幽门螺杆菌感染及胃炎类型与反流性食管炎关系的研究  

The roles of Helicobacter pylori and pattern of gastritis in the pathogenesis of reflux esophagitis

作　　者：高炳霞 段丽萍 王琨 夏志伟 林三仁 

出　　处：《中华医学杂志》2006年第38期2674-2678,共5页National Medical Journal of China

摘　　要：目的研究幽门螺杆菌(Hp)感染对胃炎类型及食管酸暴露的影响,特别是 Hp 的定植密度与反流性食管炎(RE)的关系,进一步探讨 Hp 在反流性食管炎(RE)发病中的作用。方法具有典型反酸、烧心等症状的223例胃食管反流病患者,经胃镜检查并取胃黏膜活检进行病理学检查、胃食管24h pH 监测。根据胃镜下食管黏膜有无糜烂诊断 RE 或非糜烂性反流病(NERD),结合胃镜及病理,将胃炎分为4组:慢性非萎缩性胃窦炎组(CNAA 组,胃窦慢性非萎缩炎症为主,胃体部黏膜基本正常);慢性非萎缩胃炎组(CNAG 组,胃窦、体均有明显慢性非萎缩性炎症);慢性萎缩性胃窦炎组(CAA 组,慢性胃窦萎缩性炎症);慢性萎缩性胃炎组(CAG 组,慢性胃窦、体部多灶性萎缩性炎症)。WS 染色诊断 Hp 感染状态,并根据 Hp 定植密度分为轻、中、重度感染。24h pH 监测以DeMeester 积分≥15为阳性诊断标准。结果 223例 GERD 患者中62例(27.8％)胃镜证实为 RE,余161例(72.2％)为 NERD。Hp 阳性者67例(30.0％),Hp 阳性及 Hp 阴性患者之间的年龄、性别、RE发生率、pH 监测阳性率、DeMeester 积分等比较差异无统计学意义;223例患者中 CNAA 45例(20.2％),CNAG 88例(39.5％),CAA 65例(29.2％),CAG 25例(11.2％)。Hp 阳性患者表现为明显的胃窦、胃体部非萎缩性慢性炎症(56.7％),与 Hp 阴性组患者胃炎的构成比显著不同(P<0.05);RE 组 CAG 所占比例低于 NERD 组(6.5％比13％);67例 Hp 阳性的 GERD 患者中,胃体部中重度感染组的24h pH 监测阳性率及胃内平均 pH 值与轻度感染组比较差异有统计学意义(46.4％比73.5％和2.3±0.8比2.0±1.1,P<0.05)。结论 Hp 感染对胃炎的类型和部位有明显的影响;Hp 感染的部位和程度对胃内酸度及食管酸暴露的程度亦有显著影响;弥漫性萎缩性胃炎可能对 RE的发生有一定的保护作用。Objective Comparing the infection rates and density of Helicobacter pylori （ H. pylori） and the patterns of gastritis in reflux esophagitis （RE） and non-erosive reflux disease （NERD） patients to investigate the role of H. pylori in the pathogenesis of RE. Methods Two hundred and twenty-three outpatients with typical gastroesophageal reflux symptoms who consecutively visited the hospital underwent ambulatory 24-hour pH monitoring and gastroscopy, and biopsy of the gastric mucosa. RE and NERD were diagnosed based on the presentation of endoscopy. Gastritis was divided into four different patterns：chronic non-atrophic antritis （ CNAA ） ; chronic non-atrophic pan-gastritis （ CNAG ） ; chronic atrophic antritis （CAA）; and chronic atrophic pan-gastritis （CAG）. H. pylori infection was evaluated by Warthin-Starry staining. DeMeester score ≥ 15 was considered as pathological acid reflux. Results Sixty-two patients （27.8%） were found to have RE, 161 （72. 2% ） were found to have NERD. Totally, 67 patients had H. pylori infection （ 30.0% ）. There was no significant difference in H. pylori infection rate between the RE and NERD groups （25.8% vs. 31.5%, P 〉0. 05）. 45 of the 223 patients were diagnosed as with CNAA （20.2%）, 88 （39.5%） with CNAG, 65 （29.2%） with CAA, and 25 （11.2%） with CAG. The CAG rates in the RE and NERD groups were 6. 5% and 13.0% respectively （ P 〉 0.05 ）. There were no differences in abnormal pH monitoring rate and DeMeester score among the different patterns of gastritis. In the sixty-seven H. pylori-positive GERD patients, the 24 h pH monitoring positive rate of the moderate-severe H. pylori colonization density group was 46. 4%, significantly higher than that of the mild H. pylori colonization density group （73.5%, P 〈0. 05） ; and the mean intra-gastrie pH value during 24 hours of the moderate-severe 11. pylori colonization density group was 2.3 ± 0. 8, significantly higher than that of the mild H. pylori colonization density

关 键 词：胃食管反流 螺杆菌 幽门 食管炎 消化性 非糜烂性反流病 

分 类 号：R571[医药卫生—消化系统] R573.3[医药卫生—内科学]