有消化道症状儿童胃黏膜病理组织学特点及幽门螺杆菌感染情况

Histopathological characteristics of gastric mucosa and Helicobacter pylori infection status in children with gastrointestinal symptoms

目的观察有消化道症状儿童胃黏膜病理组织学特点,并分析其幽门螺杆菌(Hp)感染情况。方法选取2018年1月—2019年12月华中科技大学同济医学院附属武汉儿童医院86例有消化道症状儿童,根据Hp感染情况分为Hp阳性组51例与Hp阴性组35例,Hp阳性组患儿根据血清CagA抗体和VacA抗体检测结果分为菌株I型组36例、中间型组9例和II型组6例。所有患儿均接受胃镜检查,且取胃黏膜进行病理组织学检查,收集患儿临床资料,分析Hp感染影响因素及Hp感染与病理组织学特点的关系。结果86例受检者中,慢性胃炎41例(47.67%)、慢性胃炎合并十二指肠球炎29例(33.72%)、十二指肠溃疡9例(10.47%)、胃溃疡7例(8.14%);Hp阳性组中重度黏膜病变、活动性炎症、中重度炎症活动性及滤泡样改变发生率高于Hp阴性组(P<0.05);黏膜病变程度、活动性炎症发生率、滤泡样改变发生率为:菌株I型组>中间型组>II型组,差异有统计学意义(P<0.05);Hp感染率在年龄、家庭人均收入、居住环境、父母最高受教育程度及消化系统疾病家族史等因素上比较有统计学意义(P<0.05);年龄大、家庭人均收入低、集体居住用餐、父母最高受教育程度低、消化系统疾病家族史为有消化道症状儿童Hp感染的危险因素(P<0.05)。结论有消化道症状且Hp感染儿童胃黏膜病变更严重,滤泡样改变发生率更高,尤其是I型菌株感染者,Hp感染影响因素较多,建议采取针对性预防措施,降低Hp感染风险。

OBJECTIVE To observe the histopathological characteristics of gastric mucosa in children with gastrointestinal symptoms,and to analyze the status of Helicobacter pylori(Hp)infection.METHODS From Jan.2018 to Dec.2019,a total of 86 children with gastrointestinal symptoms admitted to Wuhan Children’s Hospital,Tongji Medical College,Huazhong University of Science and Technology were selected and divided into 51 cases of Hp positive group and 35 cases of Hp negative group according to Hp infection.According to the detection results of serum CagA antibody and VacA antibody,the children in the Hp positive group were divided into 36 cases of strain type I group,9 cases of intermediate type group,and 6 cases of type II group.All children underwent gastroscopy,and gastric mucosa was collected for histopathological examination.The clinical data of children were collected,and the influencing factors of Hp infection and the relationship between Hp infection and histopathological characteristics were analyzed.RESULTS Of the 86 subjects,41 cases(47.67%)had chronic gastritis,29 cases(33.72%)had chronic gastritis complicated with duodenal bulbar inflammation,9 cases(10.47%)had duodenal ulcer,and 7 cases had gastric ulcer(8.14%).The incidence rates of moderate to severe mucosal lesions,active inflammation,moderate to severe active inflammatory,and follicular-like changes in the Hp positive group were significantly higher than those in the Hp negative group(P<0.05).The order of the degree of mucosal lesions,the incidence of active inflammation,and the incidence of follicular changes from high to low was as follows:type I group>intermediate type group>type II group(P<0.05).The Hp infection rate was significant in terms of age,family income per capita,living environment,parents’highest education level and family history of digestive system diseases(P<0.05).Advanced age,low family income per capita,group living and dining,parents with low education level,and family history of digestive system diseases were independent risk factors for Hp infection in children with digestive tract symptoms(P<0.05).CONCLUSION Children with gastrointestinal symptoms and Hp infection have more serious gastric mucosal lesions,and a higher incidence of follicular changes,especially in children with type I infections.There are many factors influencing Hp infection,and it is recommended to take targeted preventive measures to reduce the risk of Hp infection.