加强对老年人胃部疾病与胃随龄变化研究

胃黏膜增龄变化的基本表现为胃窦固有层腺体数量减少，胃窦黏膜固有层胶原组织增生，但胃底腺腺体实质比略高于非老年组，壁细胞数量在不同年龄组间差异无统计学意义。由于老年人胃体萎缩性胃炎发生率增加，导致部分老年人胃酸偏低，但老化不是胃酸分泌减少的独立原因，年龄增长并不影响空腹状态下胃内氢离子活性。质子泵抑制剂与氯吡格雷合用是否会降低疗效，是当前关注热点。国内对于80岁以上的109例老龄患者观察，认为质子泵抑制剂不影响服用氯吡格雷患者的临床前景，不足之处是观察的例数偏少，且联用质子泵抑制剂治疗时间较短。对老年人根除幽门螺杆菌感染的组织学变化，结果表明，幽门螺杆菌根除者慢性炎症好转率达87．4％，急性活动性炎症好转率为57．8％，较幽门螺杆菌未根除者炎症好转率明显增加。

Pay more attention to the research of gastric diseases and aging gastric mucosa in the elderly

The histopathologic characters of gastric mucosa with aging are the loss of gastric glands at lamina propria and their replacement with hyaline-like connective tissue. The rate of glandular parenchyma in aged group was higher than that of non-aged adults, but there were no statistical difference of the parietal cell numbers between the two groups. The incidence of atrophic gastritis increases in elderly subjects, and the gastric acidity decreases with atrophy. However, aging is not the only cause of reduced gastric acid secretion; it has no effect on gastric hydrogen ion activity at fasting state. Reports about proton pump inhibitor （PPI） and clopidogrel combination treatment are still controversial. The observation of 109 octogenarian patients in China showed that PPI had no side effect on the clinical therapy when combined with clopidogrel. The shortages of the study are the limitation of case number and shorter treatment duration. Helicobacter pylori （Hp） infection plays a critical role in the development of some gastric diseases, especially atrophic gastritis and intestinal metaplasia. Histological changes of aging patients after H. pylori eradication indicated that inflammation was significantly improved compared with the patients without Hp eradication, with the improvement rate of chronic inflammation at 87.4%, and the improvement rate of acute active inflammation at 57.8%, respectively.