胃癌前病变与幽门螺杆菌关系随访研究

A Followup Study of Relationship between Gastric Cancer and Helicobacter Pylori

目的：探讨胃癌前病变病理改变的性质、程度和幽门螺杆菌（ＨＰ）感染及药物治疗与其变化过程的关系。方法：胃镜活检慢性萎缩性胃炎（萎缩）３７例，伴肠上皮化生（肠化）１９例、不典型增生７例，观察其与ＨＰ关系，ＨＰ以Ｇｉｍｅｓａ染色，肠化者以粘液组织化学染色。１９例萎缩伴肠化服德诺２８ｄ加施尔康６个月，ＨＰ阳性者加阿莫西林１４ｄ治疗，常规胃镜查ＨＰ根除率。随访６～３１．５个月复查胃镜及ＨＰ。结果：萎缩、肠化、不典型增生ＨＰ阳性率分别为８６．５％（３２／３７）、７８．９％（１５／１９）和５７．１％（４／７）。１９例萎缩伴肠化ＨＰ根除率为６６．７％（１０／１５），萎缩、炎症、肠化改善有效率分别为６３．２％（１２／１９）、７３．７％（１４／１９）和７８．９％（１５／１９）。其中已根除ＨＰ者分别占６６．７％（８／１２）、７１．４％（１０／１４）和６６．７％（１０／１５），与未根除ＨＰ者炎症与肠化改善例数比较有显著性差异（Ｐ＜０．０１）。结论：胃癌前病变与ＨＰ关系密切，联合抗ＨＰ药物及多种维生素疗法对改善胃癌前病变有效。

bjective: The purpose of the study was to investigate the relationship between gastric precancerous change and Helicobacter pylori (HP). Methods: Thirtyseven patients with chronic atrophic gastritis(CAG),19 cases of CAG with intestinal metaplasia(IM) and 7 cases with atypical hyperplasia were biopsyed by endoscopy to observe their correlation with HP.The HP positive specimens were stained with Gimesa's dyeing, and the sections from patients with IM were examined with mucus histochemistry dye.Ninteen cases of CAG with IM were treated Denol for 28 days and TheragraM for 6 months.The HP(+) cases were added with Amoxycillin remedy for 14 days.HP eradication was examined by regular endoscopy.The patients were counterchecked by endoscopy and HP at the followup of 631.5 months. Results: The HP positive rate of patients with CAG,IM and atypical hyperplasia was found to be 86.5%(32/37),78.9%(15/19) and 57.1%(4/7),respectively.The HP eradication in 19 cases of CAG with intestinal epidermis was detected in 10 of 15 (66.7%). The effective rate of improvement of atrophy, inflammation and IM was found to be 63.2% (12/19), 73.7% (14/19) and 78.9%(15/19),respectively.The HP eradication rate was found to be 66.7%(8/12), 71.4%(10/14) and 66.7%(10/15),respectively.These values are of significance(P<0.01) in comparison with those from noneradication group. Conclusions: There is a close relationship between gastric precancerous changes and HP.The combined therapy of antiHP drugs with multivitamins is effective to improve gastric precancerous changes.