幽门螺杆菌阴性消化性溃疡的病例对照研究

背景：幽门螺杆菌（H．pylori）感染是消化性溃疡（PU）的重要病因，但H．pyZori阴性溃疡在PU中仍占有一定比例。目的：分析总结H．pyfori阴性PU的临床特点。方法：回顾性分析2004年1月-2007年3月北京大学第三医院住院PU患者的病例资料。从H．pylori阳性患者中以l：l的比例为H．pylori阴性组随机选取性别相同、年龄相近的对照，分析比较两组临床特点。结果：共纳入480例PU患者，男女比例为3．62：1；HpyZori阴性120例，阳性360例，阴性患者中位年龄显著高于阳性患者（P〈0．001）。病例对照研究显示，Hpylori阴性组首发症状存在腹痛者显著少于对照组，有恶心、呕吐症状以及有PU史和非甾体抗炎药（NSAIDs）服用史者显著多于对照组（P〈0．05）。H．pyZori阴性组胃溃疡显著多于对照组，十二指肠溃疡显著少于对照组（P〈0．05）；内镜下慢性非萎缩性胃炎显著少于对照组，息肉显著多于对照组（P〈0．05）：组织学上胃黏膜炎症、炎症程度和活动性显著轻于对照组，淋巴组织增生和肠化生显著少于对照组（P〈0．05）。结论：H．pyfo矗阴性PU占本组PU总数的25．O％，患者年龄相对较大，临床多表现为无痛性溃疡，多有PU史和NSAIDs服用史。溃疡多发生于胃部，黏膜炎症程度较轻，活动性炎症少见。

Helicobacter pylori-negative Peptic Ulcer:A Case-control Study

Background： Helicobacter pylori （H. pylori） infection is the main etiological factor of peptic ulcer （PU）, however, there still exist a certain proportion of H. pylori-negative PU patients. Aims： To analyze the clinical features of H. pylori- negative PU. Methods： The medical records of all inpatients diagnosed as PU in Peking University Third Hospital from Jan. 2004 to Mar. 2007 were analyzed retrospectively. Gender- and age-matched controls were randomly selected from H. pylori-positive patients for H. pylori-negative group at a ratio of 1：1. The clinical features of these two groups were compared. Results： Four hundred and eighty PU patients were enrolled; the ratio of male to female was 3.62：1. Of all these cases, 120 were H. pylori-negative and 360 were H. pylori-positive, the median age of H. pylori-negative patients was older than that of H. pylori-positive ones （P〈0.001）. In this case-control study, patients in H. pylori-negative group had less abdominal pain but more nausea and vomiting, and more PU history and history of taking non-steroidal antiinflammatory drugs （NSAIDs） （P〈0.05）. Under endoscopy, patients in H. pylori-negative group had more gastric ulcer but less duodenal ulcer, more polyps but less chronic non-atrophic gastritis （P〈0.05）; degree and activity of mucosal inflammation, lymphoid tissue hyperplasia and intestinal metaplasia were less than those in control group （P〈0.05）. Conclusions： 25.0% of PU patients enrolled in this study is H. pylori-negative. Patients with H. pylori-negative PU are older, and have less abdominal pain, more PU history and history of taking NSAIDs. Ulcers mainly occur in the stomach, mucosal inflammation is milder and active inflammation is infrequently seen.