胃黏膜肠化生的逆转性问题  

Discussion on the reversibility of gastric intestinal metaplasia

作　　者：李凯[1] 唐志鹏[1] 郑丰杰[2] 洪原淑[1] 

机构地区：[1]上海中医药大学附属龙华医院,上海市200032 [2]北京中医药大学,北京市100029

出　　处：《世界华人消化杂志》2007年第2期140-144,共5页World Chinese Journal of Digestology

摘　　要：胃黏膜肠化生作为胃癌前病变,与胃癌的发病存在密切联系.关于肠化生是否具有逆转性,目前尚有争议.但来自流行病学的证据显示,经过长期随访研究,肠化生可以逆转,但改变程度较小.除H pylori感染外,维生素C缺乏、胃酸减少和/或胆汁返流等亦是其发病因素.肠化生的发病机制尚处于探索阶段,H pylori毒力因子、肠道特异性转录因子、微卫星不稳定性等均参与其发病环节,但尚不能肯定肠化生是由干细胞突变引起的胃上皮细胞表型的改变.肠化生在诊断上存在诸多困难,严格的内镜评估以及正确的取检部位尤为重要.单独根除H pylori似乎不足以逆转肠化生,联合应用其他化学阻断剂以及中医药,可能是一条新的治疗途径.Gastric intestinal metaplasia （IM）, as precancerous lesion of the stomach, is closely associated with the development of gastric cancer. Whether gastric IM can be reversed is still in controversy. Epidemiological evidence showed that IM was reversible after long-term following up, but the reversed degree was low. Besides H pylori infection, deficiency of vitamin C in the gastric mucosa, shortage of gastric acid and/or bile reflux can cause this precancerous condition. The pathogenesis of gastric IM, in which H pylori virulence factors, intestine-specific transcription factors, and microsatellite instability are involved, is being investigated at the present time, but it can＇t be affirmed that IM is a kind of phenotype alteration in gastric epithelial cells induced by stem cell mutation. It is fairly difficult to make diagnosis for IM unless careful endoscopic evaluation is performed and proper biopsy sites are selected. Eradication of H pylori alone may not be enough to reverse IM, and its combination with other chemopreventive agents and/or Chinese medicine may be an effective strategy.

关 键 词：胃黏膜肠化生 胃癌前病变 胃癌 逆转性 

分 类 号：R573[医药卫生—消化系统]