幽门螺杆菌感染在胃癌及癌前病变中的研究

目的　研究胃癌及癌前病变与Hp感染的关系 ,以探讨Hp可能的致癌机制。 方法　经内镜和病理明确诊断的胃癌及癌前病变者共 5 48例 ,包括慢性浅表性胃炎 (CSG) 16 3例、慢性萎缩性胃炎 (CAG) 2 0 7例、肠上皮化生 (IM) 71例 ,异型增生(DYS) 4 5例及胃癌 (GC) 6 2例。每例均活检胃窦大小弯、胃角及胃体大小弯共 5块 ,以WS法检测Hp。结果　癌前病变及胃癌Hp感染均较高 ,CAG(4 2 .5 % ) ,IM(76 .1% ) ,DYS(88.9% )和GC(72 .5 % ) ,与CSG(2 3.9% )有显著性差异 (P <0 .0 5或P <0 .0 1)。随着年龄增大 ,CAG、IM、DYS和GC逐步增多 ,而且≥ 5 6岁年龄组IM、DYS和GC显著多于≤ 40岁组 (P <0 .0 5 ) ,但CSG则相反。肠型胃癌和Hp感染密切相关 (P <0 .0 5 ) ,从胃窦小弯和大弯、胃角及胃体小弯和大弯顺序 ,Hp感染随着CSG、CAG、IM、DYS和GC病变而增高 ,Hp感染部位也在上移 ,尤其在胃体小弯及大弯 ,IM、DYS和GC的Hp感染显著高于CSC部位 (P <0 0 5 )。结论　Hp感染是导致从胃炎→胃萎缩→肠化→异型增生→癌变序列发展的危险因子 ,肠型胃癌和Hp感染密切相关 ,胃镜检查应该多部位取活检作病理及Hp检测 ,尤其是高位

Research of Helicobacter pylori infection in gastric cancers and precancerous lesions

Aim To study the role of Helicobacter pylori (Hp) infection in precancerous conditions and gastric cancers.Methods A total of 548 patients was diagnosed with chronic superficial gastritis(CSG,n=163),chronic atrophic gastritis(CAG,n=207),intestinal metaplasia(IM,n=71),dysplasia(DYS,n=45) and gastric carcinomas(GC,n=62).by endoscopy and histopatholgy.Hp was examined by Warthin-Starry method.Results The detection rates of Hp in CAG(42.5%),IM(76.1%),DYS (88.9%) and GC(72.5%) were significantly higher than that in CSG (23.9%,P<0.05 or P<0.01).The prevalence rates varied by age,with an upward trend of IM,DYS and GC(P<0.05),but a downward trend of CSG (P<0.05).The Hp infectious rates of intestinal type(68.4%) was higher than that of diffuse type(41.7%) in gastric carcinomas (P=0.05).The trend of biopsy site from the lesser and greater curvature of antrum,and a gulus and the lesser and greater curvature of gastric body,the prevalence of Hp positively of CAG,IM and DYS were upward,Hp positive rates in IM and DYS were obviously higher than that in CSG in the lesser and greater curvature of gastric body(P<0.05).Conclusion Hp may be a risk factor in the development of CSG to CAG to IM to DYS to cancerous lesion.The intestinal type gastric carcinomas is close associated with Hp infection.Biopsies should take multiple sites in the stomach for histopathology and Hp examination.