结节型十二指肠炎的内镜表现及其临床病理学特征

目的 探讨结节型十二指肠炎内镜下表现与其组织学特征的关系及其发病机制。方法 观察内镜下136例结节型十二指肠炎的表现，对其活检标本均行H-E染色，观察病理改变，Giemsa染色及快速尿素酶试验诊断幽门螺杆菌感染，十二指肠黏膜兼作AB／PAS染色，观察十二指肠胃上皮化生。结果 136例结节型十二指肠炎内镜下表现为直径0．2～1．0cm大小不等的结节，伴有不同程度的充血、水肿，其中伴糜烂21例，出血点及（或）瘀斑30例。检出率占同期15820例内镜检查的0．9％，十二指肠炎的3．8％。病理诊断为十二指肠炎107例，其中慢性十二指肠炎53例，表现为间质内可见慢性炎性细胞浸润，肠绒毛缩短或萎缩、变平．肠腺不同程度减少；活动性十二指肠炎54例，除慢性炎性细胞外，黏膜层及固有层内还有不同程度的中性粒细胞浸润，伴Brunner腺增生51例，胃型上皮化生59例。136例中检出胃黏膜异位增生7例以及血吸虫虫卵所致的炎性病变4例，107例结节型十二指肠炎中，幽门螺杆阳性（Hp^＋）者为45．8％（49／107）。其中，53例慢性十二指肠炎患者中HP^＋者为32．1％（17／53），54例活动性十二指肠炎中Hp^＋检出率为59．3％（32／54），后者的Hp^＋检出率显著高于前者（P〈0．01）。结论 结节型十二指肠炎是一类特殊的非特异性十二指肠炎，内镜下表现与组织学改变存在不一致性。其发生可能与Hp感染及胃上皮化生、Brunner腺增生有关。

Endoscopic and histopathological characteristics of nodular duodenitis

Objective To elucidate the pathogenesis of nodular duodenitis by investigating its endoscopic and histopathological characteristics. Methods One hundred and thirty-six patients were enrolled into study. Histopathological changes of duodenal tissue specimens were examined by H-E and AB/PAS staining. H.pylori was demonstrated by Giemsa staining and rapid urease test. Results Under endoscopy, all 136 patients with nodular duodenitis had nodular lesions (ranged from 0.2 cm to 1.0 cm), variant degrees of erythema and edema, among them 21 cases had erosion, and 30 cases had haemorrhagic spots and/or ecchymoses. The detecting rate of nodular duodenitis was 0.9%(136/15 820) of all the endoscopic examinations and 3.8%(136/3541) of duodenitis. There was 107 cases of nodular duodenitis identified by histopathological examination including 53 cases of chronic duodenitis and 54 cases of active duodenitis. The histopathological characteristics of chronic duodenitis were lymphocytes and plasmocytes infiltration and varied degrees of atrophic duodenal villi and glands. While in active duodenitis, there was neutrophilic granulocytes infiltration. There were 51 cases of Brunner's gland hyperplasia and 59 cases of gastric epithelial metaplasia. Among all patients, 7 cases were proved to be gastric heterotopia, 4 cases of schistosomiasis and 18 cases of normal tissue. Among 107 nodular duodenitis, the positive rate of H.pylori infection was 45.8% (49/107), the infection rate of H.pylori in active duodenitis(59.3%,32/54) was significantly higher than that in chronic duodenitis (32.1%,17/53) (P<0.01).Conclusions Nodular duodenitis may represent as a specific type of idiopathic duodenitis. The endoscopic findings and histopathological changes was inconsistent. The pathogenesis of nodular duodenitis might be correlated with gastric metaplasia and Brunner's gland hyperplasia.