幽门螺杆菌根除治疗前后组织学检查和^(13)C-尿素呼气试验的准确性分析  

Analysis of Histological Detection of Helicobacter pylori Before and After Eradication Therapy: Compared with the Results of ^(13)C-Urea Breath Test

作　　者：张川[1] 关玉盘[1] 袁志芳[1] 吴雨龙[1] 山田宣孝[2] 温敏[2] 郑纪银[1] 阎雪燕[1] 高峰[1] 高辉[1] 

机构地区：[1]首都医科大学附属北京朝阳医院京西院区消化内科,100043 [2]日本医科大学病理部和附属病院外科病理部

出　　处：《胃肠病学》2006年第4期215-218,共4页Chinese Journal of Gastroenterology

摘　　要：背景:幽门螺杆菌(H.pylori)的研究已有20多年的历史,但关于根除治疗前后H.pylori感染与炎症的关系以及评价治疗效果时应用何种方法、在何部位取活检的研究不多,仍存在争议。目的:探讨并比较H.pylori感染根除治疗前后不同活检部位组织学检查和13C-尿素呼气试验(UBT)检查的准确性。方法:受试者在根除治疗前后于胃窦、胃体和胃角处分别取黏膜活检标本各1块,以Giemsa染色、改良甲苯胺蓝染色和免疫组化法检测H.pylori感染情况。并对部分H.pylori感染的组织学检查和13C-UBT进行评估。结果:治疗前胃窦、胃体、胃角H.pylori感染率分别为61.3%、66.0%和59.6%。对4810例证实有H.pylori感染的患者在根除治疗后随访6周,有22.0%的病例有细菌残留,胃窦、胃体和胃角处H.pylori感染率分别为17.4%、17.3%和18.3%,各组间无显著性差异(P>0.05)。H.pylori感染者根除治疗前99.7%有活动性炎症,99.0%有慢性炎症。根除治疗后尽管有细菌残留,但炎症活动性减低。组织学检查H.pylori感染的患者中,根除治疗前有78.3%13C-UBT阳性;根除治疗后,仅有49.6%13C-UBT阳性。结论:根除治疗前13C-UBT和组织学检查结果的符合度较高,但对抗H.pylori治疗效果的评价,组织学检测优于13C-UBT。Background： Study of Helicobacterpylori （H. pylori）has a history over 20 years. However, the relationship between H. pylori infection before and after its eradication and inflammation was seldom studied. The methods which should be taken and the sites which should be biopsied for the evaluation of therapeutic effect of H. pylori eradication are still controversial. Aims： To test and compare the accuracy of histological detection of H. pylori from different biopsy sites and the results of ^13C-urea breath test （UBT） before and after H. pylori eradication therapy. Methods： Biopsy specimens were taken from the antrum, body and angulus of stomach before and after H. pylori eradication, Giemsa, modified toluidine blue and immunohistochemistry were performed for the histological detection of H. pylori infection and ^13C-UBT was performed routinely. The activity of H. pylori infection, mucosal inflammation, glandular atrophy and intestinal metaplasia were scored according to the update Sydney System. Results： Before H. pylori eradication therapy, the H. pylori infection rate detected was 61.3%, 66.0% and 59.6% in the antrum, body and angulus, respectively. Of the 4810 cases received H. pylori eradication therapy, residual H. pylori was detected in 20% of cases after 6 weeks followup. The residual H. pylori detection rate was 17.4%, 17.3% and 18.3% in the antrum, body and angulus, respectively, and no significant difference was found between these three sites （P〉0.05）. Before eradication therapy, 99.7% of H. pylori infected patients had active inflammation and 99.0% had mucosal chronic inflammation. The activity of inflammation reduced after eradication therapy despite the presence of residual bacteria. Before eradication therapy, ^13C-UBT was positive in 78.3% of H. pylori infected patients, but was positive in only 49.6% in those cases with residual H. pylori after eradication therapy. Conclusions： The concordance rate between ^13C-UBT and histopathological examination of H. pylori infection is

关 键 词：螺杆菌 幽门 ^13C-尿素呼气试验 组织学 药物疗法 

分 类 号：R573[医药卫生—消化系统] R446.8[医药卫生—内科学]