老年人原发性胆汁反流性胃炎病理特征分析

Pathological features of primary bile reflux gastritis in the elderly

目的：探讨原发性胆汁反流对老年人胃黏膜组织损伤的病理特点。方法回顾性地分析2013年1月～2014年8月于我院经胃镜检查诊断的77例老年原发性胆汁反流性胃炎（BRG）患者为观察组，同时取同期诊断为幽门螺杆菌（Hp）感染的非BRG慢性胃炎的78名老年患者为对照组，分析两组患者胃黏膜组织的病理变化特点。结果原发性BRG患者Hp感染率为19.5%。胆汁反流组与Hp感染的非BRG慢性胃炎病理组织特征比较：轻、中、重慢性炎分别为32.5% vs 11.5%、58.4% vs 34.6%和9.1% vs 53.8%，中性粒细胞浸润分级（无、轻、中、重）分别为83.1% vs 41.0%、11.7% vs 20.5%、5.2% vs 32.1%和0.0% vs 6.4%。淋巴滤泡、肠上皮化生和胃黏膜萎缩检出率分别为4.3%vs 26.9%、5.2%vs 17.9%和6.5%vs 25.6%；胆汁反流组中，Hp阳性和Hp阴性患者轻、中、重度慢性炎分别为：13.3% vs 37.1%、53.3% vs 59.7%和33.3% vs 3.2%，中性粒细胞浸润分级（无、轻、中、重）分别为53.3%vs 41%、20.0%vs 9.7%、20.0%vs 0.0%和6.7%vs 0.0%，淋巴滤泡、肠上皮化生和胃黏膜萎缩检出率分别为53.3%vs 4.8%、0.0% vs 6.5%和0.0%vs 8.1%。结论原发性胆汁反流可引起老年患者胃黏膜组织慢性炎症反应、肠上皮化生、腺体萎缩，但其发生率低于Hp感染的慢性胃炎。中性粒细胞浸润和淋巴滤泡形成主要与Hp感染相关，Hp感染并未增加原发性胆汁反流患者胃黏膜萎缩、肠化生不良结局的发生。

Objective To investigate the pathological features of primary bile reflux gastritis （BRG） in the elderly. Methods Clinical data of 77 elderly patients with primary BRG diagnosed by endoscopy （observation group） and another 78 elderly patients suffering from chronic gastritis by Helicobacter pylori （Hp） infection but not with bile reflux （control group） admitted in our hospital from January 2013 to August 2014 were collected and retrospectively analyzed. The pathological changes in the gastric mucosa tissue were observed and compared between the 2 groups. Results The Hp infection rate was 19.5% in the primary BRG patients. The rates of mild, moderate and severe gastritis were 32.5% vs 11.5%, 58.4% vs 34.6% and 9.1% vs 53.8% in the observation group and the control groups respectively. Neutrophils infiltrating classification （no, mild, moderate and severe） were 83.1% vs 41.0%, 11.7% vs 20.5%, 5.2% vs 32.1%and 0.0% vs 6.4%respectively for the 2 groups. The detection rates of lymphoid follicles, intestinal metaplasia and gastric mucosal atrophy were 4.3% vs 26.9%, 5.2% vs 17.9% and 6.5% vs 25.6%, respectively between them. What’s more, between the Hp-positive and Hp-negative patients from the observation group, the ratios of mild, moderate and severe inflammation were 13.3% vs 37.1%, 53.3% vs 59.7% and 33.3% vs 3.2% respectively, the ratios of no, mild, moderate and severe infiltration of neutrophils were 53.3%vs 41.0%, 20.0%vs 9.7%, 20.0%vs 0.0%and 6.7%vs 0.0%, respectively, and the rates of lymphoid follicles, intestinal metaplasia and gastric grand atrophy were 53.3% vs 4.8%, 0.0% vs 6.5%and 0.0% vs 8.1%, respectively. Conclusion Primary bile reflux results in chronic inflammation in gastric mucosa, intestinal metaplasia, and gland atrophy in the elderly patients. But the incidence of BRG is lower than that of chronic gastritis due to Hp infection. Neutrophils infiltration and lymph follicles formation are mainly associated with Hp infection. However, for the patients with primary BRG, Hp infection does not increase the risks of mucosal atrophy and intestinal metaplasia.