中原地区儿童幽门螺杆菌感染与胃黏膜癌前病变发生的临床研究  

Relationship between Helicobacter pylori Infection and Precancerous Lesions of Gastric Mucosa in Children in Central Plain Area of China

作　　者：于淼 宋晓霞 马菁 邵俏俏 余雪纯 祁亚宾 胡若冰 卫珮如 肖伟 贾百灵 程艳波 孔令非 陈传亮 丁松泽 YU Miao;SONG Xiaoxia;MA Jing;SHAO Qiaoqiao;YU Xuechun;QI Yabin;HU Ruobing;WEI Peiru;XIAO Wei;JIA Bailing;CHENG Yanbo;KONG Lingfei;CHEN Chuanliang;DING Songze(Department of Gastroenterology and Hepatology,People's Hospital of Zhengzhou University,Henan Provincial People's Hospital,Zhengzhou 450003,China;Department of Pathology,People's Hospital of Zhengzhou University,Henan Provincial People's Hospital,Zhengzhou 450003,China;Department of Pediatrics,People's Hospital of Zhengzhou University,Henan Provincial People's Hospital,Zhengzhou 450003,China;Department of Medical Imaging,People's Hospital of Zhengzhou University,Henan Provincial People's Hospital,Zhengzhou 450003,China)

机构地区：[1]郑州大学人民医院河南省人民医院消化内科,河南省郑州市450003 [2]郑州大学人民医院河南省人民医院病理科,河南省郑州市450003 [3]郑州大学人民医院河南省人民医院儿科,河南省郑州市450003 [4]郑州大学人民医院河南省人民医院影像科,河南省郑州市450003

出　　处：《中国全科医学》2022年第23期2849-2855,共7页Chinese General Practice

基　　金：国家自然科学基金联合基金项目(U1604174);河南省科技攻关项目(SBGJ202002004);河南省卫生计生科研创新人才工程项目(51282)。

摘　　要：背景慢性幽门螺杆菌(H.pylori)感染是引起成年人胃黏膜癌前病变的主要原因,但其是否也可能发生在儿童中尚存在争议。目的探讨中原地区因上消化道症状住院的儿童H.pylori感染情况及其胃黏膜癌前病变情况。方法连续选取2018年8月至2021年7月因上消化道症状(如腹痛、腹胀、恶心、呕吐、打嗝、反酸等)于郑州大学人民医院就诊的18岁以下患儿1015例。患儿均行上消化道内镜检查,并取胃黏膜活检组织行快速尿素酶试验和组织病理学检查。回顾性收集患者的临床资料及病理资料。依据H.pylori感染情况将患儿分为感染组与未感染组,比较感染组与未感染组患儿年龄、性别、内镜检查结果,不同年龄段患儿H.pylori感染率。比较感染组与未感染组患儿胃黏膜癌前病变发生率、胃黏膜活动性炎症发生率、胃黏膜中性粒细胞浸润程度、胃黏膜淋巴细胞浸润程度。比较感染组与未感染组不同年龄段患儿胃黏膜活动性炎症发生率、胃黏膜中性粒细胞浸润程度、胃黏膜淋巴细胞浸润程度。结果1015例患儿中,感染H.pylori 854例(84.14%,即感染组),未感染H.pylori 161例(15.86%,即未感染组)。感染组患儿年龄大于未感染组,浅表性胃炎发生率低于未感染组,疣状胃炎发生率高于未感染组(P<0.05)。1015例患儿中1~4岁54例,5~8岁199例,9~12岁435例,13~18岁327例。5~8、9~12、13~18岁患儿H.pylori感染率高于1~4岁患儿(P<0.05);9~12、13~18岁患儿H.pylori感染率高于5~8岁患儿(P<0.05)。感染组患儿中经胃黏膜病理结果证实的癌前病变发生率为4.33%(37/854),其中包括17例胃黏膜萎缩、11例肠上皮化生和9例不典型增生。感染组患儿胃黏膜癌前病变发生率高于未感染组〔0.62%(1/161)〕(χ^(2)=5.178,P<0.05)。感染组患儿胃黏膜活动性炎症发生率、胃黏膜中性粒细胞浸润程度、胃黏膜淋巴细胞浸润程度均高于未感染组(P<0.05)。5~8、9~12�Background Helicobacter pylori(H.pylori)infection induced precancerous lesions of gastric mucosa mostly in adulthood.However,it is debatable whether these pathological changes could also occur in children.Objective To investigate the relationship between H.pylori infection and precancerous lesions of gastric mucosa in children hospitalized due to upper gastrointestinal symptoms in central plain area of China.Methods A total of 1015 children under the age of 18 years old were enrolled.These children attended the People’s Hospital of Zhengzhou University for upper gastrointestinal symptoms such as abdominal pain,bloating,nausea,vomiting,hiccups,and acid reflux from August 2018 to July 2021.All children underwent gastroscopy,from which gastric mucosal biopsy tissues were taken for rapid urease test and histopathological examination.The clinical and pathological data of the patients were collected retrospectively.The children were divided into infected and uninfected groups according to H.pylori infection status.The age,sex,endoscopic diagnosis,and H.pylori infection rate were compared between children in infected and uninfected groups.The incidence of precancerous lesions of gastric mucosa,inflammatory activity and the degree of inflammatory cell infiltration were compared between infected and uninfected groups,meanwhile these tests were also compared in children of different age groups.Results Among the 1015 children,854(84.14%)were infected with H.pylori and 161(15.86%)were not infected.H.pylori-infected children were significantly older than those of non-infected subjects(P<0.05).Endoscopy examination revealed that the proportion of chronic superficial gastritis in H.pylori-infected group was significantly higher than that in uninfected group,while nodular gastritis was more common in H.pylori-uninfected patients(P<0.05).Among the enrolled children,54 were 1-4 years old,199 were 5-8 years old,435 were 9-12 years old,and 327 were 13-18 years old.H.pylori infection rate in groups of 5-8,9-12 and 13-18 year-old ch

关 键 词：幽门螺杆菌 儿童 住院 上胃肠道 胃黏膜 癌前病变 组织病理 体征和症状 消化系统 河南 

分 类 号：R377[医药卫生—病原生物学]