幽门螺杆菌根除对胃黏膜萎缩和肠上皮化生的影响

Effect of Helicobacter pylori eradication on gastric atrophy and intestinal metaplasia in patients with atrophic gastritis

目的:探讨根除幽门螺杆菌(Helicobacterpylori,H.pylori)对胃黏膜萎缩和肠上皮化生的影响.方法:选取2009-08/2009-12上海市第七人民医院392例萎缩性胃炎患者,进行H.pylori检测及根除治疗后,其中300例患者进行为期1年及3年的窄带成像放大内镜(narrow bandimaging-magnifying endoscopy,NBI-ME)和组织病理学结果随访.结果:H.pylori根除成功患者第1年随访,活动性及慢性炎症(胃窦部分别由1.41±0.64降至1.21±0.65,1.83±0.59降至1.43±0.50;胃体部分别由1.36±0.67降至1.18±0.67,1.71±0.46降至1.35±0.48,P<0.005)均明显改善;第3年随访,活动性及慢性炎症(胃窦部分别由1.51±0.62降至1.31±0.69,1.97±0.60降至1.46±0.50;胃体部分别由1.48±0.65降至1.26±0.69,1.90±0.56降至1.46±0.50,P<0.005)均明显改善;胃体部萎缩评分明显下降(第1年由1.54±0.65降至1.36±0.68,第3年由1.68±0.65降至1.50±0.69,P<0.005).胃窦及胃体部黏膜肠上皮化生评分均无明显改变.结论:根除H.pylori能明显改善胃黏膜炎症,并且减轻胃体部黏膜萎缩.

AIM： To investigate the ettect ot t-lelzcobacter py- lori （H. pylori） eradication on gastric atrophy and intestinal metaplasia in patients with atrophic gastritis. METHODS： Three hundred and ninety-two pa- tients with atrophic gastritis and intestinal meta- plasia who were treated from August 2009 to December 2009 at Shanghai ？,h People＇s Hospital were enrolled, of whom 300 were followed for 1 and 3 years by narrow band imaging-magnify- ing endoscopy （NBI-ME） and histopathological analysis after H. pylori eradication. RESULTS： In patients with successful eradica- tion, grades of disease activity and chronic in- flammation significantly decreased at 1 year （in the antrum： 1.41 ±0.64 vs 1.21 ± 0.65, 1.83 ± 0.59vs 1.43 ±0.50; in the corpus： 1.36± 0.67 vs 1.18±0.67, 1.71± 0.46 vs 1.35±0.48, all P 〈 0.005） and 3 years （in the antrum： 1.51 ＋ 0.62 vs 1.31 ± 0.69,1.97 ±0.60 vs 1.46 ± 0.50; in the corpus： 1.48 ±0.65 vs 1.26±0.69,1.90 ±0.56 vs 1.46± 0.50, all P 〈 0.005）. The grade of corpus atrophy also significantly decreased at I year （1.54 ±0.65 vs 1.36 ± 0.68, P 〈 0.005） and 3 years （1.68± 0.65 vs 1.50 ±0.69, P 〈 0.005） after successful eradication. However, there was no significant change in intestinal metaplasia in both the antrum and corpus.CONCLUSION： Eradication of H. pylori results in the alleviation of the severity of gastritis and the reversion of gastric atrophy in the corpus.