儿童慢性胃炎、十二指肠炎和消化性溃疡内镜和病理改变

Endoscopic and histopathological characteristics of chronic gastritis,duodenitis and peptic ulcer in children

目的探讨儿童慢性胃炎、十二指肠炎和消化性溃疡内镜下表现与其组织病理学特点的关系,以及幽门螺杆菌(Hp)感染与儿童胃十二指肠黏膜组织病理学变化严重程度的相关性。方法观察366例有上消化道症状的儿童内镜下的疾病类型,对其活检标本进行组织病理学检查。结果366例患儿经内镜诊断胃十二指肠疾病类型:单纯慢性胃炎206例(56.3%),慢性胃炎并十二指肠炎112例(30.6%),慢性胃炎并消化性溃疡48例(13.1%)。经组织病理学检查,全部病例存在胃窦黏膜和十二指肠球部黏膜慢性炎症改变。Hp检查阳性者106例(28.96%),其中Hp感染者的胃窦黏膜炎症程度明显较未感染者重(P<0.01),而Hp感染与否与十二指肠黏膜慢性炎症严重程度无关(P>0.05)。Hp感染组与未感染组在引起胃窦黏膜炎症活动性、萎缩和淋巴滤泡形成的发生率上差异均有统计学意义(P<0.01)。结论内镜下表现正常的十二指肠黏膜经组织学检查均有慢性炎症改变,其严重程度与Hp感染无关。Hp感染可引起较严重的胃黏膜组织学改变,有症状的Hp感染儿童应予根除Hp治疗。

Objective To investigate the relationship between the endoscopic characteristics of chronic gastritis, duodenitis, peptic ulcer and their histopathologic findings in children, and explore the relationship between Helicobacter pylori（Hp） infection and the severity of histopathologic changes of gastroduodenal mucosa in children. Methods Three hundreds and sixty-six children with chronic upper gastrointestinal symptoms who were examined by gastroseopy were enrolled. The gastric and duodenal mucosal biopsy specimens of all the patients were studied histopathologically. Results Types of chronic gastroduodenal diseases in all these patients were： chronic gastritis （n = 206, 56.3% ） , chronic gastritis combined with duodenitis （n =112, 30.6% ）, chronic gastritis combined with peptic ulcer （n =48, 13.1% ）. There was chronic inflammation in gastric mucosa and duodenal bulb mucosa in all the cases examined by histopathologic examination. Hp infection was found in 106 cases （28.96%）. The gastric mucosal inflammation was more severe in those with Hp infection than those without （ P 〈 0. 01 ） , while there was no relationship between the severity of duodenal mucosal inflammation and Hp infection （P 〉 0.05）. The were significant differences in the incidences of inflammation activity, atrophia and nodulus lymphaticns of gastric mucosa between those with Hp infection and those without （ P 〈 0. 01 ）. Conclusion There may exist chronic inflammation in duodenal bulb mucosa with normal endoscopic findings, the severity of which is not related to Hp infection. Hp infection can lead to severe histopathologic changes of gastric mueosa. Children with symptons of Hp infection should receive treatment on Hp.