十二指肠溃疡患者幽门螺杆菌感染与十二指肠胃上皮化生的关系

Study on the Relation between Helicobacter Pylori Infection and Gastric Metaplasia in the Duodenum in the Duodenal Ulcer Patients

目的 通过对十二指肠溃疡 (DU)患者幽门螺杆菌 (Hp)感染与十二指肠胃上皮化生 (DGM)关系的研究 ,进一步阐明DU的发病机制。方法 检测 12 1例患者的内镜、病理、Hp感染和DGM情况。结果 胃内、十二指肠球部的Hp检出率在DU组分别为 90 4%、40 4% ,非DU组分别为 60 9%、2 9% ,P 均 <0 0 0 1;DGM的检出率在DU组为 92 3 % ,非DU组为 42 0 % ( P <0 0 0 1) ,且前者的DGM程度更重 (P <0 0 0 1) ;胃部Hp阳性者DGM的发生率 ( 73 0 % )显著高于胃部Hp阴性者 ( 3 7 5 % ,P <0 0 0 1) ,DGM( ++)及以上者在Hp阳性组发生率 ( 4 7 2 % )也高于Hp阴性组 ( 2 1 9% ,P <0 0 5 ) ;在十二指肠 ,Hp多定植于DGM区 ,且随着DGM程度的加重 ,Hp检出率呈递增趋势。结论 Hp感染特别是十二指肠Hp定植及DGM是影响DU发生发展的两大危险因素 ;

Objective To study on the relation between Helicobacter pylori (Hp) infection and gastric metaplasia in the duodenum(DGM) in the duodenal ulcer(DU) patients to elucidate the pathogenesis of DU.Methods One hundred and twenty-one patients were examined by endoscopy, pathology and Hp infection test.Results The detection rates of Hp in stomach and in duodenal bulb were much higher in patients with DU(90 4%, 40 4%) than those in patients without DU(60 9%, 2 9%, both P<0 001).The prevalence of DGM was much higher in the DU patients(92 3%) than that in the non-DU patients(42 0%,P<0 001),and the extent of DGM was also more serious in the former than in the latter(P<0 001).DGM was identified in 73 0% of patients with Hp in stomach, and in 37 5% of patients without Hp(P<0.001). The extent of DGM was significantly greater in the patients with Hp positive in stomach than that in the patients with Hp negative.47 2% of Hp positive patients had DGM(++) and more serious DGM compared with the Hp negative patients(21 9%,P<0 05). In duodenum, Hp was mostly detected on areas of DGM, and Hp prevalence showed an increasing trend with the extent of DGM increasing.Conclusions Hp infection,especially in duodenum and DGM may be two major risk factors influencing appearance and development of DU. There is a significant association between Hp infection and DGM.