivity — 90.0 %, specificity — 77.2 %) and the level of IL-8 above 14.4 pg/ml (sensitivity — 80.0 %, specificity — 78.3 %).

Keywords

• atrophic gastritis, cytokine balance, intestinal metaplasia, dysplasia, diagnostic criteria