胃窦粘膜活检HE切片检测幽门螺杆菌感染

Predication of active helicobacter pylori infection through routine antral histology by HE stain

目的：确定幽门螺杆菌（ＨＰ）相关性胃炎是否存在具有诊断价值的病理变化。方法：比较观察１３０例病人胃窦粘膜活检ＨＥ切片的病理改变与ＨＰ感染的关系。ＨＰ感染以快速尿素酶试验、胃粘膜Ｇｉｅｍｓａ染色和１４Ｃ尿素呼气试验确定。以盲法方式由一病理医生阅片，按０级（无）至３级（重）分级记录胃窦急性炎症、慢性炎症、淋巴样组织集结和肠化。结果：１３０例病人有７５例ＨＰ阳性，５０例阴性，５例被剔除。ＨＰ感染与急性、慢性炎症、淋巴样组织集结相关；与肠化无相关。以急性（＞１级）、慢性（＞２级）炎症、淋巴样组织集结（＞１级）预测ＨＰ感染，其阳性和阴性预测值分别为８７％和５０％、８１％和７９％、７８％和５２％。

Purpose To determine whether the presence of typical histological features of HP gastritis may yield diagnostic information. Methods Compared antral histology by H&E stain to the presence of HP as detected on rapid urease test, giemsa stain of gastri specimens, 14 C urea breath test in 130 patients. Patients were diagnosed as having active HP infection if at least two of these tests were positive. Patients were considered as having no HP infection if three tests were negative. Patients with only one test postive were excluded. All slide were reviewed by a single blind pathologist and grade 0 (none) to 3 (severe) for the presence of acute or chronic inflammation. lymphoide aggregates, and intestinal metaplasia. Results Of 130 patients seventy five were classified as HP postive, 50 patients as negative, and 5 patients excluded. Active HP infection was associated with the presence of acute or chronic inflamation, or lymphoid aggregates, but not intestinal metaplasia. The positive and negative predicative values of HP infection in the presence of acute inflamation, chronic inflamation (grade 2 or grade 3) and lymphoid aggregates were 87% and 50%, 81% and 79%, 78% and 52% respectively. Conclusion The use of HE histological determined feature in conjuncton with other tests to diagnose HP infection is valuable.