幽门螺杆菌感染与儿童结节性胃炎组织病理学表现的关系

目的 探讨儿童结节性胃炎的病理学特征以及与幽门螺杆菌（Hp）感染的关系。方法 213 例具有上消化道症状行胃镜检查的儿童纳入研究，按镜下表现分为结节性胃炎组和非结节性胃炎组。应用改良悉尼标准评估胃黏膜组织病理学特征。比较两组间Hp 感染、胃炎程度和淋巴滤泡形成的发生率。结果 共38 人（17.8%）诊断为结节性胃炎。与非结节性胃炎组相比，结节性胃炎组Hp 感染率（86.8% vs 14.3%，P<0.01）、胃黏膜中-重度炎症比率（81.6% vs 15.4%，P<0.01）和淋巴滤泡形成比率（52.6% vs 10.3%，P<0.01）均增高。结节性胃炎对诊断Hp 感染的特异度为96.8%，阳性预测值为86.8%。在Hp 感染的58 人中33 人（56.9%）存在结节性胃炎，而Hp 阴性155 人中仅5 人存在结节性胃炎（3.2%），差异有统计学意义（P<0.01）。Hp 感染与非Hp 感染患儿相比，胃黏膜中-重度炎症表现（86.2% vs 5.2%，P<0.01）和淋巴滤泡形成（84.2% vs 14.9%，P<0.01）比率更高。不同部位胃组织的Hp 定植量、炎症程度、活动程度在结节性胃炎组和非结节性胃炎组中均不相同（P<0.01）。结论 结节性胃炎为儿童Hp 感染的一种特殊征象，其病理多呈中-重度炎症改变，是提示Hp 感染的内镜指标，应考虑Hp 根除治疗。

Relationship between Helicobacter pylori infection and histopathological features of nodular gastritis in children

Objective To study the relationship between Helicobacter pylori (Hp) infection and histopathological features of nodular gastritis (NG) in children. Methods A total of 213 children who had undergone gastroscopy due to upper gastrointestinal symptoms were enrolled and were divided into NG and non-NG groups according to endoscopic appearance. The histopathological features of gastric mucosa were evaluated using the updated Sydney System. The rates of Hp infection, moderate to severe inflammation and lymphoid follicles formation of gastric mucosa were compared between the two groups. Results Thirty-eight (17.8%) of the subjects were diagnosed with NG. The NG group had significantly increased rates of Hp infection (86.8% vs 14.3%; P<0.01), moderate to severe inflammation (81.6% vs 15.4%; P<0.01) and lymphoid follicles formation of gastric mucosa (52.6% vs 10.3%; P<0.01) compared with the non-NG group. NG had a high specificity (96.8%) and a positive predictive value (86.8%) for the diagnosis of Hp infection. NG was observed in 33 (56.9%) of 58 Hp-positive children and in 5 (3.2%) of 155 Hp-negative children (P<0.01). Hppositive children had higher rates of moderate to severe inflammation (86.2% vs 5.2%, P<0.01) and lymphoid follicles formation of gastric mucosa (84.2% vs 14.9% P<0.01) compared with Hp-negative children. There were significant differences in Hp colonization, degree of inflammation and inflammation activity in gastric tissues between the NG and non-NG groups (P<0.01). Conclusions NG is a special sign of Hp infection in children, which mostly shows moderate to severe inflammation of gastric mucosa, and can be used as an endoscopic indicator of Hp infection. Hp eradication therapy should be considered in the treatment of NG.