幽门螺杆菌感染患者胃黏膜组织学炎症评价依据及诊断标准的探讨

目的 探讨幽门螺杆菌（Hp)相关性胃黏膜炎症的病变特征及炎症程度的组织学评价标准。方法 2134例胃活检组织学病理检查病例，包括胃窦、胃体、胃角取材。Hp检测按快速尿素酶试验及组织学甲杠胺蓝或免疫组化染色，HE组织学切片染色用于组织炎症及炎症活动度的评价。结果Hp感染主要引起胃黏膜上皮细胞的病变，正常胃黏膜腺上皮内无炎细胞浸润，重度炎症有上皮层炎细胞的聚集破坏。黏膜炎症分级反映了Hp感染状况且不受活检部位、组织取材标本小、包埋切片方向的影响。在Hp感染阳性组，重度活动性炎症者占39．6％，而在阴性组仅为0．4％，二者差异有显著意义。Hp胃黏膜定植量与黏膜炎症程度有明显的相关性。结论 本研究提出的胃黏膜炎症分级方法十分简便，标准容易掌握，反映了Hp的定植情况及其致病的生物学特性。

Helicobacter pylori associated gastric mucosal inflammation and histopathological assessment

Objective To investigate the pathological features of Helicobacter pylori associated gastric mucosal inflammation and to establish relevant histopathological assessment standards. Methods Biopsy specimens from the gastric antrum, body of stomach, and gastric angle were taken from 2 134 cases of H. pylori associated gastric mucosal inflammation. H. pylori was identified by means of rapid urase test and toluidine blue staining or immunohistological staining. The severity of mucosal inflammation was evaluated with HE staining. Ultrastucture evaluation was conducted for part of the specimens. Results In H. pylori positive cases lymphocytic infiltration could be observed in glandulous epithelium. which was not found in normal gastric mucosa. Scoring of severity of mucosal inflammation reflected the status of H. pylori infection and was not influenced by the biopsy site, size of specimen, and direction of sectioning. Severe active inflammation could be seen in 39.6% of the H. pylori positive cases, and 0.4% of the H. pylori negative cases. The severity score of inflammation was significantly correlated with the amount of H. pylori colonization. Conclusion Reflecting the real status of H. pylori associated mucosal inflammation. The grading method reported here is simple, reliable, and easy to master.