铝碳酸镁对幽门螺杆菌感染活动性胃溃疡愈合质量的影响

Effects of hydrotalcite on healing quality of active gastric ulcer with Helicobacter pylori infection

目的观察铝碳酸镁对H．pylori感染活动性胃溃疡患者组织学溃疡愈合质量的影响。方法将纳入的H．pylori感染活动性胃溃疡患者145例分为两组：对照组用埃索美拉唑＋阿莫西林＋呋喃唑酮三联疗法，治疗组用上述三联疗法＋铝碳酸镁。治疗后4周复查胃镜，并用HE染色、Van Gieson染色、阿利新蓝-过碘酸雪夫（AB-PAS）染色和SP免疫组织化学染色及计算机图像分析技术，观察治疗前后溃疡周边黏膜组织结构成熟类型、胶原纤维含量、中性黏液含量、表皮细胞生长因子受体（EGFR）及碱性成纤维细胞生长因子（bFGF）表达变化。治疗前后比较用配对样本t检验，两组间比较采用F检验或卡方检验。结果治疗组再生黏膜组织结构类型为优者占62．9％（39／62），对照组占40．6％（26／64），差异有统计学意义（χ^2=13．09，P=0．03）。两组再生黏膜中性黏液含量、肉芽组织胶原纤维含量均较治疗前增加，以治疗组增加更显著，分别为（55．1±10．4）％和（45．8±7．1）％，差异均有统计学意义（F=12．85、18．17，P均〈0．01）。两组EGFR、bFGF阳性细胞百分数均较治疗前增高，以治疗组增高更明显，分别为（49．5±8．4）％和（48．8±9．4）％，组间差异有统计学意义（F=12．17、18．73，P均〈0．01）。结论铝碳酸镁联合三联抗H．pylori治疗能提高H．pylori感染活动性胃溃疡患者溃疡周边再生黏膜组织学结构成熟度和功能成熟度，提高溃疡愈合质量。

Objective To observe the effects of hydrotalcite on histological ulcer healing quality in patients with Helicobacterpylori （Hp） positive active gastric ulcer. Methods A total of 145 patients with Hp positive active gastric ulcer were divided into two groups. The control group was treated with esomeprazole, amoxicillin and furazolidone triple therapy. The treatment group was treated with above triple therapy and hydrotalcite. After four week treatment, gastroendoscopy was repeated. The sections of gastric biopsy specimens were stained with hematoxylin-eosin （HE） staining, Van G-ieson staining, Alcian blue-periodic acid stiff （AB-PAS） staining, streptavidin-perosidase （SP） immunohistochemistry staining and computer imaging analysis technology were applied to observe maturity type of mucosal structure at the margin of ulcer, the content of collagen and neutral mucus, and the changes of expression of epithelial growth factor receptor （EGFR） and basic fibrobast growth factor （bFG-F） before and after treatment. Paired samples t test was performed for comparison before and after treatment. F test and Chisquare test were used for comparison between two groups. Results The percentage of maturity type of regenerated mucosal structure of treatment group was 62.9% （39/62）, however that of control group was 40.6% （26/64）, and the difference was statistically significant （χ^2=13.09, P=0.03）. Compared with those before treatment, the content of collagen in granulation tissue and neutral mucus in regenerated mucosa increased in both groups after treatment, and the increase was more significant in treatment group （ （55.1 ± 10.4） % and （45.8 ± 7. 1 ） %, respectively） ; and the differences were statistically significant （F=12.85 and 18.17, both P〈0.01）. Compared with those before treatment, the percentage of EGFR and bFGF positive cells of both two groups increased, and the increase was more significant in treatment group （（4 9.5±8.4）% and （48.8±9.4）%, respectively）, and the differences were statistically significant （F= 12.17 and 18.73, both P〈 0.01）. Conclusion Hydrotalcite combined with anti-Hp triple therapy can improve the maturity degree of structure and function of regenerated mucosa at the margin of ulcer in patients with Hp positive active gastric ulcer and then improve the healing quality of ulcer.