三种内镜下胃黏膜形态表现诊断萎缩性胃炎及幽门螺杆菌感染的临床研究  

Clinical study on the relationship between features of gastroscopic gastric mucosa in patients with atrophic gastritis and Helicobacter pylori infection

作　　者：牛应林[1] 李文燕[1] 周巧直[1] 翟惠虹[1] 董宁宁[1] 郭水龙[1] 

机构地区：[1]首都医科大学附属北京友谊医院消化内科,北京100050

出　　处：《临床和实验医学杂志》2017年第11期1053-1056,共4页Journal of Clinical and Experimental Medicine

基　　金：国家自然基金资助项目(编号:81670474)

摘　　要：目的探讨内镜下胃黏膜形态改变诊断萎缩性胃炎的临床价值;观察内镜下胃黏膜形态改变与幽门螺杆菌(Hp)感染的关系。方法常规因上消化道症状接受胃镜检查的门诊患者根据内镜下表现分三组:第1组为内镜下胃窦黏膜表面呈弥漫颗粒样改变的患者,在胃黏膜颗粒样改变的区域取活检两块做快速尿素酶检测及病理加嗜银染色检测;第2组为在胃窦部有大片灰白区域,其中可透见血管,活检两块做快速尿素酶检测及病理加嗜银染色检测;第3组为黏膜变薄变白的区域,明显低于周围发红黏膜,分界明显。分别在黏膜变薄和周围黏膜发红两个区域各活检两块做快速尿素酶检测及病理加嗜银染色检测。尿素酶和组织嗜银染色均阳性者判断为胃Hp感染。比较三组诊断萎缩性胃炎的准确性,比较三组胃黏膜形态表现Hp感染的差异性。结果第1组85例,病理结果:Hp阳性率88.3%,萎缩性炎25.8%,肠化生11.1%,异性增生4.4%;第2组108例,病理结果:Hp阳性率31.5%,萎缩性炎49%,肠化27.8%,异性增生10.2%;第3组15例,Hp阳性率26.7%,萎缩性炎93.3%,肠化60%,异性增生26%。第1组与第2组比较幽门螺旋杆菌感染及萎缩性胃炎均有差异性(P<0.05),第3组与第1组及第2组之间比较萎缩性胃炎比率有显著性差异(P<0.05)。结论界限明显的胃黏膜变薄伴血管透见表现可以作为萎缩性胃炎的内镜下特异性表现;随萎缩率增高,Hp感染率反而下降。Objective In the present study, authors tried to establish endoscopic criteria for diagnosis of atrophic gastritis and Helicobacter pylori infection. Methods Outpatients received endoscopic examination for their discomfort in upper digestive tract were divided into three groups according to endoscopic features. Endoscopic features in first group included diffuse granular changes in gastric antrum. Bioptic specimens were taken from two points and evaluated by pathological examination. Both rapid urease test and silver staining had been done to detect the infec-tion of Helicobacter pylori. Endoscopic features in patients of second group included large pale area and visible vessel under the mucosa. Endo-scopic features in third group included an obvious margin between thin and white mucous membrane and surrounding red mucosa. Biopsy and de-tection of Helicobacter pylori infection were also done in patients of second and third groups by the same method as that in the first group. Those patients with positive rapid urease test and positive silver staining were diagnosed as Helicobacter pylori infection. Results 85 patients were included in the first group. The rates of positive Hp infection, atrophic gastritis, intestinal metaplasia and dysplasia were 88. 3% , 25. 8% , 11. 1% and 4. 4% respectively. 108 patients were enrolled in the second group, and their rates of positive Hp infection, atrophic gastritis, intestinal meta-plasia and dysplasia were 31.5% , 49% , 27.8% and 10.2% respectively. 15 patients were included in the third group, their pathological features of thin and white mucous membrane were pathological criteria for diagnosis of atrophy, and the surrounding red mucous membrane was infected with chronic inflammation. The difference in rates of Helicobacter pylori infection and atrophic gastritis between first and second groups was statistically significant （ P 〈0.05） . There was also statistical difference in the rate of atrophic gastritis between these 2 groups and third group （P〈0.05） . Conclu

关 键 词：萎缩性胃炎 内镜 胃黏膜形态 幽门螺杆菌 

分 类 号：R573.32[医药卫生—消化系统]