青年人原发性胆汁反流性胃炎病理特征分析40例

Pathological features of primary bile reflux gastritis in adolescents:an analysis of 40 cases

目的:探讨青年人原发性胆汁反流性胃炎(bile reflux gastritis,BRG)的病理特征.方法:选择40例青年人原发性BRG为观察组,均经临床、内镜及胃内24h胆汁监测确诊;取同期30例健康青年志愿者为对照组.分别取胃窦和胃体活检标本进行HE染色和改良Giemsa染色,进行组织病理分析.结果:观察组淋巴细胞浸润较轻,0-2级占87.5%,有中性粒细胞浸润者多伴Hpylori感染,胃小凹延长者占22.5%、毛细血管扩张和间质水肿均为40.0%(肠化生12.5%,黏膜萎缩20.0%),Hpylori感染者22.5%(除肠化生及Hpylori感染外),其他黏膜病变与对照组比较有显著性差异(P<0.05),而且胃窦病变重于胃体.结论:青年人原发性BRG具有化学性胃炎的部分特征,而且有向黏膜萎缩与肠化生转变的趋势.

AIM：To analyze the pathological features of primary bile reflux gastritis（BRG）in adolescents. METHODS：Forty adolescents clinically diagnosed with primary BRG by endoscopy and 24-hour gastric pH and bile monitoring were included in the study.Thirty healthy adolescent volunteers were enrolled as controls.Gastric antrum and corpus mucosa biopsy specimens were taken and subjected to routine HE staining and modified Giemsa staining to conduct pathological examination. RESULTS：Lymphocyte infiltration was mild in BRG adolescents,and grade 2 or less lymphocyte infiltration was noted in 87.5%of patients.Neutrophil infiltration was often concurrent with Helicobacter pylori（H pylori）infection.Lengthening of gastric pits,trichangiectasia,interstitial edema,mucosal atrophy,intestinal metaplasia and H pylori infection were observed in 22.5%, 40.0%,40.0%,12.5%,20.0%and 22.5%of patients,respectively.Except intestinal metaplasia and H pylori infection,the prevalences of other pathological alterations were significantly different between healthy adolescents and BRG adolescents（P〈0.05）.Additionally,these pathological alterations were more severe in the antrum than in the corpus. CONCLUSION：Primary BRG in adolescents shows some features of chemical gastritis and has a tendency to evolve towards mucosal atrophy and intestinal metaplasia.