胆汁反流性胃炎患者幽门螺杆菌感染及其胃粘膜病理学表现研究*

目的 探讨胆汁反流性胃炎（BRG）患者幽门螺杆菌（Hp）感染及其胃粘膜病理学变化。方法 我院诊治的BRG患者618例和无胆汁反流的慢性浅表性胃炎（CSG）患者1486例,采用¹⁴C-尿素呼气试验、血清抗-Hp抗体检测和对组织切片行硼酸亚甲蓝染色三种方法对受试者进行Hp感染诊断,常规行胃镜检查,参照新悉尼系统标准,将组织学上胃黏膜慢性炎性反应、炎性反应活动性、萎缩和肠上皮化生的严重程度分为无、轻、中和重4个等级。结果 BRG患者Hp感染率为32.7%（202/618）,而CSG组患者为40.6%（603/1486）,两组间无显著性差异（P>0.05）;在202例Hp阳性的BRG患者中,胃粘膜轻、中、重度炎症反应发生率分别为10.9%、61.4%和27.7%,显著重于416例Hp阴性患者的40.4%、51.7%和7.9%（P<0.05）,胃粘膜淋巴滤泡形成、肠化生和活动性炎症发生率分别为15.4%、5.4%和16.8%,也显著重于Hp阴性患者的2.7%、10.8%和0.7%（P<0.05）;603例Hp阳性的CSG患者胃粘膜轻、中、重度炎症反应发生率分别为29.2%、59.4%和11.5%,与883例Hp阴性患者的34.1%、54.0%和11.9%比,无显著性差异（P>0.05）,胃粘膜淋巴滤泡形成、肠化生和活动性炎症发生率分别为10.4%、1.8%和8.5%,与Hp阴性患者的7.8%、1.0%和5.0%比,也无显著性差异（P>0.05）;观察胃粘膜病理学轻度、中度和重度炎症情况发现,117例内镜下胃粘膜III级BRG患者炎症程度显著重于200例I级或301例II级患者（P<0.05）。结论 BRG患者无论是胃镜下表现还是胃粘膜组织病理学变化都存在明显的病变,胆汁反流和Hp感染是引起胃粘膜炎症反应的重要因素。

Prevalence of Helicobacter pylori infection and gastric mucosa inflammation in patients with bile reflux gastritis

Objective To investigate the prevalence of Helicobacter pylori （Hp） infection and gastric mucosa inflammation in patients with bile reflux gastritis（BRG）. Methods 618 patients with BRG and 1486 patients with chronic superficial gastritis（CSG） without bile reflux were recruited in our hospital between March 2015 and February 2017. Gastroscopy was carried out in all patients,and the Hp infection was determined by ¹⁴C-urea breath test,serum anti-Hp antibody detection and gastric mucosa histopathological examination. Results The prevalence of Hp infection was 32.7%（202/618） in patients with BRG,no significant difference as compared to 40.6% （603/1486） in patients with CSG （P>0.05）;the mild,moderate and severe inflammatory reaction of gastric mucosa in 202 BRG patients with Hp positive were 10.9%,61.4% and 27.7%,much severer than 40.4%,51.7% and 7.9% （P<0.05） in 416 patients with Hp negative,and the incidences of lymphoid follicle formation,intestinal metaplasia and active inflammation were 15.4%,5.4% and 16.8%,respectively,also much severer than 2.7%,10.8% and 0.7%（P<0.05） in patients with Hp negative;the mild,moderate and severe inflammatory reaction of gastric mucosa in 603 CSG patients with Hp positive were 29.2,59.4% and 11.5%,no significant difference as compared to 34.1%,54.0% and 11.9%,respectively （P>0.05） in 883 patients with Hp negative,and the incidences of lymphoid follicle formation,intestinal metaplasia and active inflammation were 10.4%,1.8% and 8.5%,also no significant difference as compared to 7.8%,1.0% and 5.0%,respectively（P>0.05） in patients with Hp negative;the pathological examination of gastric mucosa showed that the severity of inflammation in 117 BRG patients with III degree of gastric mucosal lesions under gastroscopy were more severe than in 200 patients with I degree or 301 patients with II degree （P<0.05）. Conclusion The gastric lesions under gastroscopy and histopathological inflammation of gastric mucosa are obvious in patients with BRG and bile reflux and Hp infection are the important factors in the pathogenesis of gastric mucosa inflammation. The endoscopic classification has a significant implication in early judgment of the disease.