消化性溃疡临床及病理特征对照研究

 目的 分析Hp(+)溃疡和Hp(-)溃疡的临床及病理特征。方法 分组比较112例Hp(+)溃疡和86例Hp(-)溃疡患者的临床资料、内镜特征和黏膜病理改变。结果 两组年龄、性别构成、伴随疾病无统计学差别。Hp(-)组服用NSAIDs比例36.0%高于Hp(+)组21.4%（P＜0.05）；Hp(+)组消化道症状评分高于Hp(-)组［（6.0±2.1） vs （5.2±1.5）］，以上腹痛最为突出，而Hp(-)组的恶心及呕吐症状更多见（P＜0.05）。两组溃疡均以十二指肠溃疡为主，但Hp（-）组胃溃疡比例40.7%高于Hp（+）组24.1%，Hp（+）组十二指肠溃疡比例62.5%高于Hp（-）组47.7%（P＜0.05）。内镜下两组溃疡分期、数目、合并胆汁反流无统计学差别。Hp(+)组长径1.0 cm以下溃疡比例68.7%高于Hp(-)组48.8%，Hp(-)组长径1.0 cm以上溃疡比例51.2%高于Hp(+)组的31.3%，Hp(-)组镜下出血率30.2%高于Hp(+)组17.9%（均P＜0.05）。Hp(+)组黏膜慢性炎性反应、炎性反应活动性、淋巴组织增生、肠化生等病理改变高于Hp(-)组（P＜0.05），黏膜炎性反应及炎性反应活动性与Hp密度呈正相关（P＜0.01，r=0.560和0.547）。结论 Hp(+)溃疡消化道症状较重，以十二指肠溃疡为主，溃疡较小，病理改变更明显。Hp(-)溃疡与NSAIDs密切相关，胃溃疡比例较高，溃疡较大，呈多发趋势，更易合并出血。

A case-control study on clinical features and pathology of peptic ulcer

Objective To study the clinical features and pathology differences between the H.pylori-positve and the H.pylori- negative peptic ulcers. Methods 112 patients were enrolled in H.pylori-positve group and 86 in H.pylori-negative group. The clinical, endoscopic and pathological characteristics of these two groups were compared. Results There ware no significant differences in demographic characteristics and concomitant diseases between the two groups.The patients in H.pylori-positve group had higher rate of taking NSAIDs and the gastrointestinal symptom score,more abdominal pain but less nausea and vomiting(P＜0.05). In the two groups of patients, DU had major proportion. The GU proportion was higher in the H.pylori-negative group, but in the positive group DU proportion was higher (P＜0.05). Under endoscopy, patients in H.pylori-negative group had more gastric ulcer but less duodenal ulcer, greater peptic ulcer diameter and higher tendency to cause bleed(P＜0.05).No significant differences were found between the H.pylori-positve and the H.pylori- negative patients in incidence of complex ulcer,ulcer stage, number of ulcers and bile reflux. H.pylori-negative patients’ degree and activity of mucosal inflammation, lymphoid tissue hyperplasia and intestinal metaplasia were more than those in H.pylori- negative patients(P＜0.05), The degree and activity of mucosal inflammation were aggravated with increasing H.pylori density(P＜0.05). Conclusions H.pylori-positve peptic ulcers have higher gastrointestinal symptom score,more DU,less size and more pathological changes,while the H.pylori- negative peptic ulcers have a close relationship with NSAIDs,more GU,larger size and a higher tendency to bleed.