慢性萎缩性胃炎伴肠上皮化生患者200例临床分析

目的:对慢性萎缩性胃炎伴肠上皮化生200例患者进行临床分析,探讨其病因、诊断及治疗方式。方法:对我院确诊的200例慢性萎缩性胃炎伴肠上皮化生患者资料进行临床回顾性分析。结果:本组Ⅰ级57例,占28.5%;Ⅱ级108例,占54%;Ⅲ级35例,占17.5%。200例患者中重度Hp感染者12例,轻、中度Hp感染者188例。本组93例可见腺体萎缩,占46.5%;77例为不典型增生,占38.5%;30例为肠上皮化生,占15.0%。临床治愈95例,占47.5%;显效77例,占38.5%;好转10例,占5.0%;未愈18例,占9.0%;总有效率为91.0%。结论:慢性萎缩性胃炎伴肠上皮化生与多因素相关;胃镜检查及病理组织学检查是本病的主要诊断手段。根本性治疗应该是阻止腺体的进一步萎缩,同时促进胃黏膜和腺体的生长和再生。对本病应该要早诊断,早治疗,提高其治愈率。     

朱克俭辨治慢性萎缩性胃炎伴肠上皮化生经验浅析

慢性萎缩性胃炎(chronic atrophic gastritis, CAG)是指由于胃黏膜腺体萎缩减少,伴或不伴肠上皮化生及不典型增生的胃黏膜慢性炎症[1].高盐饮食、偏食辛辣是其常见的致病因素[2].早在 1978 年,世界卫生组织将其列为癌前疾病,在 CAG 基础上发生的肠上皮化生和上皮内瘤变被列为肠型胃癌的癌...     

肠化方加减治疗慢性萎缩性胃炎伴肠上皮化生临床疗效观察

目的：观察肠化方加减治疗慢性萎缩性胃炎伴肠上皮化生的临床疗效。方法：将70例患者随机分为治疗组和对照组,每组35例。治疗组给予肠化方辨证加减治疗,对照组给予胃复春片治疗,疗程均为12周。观察两组患者的临床症状、生存质量、胃黏膜病理组织学的改善情况。结果：①治疗组和对照组症状改善的总有效率分别为91.43%和65.71%,治疗组的疗效优于对照组（P〈0.01）;治疗组患者的胃脘疼痛、胃脘痞闷、嗳气、疲乏、失眠等症状均显著改善（P〈0.05）,对照组患者仅嗳气症状显著改善（P〈0.05）。②两组患者的生存质量量表总积分较治疗前均显著降低（P〈0.01,P〈0.05）,且治疗组患者的总积分较对照组降低更加显著（P〈0.01）。③两组患者的胃黏膜病理总积分较治疗前均显著降低（P〈0.01,P〈0.05）,且治疗组较对照组降低更加显著（P〈0.01）;治疗组患者的胃黏膜萎缩和肠化程度较治疗前均显著改善（P〈0.01）。结论：肠化方加减治疗能有效改善慢性萎缩性胃炎伴肠上皮化生患者的临床症状,提高其生存质量,改善患者的胃黏膜萎缩、肠化生等病理形态。     

浊毒论治慢性萎缩性胃炎伴肠上皮化生疗效观察

目的 观察浊毒论治慢性萎缩性胃炎伴肠上皮化生临床疗效.方法 92例慢性萎缩性胃炎伴肠上皮化生患者随机分为两组.治疗组52例,口服化浊解毒方,对照组40例,口服胃复春.均连用24周.结果治疗后两组临床疗效比较,差异有统计学意义(P＜0.01);两组患者治疗后症状积分与治疗前比较,差异均有统计学意义(P＜0.0 1),治疗后两组症状积分比较,差异有统计学意义(P＜0.05);两组治疗后各胃镜象(除水肿外)变化情况比较,差异均有统计学意义(P＜0.05);两组各胃黏膜病理表现改善情况比较,差异有统计学意义(P＜0.01);两组抗幽门螺杆菌(HP)感染的疗效比较,差异无统计学意义(P＞0.05).结论 从浊毒论治慢性萎缩性胃炎伴肠上皮化生临床疗效满意,化浊解毒方不仅能够较好改善CAG患者的临床症状,而且对于胃黏膜的恢复、肠上皮化生的改善也取得了较满意的疗效.     

