原发性十二指肠胃反流程度与胃黏膜炎性反应关系的研究

目的 分析原发性病理性十二指肠胃反流(DGR)患者胃黏膜病变、幽门螺杆菌(Hp)感染及胆汁反流变化以及相互间的关系.方法 对58例原发性病理性DGR患者进行24 h胃内胆汁监测,以反流时间百分23.60%为界,将患者分为高反流组(29例)和低反流组(29例).并行胃镜检查及胃黏膜活检.分析原发性病理性DGR患者胃黏膜炎性反应、Hp感染、胆汁反流间的关系.结果 高反流组及低反流组的Hp阳性率分别为20.7%(6/29)和48.3%(14/29),差异有统计学意义(P＜0.05).高反流组胃窦和胃角部黏膜肠上皮化生检出率高于低反流组(P＜0.05).胃窦、胃角部黏膜新悉尼系统病理积分Hp阳性组高于Hp阴性组(P＜0.05),高反流组高于低反流组(P＜0.05).Hp阳性组胆红素吸收值≥0.25的时间百分比低于Hp阴性组(P＜0.05),HP阳性组短时间反流频率、长时间反流频率、最长反流时间、吸收值最大值、平均值和中位值与Hp阴性组间差异无统计学意义(P＞0.05).Hp阳性组和阴性组胆红素吸收值≥0.25的时间百分比与胃窦、胃角部黏膜新悉尼系统病理积分均呈正相关(P＜0.05).结论 原发性病理性DGR导致胃窦黏膜损伤的主要因素可能为胆汁反流,胆汁反流可抑制HP在胃内定植,Hp感染可能与胆汁反流协同作用导致胃黏膜损伤.

Relationship between primary pathological duodenogastric reflux and chronic inflammation of gastric mucosa

Objective To study the association among gastric mucosal lesions caused by primary pathological duodenogastric reflux(DGR),H.pylori infection,and bile reflux.Methods Twenty-four hour intragastric bilirubin monitoring were performed on 58 patients with primary pathological DGR.The patients were divided into high reflux group(n=29)and lOW reflux group(n=29)based on the severity of bile reflux(＜23.60%).The association among gastric mucosal lesions,H.pylori infection,and bile reflux were analyzed.Results The positive rate of H.pylori infection was 20.7% (6/29)in high reflux group and 48.3%(14/29)in low reflux group(P＜0.05).The frequency of intestinal metaplasia in gastric antrum and angularis in high reflux group was higher than that in low reflux group(P＜0.05).The pathological scores of gastric antrum and angularis in H.pylori positive group and high reflux group were higher than those in H.pylori negative group and low reflux group (P＜0.05).The time percentage of bilirubin absorbance≥0.25 in H.pylori positive group was lower than that in negative group(P＜0.05),while the difference in short reflux frequency,long reflux frequency,longest reflux time,maximum,mean and median value of absorbance between H.pylori positive and negative groups showed no significant difference(P＞0.05).The time percentage of bilirubin absorbance≥0.25 was positively correlated with pathological scores of gastric antrum and angularis in both H.pylori positive and negative groups(P＜0.05),but was not correlated with that of gastric body(P＞0.05).Conclusions In patients with primary pathological DGR,excessive bile reflux is related to chronic lesion of gastric mucosa.regardless of H.pylori infection.Bile reflux may inhibit H.pylori to locate in gastric mucosa.H.pylori infection and bile reflux may co-contribute to gastric mucosal lesions.