胃窦黏膜活检病理与幽门螺杆菌感染

目的探讨胃窦黏膜活检病理变化是否具有幽门螺杆菌(H.pylori)感染的预测价值。方法分析347例患者胃窦黏膜活检病理改变与H.pylori的关系。H.pylori感染以快速尿素酶和Giemsa染色确定。并比较慢性胃炎、胃溃疡、十二指肠球部溃疡3组疾病在急性炎症、中～重度浅表炎症、淋巴滤泡增生及肠化4项指标对H.pylori感染的敏感性、特异性、阳性预测值、阴性预测值。结果347例患者有206例H.pylori阳性,阳性率为59.4%。上消化道疾病患者及慢性胃炎患者H.pylori感染者急性炎症、中～重度浅表性炎症、淋巴滤泡发生率显著高于H.pylori阴性者(P<0.01),肠化与萎缩无显著性差异;胃溃疡患者H.pylori感染者中～重度浅表性炎症、淋巴滤泡及肠化明显高于H.pylori阴性者;十二指肠球部溃疡患者H.pylori感染中～重度浅表性炎症明显高于H.pylori阴性者。3组疾病的4项指标阳性预测值(51.6%～100.0%)均优于阴性预测值(23.0%～58.6%);除慢性胃炎组肠化阳性预测值(51.6%)较低外,其余病理改变对H.pylori感染阳性预测值均>80.0%,其中胃溃疡组阳性预测值最高。结论胃窦黏膜活检病理配合其他检测手段对H.pylori感染有一定的诊断价值。

Gastric antrum mucous membrane biopsy pathology and H.pylori infection

Objective It is to discuss whether gastric antrum mucous membrane biopsy pathology change possess H.pylori infection predictive value.Methods The relationship between gastric antrum mucous membrane biopsy pathology change and H.pylori in 347 patients was analyzed.H.pylori infection was definited with rapid urease and Giemsa stain.The sensitivity,specificity,positive and negative values of H.pylori infection with acute inflammation,midrange and serious chronic inflammation,lymph foilicie hyperplasia and intestinal metaplasia in the patients with chronic gastritis,gastric ulcer and duodenal duodenobulbar ulcer were compared.Results 206 cases were definited as H.pylori positive in 347 patients and the positive rate was 59.4%.In upper digestive tract disease and chronic gastritis patients,the acute inflammation,midrange and serious chronic inflammation and lymph foilicie hyperplasia rate in H.pylori infection patients were significantly higher than that in H.pylori negative patients(P<0.01),but there was no significant difference on intestinal metaplasia and analosis.In gastric ulcer patients,midrange and serious chronic inflammation,lymph foilicie hyperplasia and intestinal metaplasia in H.pylori infection patients were obviously higher than that in H.pylori negative patients.In duodenal duodenobulbar ulcer patients,midrange and serious chronic inflammation in H.pylori infection patients were obviously higher than that in H.pylori negative patients.The positive values(51.6%～100.0%) for H.pylori infection was prior to negative values(23.0%～58.6%) for H.pylori infection in the three groups of disease.The positive values for H.pylori infection of intestinal metaplasia was lower in chronic gastritis group(about 51.6%),the other positive values for H.pylori infection of histopathology were more than 80.0%.The positive values in gastric ulcer group was the highest.Conclusion Gastric antrum mucous membrane biopsy pathology combined with other tests is valuable to diagnose H.pylori infection.