半夏泻心汤合丹参饮治疗慢性萎缩性胃炎伴肠上皮化生60例分析

目的 观察半夏泻心汤合丹参饮治疗慢性萎缩性胃炎伴肠上皮化生的临床疗效.方法 治疗慢性萎缩性胃炎伴肠上皮化生患者60例,分为治疗组与对照组,分别观察疗效.结果 治疗效果显著,临床症状、肠化生表现,治疗组优于对照组,且具有统计学意义,HP转阴率无显著统计学意义,但治疗组优于对照组.结论 临床效果显著,疗效确切.     

芪莲舒痞颗粒治疗慢性萎缩性胃炎肠上皮化生的临床研究

目的探讨中药芪莲舒痞(QLSP)颗粒治疗萎缩性胃炎(CAG)伴肠上皮化生(IM)的临床疗效。方法将经胃镜和病理组织学确诊为慢性萎缩性胃炎并符合CAG肠上皮化生的92例患者按照平行、随机、对照的原则分为QLSP组37例、胃复春组29例和维酶素组26例,三组均以6个月为1个疗程,疗程结束后,病理学检查肠上皮化生的改善情况。结果 QLSP组、胃复春组、维酶素组病理疗效显效率分别为43.2%、31.0%、3.8%,有效率分别为48.6%、41.4%、46.2%,总有效率分别为91.9%、72.4%、50.0%。QLSP组治疗前后病理积分比较,差异有统计学意义(P0.01),QLSP组治疗后病理积分分别与胃复春组和维酶素组比较,差异均有统计学意义(P0.01)。结论芪莲舒痞颗粒对肠化生的病理总有效率和肠化生病理积分的改善均优于胃复春组和维酶素组。     

郑氏胃药治疗萎缩性胃炎伴肠上皮化生40例

目的：观察郑氏胃药治疗萎缩性胃炎伴肠上皮化生的疗效.方法：选择明确诊断的患者80例,随机分治疗与对照两组,各40例.治疗组采用郑氏胃药基本方辨证分型治疗,对照组采用猴头菌片治疗,疗程均为1～3个月.比较两组临床症状、胃镜及病理组织学改变.结果：胃脘胀满等症状、胃镜及组织病理学改变,治疗组明显优于对照组,P〈0.05.结论：郑氏胃药对萎缩性胃炎伴肠上皮化生疗效确切.     

魏睦新教授辨证与辨病结合治疗萎缩性胃炎经验撷要

慢性萎缩性胃炎（CAG）是指胃黏膜遭到反复侵害而见胃黏膜固有腺体萎缩,黏膜变薄,或伴肠上皮化生、异型增生为病理特点的病症。魏睦新教授采用宏观辨证分型治疗和微观辨病分类治疗,使萎缩性胃炎肠上皮化生和异型增生逆转,疗效显著,对于防治慢性萎缩性胃炎伴肠化恶变成胃癌有着积极的作用。     

自然人群中3432份样本的胃粘膜病理观察

通过对自然人群的3432份胃粘膜病理观察,检出胃癌5例并发现在胃癌高发区人群中,以慢性浅表性胃炎(CSG)检出较为常见,约占总数的67.28％,其次为慢性萎缩性胃炎(CAG),肠上皮化生(IM),分别占总数的3.88％,14.28％。部位检出:CSG体部高于窦部,CAG与IM则窦部明显高于体部(P<0.05)。本报告支持CAG、IM为癌前病变的论点。     

Relationship of Helicobacter pylori eradication with gastric cancer and gastric mucosal histological changes: a 10-year follow-up study

