胃粘膜淋巴组织增生与幽门螺杆菌感染的关系

胃炎、胃十二指肠溃疡、胃癌等疾病与幽门螺杆菌（helicobactepyfori，HP）感染的关系已从根本上改变了许多传统的观念，正常胃粘膜由无淋巴组织到有淋巴细胞、淋巴组织增生和形成淋巴瘤的过程中，HP是否起了促变作用是值得研究的课题之一。为此，我们探讨了胃粘膜淋巴组织增生与幽门螺杆菌感染的关系。1材料和方法收集我院胃镜室1984～1993年53400例胃镜检查发现的40例胃原发性淋巴瘤作为肿瘤组材料，再随机取同期胃镜活检中发现的胃粘膜淋巴滤泡增生的104例作为增生组材料，同时随机取412例无淋巴滤泡增生的慢性胃炎病例作为炎症组材料…     

胃癌组织中HpureA基因表达

目的：了解胃癌组织AprueA基因表达状况,探讨HpureA基因与胃癌的关系。方法：采用Warthin-Starry银染、原位PCR方法检测慢性浅表性胃炎（CSG）35例、慢性萎缩性胃炎（CAG）40例、胃癌（CG）35例胃粘膜Hp及ureA基因感染状况。观察非癌患者胃膜炎症反应程度。结果：慢性浅表性胃萎缩性胃炎、胃癌组织、癌旁胃粘膜组织Hp检出率分别为48．57％、62．5％、0、54．28％;ureA基因检率分别为51．42％、75％、37．14％、82．86％,萎缩性胃炎、癌旁组ureA基因检出率显著高于浅表性胃炎组（P＜0．05,P＜0．01）。非癌患者胃粘膜单个核细胞、分叶核细胞浸润程度ureA组、Hp^ 级较HP组显著增多（P＜0．01）。结论：纤维性胃炎、胃癌患者HpureA基因表达显著高于慢性浅表性胃炎组。Hp感染引更严重的炎症反应。说明Hp感染与萎缩性胃炎、胃癌关系,在胃癌的发生中起着重要作用。     

幽门螺杆菌感染与胃息肉关系探讨

目的：探讨不同类型胃息肉与幽门螺杆菌感染的关系。方法；经胃镜活检及病理诊断胃息肉106例，内镜下除的胃息肉作HE染色，判定胃秘肉组织学类型及炎症反应程度。同时在胃窦部取材2－3块，分别作快速尿毒酶试验及美蓝染色，以检测Hp感染率，两均阳性判为Hp感染。结果：106例胃息肉Hp总检出率为65．1％。胃息肉以增生息肉多见，共76例，占71．7％，腺瘤性息肉30例，占28．3％。Hp感染率在增生性息肉中为73．7％（56／76），显高于腺瘤性息肉43．1％（13／30）（P＜0．01）。活动性炎症在增生性息肉中为55．3％（42／76），显高于腺瘤性息肉30％（9／30）（P＞0．05）。结论：增生性息肉的发生可能与Hp感染有关，这可能与Hp引起胃粘膜活动性炎症反应有关。     

幽门螺杆菌感染与肝硬化相关因素分析

目的探讨肝硬化患者幽门螺杆菌（Hp）感染与肝硬化相关因素关系。方法对46例肝硬化及30例浅表性胃炎Hp感染率、CagA阳性率进行研究。分析Hp感染与乙型肝炎病毒感染、门脉高压性胃病及血氨关系。结果肝硬化组与浅表性胃炎组Hp感染率及CagA阳性率两组无统计学差异（P〉0．05）。Hp感染率与乙肝病毒指标之间及门脉高压性胃病发生无相关性（P〉0．05）。结论Hp感染在肝硬化胃粘膜病变中起一定作用，但不是主要因素。Hp感染可致血氨升高，但与肝性脑病关系有待进一步研究。     

新三联法根除幽门螺杆菌的疗效探讨

幽门螺杆菌（Hp）是1983年由澳大利亚学者首先发现。近20年来,幽门螺杆菌（Hp）被认为是胃肠道疾病的重要致病因素,它的感染与慢性胃炎、消化性溃疡、胃癌、胃黏膜相关淋巴组织（MALT）淋巴瘤关系十分密切。根除Hp对缓解胃炎症状,治愈消化性溃疡,预防溃疡复发,预防癌变均有重要意义。我们选用埃索美拉唑＋左氧氟沙星＋阿莫西林新三联1周疗法根除Hp,效果满意．现报道如下。     

