幽门螺杆菌感染与十二指肠球部黏膜胃上皮化生的关系  

Relationship between Helicobacter pyloriinfection and gastric metaplasia in the mucosa of duodenal bulb

作　　者：陈晓宇[1] 施尧[1] 彭延申[1] 马耀宙[1] 萧树东[1] 

机构地区：[1]上海第二医科大学附属仁济医院上海市消化疾病研究所,200001

出　　处：《中华消化杂志》2004年第9期519-522,共4页Chinese Journal of Digestion

摘　　要：目的　研究十二指肠球部黏膜幽门螺杆菌 (Hp)感染与黏膜胃上皮化生的关系 ,探讨其在十二指肠球部炎症和溃疡发生中的作用。方法　 2 0 0 2年十二指肠球部黏膜活检的存档蜡块 82例 ,作H E、改良Giemsa和AB/PAS染色。内镜诊断为基本正常球部黏膜 10例 ;十二指肠球炎 4 7例 (其中充血糜烂型 16例 ;隆起型 31例 )和球部溃疡 2 5例。结果　 (1)内镜诊断基本正常的十二指肠球部黏膜 ,组织学 6 0 %有轻中度的炎症细胞浸润 ,但无胃上皮化生和Hp定植。 (2 )胃上皮化生是十二指肠球部黏膜最常见的病理变化 (37/ 82 ,4 5 % )。 (3)Hp只有在胃上皮化生的黏膜中才能找到 ,检出率为 76 %(2 8/ 37)。十二指肠球部溃疡边缘黏膜胃上皮化生发生率 (72 % )明显高于球炎黏膜 (4 0 % ) ,差异有显著性 (P =0 .0 0 78)。 (4 )虽然十二指肠球部溃疡边缘胃上皮化生黏膜的Hp检出率 (89% ,16 / 18)明显高于十二指肠球炎黏膜 (6 3% ,12 / 19) ,但是两者差异无显著性 (P =0 .0 6 2 )。不论何期溃疡Hp检出率均很高 ,本研究中溃疡活动期、愈合期和瘢痕期分别为 15例、6例和 4例 ,其溃疡边缘胃上皮化生中Hp检出率分别高达 9/ 10、5 / 6和 2 / 2例。结论　十二指肠球部溃疡周围黏膜高发胃上皮化生 ,使Hp更易于定植 ,推测如不根除Hp感染 ,?Objective To investigate the relationship between Helicobacter pylori(H. pylori)infection and gastric metaplasia in the duodenal bulb and to pursue whether they play critical roles in pathogenesis of duodenitis and ulcer.Methods Eighty-two archive paraffin blocks of duodenal biopsy were obtained. All sections were stained with H-E, AB/PAS and Giemsa stains for histology, gastric metaplasia and H. pyloriassessment. There were 10 patients with normal duodenum, 47 with duodenitis and 25 with ulcer confirmed by endoscopy. Results There was a discrepancy in diagosis of the normal duodenal bulb mucosa between endoscopy and histopathology. Mild to moderate infiltration of inflammatory cell without gastric metaplasia were detected in 60% of cases with the normal duodenal bulb mucosa judged by endoscopy. Gastric metaplasia in duodenal bulb was the major phenomena in the patients with duodenitis and ulcer (37/82, 45%). H. pyloriinfection in the duodenal bulb always appeared in areas of gastric metaplasia. H. pyloriwas identified in 28 out of 37 (76%) cases in the gastric metaplasia mucosa. The prevalence of gastric metaplasia in the duodenal bulb between the patients with ulcer (72%) and duodenitis (40%) was significantly different (P=0.0078). The frequency of H. pyloricolonization was higher in the patients with duodenal ulcer (89%) than the patients with duodenitis (63%), but did not reach statistical significance(P=0.062). H. pyloriinfection was also higher in the ulcer patients with active, healed or scar stage, being 9/10, 5/6 and 2/2, respectively. Conclusions There is a difference in the frequency of H. pyloricolonization in the gastric metaplasia mucosa in the patients with ulcer and duodenitis, which suggests that infection with H. pylorimay play an important role in ulcer recurrence.

关 键 词：黏膜 胃上皮化生 十二指肠球部溃疡 溃疡 检出率 十二指肠球炎 正常 隆起 边缘 显著性 

分 类 号：R573.1[医药卫生—消化系统]