Hp阴性及进展期胃黏膜相关淋巴组织淋巴瘤初始根除Hp疗效分析

Effect of Helicobacter pylori eradication therapy as the initial treatment for patients with Helicobacterpylori-negative and disseminated gastric mucosa-associated lymphoid tissue lymphoma

[目的]分析幽门螺杆菌(Hp)阴性及进展期胃黏膜相关淋巴组织(MALT)淋巴瘤患者初始根除Hp治疗效果。[方法]收集我院2009-05-2017-12期间44例胃MALT淋巴瘤患者资料,对临床特点、内镜表现、病理检查及转归进行回顾性研究。[结果]44例中33例Hp阳性(阳性组)、11例Hp阴性(阴性组),中位发病年龄分别为58岁、52岁(2组比较P<0.05),阳性病例病灶多位于胃远端,阴性以胃近端及弥漫性病变为主(P<0.05)。总完全缓解(CR)率86.4%,化疗前接受Hp根除治疗者CR率高于未接受Hp根除治疗者(94.1%∶60%;P<0.05)、而复发率远远小于未接受Hp根除治疗者(2.9%∶37.5%;P<0.05)。相对阳性组,阴性组患者治疗后到达CR所需时间更长(P<0.05)。阳性组与阴性组接受Hp根除治疗后早期患者的CR率比较差异无统计学意义。[结论]Hp阴性胃MALT淋巴瘤患者发病更早。根除Hp治疗可以作为Hp阴性及进展期胃MALT淋巴瘤患者有效的初始治疗方案,但Hp阴性患者疗效评估需要更长的随访时间。

[Objective]To investigate the effectiveness of Helicobacter pylori(Hp)eradication therapy as the initial treatment for patients with Hp-negative and disseminated gastric mucosa-associated lymphoid tissue(MALT)lymphoma.[Methods]We retrospectively reviewed the medical records of patients from May 2009 to December 2017.[Results]Of the 44 patients,the rate of Hp infection was 75%.The overall complete remission(CR)rate was 86.4%.The median age of Hp-positive patients was 58 and that of Hp-negative was 52(P<0.05).The lesions of Hp-negative patients were located more frequently in the proximal and diffuse part of the stomach,while distal lesions were common in positive patients(P<0.05).The CR rate after initial eradication therapy was 94.1%,which was higher than untreated group(P<0.05).There was lower recurrence rate in eradication therapy group than untreated group(P<0.05).The median time to reach CR tended to be longer in Hp-negative group than in Hp-positive group(P<0.05).There was no significant different in CR rate between Hp-positive and Hp-negative group after initial eradication therapy in patients with stage I-IIE1.[Conclusion]Patients with Hp-negative gastric MALT lymphoma seem to be younger than Hp-positive.Initial eradication therapy may be effective for Hp-negative and disseminated gastric MALT lymphoma.It requires more research to evaluate the efficacy in Hp-negative patients.