幽门螺杆菌感染与胃癌前病变胃内分布的特点

Correlation between Helicobacter pylori infection and distribution of gastric premalignant lesions

目的：检测胃幽门螺杆菌(Hpylori)阳性患者胃癌前病变的组织病理情况和在胃内的分布特点.方法：伴有消化不良症状的门诊患者,先应用^(14)C尿素酶呼气试验检测Hpylori感染,如为阳性则行胃镜检查,于胃窦大、小弯侧及胃体大、小弯侧,分别取活检做病理检查,判断是否存在癌前病变,如：萎缩、肠化和不典型增生,并分析其分布特点.结果：在128例Hpylori阳性患者中,胃癌前病变71例,占55.5%.而阴性患者中,癌前病变的发生率仅占31.3%(10/32),两组间有显著性差并(P＜0.05).在Hpylori阳性组患者中,癌前病变在各部位所占的百分比分别为,胃窦小弯侧(58.5%)＞胃窦大弯侧(36.9%)＞胃体小弯侧(23.8%)＞胃体大弯侧(14.6%).而在Hpylori阴性对照组中,胃窦小弯侧(31.3%)＞胃窦大弯侧(18.2%)＞胃体小弯侧(15.6%)＞胃体大弯侧(12.5%).结论：Hpylori感染与胃癌前病变密切相关,胃癌前病变以胃窦小弯侧阳性率最高,其次为胃窦大弯侧.

AIM： To determine the distribution and prevalence of premaligant lesions （gastric atrophy, intestinal metaplasia and desplasia） in the stomach of H pylori infected patients. METHODS： Outpatients with the symptoms of dyspepsia were enrolled in this study and received a ^14C-urea breath test for the diagnosis of H pylori infection. Endoscopic examination with antral and corporal biopsy was performed, and gastritis, atrophy, and metaplasia were classified. RESULTS： Premaligant lesions were identified in 55.47% （71/128） of H pylori infected patients, but only in 31.25% （71/128） of H pylori negative patients （P 〈 0.05）. The incidence rate of gastric premalignant lesions noted in H pylori positive patients was 58.46% in the lesser curvature of the antrum, 36.92% in the greater curvature of the antrum, 23.85% in the lesser curvature of the body and 14.62% in the greater curvature of the body. The differences between any two of the above different areas were significant （P 〈 0.05）. However, the difference was not found in H pylori negative patients （P 〉 0.05）. CONCLUSION： H pylori infection is closely associated with gastric premalignant lesions, which mostly present in the lesser curvature of gastric antrum, and then in the greater curvature of the antrum.