Background Helicobacter pylori （Hp） is a common and potentially curable cause of gastric mucosa lesion. This study investigated the relationship of Hp infection with histological changes in gastric mucosa and gastric cancer in Hp-positive patients compared with Hp-eradication patients followed up for ten years. Methods From an initial group of 1 006 adults, 552 Hp-positive subjects were randomly assigned to a treatment group （T; n=276） or a placebo group （P; n=276）. In the randomized, double-blind, placebo-controlled, parallel trial, T group subjects received oral doses of omeprazole, amoxicillin and clarithromycin for 1 week; those in the P group received a placebo. One month after treatment ended, a 13C urea breath test was performed, and Hp was undetectable in 88.89% of the T group. All subjects were followed at 1, 5, 8, and 10 years after treatment, with endoscopy and biopsies for histological examination. Results Gastric mucosa inflammation was significantly milder in the T group than that in the P group one year after Hp eradication and this persisted for 10 years. Glandular atrophy and intestinal metaplasia （IM） had deteriorated in both groups during ten years. However, the increased score of glandular atrophy at both the gastric antrum and corpus, and IM only at the gastric antrum, in the P group was more obvious than that in the T group. During the 10 years, 9 patients were diagnosed with gastric cancer （2 in the T group; 7 in the P group; P=0.176）. When mucosal atrophy was absent at the gastric antrum and corpus when entering the study, the incidence of gastric cancer in the P group （n=6） was much higher than that in the T group （n=0, P=0.013）. Conclusions Hp eradication may significantly diminish and delay the development of IM and atrophy gastritis. Hp especially in the early stage of Hp infection. and help halt progression of gastric mucosal inflammation eradication is helpful for reducing the risk for gastric cancer,     

A five-year follow-up study on the pathological changes of gastric mucosa after H. pylori eradication

Objectives To investigate the relationship between H.pylori infection,gastric cancer and other gastric diseases through the changes in gastric mucosa and the status of different gastric diseases within 5 years after H.pylori eradication in H.pylori-positive subjects in a high incldence region of gastric cancer. Methods One thousand and six adults were selected from the general population in Yantai,Shandong province,a high Incidence region for gastric cancer in China.Gastroscopy and Campylobacter-like organism(CLO)testing were performed on all subjects,Biopsy samples from the gastric antrum and body were obtained for histology and assessment of H.pylori infection.All H.pylori-positive subjects were then randomly divided into two groups:treatment group receiving Omeprazole Amoxicillin Clarythromycin(OAC) triple therapy and placebo as controls.These subjects were endoscopically followed up in the second and fifth year.We compared the endosopic appearance and histology of the biopsy specimens from the same site obtained at the first and last visits.Results All 552H.pylori-positive subjects were randomly and evenly divided into treatrment group or control group.During the five-year follow-up,the numbers of patients who continued to be negative or positive for H.pylori were 161 and 198,respectively.Statistical analysis revealed that:①At the initial visit,there were no significant differences in the severity and activity of inflammation,atrophy and intestinal metaplasia between the biopsy specimens from the antrum and body resopectively in both groups. ②The severity and activity of inflammation in both the antrum and body were markedly reduced after H.pylori eradication(P=0.000).③Within five years after H.pylori eradication,intestinal metaplasia in the antrum either regressed or had no progression,while the proportion of intestinal metaplasia in the H.pylori-positive group increased significantly(P=0.032).④After H.pylori eradication,the atrophy in both the antrum and body had no significant regression.The P value was 0.223 and 0.402,respectively.Conclusions H.pylori eradication results in remarkable reduction in the severity and activity of chronic gastritis,marked resolution of intestinal metaplasia in the antrum.On the other hand.continuous H.pylori infection leads to progressive aggravation of atrophy and intestinal metaplasia.     

