长期使用质子泵抑制剂治疗对幽门螺杆菌胃炎诊断与胃病理性变化的影响

Effects of Long-Term Proton Pump Inhibitor Therapy on Diagnosis of Helicobacter Pylori Gastritis and Gastric Pathological Changes

目的观察长期使用质子泵抑制剂(PPI)治疗对幽门螺杆菌(HP)胃炎诊断与胃病理性变化的影响。方法将61例HP胃炎患者按就诊前是否使用过PPI治疗分为观察组31例(使用过PPI治疗超过半年以上)、对照组30例(未使用过PPI治疗),比较2组C14尿素呼气试验阳性率、HP抗体分型阳性率、C14尿素呼气试验漏诊率及萎缩性胃炎、肠上皮化生、异型增生和胃癌发生率,分析观察组患者胃病理变化与年龄、性别、生活习惯(吸烟、饮酒、锻炼)、疾病史(高血压、糖尿病)的关联性。结果观察组C14尿素呼气试验漏诊率为77.43%,对照组为-6.67%。观察组C14尿素呼气试验阳性率显著低于对照组(16.12%比96.67%,P<0.001),肠上皮化生、萎缩性胃炎发生率显著高于对照组(12.90%比0.00%、19.35%比3.33%,均P<0.05)。长期使用PPI治疗的患者胃病理变化与年龄、嗜酒有显著关联性(P<0.05)。结论长期使用PPI治疗的HP胃炎患者,C14尿素呼气试验的阳性率极低,容易造成漏诊,同时患者罹患萎缩性胃炎、肠上皮化生、异质增生和胃癌的概率增高。

Objective To observe the effects of long-term proton pump inhibitor(PPI)therapy on diagnosis of Helicobacter pylori(HP)gastritis and gastric pathological changes.Methods A total of 61 patients with HP gastritis were divided into two groups:observation group(31 patients who had received PPI treatment for more than 6 months)and control group(30 patients who had not received PPI treatment).The positive rate of C14 urea breath test,positive rate of HP antibody typing,missed diagnosis rate of C14 urea breath test,and incidences of atrophic gastritis,intestinal metaplasia,dysplasia and gastric cancer were compared between the two groups.The relationships of gastric pathological changes to age,gender,living habits(smoking,drinking and exercise)and disease history(hypertension and diabetes)were analyzed in the observation group.Results The missed diagnosis rate of C14 urea breath test was 77.43% in the observation group,and-6.67% in the control group.The positive rate of C14 urea breath test in the observation group was lower than that in the control group(16.12%vs 96.67%,P<0.001).The incidences of intestinal metaplasia and atrophic gastritis in the observation group were higher than those in the control group(12.90%vs 0.00% and 19.35%vs 3.33%,respectively;P<0.05).The changes in gastric pathology were significantly correlated with age and alcohol addiction in the observation group.Conclusion In patients receiving long-term PPI therapy,the positive rate of C14 urea breath test is very low,which is easy to cause missed diagnosis.Meanwhile,the patients have an increased risk of atrophic gastritis,intestinal metaplasia,dysplasia and gastric cancer.