胃癌发生不同阶段临床和胃镜表现及与幽门螺杆菌感染的关系  

The relationship between clinical manifestations,gastroscope results and Helicobacter pylori infection in different stages of gastric cancer

作　　者：王雨[1] 曹丹[1] 刘晓明[1] 黄利华[2] 徐灿霞[1] 

机构地区：[1]中南大学湘雅三医院消化内科,湖南长沙410013 [2]中南大学湘雅三医院医学实验中心,湖南长沙410013

出　　处：《中国微生态学杂志》2012年第12期1057-1059,1063,共4页Chinese Journal of Microecology

基　　金：国家自然科学基金资助(81172301)

摘　　要：目的观察慢性浅表性胃炎(CSG)→萎缩性胃炎(CAG)→肠上皮化生(IM)→非典型增生(DYS)→胃癌(GC)五个不同阶段临床和胃镜表现及其与幽门螺杆菌(H.pylori)感染的关系。方法对经胃镜及病理证实的上述GC发生五个不同阶段的患者各50例,详细询问其临床症状,记录胃镜下表现,并用快速尿素酶试验(RUT)、14C尿素呼气试验(14C-UBT)、组织学检查及H.pylori培养等方法检测H.pylori感染情况。结果 (1)CSG和GC的临床表现分别以上腹胀和早饱、体重减轻为主,其他阶段均以上腹痛为主;(2)CSG、CAG和GC的胃镜下表现依次以疣状隆起及糜烂、黏膜变薄及血管显露、巨大溃疡及出血为多见,而IM和DYS均以直径小于2 cm的溃疡为多见(P<0.05);(3)H.pylori感染:从CSG→GC不同阶段,H.pylori感染率依次降低(分别为80%、78%、62%、56%和36%,P<0.05);临床表现中上腹痛及纳差H.pylori感染率高,早饱H.pylori感染率低(P<0.05);不同胃镜下表现中溃疡H.pylori感染率最高(P<0.05)。结论体重减轻可作为胃癌警示信号,胃镜下巨大溃疡及出血以GC多见;H.pylori感染率与GC发生阶段呈负相关,临床表现为上腹痛、纳差,及胃镜下溃疡患者H.pylori感染率高。Objective To investigate the association between the clinical manifestation,gastroscope,and Helicobacter pylori infection during the sequential pathological stages from chronic superficial gastritis（CSG）,chronic atrophic gastritis（CAG）,intestinal metaplasia（IM）,dysplasia（DYS） to gastric cancer（GC）.Methods According to the gastroscope and pathological analysis,50 patients in the five stages were selected,their gastroscope results and clinical symptoms were noted.The infection of H.pylori were measured by rapid urease test（RUT）,14C-urea breath test（14C-UBT）,and pathology or H.pylori culture.Results（1） The clinical manifestations of CSG and GC were abdominal distention,early satiety and weight loss（P0.05）,and abdominal pain were common in other stages（P0.05）.（2） Gastroscope exhibited verrucous uplift and erosion in CSG,thinned mucous and uncovered blood vessels in CAG,ulcer less than 2 cm in diameter in the IM and DYS,and bleeding giant ulcer in GC（P0.05）.（3） The infection rate of H.pylori in different stages from CSG to GC was 80%,78%,62%,56% and 36% respectively（P0.05）.And the infection rate of H.pylori was high in clinical symptoms with abdominal pain and asitia（P0.05）,but low in those with early satiety（P0.05）.The infection rate of H.pylori was the highest in ulcer under gastroscope,up to 73%（P0.05）.Conclusion The weight loss could be a warning signal of GC,and bleeding giant ulcer presents high risk of GC.Negative correlation was shown between the infection of H.pylori and the sequential pathologies from CSG to GC,and high H.pylori infection rate was found in patients with abdominal pain,asitia in clinic and gastric ulcer through gastroscope.

关 键 词：胃癌 幽门螺杆菌 临床表现 胃镜 

分 类 号：R442.7[医药卫生—诊断学]