幽门螺杆菌感染与反流性食道炎关系的临床研究

目的探讨幽门螺杆菌感染与反流性食道炎的关系。方法回顾我院1997年2月至2003年2月接受胃镜检查7230例患者,年龄30-65岁,选择符合入选条件6885例,分为4组：（1）对照组：胃镜检查无明确病变者（肉眼与病理检查仅示轻度慢性浅表性胃炎）298例;（2）十二指肠球部溃疡（duodenal ulcer,DU）组：胃镜诊断DU活动期病例588例;（3）反流性食道炎（reflux esophagitis,RE）组：由167例无继发情况的RE病例组成;（4）DU并RE组：26例,进行幽门螺杆菌（Helicobacter pylori,Hp）感染率的对比研究,各组平均年龄、性别比经t检验无显著差异（P=0．20）。Hp检测分别作快速尿素酶试验及warthinstarrry银染色,两者均阳性或阴性判断为Hp阳性或Hp阴性。统计方法采用软件包SPAAFORWINDOWS12．0,用x^2检验比较各组间Hp阳性率差异。结果4组Hp检出率分别为45．64％,71．77％,36．52％和38．46％。Hp检出率RE组比对照组低（x^2=3．638,P=0．35）,但差异无显著性意义。RE组低于DU组（x^2=70．087,P=0．000）,DU组高于DU＋RE组（x^2=13．246,P=0．00）,差异均具有非常显著性意义。结论不能否认Hp感染对食管的保护作用,Hp感染可能减少RE的发生。     

EB病毒、幽门螺杆菌cagA和vacA基因型感染与胃癌的关系研究

目的探讨EB病毒,H．pyloficagA基因、vacA基因在胃癌发生发展中的作用及三者关系。方法以病理活检确诊的胃癌病人为实验组（46例）,癌前病变（包括肠化生、萎缩性胃炎、非典型增生等）病人对照组（43例）,胃镜下取胃癌组织,采用PCR体外扩增方法,检测胃癌组织及癌前病变组织中EBV—DNA,用快速尿素酶试验检测HP,阳性病人做PCR体外扩增,并用PCR法进行H．pylori cagA和vacA基因检测,进行基因分型。结果（1）对照组2例,阳性率为4．6％（2／43）;实验组10例,阳性率为21．7％（10／46）。实验组与对照组差异有统计学意义（P〈0．05）。EBVaGC（EBVassociated gastric carcinoma,EBVaGC）和EBVnGC（EBVnegative gastric careinoma,EBVnGC）在年龄、病理类型方面差异无显著性（P〉0．05）;在性别方面差异有统计学意义,男性EBV阳性率高于女性（P〈0．05）。（2）等级统计分析表明,EBV感染与慢性胃炎→萎缩→肠化生→高中低分化胃癌演变过程中呈正相关（r=0．25465,P=0．0160）。（3）实验组H.pylori感染率60．9％（28／46）,对照组Hpylori感染率37．2％（16／43）,实验组与对照组差异有统计学意义（P〈0．05）。（4）慢性浅表性胃炎、萎缩、肠化生、胃癌各组织中H．pylofi与cagA和vacA表达均呈正相关（P〈0．01）。（5）H．pylori、H．pylori cagA、vacA阳性和阴性在性别、年龄差异无显著性（P〉0．05）,但在病理类型方面H．pylori、cagA、vacA阳性和阴性有统计学差异（P〈0．01）。（6）相关性分析表明EBV感染与H．pylori cagA呈正相关（P=0．0287,r=0．23199）,与H．pylorivacA无相关性（P=0．8094,r=0．02595）。结论（1）EBV感粢与胃癌的发生发展有一定相关性,EBVaGC好发于男性。EBV感染与慢性胃炎→萎缩→肠化生→胃癌演变过程中呈正相关。但EBV感染与胃癌病人年龄、病理类型、无明显相关性。（2）H．pylori感染与胃癌的发生密切相关,H．pylori感染与胃癌的临床病理类型相关,但H．pylorl感染与胃癌病人性别、年龄无明显相关性。（3）胃癌发生中EBV感染和cagA的表达呈正相关,与vacA无明显相关性。     

