幽门螺杆菌感染对胃粘膜病变作用的五年随访观察  

Effects of helicobacter pylori infection on gastric mucosaia: a 5-year cohort study

作　　者：陈世耀[1] 朱畴文[1] 刘天舒[1] 张希德[1] 王吉耀[1] 

机构地区：[1]复旦大学医学院附属中山医院消化科,上海200032

出　　处：《中华医学杂志》2001年第7期422-424,共3页National Medical Journal of China

摘　　要：目的　评价 5年随访根除幽门螺杆菌 (Hp)感染对胃粘膜病变的作用。方法　采用前瞻性队列研究方法 ,病例为上海 7家企业单位在我院定点体检进行胃镜检查的病人。入选时间为1993年 7月至 1994年 6月 ,部分病人有中上腹不适 ,胃镜及病理检查确诊为慢性胃炎的病人作为入选病例。入选时确定Hp感染状态 ,阳性病人根据自愿原则或采用根除Hp感染治疗 ,或采用对症治疗。阴性组仅在有消化不良症状时采用对症治疗。全部对象跟踪随访 5年。结果　入选时 30例Hp阴性 ,45例Hp阳性。结束随访时 ,2 4例阴性无变化 (另 3例失访 ,1例变为阳性 ,2例可疑 ) ,作为对照组。 45例阳性病人中 ,1例失访 ,16例经抗Hp感染治疗结束 4周后转阴 ,作为Hp阴性观察组 ;2 8例仍为Hp阳性 ,作为Hp阳性观察组。对照组仅 17%～ 33%的病人炎症有进展 ,Hp阳性观察组 ,炎症加重的病人占 43%～ 5 7% ;Hp阴性观察组 ,5 0 %的病人炎症减轻 ,仅 2 5 %的病人炎症加重 ,明显低于持续Hp感染组。 5年随访中 ,对照组有 16 %～ 2 5 %的病人肠化生加重 ,但 5 0 %～ 6 7%的病人无明显变化 ;Hp阳性观察组肠化生加重的病人增至 43%～ 5 7% ,而Hp阴性观察组无一例加重 ,75 %的病人维持原状。结论　根除Hp感染不仅可减轻病人的炎症程度 ,同时能阻止肠上皮化生的发?Objective To observe the changes in severity of gastritis and intestinal metaplasia by following up a group of patients for 5 years to explore the effect of Helicobacter pylori (Hp) on the disease process Methods In this prospective cohort study, patients were selected from 7 enterprises by regular endoscopic examination in Zhongshan Hospital from July 1993 to June 1994 Recruited patients were those with upper abdominal discomfort and diagnosed as chronic gastritis endoscopically and pathologically Hp positive patients were given either eradication therapy or symptomatic treatment according to their willingness All the patients were followed up for 5 years Results Among the total 75 patients (30 were Hp positive and 45 were Hp negative), 24 Hp negative cases were recruited as control group Among 45 originally Hp positive patients, except for one drop out case, 16 cases in whom Hp was eradicated were defined as the eradication group and the remaining 28 patients with persistent Hp infection were assigned into the infection group In the control group, in only 17%～33% of patients the gastritis was worsened In the infection group, 29%～42% of patients had no changes in their gastritis severity, however in 43%～57% of patients the disease was worsened While in the eradication group, in 50% of patients the disease was improved, and in only 25% of patients the disease was aggravated, with an aggravalion rate much lower than that in infection group For intestinal metaplasia (IM), in the control group, 16%～25% of patients had their IM aggravated, but no changes occurred in 50%～67% of patients In the infection group, the rate of IM worsening increased to 43% 57%, while no IM worsening could be seen in eradication group, 75 0% of the patients in this group maintained their original status Conclusions Eradication of Hp could not only ameliorate the severity of gastritis, but also inhibit the development of IM

关 键 词：幽门螺杆菌 肠化生 胃粘膜病变 胃镜检查 

分 类 号：R573[医药卫生—消化系统]