幽门螺杆菌相关性胃炎内镜随访研究

A FOLLOW UP STUDY OF HELICOBACTER PYLORI RELATED GASTRITIS

为了解Ｈｐ长期感染是否促进胃粘膜萎缩、肠上皮化生和异型增生的形成与发展，对首次胃镜检查诊断为慢性胃炎而不伴有肠化生和异型增生的１２０例Ｈｐ阳性患者和８７例Ｈｐ阴性患者进行内镜随访。随访时间３～８年，平均４．８年，随访次数２－１０次，活检组织进行Ｈｐ检查、病理学检查和ＡｇＮＯＲｓ，银染及ＰＣＮＡ免疫组化染色。结果Ｈｐ阳性患者其慢性萎缩性胃炎、肠化生、Ⅲ型肠化生和异型增生的发生率显著高于Ｈｐ阴性患者，Ｈｐ阳性胃粘膜ＰＣＨＡ标记指教和ＡｇＮＯＲｓ数也显著高于Ｈｐ阴性胃粘膜。表明Ｈｐ感染可能通过刺激胃粘膜细胞的过度增殖、更新加快，促进萎缩性胃炎和肠化生的形成与发展，从而增加患胃癌的危险性。

Helicobacter pylori (Hp )infection has been put forward as a risk factor for development of gastric mucosal atrophy , intestinal metaplasia and gastric cancer. The purpose of this study was to investigate the long term effects of Hp related gastritis on the gastric mucosa. 1 20 subjects positive for Hp and 87 negative subjects were studied for a mean follow up of 4. 8 years (ractge 3～8 years ) . Gastroscupic examinations with biopsy sampling were done in all patients at least two times. Biopsy specimens were used for assessment of Hp infection ,histology and proliferative kinetics. Results ,after 3 to 8 year' s fol- low up , the incidences of chronic atrophic gastritis , intestinal metaplasia , type Ⅲintestinal metaplasia and dysplasia(65.8%,45. 8%,11. 2%,8. 3%,respectively)in Hp positive patients were significantly higher than those in Hp negative patients (51. 7% , 1 6. 1% . 2. 3 % , 2. 3% respectively). The proliferative cell nucleolar antigen labeling index and silver stained nuclenlar organizer regions counts in Hp positive patients(17. 68±2. 86,2. 81±0. 54,respectively)were also significantly higher than those in Hp negative patients(12. 45±2. 64,1. 78±0. 33,respectively).Hp infection may play a promotional role in the development of glandular atrophy and intestinal metaplasia , possibly by inducing excessive cell proliferation and rapid cell turnover.