反流性食管炎与幽门螺杆菌感染的相关性研究  

Study on the relationship between reflux esophagitis and helicobacter pylori infection

作　　者：汤瑾[1] 孙永顺[1] 孙吉[1] 史燕敏[1] 蔡维[1] 朱生樑[1] 

机构地区：[1]上海中医药大学附属岳阳中西医结合医院消化内科,上海200437

出　　处：《中国医药导报》2013年第17期66-68,共3页China Medical Herald

基　　金：国家中医药管理局"十一五"重点专科资助项目(编号:09J1C1L206B118);上海市卫生局资助项目(编号:2012L018A)

摘　　要：目的探讨反流性食管炎（RE）与幽门螺杆菌（Hp）感染的相关性。方法回顾性分析2009年1月~2011年12月上海中医药大学附属岳阳中西医结合医院的胃镜检查病例,比较反流性食管炎和慢性胃炎的Hp感染率,并将反流性食管炎按洛杉矶分类法分级,比较各级反流性食管炎的Hp感染率。收集经胃镜检查确诊的Hp阳性反流性食管炎患者107例,按1∶1比例随机分为治疗组54例,对照组53例,治疗组第1周给予标准三联疗法根除Hp治疗（口服雷贝拉唑10 mg,2次/d＋克拉霉素500 mg,2次/d＋阿莫西林1000 mg,2次/d）,后口服雷贝拉唑10 mg,2次/d;对照组给予雷贝拉唑10 mg,2次/d口服治疗。两组疗程均为8周。治疗结束复查胃镜,治疗组行14C呼气试验检测Hp,观察两组患者临床症状改善和胃镜下食管炎症的改善。结果回顾性分析发现反流性食管炎和慢性胃炎Hp感染率分别为38.12%和56.22%,差异有高度统计学意义（P〈0.01）;反流性食管炎A、B、C、D级HP感染率分别为41.87%、37.74%、31.63%和25.64%,差异无统计学意义（P〉0.05）,但呈现反流性食管炎等级越轻,Hp感染率越高的趋势;随机对照研究发现治疗组进行Hp根除治疗后,临床症状积分改善有效率为90.48%,与对照组的88.68%相当,胃镜下食管黏膜炎症改善有效率治疗组为55.88%,对照组为80.0%,两者差异有统计学意义（P〈0.05）。结论 HP感染可能是反流性食管炎的一种保护性因素。Objective To study the relationship of reflux esophagitis（RE） and Helicobacter pylori（Hp） infection.Methods Patients by gastroscopy from January 2009 to December 2011 in hospital were retrospectively analyzed,and HP infection ratio of RE and chronic gastritis were compared.The severity grade of RE was according to Losangeles standard,with comparison of Hp infection ratio of every grade.107 patients diagnosed as RE and Hp positive by gas troscopy were randomly divided into the treatment group of 54 cases and the control group of 53 cases.The first week of the treatment group was given standard triple therapy for Hp eradication（rabeprazole with 10 mg bid ＋ clarithromycin 500 mg bid＋ amoxicillin 1000 mg bid）,after that oral administration of rabeprazole 10 mg bid,while control group was treated with rabeprazole 10 mg bid treatment.After 8 weeks treatment,gastroscope was performed to investigate esophageal inflammation;clinical symptoms were observed;14C breathing test was performed to detect Hp infection in the controls.Results The ratio of the HP infection was 38.12% in patients with RE and 56.22% in patients with chronic gastritis（P ＆lt; 0.01） in the retrospective analysis;the ratio of the HP infection of RE A,B,C,D grade were 41.87%,37.74%,31.63% and 25.64% respectively（P ＆gt; 0.05）.The trend was observed that the lighter reflux esophagitis grade was,the higher HP infection ratio was;randomized controlled study found after Hp eradication thera py clinical effective rate was 90.48% in treatment group,and 88.68% in the controls.Endoscopic esophageal mucosal inflammation effective ratio was 55.88% in treatment group,and 80.0% in the controls（P ＆lt; 0.05）.Conclusion Hp infection may be a protective factor for RE.

关 键 词：反流性食管炎 幽门螺杆菌 相关性 

分 类 号：R571[医药卫生—消化系统]