幽门螺杆菌感染后胃窦部G、D细胞变化的研究

为探讨幽门螺杆菌（Hp）感染后胃窦部内分泌G细胞（分泌胃泌素）、D细胞（分泌生长抑素）的变化，用免疫组织化学方法对40例慢性胃炎（CG）（包括10例为Hp阴性患者）、40例活动期胃溃疡（GU）和45例活动期十二指肠球部溃疡（DU）患者（其中各包括15例Hp阴性患者）的胃窦粘膜内G、D细胞进行标记后，运用医学图像分析系统对G、D细胞进行定量分析。结果显示：Hp感染后，G细胞数目变化不大（P＞0．05），但胞体灰度值增加（P＜0．05）；D细胞数目减少（P＜0．05），D细胞胞体灰度值无明显变化；各组G／D细胞数目比值有差异（P＜0．01）；Hp阳性的DU较GU组G细胞胞体灰度值增加，D细胞数目减少，差异有显著性意义（P＜0．01），G／D细胞数目比值增大。本研究结果提示，Hp感染后胃窦部G、D细胞变化对某些疾病的发生发展起一定作用。     

幽门螺杆菌感染与胃黏膜相关淋巴组织淋巴瘤的细胞生物和遗传学进展

黏膜相关淋巴组织(mucosa associated lymphoid tissue,MALT)淋巴瘤是指抗原长期刺激,发生免疫应答及局部炎症,从无到有产生淋巴组织,淋巴细胞免疫性增殖,异常克隆性增生,从良性转化为恶性,形成黏膜相关淋巴组织淋巴瘤〔1〕。MALT淋巴瘤可发生于消化道、肺、唾液腺、甲状腺、乳     

幽门螺杆菌的研究进展

自1983年Warren.Marshall首先从胃炎病人胃内分离出幽门螺杆菌(Helicobacter pylori,Hp)后,各国学者经过广泛深入的研究发现Hp与慢性活动性胃炎、胃十二指肠溃疡、胄粘膜相关性淋巴瘤(MALT)及胃癌的发病有密切关系,1994年国际癌症研究中心将其归为I类致癌因子[1]。虽其具体机制     

Gastric mucosa-associated lymphoid tissue lymphoma: spectrum of findings at double-contrast gastrointestinal examination with pathologic correlation.

Mucosa-associated lymphoid tissue (MALT) is found in the surface epithelium of the stomach. MALT lymphoma is extranodal lymphoma originating from MALT. In the stomach, a strong association with Helicobacter pylori infection has been demonstrated. Low-grade gastric MALT lymphoma has been reported to have variable features at upper gastrointestinal (UGI) examination. Twenty-two patients with low-grade MALT lymphoma had ulcers (n = 11), fold thickening (n = 7), mucosal nodularity (n = 7), masses (n = 6), or prominent areae gastricae (n = 4) at UGI examination. Six patients with high-grade MALT lymphoma had masses (n = 4), fold thickening (n = 3), ulcers (n = 1), or mucosal nodularity (n = 1) at UGI examination. These findings were similar to those in gastric carcinoma or gastritis. Differentiation of low-grade MALT lymphoma from gastritis or gastric carcinoma was more difficult than differentiation of high-grade MALT lymphoma. Lesions of MALT lymphoma associated with H pylori gastritis were diffuse or multiple in 65% of cases; however, lesions of MALT lymphoma without proved H pylori gastritis were focal or solitary in 80% of cases. Therefore, multiplicity of lesions in MALT lymphoma was closely associated with H pylori infection.     

Low-grade gastric mucosa-associated lymphoid tissue lymphoma: correlation of radiographic and pathologic findings.

PURPOSE: To describe upper gastrointestinal (Gl) examination findings of low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma and to correlate them with pathologic examination findings. MATERIALS AND METHODS: A retrospective review of upper Gl examinations was performed in 25 patients with proved low-grade gastric MALT lymphomas. Upper Gl examinations were reviewed for common findings and most probable diagnosis, and these findings were correlated with pathologic findings in resected specimens in 15 patients. RESULTS: The common findings at upper Gl examination included mucosal nodularity (n = 13), ulcer (n = 12), rugal thickening (n = 6), mass (n = 4), and enlarged areae gastricae (n = 2). The most probable diagnoses were early gastric carcinoma (n = 7), advanced gastric carcinoma (n = 6), gastritis (n = 9), and lymphoma (n = 3). Of 17 lesions found on resected specimens, six ulcers and two masses were not depicted at barium study. Disorganized convergent rugae projecting to multiple points and vague ulcer margins were present in four and seven lesions, respectively. Multiple ulcers were seen in two patients. CONCLUSION: Although the common radiographic and pathologic findings observed in low-grade gastric MALT lymphomas were similar to those of gastric carcinomas or gastritis, disorganized convergent rugae, vague ulcer margins, and multiplicity of lesions may be helpful in differentiating them from gastric carcinomas or gastritis.     

