球部幽门螺杆菌感染与不同期十二指肠溃疡的关系

Relationship between helicobacter pylori infection in bulb and duodenal ulcers of different stages

目的研究十二指肠溃疡（ＤＵ）的胃镜下和组织学愈合是否受球部幽门螺杆菌（Ｈｐ）感染的影响。方法对７０例活动期ＤＵ（Ａ）和４０例瘢痕期ＤＵ（Ｓ组）患者溃疡边缘粘膜活检标本采用快速尿素酶试验和改良姬姆萨染色检测Ｈｐ，并对粘膜固有层内中性多形核白细胞（ＰＭＮ）浸润状态进行观察。结果Ｓ组和Ａ组Ｈｐ阳性率各为６００％和７１４％，差异无显著性（Ｐ＞０．０５）。Ｓ组和Ａ组中Ｈｐ阳性者ＰＭＮ浸润率和ＰＭＮ计数（各为９１７％；２０３±０．５１和１０００％；２３４±０．４０）分别明显高于（Ｐ均＜００１）其Ｈｐ阴性者（各为５６３％；０６７±０．２９和６５０％；１１１±０．３２）。在Ｈｐ阳性者，Ｓ组ＰＭＮ浸润率和ＰＭＮ计数均与Ａ组相近（Ｐ＞０．０５）；在Ｈｐ阴性者，Ｓ组仅ＰＭＮ浸润与Ａ组相近（Ｐ＞０．０５），其ＰＭＮ计数则明显低于Ａ组（Ｐ＜０．０１）。结论ＤＵ的胃镜下愈合可不受球部Ｈｐ感染的影响，但后者与溃疡边缘粘膜活动性炎症密切相关从而使ＤＵ的组织学愈合质量明显受其影响。

Aims To study whether Helicobacter pylori(Hp)infection in bulbar mucosa has influences on the endoscopically and histologically healing of duodenal ulcer(DU). Methods Biopsies were obtained from the bulbar mucosa surrounding ulcers from 70 patients with active DU(group A) and 40 with scarring DU(group S)to detect Hp with rapid urease test and modified Giemsa stain and to assess the PMN infiltration in the stroma of villi. Results Hp positive rate was 60.0% in group S compared to 71.4% in group A (P>0.05).The PMN infiltrating rates and PMN accounts of Hp-positive patients in group S and group A(91.7%;2.030.51 and 100.0%;2.340.40 respectively )were respectively remarkablely higher than(P<0.01) that of Hp-negatives (56.3%;0.670.29 and 65.0%;1.110.32 respectively).Among Hp-positives the PMN infiltrating rate and PMN account of group S were all similar to that of group A,whereas among Hp-negatives only the PMN infiltrating rate of group S was similar to,with its PMN account significantly lower than that of group A (P<0.01). Conclusions The endoscopically healing of DU may not be influenced by Hp infection in bulb.However,the latter correlates closely with active inflammation surrounding DU and so has great influcnces on the histologically healing of DU.