十二指肠球部胃化生和Hp感染与胃窦部病变相关性研究

A study on relationship between duodenal gastric metaplasia, Hp and gastric antral diseases

目的探讨十二指肠球部胃化生（ＤＧＭ）、Ｈｐ感染和胃窦部病变相关性，方法收集１２６例胃镜检查所见、组织病理学、Ｈｐ和胃泌酸量及胃内２４小时ｐＨ值的资料行对比研究。结果ＤＧＭ的发生率５２．３％，在反流性胃炎中６７．９％；粘膜糜烂中２０．７％；溃疡中４０．８５％，反流性胃炎与另二组差异显著（Ｐ＜０．００５）。在慢性非活动性炎症、慢性活动性炎症和胃粘膜上皮肠化生中分别为４１．１％、４５．９％和４１．８％，三组差异不显（Ｐ＞０．０５）。在轻、中和重度胃酸分泌亢进者中分别为２６．０％、６６．０％和１００％，各组间差异显著（Ｐ＜０．０５）。２４小时胃内ｐＨ＜４的时间在有、无ＤＧＭ组间无明显差异（Ｐ＞０．０５）。睡眠期间ｐＨ＞６的时间在２小时以上者ＤＧＭ明显多于无ＤＧＭ（Ｐ＜０．０５）。十二指肠球部和胃窦部Ｈｐ检出率为４１．２％和８０．９％。十二指肠球部Ｈｐ阳性者在胃窦部Ｈｐ（＋）占２７．１％；（＋＋）占８０．１％和（＋＋＋）占１００％，各组间差异显著（Ｐ＜０．０５）。结论ＤＵ患者的ＤＧＭ发生率与胃窦部的反流性胃炎、胃酸分泌亢进和Ｈｐ感染等病有相关性。

Objective This study was attempted to probe the correlation between duodenal gastric metaplasia(DGM), Helicobacter Pylori(Hp)growth and disorders at gastric antrum.Methods The gastroscopic histopathology, Hp culture findings and data of gastric acid output,24 hour pH value in 126 patients were collected and analyzed.Results The mean incidence of DGM was 53.3%, separately being 67.9% in cases with reflux gastritis, 20.7% with mucosal errosion,40.85% in peptic ulcer, with significant difference( P <0 05) between the former and the latter two, the incidence of DGM associated with antral mucosal disorders as chronic non active inflammation, chronic active inflammation,and intestinal metaplasia being 41.1%,45.9% and 41.8% respectively with no significance( P <0 05)among them. DGM also deveploped in patients with various gastric hyperacidity, seen in 26.2%,66.0%and100% of cases with mild,moderate and servere derangement respectively,and associated with significant difference ( P <0 05). No difference was detected between patients with or without DGM. whose gastric pH for 24 hour period maintained below 4( p >0 05). While DGM occurred more frequently( P <0 05) in cases with pH<6 lasting for 2 hours during sleep.41.2% of cultures for Hp from duodenal specimen and 80.9% from gastric autrum were positive. In association with positive duodenal Hp, Hp at autrum showed quantitatively as(+)、(++)、(+++) in 27.1%, 80.1% and 100% of patients accordingly with difference ( P <0 05).Conclusion The incidence of DGM in patient with duodenal ulcer related with reflux gastritis at antrum,hyperacidity and Hp infection.