小儿消化性溃疡111例胃窦病理活检与^(13)C呼气试验的幽门螺杆菌感染分析

Correlation between pathological biopsy of gastric antrum and Helicobacter pylori(Hp)infection in^(13)C breath test of children with peptic ulcer:An analysis of 111 cases

目的探究电子胃镜下小儿消化性溃疡胃窦病理活检炎症严重程度与幽门螺杆菌(Hp)阳性的相关性,为临床诊治提供一定的循证依据。方法以2019年10月至2021年7月厦门大学附属第一医院儿科就诊并行胃镜检查证实有消化性溃疡的111例患儿为观察对象,收集其一般资料,同时分析各相关指标:如^(13)C呼气试验、胃窦病理活检、免疫组化等,研究消化性溃疡患儿胃窦炎症严重程度与Hp阳性关系。结果111例消化性溃疡患儿中,胃溃疡1例,十二指肠球部溃疡108例,复合溃疡2例;96例做了^(13)C呼气试验,94例做了胃窦部病理活检及免疫组化。胃镜病理活检Hp阳性者13例胃窦炎症均为中重度,阳性组与阴性组差异有统计学意义(秩和=931.5,P<0.05)。^(13)C呼气试验阳性者19例胃窦炎症为中重度,阳性组与阴性组差异有统计学意义(H=10.280,P<0.05)。^(13)C呼气试验、胃镜病理活检Hp均阴性者胃窦炎症多较轻微,均阳性组与均阴性组差异有统计学意义(秩和=888.5,P<0.001)。结论幽门螺杆菌感染是消化性溃疡胃窦中重度炎症的主要病因;Hp活检阳性比^(13)C呼气试验阳性更能反映胃窦炎症的严重程度,电子胃镜检查在^(13)C呼气试验阳性的患儿中极有必要,可为儿童是否抗Hp治疗提供更有力的循证依据。

Objective To explore the correlation between the severity of gastric antrum inflammation by pathological biopsy and positive Helicobacter pylori(Hp)in children with peptic ulcer under electronic gastroscopy,and provide certain evidence-based basis for clinical diagnosis and treatment.Methods A total of 111 children who had peptic ulcers confirmed by gastroscopy at the Pediatric Department of the First Affiliated Hospital of Xiamen University from October 2019 to July 2021 were included as the observation subjects.General data were collected and various related indicators were analyzed at the same time,including as^(13)CC breath test,pathological biopsy of gastric antrum,immunohistochemistry,etc.,in order to study the correlation between the severity of gastric antrum inflammation and positive Hp in children with peptic ulcer.Results Among 111 children with peptic ulcer,there was 1 gastric ulcer,108 duodenal ulcer,and 2 compound ulcers;among them 96 cases received^(13)CC breath test,94 cases received gastric antrum biopsy and immunohistochemistry.All the 13 cases with Hp-positive in gastroscopy pathological biopsy had moderate to severe antral inflammation,and the difference between positive group and negative group was statistically significant(rank sum=931.5,P<0.05).The same results were also found in 19 patients with positive^(13)CC breath test(H=10.280,P<0.05).The antral inflammation in patients with negative Hp in^(13)CC breath test and gastroscopy biopsy was more mild,and the difference between positive and negative groups was statistically significant(rank sum=888.5,P<0.001).Conclusion Hp infection is the main cause of maderate to severe inflammation in the gastric antrum of peptic ulcer;a positive Hp biopsy is more likely to reflect the severity of gastric antrum inflammation than a positive^(13)CC breath test.Electronic gastroscopy is extremely necessary for children with a positive^(13)CC breath test,which can give a stronger evidence-based proof for performing anti-Hp treatment.