幽门螺杆菌在慢性胃炎病理类型及年龄分布上的特点

对胃镜检查病理诊断为慢性胃炎者２９４９例进行临床病理分析，重点观察了幽门螺杆菌，慢 活动性胃炎，慢性浅表性胃炎，慢性萎缩性胃炎，肠上皮化生在年龄分布上的特点以有它们之间的关系。结果见ＨＰ相关性胃炎与慢性活动性胃炎无论在年龄分布上还是在慢性胃炎各类型中的分布上都有明显的同步性。     

胃癌前病变与幽门螺杆菌关系随访研究

目的：探讨胃癌前病变病理改变的性质、程度和幽门螺杆菌（ＨＰ）感染及药物治疗与其变化过程的关系。方法：胃镜活检慢性萎缩性胃炎（萎缩）３７例,伴肠上皮化生（肠化）１９例、不典型增生７例,观察其与ＨＰ关系,ＨＰ以Ｇｉｍｅｓａ染色,肠化者以粘液组织化学染色。１９例萎缩伴肠化服德诺２８ｄ加施尔康６个月,ＨＰ阳性者加阿莫西林１４ｄ治疗,常规胃镜查ＨＰ根除率。随访６～３１．５个月复查胃镜及ＨＰ。结果：萎缩、肠化、不典型增生ＨＰ阳性率分别为８６．５％（３２／３７）、７８．９％（１５／１９）和５７．１％（４／７）。１９例萎缩伴肠化ＨＰ根除率为６６．７％（１０／１５）,萎缩、炎症、肠化改善有效率分别为６３．２％（１２／１９）、７３．７％（１４／１９）和７８．９％（１５／１９）。其中已根除ＨＰ者分别占６６．７％（８／１２）、７１．４％（１０／１４）和６６．７％（１０／１５）,与未根除ＨＰ者炎症与肠化改善例数比较有显著性差异（Ｐ＜０．０１）。结论：胃癌前病变与ＨＰ关系密切,联合抗ＨＰ药物及多种维生素疗法对改善胃癌前病变有效。     

中药丁香胃灵散对慢性萎缩性胃炎病理组织学改变逆转的影响

中药胃粘膜再生方—丁香胃灵散,代号CG-Ⅱ,是由理气活血,益气养阴中药为主组成,为观察其促进胃粘膜再生作用,对44例慢性萎缩性胃炎(CAG)进行CG-Ⅱ治疗3～12个月,并观察治疗后胃粘膜萎缩、肠化生的变化;发现两种病变均有逆转变化,总有效率72.7%。以疗程长者效果最佳。其中16例在CG-Ⅱ治疗后查细胞标记指数(LI),13例已属CSG范围。说明CAG不是不可逆转的病变,治疗得当可以逆转;也说明CG-Ⅱ有较好的促胃粘膜再生作用。     

胃癌及癌前病变组织中环氧合酶-2和诱导型一氧化氮合酶蛋白的表达

目的：探讨胃癌及癌前病变组织中环氧合酶-2（COX-2）和诱导型一氧化氮合酶（iNOS）蛋白的表达及意义。方法：采用免疫组化方法检测COX-2和iNOS蛋白在28例慢性浅表性胃炎、23例慢性萎缩性胃炎伴肠化、19例胃黏膜不典型增生及53例胃癌组织中的表达情况。结果：慢性浅表性胃炎、慢性萎缩性胃炎伴肠化、不典型增生胃黏膜及胃癌组织中COX-2蛋白的阳性表达率分别为17.9%、30.4%、42.1%和62.3%;iNOS蛋白的阳性表达率分别为21.4%、34.8%、52.6%和71.7%,差异均有统计学意义（COX-2：χ2=16.725,P=0.001;iNOS：χ2=21.300,P〈0.001）。胃癌组织中,COX-2和iNOS蛋白在侵及浆膜层组织及有淋巴结转移组织中阳性表达率均高于未侵及浆膜层组织及无淋巴结转移组织（COX-2：χ2=4.154和5.123,P=0.042和0.024;iNOS：χ2=5.539和8.640,P=0.019和0.003）;且两者间有关联（rP=0.351,P=0.006）。结论：COX-2和iNOS参与胃癌形成的全过程,且可能为其早期事件。