幽门螺杆菌根除后慢性萎缩性胃炎胃粘膜的改变

The Pathological Changes of Gastric Mucosa in Patients with Chronic Atrophic Gastritis after the Eradication of Helicobacter Pylori

目的探讨幽门螺杆菌 (Hp)根除后胃腺体萎缩、肠化、不典型增生改变的可能性。 方法 15 5例患者均经胃镜诊断为慢性萎缩性胃炎 (CAG)或伴肠化、不典型增生 ;Hp感染由13 C尿素呼气试验、快速尿素酶试验、组织学检查证实。患者分为两组 :治疗组 94例 ,对照组 6 1例。治疗组采用OAC方案 ,2次 /d ,共服药 10d。治疗结束后4～ 8周 ,检测Hp根除情况。对照组不用任何对Hp有影响的药物 ,且与治疗组在同一时间作Hp检测、胃镜等检查。结果治疗组 4例失访。 90例患者中Hp根除率为 87.8% ,萎缩程度均未减轻 ,炎症消失 6 9.6 % ,减轻 2 5 .3% ;32例肠化患者中 ,消失 2 1.9% ,减轻 37.5 % ;40例不典型增生中消失 2 7.5 % ,减轻 40 .0 %。对照组 6 1例病情无明显变化。 结论Hp根除后 ,粘膜炎症、肠化及不典型增生能够减轻或消失 。

Objective To deal with the possibility of improvement of glandula atrophy, intestinal metaplasia, and atypical hyperplasia in the gastric mucosa after eradication of Hp. Methods 155 patients were diagnosed by gastroscopy as CAG accompanied with intestinal metaplasia or atypical hyperplasia. Hp infection was based on a positive test for 13 C-UBT, RUT and pathological study. Patients were divided into two groups, 94 cases as treatment group and 61 cases as control group. The OAC scheme twice daily for 10d was used for the treatment group. At the end of treatment as well as the 4th and 8th week after the completion of treatment, the eradication rate of Hp was evaluated. The control group did not take any drug which would influnce Hp, but their Hp status was evaluated in the same way. Results 90 patients in the treatment group completed the treatment, and the other 4 cases were lost in follow up. The HP eradication rate was 87.8%. Mucosal inflammation disappeared in 69.6% and improved in 25.3%. In 32 patients with intestinal metaplasia, 21.9% disappeared and 37.5% improved. In 40 patients with atypical hyperplasia, it disappeared in 27.5% and improved in 40.0%. On the other hand, all 61 patients in the control group had no change. The difference between the treatment and the control group is significant (P< 0.01). Conclusion Mucosa inflammation, intestinal metaplasia and atypical hyperplasia can improve or even disappear after eradication of Hp, so perhaps Hp is useful in preventing the development of malignancy in patients with CAG.