原发性胆汁反流性胃炎的胃黏膜损伤情况及与胃幽门螺杆菌感染的关系

The Situation of Gastric Mucosal Injury in Primary Bile Reflux Gastritis and Its Relationship with Gastric Helicobacter Pylori Infection

目的:探讨原发性胆汁反流性胃炎(primary bile reflux gastritis,PBRG)的胃黏膜损伤情况及与胃幽门螺杆菌(Helicobacter pylori,Hp)感染的关系.方法:选取PBRG患者48例为PBRG组,以及慢性非萎缩性胃炎(chronic non-atrophic gastritis,CNAG)患者50例为对照组.根据PBRG患者胃黏膜胆染情况将其胆汁反流程度分为Ⅰ、Ⅱ、Ⅲ级.所有研究对象均行胃镜检查,记录胃镜及病理特点,并予胃黏膜组织活检苏木素染色法、13C-尿素呼气试验法、血清Hp抗体ELISA法同时检测其Hp感染情况.结果:病理组织学表现,PBRG组胃黏膜慢性炎症、萎缩、肠化生检出率均明显高于对照组(P<0.05).胆汁反流程度加重,慢性炎症检出率升高,萎缩加重、肠化生检出率也升高.PBRG组Hp检出率为47.92%,对照组Hp检出率42.00%,两组差异无统计学意义(P>0.05),且胆汁反流程度加重,Hp检出率无明显升高或下降趋势.PBRG组患者Hp阳性胃黏膜萎缩检出率明显高于Hp阴性.PBRG组患者Hp阳性血清G-17水平也明显高于Hp阴性,差异有统计学意义(P<0.05).结论:胆汁反流可导致胃黏膜慢性炎症、萎缩、肠化生的发生率明显升高.PBRG与Hp感染无明显相关,但PBRG患者合并Hp感染时,可加速胃黏膜的萎缩及加重高胃泌素血症,导致胆汁反流的迁延不愈,因此建议PBRG患者积极抗Hp治疗.

Objective:To investigate the gastric mucosal injury of primary bile reflux gastritis(PBRG)and its relationship with Helicobacter pylori(Hp)infection.Method:Forty-eight patients with PBRG were enrolled in the PBRG group and 50 patients with chronic non-atrophic gastritis(CNAG)were selected as the control group.The degree of bile reflux was classified into gradesⅠ,ⅡandⅢaccording to the gastric mucosa of PBRG patients.All subjects underwent gastroscopy,recorded gastroscopy and pathological features,and were also tested for Hp infection by gastric mucosal biopsy hematoxylin staining,13C-urea breath test,and serum Hp antibody ELISA.Result:Histopathology found that the chronic inflammation,atrophy and intestinal metaplasia rate of gastric mucosa in PBRG group were significantly higher than those in the control group(P<0.05).The degree of bile reflux was aggravated,the detection rate of chronic inflammation was increased,the atrophy was aggravated,and the detection rate of intestinal metaplasia was also increased.The detection rate of Hp in the PBRG group was 47.92%,and the detection rate of Hp in the control group was 42.00%.There was no significant difference between the two groups(P>0.05),and the degree of bile reflux increased,no significant increase or decrease in Hp detection rate.The detection rate of gastric mucosal atrophy in Hp positive group of PBRG patients was significantly higher than that of Hp negative group.The serum G-17 level in the Hp positive group of PBRG patients was also significantly higher than that in the negative group(P<0.05).Conclusion:Bile reflux can cause chronic inflammation,atrophy,and intestinal metaplasia in gastric mucosa.PBRG has no significant correlation with Hp infection,but PBRG patients with Hp infection can accelerate gastric mucosal atrophy and aggravate hypergastrinemia,leading to delayed bile reflux,so it is recommended that patients with PBRG actively anti-Hp treatment.