以胃黏膜胆汁酸浓度评估胆汁反流对胃黏膜组织的作用

背景:胃黏膜胆汁酸水平可直接反映胃黏膜细胞胆汁酸暴露的程度,并体现胆汁酸对胃黏膜的损伤程度。目的:探讨以胃黏膜组织胆汁酸浓度评估胆汁反流对胃黏膜病理改变的影响。方法:选取经内镜检查和黏膜胆汁酸浓度确诊的40例胆汁反流性胃炎患者和20例无胆汁反流性胃炎患者,评估幽门螺杆菌(H.pylori)检出率,行组织病理学评分,并分析胃黏膜胆汁酸浓度与组织病理学评分的相关性。结果:与无胆汁反流性胃炎患者相比,胆汁反流性胃炎患者H.pylori检出率无明显差异;胃窦、胃体黏膜组织胆汁酸含量显著升高(P0.05);胃窦黏膜慢性炎症和肠化生评分显著升高(P0.05),胃体黏膜慢性炎症、炎症活动性、萎缩和肠化生评分均显著升高(P0.05)。胆汁反流性胃炎患者胃窦、胃体组织病理学改变均与胆汁酸浓度相关(P0.05)。结论:以胃黏膜胆汁酸浓度评估的胆汁反流与胃黏膜病理损伤严重程度呈正相关。与无胆汁反流性胃炎相比,胃内胆汁反流主要加重胃体部组织病理学损伤。

Using Concentration of Bile Acid in Gastric Mucosa to Assess the Effect of Bile Reflux on Gastric Mucosa

The concentration of bile acid in gastric mucosa directly reflects the degree of bile acid exposure and embody the infringement intensity to gastric mucosa. Aims： To evaluate the effect of bile reflux on histopathological changes of gastric mucosa by concentration of bile acid in gastric mucosal tissue. Methods： Forty patients with bile reflux gastritis and 20 patients without bile reflux gastritis who were diagnosed by endoscopy and concentration of bile acid in gastric mucosa were enrolled. Detection rate of Helicobacter pylori （H. pylori） and histopathological score were evaluated, and its correlation with concentration of bile acid in gastric mucosa was analyzed. Results： Compared with patients without bile reflux gastritis, the concentration of bile acid in antrum and corpus were significant increased in patient with bile reflux gastritis （P〈0.05）, but no significant difference of detection rate of H. pylori was found between those with and without bile reflux gastritis （P〉0.05）. The score of chronic inflammation and intestinal metaplasia in antrum, and score of chronic inflammation, activity of inflammation, atrophy and intestinal metaplasia in corpus were significantly increased in patient with bile reflux gastritis （P〈0.05）, and the histopathological changes were correlated with the concentration of bile acid （P〈0.05）. Conclusions： The bile reflux assessed by concentration of bile acid in gastric mucosa is correlated positively with histopathological changes in gastric mucosa. Compared with the patients without bile reflux gastritis, bile reflux mainly aggravates the histopathological changes in corpus.