研究了 vacA 的四个区域与 cagA、cagE、dupA 基因和 cagA-EPIYA 基序的组合，以找到最有可能用作摩洛哥人群疾病决定标记的组合。从同意的患者中获得总共 838 份幽门螺杆菌阳性样本，之前通过 PCR 分析这些样本以表征 vacA-s -m、-i 区域、cagE 状态和 cagA 3' 区域多态性，然后使用这些样本来表征 vacA-d 区域并确定确定 dupA 基因状态。分析显示毒力较低的组合 (vacA(s2m2i2d2)dupA(-)cagE(-)cagA(-)) 占主导地位，并显示感染患者患胃癌的风险高出 13.33 倍 (1.06-166.37))与没有病变的胃炎患者和被携带 vacA(s2m2i2d2)dupA(-)cagE(-)cagA(-) 的幽门螺杆菌菌株感染的患者相比）。含有 vacA(s1m1i1d1)dupA( )cagE( )cagA(1EPIYAC) 基因型组合的菌株感染是胃溃疡和十二指肠溃疡的危险因素（比值比（95% CI）分别为 16（1.09-234.24）和 6.54（与无病变胃炎患者相比，分别为 1.60-26.69)。这些结果表明，vacA 基因型的活性形式、dupA 基因状态和 EPIYA-C 基序数量的组合可能被认为是区分几种胃部疾病的有用标记。

The combination of the four regions of vacA with cagA, cagE, dupA genes and cagA-EPIYA motifs, was studied to find the most likely combination that can be used as a disease determinant marker in Moroccan population. A total of 838 H. pylori positive obtained from consenting patients, that were previously analyzed by PCR to characterize vacA-s -m, -i regions, cagE status and cagA 3' region polymorphism, were used to characterize vacA-d region and to determine dupA gene status. The analysis shows the predominance of the less virulent combination (vacA(s2m2i2d2)dupA(-)cagE(-)cagA(-)), and shows that the risk of gastric cancer is 13.33 fold higher (1.06-166.37)) in patients infected by strains harboring vacA(s1m1i1d1)dupA(-)cagE(+)cagA(2EPIYA-C) compared to patients with gastritis without lesions and infected by H.pylori strains harboring vacA(s2m2i2d2)dupA(-)cagE(-)cagA(-). The infection with strains harboring vacA(s1m1i1d1)dupA(+)cagE(+)cagA(1EPIYAC) genotype combination represents a risk factor for gastric ulcer and duodenal ulcer (the Odds Ratio (95% CI) were 16 (1.09-234.24) and 6.54 (1.60-26.69) respectively) compared to patients with gastritis without lesions. These results suggest that the combination of the active form of vacA genotypes, dupA gene status and the number of EPIYA-C motif may be considered helpful markers to discriminate between several gastric diseases.