海尔曼螺杆菌与幽门螺杆菌相关性胃炎的临床病理特征  

Clinical characteristics of Helicobacter heilmannii- versus Helicobacter pylori-associated gastritis in Chinese patients

作　　者：张贺军[1] 崔荣丽[1] 韩亚京[1] 尚慧茹[1] 张颖[1] 金珠[1] 

机构地区：[1]北京大学第三医院消化科,北京市100191

出　　处：《世界华人消化杂志》2013年第3期244-249,共6页World Chinese Journal of Digestology

摘　　要：目的:分析海尔曼螺杆菌(Helicobacter heilmannii,H.heilmannii)相关性胃炎与幽门螺杆菌(Helicobacter pylori,H.pylori)相关性胃炎的胃镜及组织病理学差异.方法:回顾性分析2003-01/2010-01于北京大学第三医院行胃镜及病理检查的53559例病例的相关资料.对H.heilmannii相关性胃炎与H.pylori相关性胃炎在内镜所见、炎症浸润、癌前病变的等方面进行对比分析.结果:H.heilmannii感染病例的检出率为0.1%(46/53559);与H.pylori相关性胃炎相比,H.heilmannii相关性胃炎病例中螺旋杆菌定植量较少(P<0.001),胃黏膜急、慢性炎症程度轻(P<0.001),内镜下溃疡性病变更为少见(P=0.021).此外,两组病例中胃黏膜萎缩、肠上皮化生及上皮内瘤变的检出率及病变程度均无显著性差异.相关分析显示H.heilmannii相关性胃炎病例中细菌定植量仅与胃黏膜急性炎症细胞浸润程度相关(P=0.02).报道1例伴发H.heilmannii感染的胃印戒细胞癌病例.结论:H.heilmannii相关性胃炎非常少见且其炎症反应较轻,但是其癌前病变的检出率及病变程度与H.pylori相关性胃炎相比未见显著性差异,表明H.heilmannii在胃恶性相关性病变的发生过程中可能发挥与H.pylori相似的作用.AIM： To compare the endoscopic and histopathological characteristics of Helicobacter heilmannii （H. heilmannii）- versus Helicobacter pylori （H. pylori）-associated gastritis in Chinese patients. METHODS： Gastric biopsy specimens from 53 559 consecutive patients treated at Peking University Third Hospital from January 2003 to January 2010 were reviewed retrospectively. All cases of chronic gastritis were evaluated based on the Updated Sydney System. Endoscopic and histopathological characteristics of cases with H. heilmannii infection were compared with those with H. pylori infection. RESULTS： There were 46 cases with H. heilmannii infection （0.1%） and 18 326 cases with H. pylori infection （34.2%）. Compared to H. pylori-associated gastritis, H. heilmannii-associated gastritis showed a lower bacterial density （P 〈0.001）, less severe mononuclear cell infiltration （P 〈0.001） and neutrophil activity （P〈0.001）, and endoscopic findings of H. heilmannii-associated gastritis were devoid of ulcer （P = 0.021）. H. heilmannii density showed a significant correlation with neutrophil activity （P = 0.02）, but not with chronic inflammation （P = 0.159）. The percentages of patients with mucosal atrophy, intestinal metaplasia and intraepthelial neoplasia in the H. heilmannii-associated gastritis group were 23.9%, 21.7% and 4.3%, respectively, and there was no significant difference in the prevalence and degree of these precancerous lesions between the two groups. A case of signet-ring cell carcinoma concomitant with H. heilmannii infection was detected. CONCLUSION： H. heilmannii-associated gastritis is uncommon and milder than H. pylori-associated gastritis. The observation that there were no significant differences between two groups in the prevalence and degree of mucosal atrophy, intestinal metaplasia and intraepthelial neoplasia suggests that H. heilmannii may be partly responsible for malignant-associated lesions just as H. pylori does. In addition, one case of signet-ring ce

关 键 词：海尔曼螺杆菌 幽门螺杆菌 胃炎 癌前病变 胃癌 

分 类 号：R573.3[医药卫生—消化系统]