鄱阳湖区域血吸虫病患者胃黏膜病变与幽门螺旋杆菌感染状况分析

Gastric Mucosal Lesions and Helicobacter Pylori Infection among Schistosomiasis Patients in Poyang Lake Region

目的了解日本血吸虫病(简称血吸虫病)相关胃黏膜病变,探讨血吸虫感染是否会影响幽门螺杆菌(Hp)的感染,进而影响癌前病变的进展或胃癌的发生。方法将疫区志愿者653例按血吸虫感染情况分为2组:病例组(血吸虫病志愿者,IHA阳性)341例与对照组(非血吸虫病志愿者,IHA阴性)312例,对2组进行胃镜、病理检查,同时通过13 C呼气试验进行Hp检测。结果病例组胃镜下均有不同程度的胃黏膜改变,非萎缩性胃炎并糜烂、糜烂性食管炎、黏膜颗粒状改变,食管、胃底静脉曲张及门脉高压性胃病的发生率明显高于对照组,非萎缩性胃炎低于对照组(均P<0.05)。病例组完全性小肠上皮化生、不完全性小肠上皮化生及胃十二指肠黏膜下血吸虫卵沉积发生率均高于对照组(均P<0.05)。2组完全性大肠上皮化生、不完全性大肠上皮化生、异型增生及胃癌发生率比较差异均无统计学意义(均P>0.05)。病例组中Hp感染阳性159例,阳性率为46.63%;对照组中Hp感染阳性137例,阳性率为43.91%,2组比较差异无统计学意义(χ2=0.485,P=0.486)。结论血吸虫病患者胃黏膜病变的发生率与程度均高于非血吸虫病患者,但与胃癌及癌前病变无相关性;血吸虫感染并未增加Hp的感染概率。

Objective To understand the schistosomiasis-related gastric mucosal lesions,and to investigate whether schistosome infection interacts with Helicobacter pylori (Hp)infection, thereby affecting the progression of gastric precancerous lesions or development of gastric cancer. Methods A total of 653 volunteers from schistosomiasis epidemic area were divided into case group (volunteers with schistosomiasis,n=341)and control group (volunteers without schistoso-miasis,n= 312).Gastric endoscopy and subsequent pathological biopsy were performed and 13 C breath tests were carried out for Hp detection in both groups.Results Different degrees of gas-tric mucosal lesions were observed in patients with schistosomiasis.Compared with control group,incidences of atrophic gastritis with erosion,erosive esophagitis,mucosal granular changes, esophageal and gastric varices,portal hypertensive gastropathy,complete and incomplete intestinal metaplasia,and gastric and duodenal submucosal schistosome egg deposition significantly in-creased,but incidence of non-atrophic gastritis significantly decreased in case group (P <0.05). The were no obvious differences in incidences of complete and incomplete colon metaplasia,atypi-cal hyperplasia and gastric cancer between the two groups (P >0.05).In addition,no significant difference in the incidence of Hp infection was found between case group (46.63%,159 volun-teers)and control group (43.91%,137 volunteers)(χ2 =0.485,P =0.486).Conclusion Patients with schistosomiasis has a higher incidence of gastric mucosal lesions than patients without schis-tosomiasis.However,schistosome infection is not correlated with gastric cancer and precancerous lesions.Furthermore,schistosome infection does not increase the probability of Hp infection.