原发性胆汁反流性胃炎病人胃与十二指肠黏膜胃动素表达及其关系

EXPRESSION OF MOTILIN OF GASTRIC AND DUODENUM MUCOSA IN PATIENTS WITH PRIMARY BILE REFLUX GASTRITIS

目的探讨胃窦及十二指肠黏膜胃动素的表达与原发性胆汁反流性胃炎之间的关系。方法原发性胆汁反流性胃炎病人74例，其中低反流组42例，高反流组32例，24h胃内胆红素监测及电子胃镜检查未见异常者28例为对照组。采用免疫组化法检测胃动素的表达并应用病理图像分析软件进行分析。结果高、低反流组胃窦及十二指肠黏膜胃动素表达均较对照组低（F=17．85、70．96，q=3．56～16．84，P〈0.05）。化生性萎缩、非化生性萎缩组胃窦及十二指肠黏膜胃动素表达均较浅表性胃炎组低（F=8．11、8．93，q=3．05～5．8I，P〈0．05）。十二指肠黏膜胃动素表达高于胃窦（t=14．85～30．65，P〈0．01）。高、低反流组化生性萎缩检出率高于对照组（χ^3=13．061、4．031，P〈0．05）；随着胆汁反流程度的加重，幽门螺杆菌检出率下降（χ^2=3．95i～9．386，P〈0．05）。结论胃窦及十二指肠黏膜胃动素分泌失调可能在胆汁反流中起作用。胆汁反流是胃黏膜损害的危险因素之一，胆汁反流可抑制幽门螺杆菌在胃内定植。

Objective To investigate the expression of motilin in sinus ventrieuli and duodenum mucosa of primary bile reflux gastritis （PBRG）. Methods Seventy four patients with PBRG were divided into two groups： low reflux group （42 cases） and high reflux group （32 cases）, and 28 subjects with normal 24-hour gastritic bilirubin monitoring with Bilitec 2000 and endoscopy served as control group. The expression of motilin was detected immunohistochemieally and analyzed using patho-image analytic software. Results The expression of motilin in sinus ventriculi and duodenum mucosa of high and low reflux groups were lower than that in the control （F=17.85,70.96;q=3.56-16.84;P〈0.05）. Its expression in metaplasia atrophy group and non-metaplasia atrophy group was lower than that in superficial gastritis group （F=8. 11,8.93;q=3.05-5.81;P〈0.05）. The expression of motilin in duodenum mucosa was higher than sinus ventriculi （t= 14.85-30.65 ,P〈0.01）. The detection of metaplasia atrophy in high and low reflux groups was higher than the control （χ^2 = 13. 081,4. 031 ;P〈0.05）. The detection of H. pylori was decreased with aggravation of bile reflux （χ^2 =3. 951-9. 386,P〈0.05）. Conclusion The parasecretion of motilin in gastric and duodenum mucosa may play a part in bile reflux, which is one of the risk factors for gastric mucosa injury. Bile reflux can inhibit the plantation of H. pylori in the stomach.