胃黏膜相关淋巴组织淋巴瘤影像学表现(附4例报告)

目的 描述胃黏膜相关淋巴组织(mucosa—associatedlymphoidtissue，MALT)淋巴瘤影像学表现并探讨其诊断价值。资料与方法回顾性分析经病理证实的4例胃MALT。淋巴瘤的影像学和临床资料。4例均行幽门螺旋杆菌检查和胃肠钡餐造影(GI)、CT及胃镜检查。分析病变部位、范围和浸润深度。结果4例均感染幽门螺旋杆菌。GI见胃内壁局限性或多个类圆形充盈缺损，黏膜破坏。CT表现见胃壁增厚或见小结节状突起。胃镜见胃黏膜明显增厚、充血，皱襞粗大、紊乱迂曲，并见多个小结节样增生及边缘模糊的浅表溃疡。结论 胃MALT淋巴瘤影像学表现虽没有特异性，但如有幽门螺旋杆菌感染时，应考虑到胃MALT淋巴瘤的可能。     

14C-尿素呼气试验诊断幽门螺杆菌感染的价值

 目的 探讨正常人群和慢性胃炎及消化性溃疡患者幽门螺杆菌(Hp)感染情况.方法 3 497例健康体检者和638例慢性胃炎和消化性溃疡患者行14C-尿素呼气试验(14C -Urea breath test,14C-UBT)Hp检测.计算机自动得出数据,2 min计数(dpm)＜100 dpm 为正常,即Hp阴性;＞101 dpm为异常,即Hp阳性.结果 健康体检3 497例,Hp阳性1 748例,阳性率50 %,发现胃癌1例(14C-UBT 1 200 dpm);慢性胃炎及消化性溃疡组638例,Hp阳性339例,阳性率53%.两组相比差异无统计学意义(P＞0.05).但是,健康体检组阳性者中＞601 dpm占41.2%(720/1748);慢性胃炎和消化性溃疡组阳性者中＞601dpm占38.3%(131/339).两组相比差异有统计学意义(P＜0.05).结论 在健康人群中存在有较高比例的Hp感染趋向,14C-UBT检测Hp的优点是简便、准确、安全、无创、经济、重复性好.     

胃MALT淋巴瘤54例临床分析

目的 探讨胃黏膜相关淋巴样组织(MALT)淋巴瘤的临床诊断与治疗.方法 回顾性分析手术切除并经病理证实的54例胃MALT淋巴瘤的诊断与治疗情况,并对其中48例进行随访,随访时间为12～159个月.结果 胃MALT淋巴瘤临床表现以腹痛和腹部不适常见,术前胃镜及病理活检确诊率达 85.2%(46/54),幽门螺杆菌检出阳性率88.9%(48/54),全组手术切除率87%(47/54),5、10年生存率分别为77.1%和72.9%.结论 幽门螺杆菌感染与胃MALT淋巴瘤存在一定关联.胃MALT淋巴瘤无特异临床症状,术前诊断均依靠胃镜及活检.对于胃MALT淋巴瘤,根除Hp治疗,外科手术切除原发灶,联合术后化疗或放疗是合理的.     

淋巴滤泡增生在幽门螺杆菌性胃炎中的病理诊断价值

目的 评价胃窦黏膜淋巴滤泡增生在幽门螺杆菌性胃炎病理诊断中的价值.方法 以淋巴滤泡增生为诊断幽门螺杆菌性胃炎的标准,与诊断幽门螺杆菌阳性的＂金标准＂进行临床流行病学分析.结果 在1385例慢性胃炎中,以淋巴滤泡增生为诊断幽门螺杆菌性胃炎标准,其诊断的准确度为79.35%,灵敏度为79.43%,特异度为79.18%,阳性预告值89.22%,阳性似然比3.93,漏诊率为20.57%,误诊率为20.82%,阴性预告值79.18%,阴性似然比0.26.结论 淋巴滤泡增生是幽门螺杆菌性胃炎的组织病理形态学特征之一,是诊断幽门螺杆菌性胃炎的重要组织学依据,但不是唯一标准.     

