根除幽门螺杆菌对胃黏膜肠化的影响  

The effect of Helicobacter pylori eradication on intestinal metaplasia of gastric mucosa

作　　者：金珠[1] 林三仁[1] 沈祖尧[2] 周丽雅[1] 丁士刚[1] 

机构地区：[1]北京大学第三医院消化科,100083 [2]香港中文大学内科学系

出　　处：《中华消化杂志》2003年第3期161-164,共4页Chinese Journal of Digestion

摘　　要：目的　幽门螺杆菌 (Hp)感染可导致慢性活动性胃炎进一步发展为慢性萎缩性胃炎、胃黏膜肠化、最终发展成肠型胃癌。通过 5年随访 ,探讨根除Hp是否对胃黏膜肠化逆转、发生及发展有影响。方法　将 1996年快速尿素酶试验及组织学方法检测Hp均为阳性的 398例病人随机分为治疗组和对照组。治疗组 2 0 1例 ,进行根除Hp治疗 ;对照组 197例 ,给予安慰剂 ;服药前及 5年后分别从胃窦部及胃体部取材检测胃炎、胃炎活动性及肠化。结果　 5年后治疗组中 15 1/2 0 1例Hp为阴性 ,对照组中 16 1/197例Hp为阳性 ;治疗组中Hp被根除的病人胃炎活动性的检出率明显减少 ,与对照组持续Hp感染者比较 ,差异有显著性 (P <0 .0 0 0 1) ;对照组中持续Hp感染者 5年后肠化检出率与自身 5年前、治疗组成功根除Hp者 5年前和 5年后比较均增高 ,差异有显著性 (P均 <0 .0 0 1) ,治疗组根除Hp的病人 5年前后比较差异无显著性 ;对照组中持续Hp感染者胃窦部 5年后肠化检出率与自身 5年前、治疗组根除Hp者 5年前和 5年后比较均增高 ,差异有显著性 (分别为P <0 .0 0 1,P <0 .0 0 1和P<0 .0 1) ,治疗组根除Hp感染的病人 5年前后比较差异无显著性 ;对照组持续Hp感染的病人与治疗组根除Hp感染的病人胃窦部肠化新增及新减情况比较无差异。 结论　Objective To investigate the effect of H.pylori eradication on intestinal metaplasia of gastric mucosa. Methods A total of 398 patients with H.pylori positive determined by rapid urease test (RUT) and confirmed in histology were randomized into two groups: the treatment group and the control group. The patients of treatment group (201 patients) were received H.pylori eradication therapy, and the patients of control group (197 patients) were given placebo. The intestinal metaplasia of gastric mucosa was determined at gastric biopsy specimens taken from both the antrum and corpus before and after five years of treatment. Results Five years later, there are 151 H.pylori negative patients in treatment group, and 161 H.pylori positive patients in control group. After eradication therapy, the detectable rates of active gastritis in H.pylori negative patients of treatment group were significantly decreased compared with those in H.pylori positive patients of control group ( P < 0.000 1). The detectable rates of the intestinal metaplasia of H.pylori positive patients in control group were much higher than those five years ago ( P < 0.001), and also higher than those H.pylori negative patients who had received H.pylori eradication therapy in treatment group ( P < 0.001). No difference was observed in the patients who had received H.pylori eradication therapy in treatment group before and after the treatment. Conclusions Eradication of H.pylori results in the alleviation of the severity of gastritis, preventing the gastric mucosa from developing intestinal metaplasia.

关 键 词：幽门螺杆菌 胃黏膜肠化 肠型胃癌 HP 慢性活动性胃炎 

分 类 号：R735.2[医药卫生—肿瘤]