胃癌及癌前病变与幽门螺杆菌

The Relationship between Helicobacter Pylori and Gastric Carcinoma and Gastric Precancerous Lesion

目的 幽门螺杆菌 (Helicobacterpylori,Hpylori)感染与胃癌的关系一直倍受人们关注 ,检查胃癌及癌前病变 ,如萎缩性胃炎、肠腺化生、异型增生病人Hpylori感染情况 ,了解Hpylori感染与胃癌的关系。方法 通过胃镜钳取胃粘膜 ,用快速尿素酶试验法(RUT)、PCR法、HE银染法等三种方法同时检查 ,判定Hpylori感染 ,并作病理细胞学检查。共查萎缩性胃炎 89例、肠腺化生 64例、异型增生 47例、胃癌 3 0例 ,功能性消化不良 10 3例作为对照。结果 Hpylori阳性率在萎缩性胃炎、肠腺化生病人中较高 ,分别是79 3 %和 81 3 % ,与对照组功能性消化不良病人 (阳性率 61 2 % )相比有显著统计学差异 ,P值均小于 0 0 1。异型增生组Hp阳性率较低 72 % ,与对照组相比P >0 0 5 ,无显著统计学差异。胃癌病人与对照组相比P <0 0 5 ,Hp阳性率显著降低。结论 Hpylori感染与萎缩性胃炎、胃粘膜肠腺化生密切相关 ,与异型增生、胃癌无直接关系。Hpylori感染主要参与癌前病变的前期阶段 。

Objective To investigate H pylori infection in gastric carcinoma and precancerous lesion,for example,atrophic gastritis?intestinal metaplasia?dysplasia,and study the possible relationship between H pylori infection and gastric carcinoma.Methods Stomach mucosal biopsies were obtained from 333 patients.Pathology and H pylori infection were examined simultanously.H pylori infection was diagnosed by rapid urease test?histology and polymerase chain reaction.Among 333 patients,there were 89 of atrophic gastritis?64 of intestinal metaplasia?47 of dysplasia?30 of gastric carcinoma and 103 of dyspepsia controls.Results The positive rate of H pylori infection was higher in atrophic gastritis (79.3%) and intestinal metaplasia (81.3%).Compared with dyspepsia (61.2%) there was significant stastistical difference with P <0.01, P <0.01,respectively.The positive rate of H pylori infection was lower in dysplasia (72.3%) and gastric carcinoma (40%).Conclusions These results suggust that H pylori infection is associated with atrophy and intestinal metaplasia.On the contrary,the positive rate of HP infection shows descending trend in dysplasia and gastric carcinoma.H pylori infection involved mainly the early stage of precancerous lesion,it plays a causal role in the chain of events leading to cancer of the stomach.