Mucosa-associated lymphoid tissue lymphoma studied with FDG-PET: a comparison with CT and endoscopic findings

OBJECTIVE: We investigated the accumulation of 2-deoxy-2-[(18)F] fluoro-D: -glucose positron emission tomography (FDG-PET) in patients with mucosa-associated lymphoid tissue (MALT) lymphoma patients as compared with computerized tomography (CT) and endoscopic imaging. METHODS: FDG-PET was performed on 13 untreated patients with MALT lymphoma. CT scanning of the affected areas was performed in all the patients to compare with the FDG-PET images. In five patients with gastric MALT lymphoma, comparison was also made with the endoscopic findings. RESULTS: Of the 13 untreated MALT lymphoma patients, all 8 non-gastric MALT lymphoma patients exhibited abnormal accumulation of FDG. However, in the five gastric MALT lymphoma patients, no abnormal FDG accumulation was observed. Although lesions could be confirmed on CT images from the patients other than those with gastric MALT lymphoma, the mucosal lesions of gastric MALT lymphoma could be observed only by endoscopy. CONCLUSIONS: FDG-PET can be used to detect MALT lymphoma when it forms mass lesions, whereas it is difficult to detect non-massive MALT lymphoma of gastrointestinal origin.     

Radiographic findings of primary B-cell lymphoma of the stomach: low-grade versus high-grade malignancy in relation to the mucosa-associated lymphoid tissue concept

OBJECTIVE: We undertook this study to assess how well double-contrast radiography and CT allow radiologists to differentiate low-grade from high-grade mucosa-associated lymphoid tissue (MALT) lymphoma of the stomach. MATERIALS AND METHODS: We retrospectively reviewed the upper gastrointestinal radiographs and contrast-enhanced CT scans of 57 patients with pathologically proven primary gastric lymphoma (low-grade [n = 29] and high-grade [n = 28] MALT lymphoma). RESULTS: On upper gastrointestinal radiography, ulceration (39%) was the most common finding in low-grade lymphoma, whereas polypoid appearance (38%) was the most common in high-grade lymphoma. In the 29 patients (33 lesions) with low-grade MALT lymphoma, upper gastrointestinal radiography revealed 13 ulcerative lesions (39%), 10 nodular lesions (30%), four infiltrative lesions (12%), two polypoid lesions (6%), and four combined lesions (12%). In the 28 patients (29 lesions) with high-grade lymphoma, upper gastrointestinal radiography revealed 11 polypoid lesions (38%), nine infiltrative lesions (31%), six ulcerative lesions (20%), one nodular lesion (3%), and two combined lesions (7%). On CT, thickening of the gastric wall in low-grade lymphoma (range, 0.3-2.5 cm; mean, 0.8 cm) was much less than that in high-grade lymphoma (range, 0.7-8.0 cm; mean, 2.5 cm). Abdominal lymphadenopathy was less frequent in low-grade lymphoma (14%) than in high-grade lymphoma (75%). CONCLUSION: Most low-grade lymphomas show superficial spreading lesions, such as mucosal nodularity, shallow ulcer, and minimal fold thickening, on upper gastrointestinal radiography, whereas most high-grade lymphomas show mass-forming lesions or severe fold thickening.     

根除Hp对高原地区Hp相关性慢性胃炎病理变迁和溃疡转归的影响

目的:观察根除幽门螺杆菌(Hp)感染对高原地区Hp相关性慢性胃炎病理变迁和溃疡转归的短期影响。方法:对Hp阳性的37例慢性胃炎和30例溃疡患者均给予以洛赛克为中心加两种抗生素的三联一周疗法,停药一月后复查Hp并观察胃镜和病理组织学变化,与根除Hp治疗前进行对比分析,同时统计Hp根除组和未根除组溃疡的愈合率。结果:37例慢性胃炎中32例Hp被根除,30例溃疡中14例Hp被根除(2例未复查),平均Hp根除率70.77%;Hp根除前慢性胃炎组中有19例胃炎活动,治疗后16例Hp被根除,根除者胃炎活动完全消退,消退率100%,而3例Hp未根除者仅1例胃炎活动完全消退,消退率33.33%(P<0.05);28例溃疡在Hp根除治疗前均有胃炎活动的病理组织学改变,14例Hp根除者中,13例胃炎活动完全消退,消退率92.86%,14例Hp未根除者中,只有6例胃炎活动完全消退,消退率42.86%(P<0.05);所有的慢性胃炎和溃疡患者胃窦粘膜均有不同程度的萎缩、肠化和异型增生,两组Hp根除前后其上述病理组织学变化均无明显改善(P>0.05);Hp根除组溃疡全部愈合,愈合率达100%,未根除组只有8例愈合,愈合率为57.14%,两组比较Hp根除组溃疡愈合率显著高于未根除组(P<0.05)。结论:根除Hp感染可使绝大部分胃炎的活动性消退,并可明显提高溃疡的愈合率,而Hp根除后短时间内无慢性胃炎(萎缩、肠化、异型增生)逆转的病理组织学表现,需长期随访观察。