根除幽门螺杆菌对胃窦黏膜萎缩和肠上皮化生逆转影响的前瞻性研究

目的 探讨根除幽门螺杆菌(Hp)对逆转胃窦黏膜萎缩和肠上皮化生(肠化生)病理改变的作用.方法 对行胃镜检查的门诊患者,于胃窦处取黏膜活检行病理学检查,并确定Hp感染状态.将Hp感染的慢性胃炎伴胃窦黏膜萎缩或(和)肠化生患者作为入选对象并分为两组,一组行Hp根除治疗,为Hp根除组(48例);另一组未行抗Hp治疗,为对照组(38例).分别在1年和5年后对两组患者进行胃镜随访,并在同一部位取材,根据2次病理结果的不同分为逆转和未逆转两种情况.结果 胃窦黏膜萎缩逆转率在Hp根除组显著高于对照组(37.1%比12.0%).5年后Hp根除组的胃窦黏膜萎缩逆转率显著高于1年后,45岁以下者显著高于45岁以上者.而在对照组中,胃窦黏膜萎缩逆转和随访的时间及年龄无明显关系.在2次随访中,肠化生逆转率在Hp根除组和对照组间差异均无统计学意义(P>0.05).结论 根除Hp尚不能逆转胃窦黏膜肠化生,但对逆转胃窦黏膜萎缩有作用,这种作用与随访观察时间及患者的年龄有关.因此,对有Hp感染的胃窦黏膜萎缩者应及早行根除Hp治疗.

The impact of Helicobacter pylori eradication on reversing gastric mucosal atrophy and intestinal metaplasia: a prospective study

Objective To investigate the effect of Helicobacter pylori (H. pylori) eradication on reversing gastric antrum atrophy and intestinal metaplasia (IM). Methods Biopsy specimens obtained from gastric antrum of patients who underwent gastroscopy were examined for pathology and the status of H. pylori infection. The H. pylori infected patients who had chronic gastritis with antrum atrophy or IM were recruited and were divided into either H. pylori eradicated group (n= 48)or control (non-eradicated) group (n=38). The gastroscopic follow-up was carried out at 1 year and 5years. The specimens examined for changes of histology and reverse of gastric antrum and IM were obtained at the same site. Results The reversing rate of gastric antrum atrophy in H. pylori eradicated group was significantly higher than that in control group (37.1% vs. 12.0%). In H. pylori eradicated group, the reversing rate of gastric antrum atrophy at 5-year was significantly higher than that at 1-year, and it was higher in patients aged below 45 years than those aged above 45 years.Whereas there was no association of reversing gastric antrum atrophy with follow-up time and age in control group. However there was no difference in reversing rate of IM between two groups in 1- or 5-year follow-up and H. pylori eradication. Conclusions H. pylori eradication can not reverse the IM of gastric antrum mucosa, but it can reverse the atrophy of gastric mucosa, which is associated with follow-up time and the age of patients. Therefore, H. pylori must he eradicated as early as possible in H. pylori infected patients with gastric antrum atrophy.