应用定标活检技术评价慢性萎缩性胃炎根除幽门螺杆菌治疗后的疗效  

Therapeutic effect of Helicobacter pylori eradication for chronic atrophic gastritis evaluated by marking targeting biopsy

作　　者：阮洪军[1] 吴伟权[1] 柯进晶[1] 徐启顺[1] 郑卫华[1] 赵仲生[2] 

机构地区：[1]浙江省人民医院消化科,杭州310014 [2]浙江省人民医院病理科,杭州310014

出　　处：《浙江医学》2010年第10期1443-1446,1584,共5页Zhejiang Medical Journal

基　　金：浙江省医药卫生科学研究基金（20008A00）5）

摘　　要：目的 应用定标活检技术评价慢性萎缩性胃炎（chronic atrophic gastritis,CAG）根除幽门螺杆菌（helicobacter py-lori,Hp）再予服用替普瑞酮和叶酸序贯治疗后的疗效.方法 对42例CAG伴Hp感染患者采用标准三联疗法根除Hp治疗1周,继续口服替普瑞酮和叶酸治疗6个月,治疗前后均行胃镜检查并在胃窦和胃角处应用定标活检技术（marking targeting biopsy,MTB）作定标活检,记录并比较治疗前后临床症状、胃镜下表现和病理组织学积分.结果 Hp感染根除率为88.10%;42例患者治疗后上腹痛、上腹胀、反酸和嗳气症状积分较治疗前均有降低（均P〈0.05）;胃镜下疗效评估总有效率为40.48%;胃黏膜病理组织学的变化为黏膜炎症、活动性和萎缩积分明显降低（均P〈0.05）,肠化积分略有降低（P〉0.05）.14例患者轻度异型增生病变消失.结论 应用MTB可以保证治疗前后胃黏膜活检标本的可比性,疗效评估可靠,可广泛应用于胃癌前病变的随访监测;CAG根除Hp治疗可使患者消化不良症状好转,胃黏膜病理组织学改善.Objective To evaluate the therapeutic effect of Helicobacter pylori （Hp） eradication for treatment ot chronic atrophic gastritis by marking targeting biopsy. Methods Forty two chronic atrophic gastritis patients with Hp infection were re- ceived standard triple-drug therapy for Hp eradication for a week, teprenone and folic acid for 6 months and were followed up for 6 month. Endoscopic biopsy samples were taken from gastric antrum and angle by the technique of marking targeting biopsy for histopathology. Clinical symptoms, endoscopic appearance and histopathology of the biopsy specimens from the same site ob- tained at the first and final visit were compared. Results The Hp eradication rate was 88.10%. Clinical symptoms score, including epigastric pain, fullness, acid reflux and heating gas decreased significantly after completing treatment （P〈0.05 respectively）. The total efficacy rate of endoscopic appearance was 40.48%. The gastric mucosal histopathology score, including mononuclear cell infiltration, neutrophil activity, glandular atrophy markedly reduced after Hp eradication （P〈0.05 respectively）; but there was no significant difference statistically in intestinal metaplasia score （P 〉0.05）. Atypical hyperplasia of gastric mucosa in 14 patients disappeared. Conclusion The technique of marking targeting biopsy can be used in assessing Hp eradication and monitoring for gastric mucosal precancerous lesions to ensure comparability of histological diagnosis.

关 键 词：定标活检技术幽门螺杆菌萎缩性胃炎治疗 

分 类 号：R259.733.2[医药卫生—中西医结合]