消化不良者胃镜检查适应证的探讨

Study on Indication of Endoscopical Intervenation for Dyspepsia Patients

目的:进一步探讨消化不良患者胃镜检查的适应证。方法:经胃镜、病理检查的4500例消化不良患者分为<45岁及≥45岁组,并进一步分为Hp阳性和Hp阴性组。比较同一年龄组不同Hp状态及不同年龄组间检查结果,并对<45岁、Hp阴性消化性溃疡易患因素作进一步分析。结果:<45岁消化性溃疡(PU)Hp阳性率高:十二指肠球部溃疡(DU)94.2％,胃溃疡(GU)86.4％≥45岁Hp阴性PU发生率升高(DU22.7％,GU33.3％)。<45岁胃癌发生率显著低于≥45岁组(P<0.01),且在≥45岁组胃癌Hp多为阴性(68.4％)。病理结果表明,<45岁组慢性萎缩性胃炎、肠上皮化生及异型增生患者人数及病变程度均显著少于并轻于≥45岁组(P<0.05,P<0.01),且在≥45岁组上述病变多发生在Hp阴性组。另外,<45岁Hp阴性PU发生主要与遗传、服用NSAIDs药物、饮酒或精神紧张有关。结论:消化不良患者胃镜检查适应证应该是(1)≥45岁。(2)<45岁Hp阳性。(3)<45岁、Hp阴性症状持续、治疗无效,尤其伴有进行性消瘦、纳差及贫血者。(4)<45岁Hp阴性、有PU遗传史、长期服用NSAID药物、饮酒或精神紧张者.(5)约20％～30％患者可免于胃镜检查。

Background/Aims: To discuss furtherly indications of endoscopical intervenation for dyspepsia paitents. Methods: 4500 cases diagonised by endoscopy and pathology were divided into two age groups (less than 45 year-old and more than 45 year-old) and two kinds of status of Hp infection (Hp positive and Hp negative) respectively. The results of endoscopy and pathology were compared between different status of Hp infection in same age group and between different age group. In addition, multifactors predisposing to peptic ulcer diseases (PUD) with Hp negative were analysed in out study. Results: In less than 45 year-old group, most of puptic ulcer patients were in HP positive group: doudenal ulcer (DU) 94.2%, gastric ulcer (GU) 86.4%. However, the incidence of PUD was increasing in Hp negative group (DU 22.7%, GU 33.3%) in more than 45 year-old group. The incidence of gastric cancer (GC) was significantly lower in less than 45 year-old group than that in more than 45 year-old group (P<0.01). Moreover, GC was predominantly in Hp negative group (68.4%) in the latter. The number and extent of chronic atropic gastritis, intestinal metaplasia and dysplasia were all significantly fewer and slighter in less than 45 year-old group than those in more than 45 year-old group respectively (P<0.05, P<0.01) and those mucosal lesions were more frequently in Hp negative group in more tham 45 year-old group. In addition, multifactors analysis showed that PUD with Hp negative aged less than 45 years was related mainly to heredity, NSAIDs, alcohol or stress. Conclusions: Indications of endoscopical examination should be (1) older than 45 year-old. (2)younger than 45 year-old with Hp postive. (3)approximately 20-30 percent of dyspepsia patients would be free from endoscopical intervenation.