消化性溃疡患者根治幽门螺杆菌和反流性食管炎的关系  

Study on relationship between Helicobacter pylori eradication to peptic ulcer and reflux esophagitis

作　　者：陈龙根[1] 董来华[1] 葛建荣[1] 王益平[1] 马君红[1] 茅育蕾[1] 

机构地区：[1]绍兴文理学院医学院附属医院消化科,浙江绍兴312000

出　　处：《临床荟萃》2003年第20期1146-1148,共3页Clinical Focus

摘　　要：目的　通过对消化性溃疡 (PU)患者根治幽门螺杆菌 (Hp)前后胃窦和食管下段黏膜病理及感染情况的分析 ,探讨Hp和反流性食管炎 (RE)的关系。方法　随机复查 10 5例PU患者 ,其中 74例用三联方案 (铋剂 +阿莫西林 +甲硝唑或呋喃唑酮 )根治Hp ,3个月后取胃窦和食管下段黏膜标本作组织学和Hp检查。RE按中国烟台试行标准进行分级。结果　 10 5例PU治疗前合并RE(I级 ) 2例 ,胃窦黏膜Hp阳性 74例 ,经抗Hp治疗后胃窦黏膜Hp转阴者 4 5例 ,发生胃镜RE(I级 ) 5例 ,组织学RE(轻度 ) 7例 ;胃窦黏膜Hp持续阳性者 2 9例 ,发生胃镜RE(I级 ) 2例 ,组织学RE(轻度 ) 4例。食管下段黏膜两组Hp均为阴性。虽然Hp转阴组发生胃镜RE和组织学RE数略高 ,但两组RE发生率差异无统计学意义 (P >0 .0 5 )。此外 ,检测 112例各级RE患者食管下段黏膜Hp感染情况 ,Ⅰ、Ⅱ、Ⅲ级RE的阳性率分别为 0 %、15 .5 5 %和 30 .77% ,三者间差异有统计学意义 (P <0 .0 1)。结论　PU根治Hp后转阴患者RE的发生率无明显升高 ,提示PU抗Hp治疗后RE的发生与胃窦黏膜是否感染Hp无明显关系。Objective To study the relationship between Helicobacter pylori(Hp) and reflux esophagitis(RE) by means of pathological examination and Hp detection of mucous membrance of pyloric antrum and lower segment of esophagus before and after Hp eradication in patients with peptic ulcer(PU).Methods 105 cases with PU were studied randomly,74 underwent histological test and Hp detection three months later after Hp eradication by using triple drug therapy (bismuth+amoxicillin +metronidazole or furazolidone). RE was graded on Chinese Yantai Standard.Results In 105 cases with PU,2 cases were complicated with RE and 74 cases were positive in Hp testing in mucosa of gastric pyloric antrum. After anti Hp therapy,45 Hp positive cases turned negative and 5 cases complicated with endoscopic RE(Grade I), 7 cases complicated with histological RE (mild).In 29 cases with persistent positive Hp, endoscopic RE(Grade I) happened in 2 cases,and histological RE(mild) in 4 cases. Hp detections in lower part of esophageus were all negative. Although the incidence of endoscopic RE and histological RE in the Hp negative cases was slightly higher than that in the cases with persistent positive Hp,there was no statistically remarkable difference(P> 0.05 ). Hp positive rates of lower segment of esophaguls in 112 cases of RE in grades Ⅰ,Ⅱ and Ⅲ were 0%, 15.55% and 30.77% ,respectively. The difference was significant(P< 0.01 ).Conclusion The incidence of RE in the PU cases has no statistical increase after Hp eradication,which shows that there is no definite relation between development of RE in PU cases after Hp eradication and Hp infection in gastric pyloric antrum. RE to Hp infection of lower segment of esophagus is relative.

关 键 词：消化性溃疡 幽门螺杆菌 食管炎 反流性 

分 类 号：R573[医药卫生—消化系统] R571[医药卫生—内科学]