儿童原发性胆汁反流性胃炎胃黏膜病理特征

Pathological features of the gastric mucosa in children with primary bile reflux gastritis

目的了解儿童原发性胆汁反流性胃炎(BRG)的病理特点。方法 59例胃镜检查发现黏液湖黄染的患儿进行Bilitec2000胃内胆红素动态监测,对胃黏膜炎症程度、炎症活动性、淋巴滤泡增生、腺体萎缩、肠化、H.pylori感染、胃小凹增生、间质水肿、黏膜浅层血管扩张、固有膜内平滑肌纤维增生10种病理改变进行评分,并作二分类Logistic回归分析。以胆汁反流总时间百分比>35.6%为病理性十二指肠胃反流(DGR)诊断标准。结果 59例患儿中诊断为病理性DGR22例,占37.3%;胃黏膜病理改变呈活动性炎症12例、淋巴滤泡增生12例、肠化3例、H.pylori感染13例、胃小凹增生10例、间质水肿31例、黏膜浅层血管扩张38例、纤维增生22例,未发现胃黏膜萎缩病例;炎症程度轻度34例、中重度19例,余6例正常。胃小凹增生者病理性DGR的阳性率、最长反流时间和胆汁反流总时间百分比均大于无胃小凹增生者,差异有统计学意义;黏膜浅层血管扩张者病理性DGR的阳性率、最长反流时间和胆汁反流总时间百分比均小于无血管扩张者;其余不同病理改变包括H.pylori感染时病理性DGR阳性率、胆汁反流各指标的差异均无统计学意义(除肠化时的反流次数外)。Logistic回归分析得出有统计学意义的变量有2个,为胃小凹增生和黏膜浅层血管扩张,胃小凹增生为危险因素,而血管扩张为保护因素。结论胃小凹增生与胆汁反流程度有关,是儿童原发性BRG的特征性病理改变,黏膜浅层血管扩张为保护因素。

Objective Bile reflux is regarded as one of the important causes of chronic inflammation of the gastric mucosa, but the pathological features are unclear. The aim of this study was to investigate the pathological features of primary bile reflux gastritis （BRG） in children. Methods Bilitec 2000 was used for 24 h monitoring of gastric bile in 59 children with upper gastrointestinal symptoms. The 10 kinds of histological characteristics of the gastric mucosa, such as the degree of inflammation, lymphatic follicle hyperplasia, intestinal metaplasia, foveolar hyperplasia, and vascular congestion were examined and scored. Pathological duodenogastric reflux （DGR） was defined as the total fraction time of bile reflux above 35.6%. Results Twenty-two out of 59 patients （37.3%） were diagnosed with pathological DGR. The positive rate of pathological DGR, the longest reflux time, and the total fraction time of bile reflux were significantly higher in patients with foveolar byperplasia than those in patients without foveolar hyperplasia, but they were significantly lower in patients with vascular congestion than those in patients without vascular congestion. The 10 kinds of pathological alterations mentioned above were analyzed by binary logistic regression. Foveolar hyperplasia and vascular congestion in the superficial layer became the significant variables in the last step. Foveolar hyperplasia was a risk factor and vascular congestion was a protective factor in pediatric patients with bile reflux. Conclusions Foveolar hyperplasia was well correlated with the severity of bile reflux, which that it is suggested a specific pathological feature in children with primary BRG, while vascular congestion served as a protective factor.