幽门螺杆菌根除疗法对胃黏膜剥离术后溃疡愈合的影响

Eradication of Helicobacter pylori in promotion of ulcer healing after endoscopic submucosal dissection

目的探讨根除不同菌型幽门螺杆菌(Hp)感染对胃黏膜剥离术(ESD)后溃疡愈合的疗效。方法选择2016年1月-2017年1月因胃黏膜病变接受ESD的Hp感染患者150例为研究对象,其中Ⅰ型Hp感染90例,Ⅱ型Hp感染60例,随机分为Ⅰ型Hp感染对照组和Ⅰ型Hp感染根除组,各45例,及Ⅱ型Hp感染对照组和Ⅱ型Hp感染根除组,各30例。Ⅰ型和Ⅱ型Hp感染对照组术后予埃索美拉唑;Ⅰ型和Ⅱ型Hp感染根除组在对照组基础上采取胶体果胶铋、克拉霉素、阿莫西林治疗。比较治疗后四组Hp根除率、溃疡最大径和溃疡面积及S1期溃疡愈合率。结果治疗后4周:Ⅰ型和Ⅱ型Hp感染根除组患者Hp根除率分别为91.11%(41/45)和93.33%(28/30)高于Ⅰ型和Ⅱ型Hp感染对照组0%(P<0.001);治疗后8周:Ⅰ型和Ⅱ型Hp感染根除组患者的溃疡最大径和溃疡面积分别为(3.07±0.45)mm、(2.19±0.41)mm和(77.40±8.55)mm^2、(76.57±8.43)mm^2低于Ⅰ型和Ⅱ型Hp感染对照组(P<0.001);Ⅱ型Hp感染对照组患者的溃疡最大径和溃疡面积分别为(6.12±0.67)mm和(143.21±15.45)mm^2低于Ⅰ型Hp感染对照组(P<0.001);Ⅰ型和Ⅱ型Hp感染根除组患者的S1期溃疡愈合率分别为84.44%(38/45)和86.67%(26/30)均高于Ⅰ型和Ⅱ型Hp感染对照组(P<0.05);Ⅱ型Hp感染对照组患者的S1期溃疡愈合率为60.00%(18/30)高于Ⅰ型Hp感染对照组(P=0.023)。结论根除Ⅰ型和Ⅱ型Hp感染均可促进ESD术后患者溃疡愈合,尤其对Ⅰ型Hp感染,均具有一定的临床意义。

OBJECTIVE To explore the eradication of different species of Helicobacter pylori（Hp）infection in promotion of ulcer healing after endoscopic submucosal dissection（ESD）.METHODS A total of 150 patients with Hp infection who received ESD for treatment of gastric mucosal lesion from Jan 2016 to Jan 2017 were recruited as the study objects,including 90 cases of typeⅠ Hp infection and 60 cases of typeⅡ Hp infection.The 150 patients who received ESD were randomly divided into the typeⅠ Hp infection control group with 45 cases,typeⅠ Hp infection eradication group with 45 cases,typeⅡ Hp infection control group with 30 cases and typeⅡ Hp infection eradication group with 30 cases.The type Ⅰ and Ⅱ Hp infection control group were treated with esomeprazole after the ESD,while the typeⅠ andⅡ Hp infection eradication group were treated with additional colloidal bismuth pectin,clarithromycin and amoxicillin on basis of the treatment of the control group.The eradication rate of Hp,maximum diameter of ulcer,area of ulcer and healing rate of ulcer in S1 were observed and compared among the four groups after the treatment.RESULTS The eradication rates of Hp of the typeⅠ andⅡ Hp infection eradication group were respectively 91.11%（41/45）and 93.33%（28/30）after the treatment for 4 weeks,significantly higher than those of the typeⅠ and Ⅱ Hp infection control group（P〈0.001）.The maximum diameter and area of ulcer of the type Ⅰ and Ⅱ Hp infection eradication groups were respectively（3.07±0.45）mm,（2.19±0.41）mm and（77.40±8.55）mm^2 and（76.57±8.43）mm^2 after the treatment for 8 weeks,lower than those of the typeⅠandⅡ Hp infection control groups.The maximum diameter and area of ulcer of the typeⅡ Hp infection control group were respectively（6.12±0.67）mm and（143.21±15.45）mm^2,significantly less than those of the typeⅠ Hp infection control group（P〈0.001）.The healing rates of S1 ulcer of the typeⅠ andⅡ Hp infection eradication group were respectively 84.44%（38/45）and 86.67%（26/30）,significantly higher than those of the typeⅠ andⅡ Hp infection control group（P〈0.05）.The healing rate of S1 ulcer of the typeⅡ Hp infection control group was 60.00%（18/30）,significantly higher than that of the type Ⅰ Hp infection control group（P=0.032）.CONCLUSION The eradication of the typeⅠ andⅡ Hp infection may promote the healing of ulcer after the ESD,especially the typeⅠ Hp infection,which has certain clinical significance.