利用探头式共聚焦激光显微内镜荧光定量评价除菌治疗对幽门螺杆菌相关性萎缩性胃炎黏膜屏障功能影响的研究

A study on fluorescence quantitative evaluating the effect of debridement therapy for Helicobacter Pylori-associated atrophic gastritis by probe-based confocal laser endomicroscopy

目的利用探头式共聚焦激光显微内镜(pCLE)间接评价幽门螺杆菌(Hp)相关性萎缩性胃炎(HpCAG)除菌治疗后胃黏膜屏障功能变化情况,以探究Correa级联反应中黏膜屏障功能的可逆转性。方法选取2023年1月1日至2023年12月31日包头医学院第二附属医院行无痛胃镜检查并且Hp呼气试验阳性患者42例,所有患者行胃镜与pCLE检查。根据病理诊断结果分为非萎缩性胃炎(NAG)组18例、萎缩性胃炎(AG)组13例和肠化生(IM)组11例。比较各组除菌治疗前后平均荧光强度、荧光素钠渗漏面积及荧光素钠渗漏量的变化情况。结果NAG组纳入94个部位、AG组纳入64个部位、IM组纳入58个部位。除菌前NAG组、AG组荧光素钠渗漏面积、荧光素钠渗漏量均大于除菌后,差异有统计学意义(P<0.05);除菌前NAG组平均荧光强度大于除菌后,差异有统计学意义(P<0.05);IM组除菌前后荧光素钠渗漏参数无统计学差异(P>0.05)。结论随着Correa级联反应的进展,胃黏膜屏障功能逐步受损,进展至IM时,胃黏膜屏障功能损伤短期内呈现不可逆趋势。

Objective Using probe-based confocal laser endomicroscopy(pCLE)to indirectly evaluate the changes in gastric mucosal barrier function after Helicobacter pylori(Hp)-associated atrophic gastritis(HpCAG)eradication therapy,in order to explore the reversibility of mucosal barrier function in the Correa cascade reaction.Method A total of 42 patients with painless gastroscopy and positive Hp breath test at the Second Affiliated Hospital of Baotou Medical College from January 1,2023,to December 31,2023,underwent gastroscopy and pCLE examination.According to the pathological diagnosis results,they were divided into 18 cases in the non-atrophic gastritis(NAG)group,13 cases in the atrophic gastritis(AG)group,and 11 cases in the intestinal metaplasia(IM)group.Compare the changes in average fluorescence intensity,fluorescein leakage area,and fluorescein leakage volume before and after eradication therapy in each group.Results The NAG group included 94 sites,the AG group included 64 sites,and the IM group included 58 sites.Before decontamination,the leakage area and leakage volume of sodium fluorescein in the NAG group and AG group were greater than after decontamination,and the difference was statistically significant(P<0.05);the average fluorescence intensity of the NAG group was greater than after decontamination,and the difference was statistically significant(P<0.05);there was no statistical difference in the leakage parameters of sodium fluorescein before and after decontamination in the IM group(P>0.05).Conclusion With the progress of the Correa cascade reaction,the barrier function of the gastric mucosa is gradually impaired,and when it progresses to intestinal metaplasia(IM),the damage of the barrier function of the gastric mucosa shows an irreversible trend in the short term.