叶酸联合幽门螺杆菌根除治疗慢性萎缩性胃炎的疗效观察  

The efficacy of Helicobacter pylori eradication and folic acid intervention in treatment of atrophicgastritis

作　　者：唐春丽[1] 赵冰[1] 田学英[1] 钱娟[1] 赵靖[1] 施维佳[1] 张国新[1] 

机构地区：[1]南京医科大学第一附属医院消化科,210029

出　　处：《中华消化杂志》2012年第7期437-440,共4页Chinese Journal of Digestion

基　　金：国家自然科学基金（81072032）

摘　　要：目的探讨叶酸联合幽门螺杆菌（Hp）根除治疗对慢性萎缩性胃炎转归的影响。方法选取2009年12月至2011年3月南京医科大学第一附属医院经胃镜及病理检查确诊的慢性萎缩性胃炎患者184例，其中Hp阳性90例，阴性94例。Hp阳性患者分为A组43例和B组47例。A组予标准三联Hp根除治疗后再予叶酸治疗3个月。B组和Hp阴性者均予叶酸治疗3个月。各组治疗前、口服叶酸1个月、口服叶酸3个月时分别进行临床症状评分并行t检验。各组治疗前及停药3个月时分别接受胃镜检查，并就胃镜下评分、病理评分行t检验。治疗前及停药3个月时分别抽取55例Hp阴性者静脉血并以ELISA法检测血清胃蛋白酶原（PG）I、PGII及胃泌素17水平。结果所有患者经叶酸治疗1个月时的I临床症状评分（1．55±0．04）与治疗3个月时（1．15±0．03）相比差异有统计学意义（t=8．18，P〈0．01）。治疗结束时，A组临床症状评分（1．06±0．04）低于B组（1．56±0．08）。差异有统计学意义（t=6．00，P〈0．01）。所有患者治疗前胃镜下评分（1．57±0．95）与治疗后（1．00±0．76）相比差异有统计学意义（t=11．12，P〈0．01）。所有患者治疗前后黏膜炎性反应、活动性、萎缩、肠上皮化生、不典型增生分级评分比较差异均有统计学意义（t值分别：5．51、6．90、7．53、6．34、2．90，P值均〈0．01）。55例Hp阴性者治疗前血清PGI水平[（1．03±0．19）nmol／L]低于治疗后[（2．24±0．33）nmol，／L]，差异有统计学意义（t=3．19．P〈0．01）。55例Hp阴性者治疗后胃泌素17水平[（0．86±0．05）nmol／L]较治疗前[（0．47±0．05）nmol／L]增高，差异有统计学意义（t=5．33，P〈0．01）。结论叶酸联合Hp根除治疗对萎缩性胃炎的转归有利，可促进血清PG及胃泌素的分泌。[Abstract] Objective To investigate the effect of folic acid combined with Helicobacter pylori （Hp） eradication therapy on chronic atrophic gastritis. Methods From December 2009 to March 2011 at the First Affiliated Hospital of Nanjing Medical University, 184 patients with endoscopic and pathological diagnosis of chronic atrophic gastritis （90 Hp positive and 94 Hp negative） were selected. Hp positive patients were divided into group A and group B. Forty-three patients in group A were treated with standard triple Hp eradication therapy and follow by folic acid therapy for three months. Forty-seven patients in group B and Hp negative patients received three months of folic acid therapy. The clinical symptoms of each group were scored before treatment, one month after folic acid therapyand three months after folic acid therapy and analyzed by t test. Patients of each group received gastroscopy before treatment and three months after medicine withdrawal. Endoscopic scores, pathological scores and t test were recorded. The serum levels of pepsinogen （Ⅰ , Ⅱ ） and gastrin 17 in venous blood of 55 Hp negative patients were detected by enzyme-linked immunosorbent assay （ELISA） method before treatment and three months after medicine withdrawal. Results Compared with three months therapy （ 1. 15 ± 0.03）, after one month {olic acid therapy （ 1. 55 ± 0. 04） was statistically significant in clinical symptoms score of all patients （t = 8. 18, P〈0.01）. By the end of therapy, clinical symptom score of group A （1.06±0. 04） was lower than that of group B （1.56±0.08）, and the difference was significant （t=6.00, P〈0.01）. There was significant difference in endoscopic scores of all patients between before treatment （1.57±0.95） and after treatment （1.00±0.76, t=11.12, P〈0.01）. The differences in each pathological score of all patients （inflammatory scoring, active scoring, atrophy scoring, intestinal metaplasia scoring, atypical hyperplasia degree scoring） were signif

关 键 词：胃炎 萎缩性 胃蛋白酶原A 胃泌素类 螺杆菌 幽门 叶酸 

分 类 号：R573.3[医药卫生—消化系统]