幽门螺杆菌感染时放大内镜下的胃黏膜改变  

The gastric mucosa alterations in chronic gastritis with Helicobacter pylori infection under magnifying endoscopy

作　　者：王瑶[1] 毕春山[1] 邸霞[1] 刘宾[1] 

机构地区：[1]首都医科大学附属北京同仁医院消化内科,100730

出　　处：《中华消化杂志》2006年第4期247-249,共3页Chinese Journal of Digestion

摘　　要：目的观察放大内镜直视下慢性胃炎患者幽门螺杆菌(Hp)感染时的胃黏膜微细形态变化。方法使用手动变焦电子放大内镜(Olympus GIF Q-240Z),对190例有不同上消化道症状患者的胃体集合静脉和胃窦小凹形态进行放大观察,并在所观察部位活检作病理组织学检查及快速尿素酶检测,以研究两者之间的相互关系。结果放大内镜下胃体下段集合静脉分为规则型(R)、不规则型(I)、消失型(D)三型,Hp感染率分别为6．0％、61．9％和72．4％,其中D型和I型的Hp感染率明显高于R 型(xRI2=36．86,XDR2=81．40,P值均<0．01)。胃小凹形态分为A、B、C、D、E五型,中度以上炎症的发病率分别为10．0％、23．1％、68．9％、10．0％和4．6％。黏膜萎缩及肠上皮化生主要发生在C、D、E三型。黏膜萎缩发生率分别为26．2％、90．0％和95．5％;肠上皮化生发生率分别为11．5％、65．0％和 95．5％。B、C、D三型存在Hp感染,其Hp感染发生率分别是29．0％(29／100)、66．7％(34／51)和 33．3％(6／18),三型间比较差异有统计学意义(XBC2=19．71,P<0．01;XCD2=6．07,P<0．05)。结论放大内镜下Hp感染的胃黏膜表现为集合静脉模糊、混乱或消失;胃小凹稀疏而粗大,开口扩张、表面发红。Objective To observe the micromorphological alterations of gastric mucosa in patients with chronic gastritis infected by Helicobacter pylori （H. pylori） under magnifying endoscopy. Methods One hundred and ninety cases with different upper digestive symptoms were recruited. After finishing general endoscopy, magnifying endoscopy （Olympus GIF Q-240Z ） was used to magnify and observe the gastric pit form of gastric antrum and the collecting vein form of gastric corpus. Biopsies were taken from the magnified sites. The characteristics of microstructures in gastric mucosa were associated with the results of H. pylori infection determined with Warthin-Starry staining and rapid urease test. Results The morphology of lower part of gastric corpus collecting venules was subdivided into type R（ regular） , type I（irregular）and type D（disappeared）, correspondent H. pylori infection rates were 6. 0%, 61.9% and 72. 4% respectively. The rate of H. pylori infection in type D and type I was significantly higher than that of type R（P〈0.01）. The morphology of gastric pits was classified as five types （A, B, C, D, E）. Of them, the incidence of moderate or severe chronic superficial gastritis were 10. 0%, 23. 1%, 68. 9%, 10. 0% and 4.6% respectively. Chronic atrophic gastritis （CAG） and intestinal metaplasia （IM） mainly occurred in types C, D and E. The incidence of CAG in types C, D, and E were 26.2%, 90.0% and 95.5%, respectively; those of IM were 11.5%, 65.0% and 95.5%, respectively. H. pylori infection only appears in types B, C and D form of gastic pit, with the positive rates of 29. 0%, 66. 7% and 33.3%, with type C significantly higher than that of type B and D（P〈0. 01 and P〈0. 05）. Conclusions Under magnifying endoscopy, H. pylori positive gastric mucosa shows the characteristics of obscured, disturbed or disappeared collecting venules in corpus and the scanty but enlarged and reddened gastric pit in antrum.

关 键 词：放大内镜 胃体集合静脉 胃小凹 幽门螺杆菌 嗜银染色 快速尿素酶测定 

分 类 号：R573[医药卫生—消化系统]