儿童上消化道疾病幽门螺杆菌感染状况与病理分析

Analysis on infectious status of helicobacter pylori and pathological examination of children's upper alimentary diseases in Guangzhou region

目的 探讨广州地区小儿上消化道疾病中幽门螺杆菌 (H .pylori)感染的临床状况与组织学特点。方法 对 1994～ 2 0 0 1年广州市儿童医院 374 2例患上消化道疾病患儿采用日产奥林巴斯GIF PQ2 0纤维胃镜和富士能EG 4 5 0PE电子胃镜检查 ,并取胃窦部黏膜进行病理学检查及快速尿素酶试验 ,13 C 呼气试验检测。结果 胃镜检查病变检出率 94 4 4 % (35 34/ 374 2 ) ,其中H .pylori感染检出率占 18 14 % (6 4 1/ 35 34)。各年龄组胃十二指肠疾病H .pylori感染率具有显著差别 (P =0 0 0 0 1) ,H .pylori感染与年龄呈显著正相关 (r =0 914 ,P =0 0 0 0 1)。H .pylori感染前三位疾病是慢性浅表性胃炎、十二指肠球炎、十二指肠球部溃疡 ,其中结节性改变占十二指肠球炎的 4 7 5 7% (98/ 2 0 6 )。随着年龄的增长 ,上消化道疾病的发生率逐渐升高 (r =0 994 ,P =0 0 0 3)。消化性溃疡的发生率亦随年龄增长而增加 (十二指肠溃疡 :r =0 976 ,P =0 0 12 ;胃溃疡 :r =0 917,P =0 0 4 3)。H .pylori感染病例中组织学显示中 重度慢性胃炎占 82 97% (190 / 2 2 9)。结论 小儿H .pylori感染率随年龄增长而递增 ,胃、十二指肠黏膜结节性改变是小儿H .pylori感染的胃镜下特征。广州地区H .

Objective To investigate the clinical status of Helicobacter pylori infection and histologic characteristics of children s upper alimentary diseases in Guangzhou region. Methods 3742 children were investigated with Olimpus fiber gastroscope and Fujinen EG-450 electron gastroscope. Gastric antrum mucosa was taken for histology and rapid urease test. 13 C-UBT was detected. Results 94 44%(3534/3742) cases had lesions under gastroscopy with 18 44%(641/3534) H.pylori positive. Significant difference was found on H.pylori infection rate among various groups (P=0 0001). Furthermore,HP infection was positively correlated with the age (r=0 914,P=0 0001). The former three diseases were chronic superficial gastritis,duodenitis,duodenal bulb ulcer,and 47 57% had nodular changes among duodenitis. Positive correlation was found between the age and the upper alimental diseases (r=0 994,P=0 003).And peptic ulcer increased with age (duodenal bulb ulcer: r=0 976,P=0 012; gastric ulcer: r=0 917,P=0 043). 82 97%(190/229) patients infected with H.pylori had moderate to heavy gastritis. And 28 cases were normal under microscopy while 12 in those were histologically chronic gastritis with H.pylori infection.Conclusion H.pylori infection rate of children increases with age. Nodular change of gastric and duodenal mucosa is one of the characteristics of children s H.pylori infection under gastroscopy. H.pylori infection in our region is greatly different from overseas or other domestic regions. Firstly,it is mostly displayed as nodular duodenitis in Guangzhou region. Secondly,H.pylori infection rate is lower in peptic ulcer patients though HP false negative caused by the use of antibiotics within 2～4 weeks before examination cannot be excluded.Finally,most patients with H.pylori infection have moderate to heavy chronic gastritis.