胃底腺息肉的临床特征分析

Clinical features of fundic gland polyps

目的探讨胃底腺息肉（FGPs）的临床特点。方法收集2005年1月至2010年5月间485例FGPs患者的临床资料进行汇总分析。结果胃镜检查发现FGPs患者485例，达同期全部胃镜检查患者数的0．6％，以中年女性多见。临床常以上腹不适（182例，37．5％）和（或）胃食管反流症状（83例，17．1％）及上腹痛（102例，21．0％）等表现行胃镜检查时发现FGPs，胃镜下多表现为胃底（51．3％，249／485）或胃体（34．6％，168／485）、单发（62．3％，302／485）或2～5枚（22．7％，110／485）直径小于5mm的广基隆起。病理为息肉内被覆囊性扩张的胃底腺上皮，伴异型增生8例和肠化生3例。合并十二指肠息肉11例和胃癌1例。幽门螺旋杆菌（坳）检出率为47．8％，与同期胃镜检查人群坳检出率（56．1％）相比差异无统计学意义（P=0．422）。12例患者进行腺瘤性息肉病蛋白（APC）和环氧合酶-2（COX-2）免疫组化染色，12例APC染色均阳性，COX-2染色阳性9例，阴性3例。结论FGPs与坳感染无明显相关性，可伴有异型增生和肠化生及合并十二指肠息肉，进行临床病理学分析和免疫组化染色可能有助于对其充分认识和规范化诊治。

Objective To investigate the clinical characteristics of fundic gland polyps （FGPs）. Methods Data of patients with FGPs diagnosed from January 2005 to May 2010 were collected and retro- spectively analyzed. Results A total of 485 patients were found to have FGPs during routine upper endosco- py, accounting for 0. 6% of total upper endoscopy examinations at the same time period. It was most fre- quently seen in middle aged females. Clinical symptoms included abdominal distention and discomfort （182/485, 37.5%）, gastroesophageal reflux symptoms （83/485, 17. 1%） and upper abdominal pain （102/485, 21.0% ）. 51.3% （249） of the polyps were located at fundus and 168 （34. 6% ） were at cor- pus, with most of FGPs （62. 3%, 302/485） were single polyp with broad base （less than 5mm）, and 22. 7% （110/485） were multiple ones scattering throughout the fundus. The pathology typically showed cystic lesions in the fundic glands, with dysplasia in 8 and intestinal metaplasia in 3, accompanied by duode- nal polyps in 11 and gastric cancer in 1. H. pylori infection was detected in 47.8 % subjects which was simi- lar to the rate of general population （56. 1% ） in the same period （P = 0. 422）. In addition, immunohisto- chemisty staining for adenomatous polyposis coli and cyclooxygenase-2 was performed in 12 patients, which showed all polyps were positive for adenomatous polyposis coli and 9 of them were cyclooxygenase-2 positive. Conclusion FGPs may not be correlate to H. pylori infection. It can be accompanied by dysplasia, intesti- nal metaplasia and duodenal polyps. Pathological and immunohistochemical studies may promote a better un- derstanding and standardized diagnosis and treatment for this disease.