瑞巴派特可提高胃溃疡的组织学愈合质量

Rebamipide Improves the Histologic Quality of Gastric Ulcer Healing in Humans

背景:质子泵抑制剂的广泛应用,以及将根除幽门螺杆菌(H.pylori)感染作为治疗胃溃疡的主要手段,极大地提高了消化性溃疡的临床愈合率,但溃疡易复发的难题仍亟待解决。溃疡愈合质量,尤其是组织学愈合质量正日益受到关注。目的:观察活动性胃溃疡患者应用瑞巴派特联合法莫替丁与单用奥美拉唑治疗前后的胃黏膜组织学变化,比较两组溃疡的组织学愈合质量。方法:将110例经胃镜检查证实伴有H.pylori感染的活动性胃溃疡患者随机分为治疗组和对照组。治疗组口服瑞巴派特片和法莫替丁片,对照组口服奥美拉唑胶囊,疗程均为6周。治疗结束后,两组复查胃镜。内镜下取胃溃疡周围黏膜(相当于原取材点处)组织2～4块,观察两组治疗前后的胃黏膜组织学变化,着重从炎性细胞浸润程度、黏膜形态结构和上皮细胞内中性黏液含量三个方面观察胃黏膜组织学恢复情况。结果:治疗6周后,两组胃黏膜组织形态好转程度相似,但治疗组胃黏膜上皮细胞内中性黏液含量恢复程度较对照组显著(P=0.0039),腺体密度较治疗前显著增加(P=0.0485)。结论:无论H.pylori感染根除与否,瑞巴派特均可使胃黏膜上皮细胞内中性黏液含量和腺体密度较快恢复,增强胃黏膜上皮细胞成熟程度,提高胃黏膜防御功能,从而提高溃疡的组织学愈合质量。

Background： Peptic ulcers healing can be accelerated by the use of proton pump inhibitors and eradication of Helicobacter pylori （H. pylori） infection, however, sometimes its relapse remains a problem. The quality of ulcer histologic healing plays an important role in ulcer recurrence. Aims： To evaluate the quality of ulcer histologic healing by treatment of rebamipide combined with famotidine or omeprazole alone in patients with active gastric ulcer. Methods： Gastric biopsy specimens were obtained from 110 patients with active gastric ulcer and H. pylori infection. The patients were divided randomly into the study group and the control group. In the study group, the patients received rebamipide combined with famotidine for 6 weeks and in the control group only omeprazole was given to the patients for six weeks. After treatment, 2-4 biopsy specimens were obtained from the area nearby the previous ulcer. The histologic changes of gastric mucosa were re-evaluated in both groups after treatment. The gastric mucosal recovery was evaluated, in particular, the degree of inflammatory cell infiltration, morphological structure of mucosa and intraepithelial mucin. Results： After 6 weeks treatment, the improvement of intraepithelial mucin content in the study group was better than that in the control group （P=0.0039）, and the glandular density increased than that before treatment （P=0.0485）. Conclusions： Whether eradication of H. pylori infection or not, the combined therapy of rebamipide and famotidine can improve the histologic quality of ulcer healing, especially the restoration of gastric intraepithelial mucin content and glandular density in patients with active gastric ulcer.