十二指肠疤痕期溃疡与胃黏膜炎症及Hp感染的关系

目的观察十二指肠疤痕期溃疡胃黏膜的组织学改变及其与Hp感染的关系,为十二指肠溃疡的治疗提供进一步的指导。方法选择内镜确诊的865例十二指肠溃疡患者,包括活动期(A期)30例、愈合期(H期)258例、疤痕期(S期)577例,于内镜检查时行常规活检取胃窦黏膜作组织病理学检查,评价Hp感染及黏膜炎症程度。同时对578例接受质子泵抑制剂和抗生素治疗1周的患者进行随访。结果S期溃疡胃黏膜Hp感染明显低于A期和H期溃疡,但仍高达56.8%。有65%的病例胃黏膜可出现活动性炎症。各期溃疡对除菌治疗的反应相同,S期溃疡治疗后仍有29.8%的病例Hp检测阳性,7.5%病例出现溃疡复发。虽然胃黏膜萎缩的发生率以A期溃疡发生率较高,但肠上皮化生无论是在活动期溃疡,或在疤痕期溃疡,发生率及病变程度均无明显的差异。结论内镜下十二指肠S期溃疡在临床上并没有真正愈合,需要根据Hp和胃黏膜炎症的分析继续进行必要的除菌治疗。

A study on the relationship among scarring stage of duodenal ulcer, gastric inflammation and Helicobacter pylori infection

Objective To investigate the relationship between Helicobacter pylori(H.pylori) infection and the histological changes of gastric mucosa in patients at scarring stage of duodenal ulcer(DU) to provide evidence to guide the therapy of this stage of ulceration.Methods Gastric biopsy specimens were obtained from 865 cases of duodenal ulcer patients,including 30 cases of active(A) ulcer,258 cases of healing(H) ulcer,and 577 cases of scarring(S) ulcer,diagnosed with endoscopic examination.The activity of gastric inflammation and the statue of H.pylori infection were evaluated by histological assays.Moreover,578 patients who were treated with proton pump inhibitor(PPI) in combination with two antibiotics for 1 week were followed up.Results The prevalence of H.pylori infection in patients with S stage of DU was 56.8%,which was lower than that of patients at stage A and stage H.65% of them were complicated with active inflammation in gastric mucosa.The response of patients at different stages of DU to anti-bacterial therapy was the same.29.8% of S stage of DU patients were still H.pylori positive after eradication treatment with 7.5% of them progressed into active stage.The incidence of gastric atrophy was higher in patients at stage A than those at stage H or stage S,whereas no difference was found among the three stage of lesions with regard to the incidence of intestinal metaplasia.Conclusion Stage S of DU diagnosed by gastroscopy was not truly cured,and further therapy to eradicate H.pylori remains to be necessary.