老年幽门螺杆菌相关性胃炎患者抗幽门螺杆菌根除治疗前后的病理学研究

Pathological study of Helicobacter pylori associated gastritis before and after eradication therapy in elderly patients

目的分析老年幽门螺杆菌（Hp）相关性胃炎患者抗Hp根除治疗前后胃黏膜病理炎症变化程度，探讨老年Hp相关性胃炎患者行抗Hp根除治疗的重要性。方法收集1989年4月至2011年6月经内镜活检病理、13C-尿素呼气试验、粪便Hp抗原检测，有长期随访资料的老年Hp相关性胃炎患者共239例，观察抗Hp根除治疗前后胃黏膜病理炎症改变程度。结果Hp彻底根除的199次治疗中，179次镜下组织学慢性炎症程度明显好转，治疗前64次有活动性炎症，治疗后27次有活动性炎症；Hp未彻底根除的66次治疗中，42次镜下组织学慢性炎症程度明显好转，治疗前39次有活动性炎症，治疗后22次有活动性炎症。Hp达根除标准的老年患者较Hp未能根除者镜下组织学慢性炎症及活动性炎症程度均明显好转（P〈0．05）。结论对老年Hp相关性胃炎患者进行抗Hp根除治疗，可明显改善患者的胃黏膜组织学慢性炎症及活动性炎症程度，有效地减少慢性胃炎的发病及减轻病变程度。

Objective To analyze the pathological changes of gastric mucosa in elderly patients with Helicobacter pylori（Hp） associated gastritis before and after eradication therapy, and to explore the importance of eradication treatment for these patients. Methods A total of 239 Hp associated gastritis cases, diagnosed with endoscopic biopsy, 13C-urea Breath Test and Hp stool antigen detection （HpSA） and had long-term follow-up data, were collected from April 1989 to June 2011. The pathological changes of gastric mucosa in these patients were observed before and after eradication therapy. Results Among 199 patients who underwent eradication therapy, the chronic inflammation was significantly alleviated in 179 patients; there were 64 patients who had active inflammation before treatment, and only 27 left after treatment. Among 66 patients who received incomplete eradication therapy, the chronic inflammation was significantly alleviated in 42 patients; there were 39 patients who had active inflammation before treatment, and only 22 left after treatment. Chronic inflammation and active inflammation were significantly alleviated in elderly patients receiving eradication therapy than in those receiving incomplete eradication therapy （P 〈 0.05）. Conclusion Eradication therapy can significantly improve the histological chronic inflammation and active inflammation of gastric mucosa in elderly patients with Hp associated gastritis, and effectively reduce the incidence of chronic gastritis and alleviate the lesion.