幽门螺杆菌在不同胃部疾病中的定植状态

The conditions of Helicobacter pylori colonization in different gastric diseases

目的探讨幽门螺杆菌（Hp）在不同胃部疾病中的定植状态，同时探讨免疫组化染色在幽门螺杆菌原位密度测量方面的应用。方法选取已知病理诊断的胃黏膜活检标本174例，其中来自胃癌高发地区135例，胃癌低发地区地区39例，分别行石蜡包埋、常规HE染色和免疫组化染色观察不同部位Hp感染密度。结果胃黏膜小凹上皮表面及腺腔内Hp定植密度评分〈1分时，免疫组化染色与HE染色经配对Χ^2检验比较，差异有统计学意义（Χ^2=9．446、P〈0．01）；定植密度评分〉1分时，两者差异无统计学意义（P〉0．05）。在浅表性胃炎组，胃黏膜小凹上皮表面及腺腔内Hp定植密度评分〉1萎缩性胃炎（23．8％）与胃癌组（16．7％），但差异无统计学意义（Χ^2=2．780、P〉0．05，Χ^2=4．876、P〉0．05）；在萎缩性胃炎和胃癌组，胃黏液内游离的Hp密度评分显著大于浅表性胃炎组（53．7％），差异有统计学意义（Χ^2=19．401、P〈0．01，Χ^2=11．002、P〈0．01）。结论胃黏膜小凹上皮表面及腺腔内Hp定植密度在浅表性胃炎，萎缩性胃炎和胃癌逐渐降低，而胃黏液内游离的Hp密度在浅表性胃炎，萎缩性胃炎和胃癌逐渐升高。

Objective To investigate the condition of Helicobacter pylori （Hp） colonization in different gastric diseases and the application of immunostaining technique in Hp density measurement. Methods Biopsy specimens of gastric mucosa were obtained from 174 patients with different gastric diseases confirmed by pathological examination, 99 males and 75 females, aged 53. 37 （ 19 - 87 ）, 135 from Zhuanghe, a high risk area of gastric cancer, and 39 from Sbenyang, a low risk area. Hematoxylin and eosin （HE） staining and immunohistochemistry were used to detect the Hp density in different parts of gastric mucosa. Results When the grade of Hp density in the gastric mucosa epithelium cell surface and lumen of gland 〈 1 there was a significant difference between HE stain and immunohistochemistry （ Χ^2 = 9. 446, P 〈 0. 01 ） , however, when the grade of Hp density in the gastric mucosa epithelium cell surface and lumen of gland 〉 1 there was no significant difference between them （ P 〉 0.05 ）. The grade of Hp density of gastric mucosa epithelium cell surface and lumen of gland in superficial gastritis was 〉 1, significantly higher than those of the atrophic gastritis group （23.8%） and gastric cancer group （ 16.7% ） （ Χ^2 = 2. 780, P 〉 0.05 ; Χ^2 = 4. 876 ,P 〉 0.05 ）. The Hp colonization density in the gastric mucosa epithelium cell surface and lumen of the patients from Zhuanghe region was significantly lower than that of the patients from Shenyang region （ Χ^2 = 5. 915, P = 0. 015 ） ; and the Hp density in the gastric mucus in the patients from Zhuanghe was significantly higher than that of the patients from Shenyang （ Χ^2= 8. 879, P = 0. 003, Χ^2 = 22. 036, P = 0. 000）. The grades of Hp density within the surface mucous gel layer in atrophic gastritis and gastric cancer was significantly higher than that of the superficial gastritis group （53.7%, Χ^2 = 11. 002,P 〈 0. 05; Χ^2 = 19. 401 ,P 〈 0.05 ）. Conclusion The density of Hp colonization in gastric mucosa epithelium cell surface and lumen of gland gradually decreases in the order of superficial gastritis-atrophic gastritis-gastric cancer,while the density of Hp within the surface mucous gel layer increases in the order of superficial gastritis-atrophic gastritis-gastric cancer.