老年人胃贲门炎病因学分析  

The etiologic investigation of inflammation in the gastric cardia in 97 elderly patients

作　　者：宫桂花[1] 纪小龙[2] 吴本俨[1] 张子其[1] 万军[1] 

机构地区：[1]解放军总医院南楼消化科,北京100853 [2]解放军总医院病理科

出　　处：《军医进修学院学报》2004年第3期197-199,共3页Academic Journal of Pla Postgraduate Medical School

摘　　要：目的 :探讨老年人胃贲门炎的病因学及其转归。方法 :经内镜及活检病理诊断为贲门炎 ,其临床及随访资料完整的共 97例。内镜观察方法 :贲门区定为齿状线以下 0 .5～ 4cm范围 ,凡有黏膜片状发红、充血、水肿、出血点、糜烂等炎症表现者 ,均取局部活检 2块以上 ,行常规病理组织学检查。炎症程度、肠上皮化生、H .pylori感染按悉尼系统分类法确定。对伴随的胃部基础病变加以评估。结果 :组织病理学显示 97例均有不同程度的黏膜固有层慢性炎伴急性炎反应 ,其中轻 中度炎症 6 8例 ( 70 .1% ) ,重度炎症 2 9例 ( 2 9.9% )。局部H .pylori感染者 36例( 37.1% ) ,伴胃其他部位H .pylori感染者 6 5例 ( 6 7.0 % )。肠上皮化生 33例 ( 34.0 % )。黏膜轻至中度萎缩者 14例( 14 .3% )。所伴随的胃部基础病变有 :慢性萎缩性胃炎 75例 ( 77.3% ) ,慢性浅表性胃炎 2 2例 ( 2 2 .7% ) ,胃食管反流病 6 6例 ( 6 8.0 % )。随访过程中发生贲门息肉 2 7例 ( 2 7.8% ) ,贲门糜烂伴局部癌变 7例 ( 7.2 % ) ,局部癌变前半年组织学可有中至重度异型增生。结论 :老年人胃食管反流病对贲门炎的形成起重要作用 ,其次为H .pylori感染 ,组织病理学显示 ,贲门黏膜炎以浅表性慢性炎为主 。Objective:To investigate the etiological agent and the prognosis of the inflammation in the gastric cardia in the aged. Methods:The carditis was identified by endoscopic findings,all biopsy specimens of the cardia were obtained below the Z-line within 4cm of the proximal stomach. The carditis had histological evidence of the grade of inflammation,H. pylori infection,intestinal metaplasia according to the updated Sydney classification.Results:All of the 97 cases had lamina propria mucosa inflammation,68(70.1%)were mild-moderate and 29(29.9%)were severe inflammation. 39(40.2%) had mucosa erosion,33(34.0%)had intestinal metaplasia. 36(37.1%)had H. pylori in cardia and 65 (67.0%) in other parts of the stomach. Background data were collected on age,diagnosis,symptoms,75(77.3%)had atrophic gastritis,66(68.0%)had GERD,27 (27.8%) had polypus of cardia,7(7.2%)cardia erosion became adenocarcinoma.Conclusions:Our data support that gastroesophageal reflux is the major cause of carditis,H. pylori infection as also being the etiologic agent for this disease in the group of patients. It should be emphasized that persistent erosion may be the risk factor for cardia adenocarcinoma.

关 键 词：老年人 胃贲门炎 病因学 组织学特点 临床转归 

分 类 号：R573.3[医药卫生—消化系统]