儿童幽门螺杆菌感染与胆汁反流的关系探讨

The relationship between H.pyloric infection and bile reflux in children

目的探讨儿童幽门螺杆菌(H.pylori)感染与胆汁反流(BR)之间的关系。方法将近十年来因反复出现上消化道症状的1418例儿童根据胃镜检查结果分为慢性浅表性胃炎组(A组)、十二指肠球炎组(B组)、十二指肠球炎合并滤泡样改变组(C组)和十二指肠溃疡组(D组)4组,每组根据是否伴有胆汁反流再分为A1A2、B1B2、C1C2和D1D2组(伴BR者列后)。所有患儿均行电子胃镜检查并在距胃窦部2～3cm的胃大小弯侧取胃粘膜活检组织各1块,分别作细菌培养和组织病理学检查。结果1418例患儿中A组450例,伴BR35例(7.78%);B组282例,伴BR32例(11.35%);C组600例,伴BR44例(7.33%);D组86例,伴BR12例(13.95%),各组BR率差异无显著性。1418例中H.pylori阳性578例(占40.76%);H.pylori阳性率随病情加重而升高;A组中非BR组(A1)H.pylori阳性率为29.64%,而BR组(A2)仅为11.43%,两者比较差异有显著性;其他各组BR与非BR组的H.pylori阳性率差异均无显著性。1418例中共有123例发生BR,其中H.pylori阳性44例,阳性率为35.77%,与总阳性率(40.76%)比较差异无显著性。结论BR可由多种原因引起,且与H.pylori之间关系复杂。BR早期可能会影响H.pylori的定植,但随着病情的进展,H.pylori可能会对BR逐渐适应。

Objectives To investigate the relationship between H.pylori infection and bile reflux （BR） in children. Methods One thousand four hundred and eighteen children with epigastrie symptoms were subdivided into four groups according to the results of electronic gastroseope：ehronie gastritis （A）, duodenitis （B）, duodenitis with follicular degeneration （C） and duodenal ulcer （D）. Each group was further divided into A1A2, B1B2, C1C2 and D1D2 （former with BR and latter without BR）. The biopsies were performed for H.pylori euhure and pathologic examination in all children. The mucous membrane of stomach tissue was taken from greater curvature of stomach and lesser curvature of stomach, which located in 2 - 3 cm aside gastric antrum,respectively. Results Four hundred and fifty eases had simple chronic gastritis （A1） and 35 of them （A2） with BR （7.78 %）. Two hundred and eighty two eases had duodenitis （B1） and 32 of them （B2） with BR （11.35 %）. Six hundred eases had duodenitis with follicular degeneration （C1） and 44 of them （C2） with BR （7.33 %）. Eighty-six eases had duodenal ulcer （Dl） and 12 of them （Dz） with BR （13.95 %）. There was no significant difference in BR rate among four groups. Among 1 418 eases, 578 were H.pylori positive （40.76 %） and the positive rate increased with the lesion of mucosa progressing. H.pylori positive rate was 29.64 % in A1 group while it was 11.43 % in A2 group. There was no significant difference in H.pylori positive rate between BR and non-BR in other groups. One hundred and twenty three cases with BR,and 44 of them were H.pylori positive （35.77 %）. The difference was not significant in comparison with total H.pylori positive （35.77 % vs 40.76 %）. Conclusions Many reasons can lead to BR. The relationship between BR and H.pylori is very complex. The result of this study indicated that the planting of H.pylori might be disturbed in early stage of BR, but it will gradually be accustomed to BR later.