根除幽门螺杆菌对胃黏膜炎症变化的人群随访研究

Changes of gastric mucosa histopathology after Helicobacter pylori eradication

目的 观察胃癌高发区中幽门螺杆菌 (Hp)阳性者根除Hp 5年后胃黏膜组织的炎症变化 ,以探讨Hp感染与胃黏膜组织炎症及胃癌的关系。方法 对胃癌高发区山东省烟台市成年人群随机抽样 1 0 0 6例 ,做内镜、快速尿素酶试验及胃窦、胃体部黏膜组织学检查 ,将Hp阳性者随机分为治疗组 (奥美拉唑 2 0mg、克拉霉素 50 0mg、阿莫西林 1 0 0 0mg)及对照组 ,2组入选者分别于 1年后、5年后进行内镜复检 ,本研究是将 5年后复查胃镜及相同部位胃黏膜组织病理检查与 5年前结果进行比较并做 χ2 检验。结果 552例Hp阳性者随机分为治疗组及对照组各 2 76例 ,5年后Hp持续阴性者 1 61例 ,持续阳性者 1 98例。 2组结果统计显示 :(1 )入选前 2组胃窦部炎症及活动度发生率与体部相比差异无显著性 ,P值分别为 0 1 0 5及 0 0 84,但萎缩及肠化生发生率明显高于体部 ,P值均为0 0 0 0 ;(2 )根除Hp 5年后胃窦、胃体部炎症及活动度均明显减轻 ,P值均为 0 0 0 0 ;(3)根除Hp 5年后胃窦部肠化生减轻或未进展 ,而Hp持续阳性组肠化生发生率明显增加 ,P =0 0 32 ;(4)根除Hp 5年后窦、体部萎缩改善差异无显著性 ,两组比较P值分别为 0 2 2 3及 0 40 2。结论 根除Hp可使胃慢性炎症及活动度明显减轻 ,窦部肠化生得到显著控制 ,溃疡病发?

Objective To investigate the relationship between Helicobacter pylori (Hp)infection and gastric cancer through the changes of gastric mucosa histopathology within 5 years after Hp eradication in Hp positive subjects in the high incidence region of gastric cancer Methods One thousand and six adults were selected from general population in Yantai, Shandong Province, the high incidence region of gastric cancer Gastroscopy and CLO test were performed in all subjects Biopsy samples from the gastric antrum and body were obtained for histology and assessment of Hp infection All the Hp positive subjects were then randomly divided into two groups: treatment group receiving OAC triple therapy and placebo as controls These subjects were endoscopically followed up in the second and fifth year In this article, we compared the endoscopic appearance and histology of the biopsy specimens from the same site obtained at the first and final visit Statistical analysis was done by χ 2 test Results All the 552 Hp positive subjects were randomly divided into treatment group or control group, 276 in each During the five year follow up, the number of patients who continued to be negative or positive for Hp was 161 and 198, respectively Statistical analysis revealed that: (1)At the initial visit, there were no significant differences in the severity and activity of inflammation between the biopsy specimens from the antrum ( P =0 105) and body ( P =0 084) in both groups But the proportion of atrophy and intestinal metaplasia in the antrum was much higher than that in the body ( P =0 000) (2) The severity and activity of inflammation in both the antrum and body were markedly reduced after Hp eradication ( P =0 000) (3) Within the five years after Hp eradication, intestinal metaplasia in the antrum regressed or had no progression, while the proportion of intestinal metaplasia in the Hp positive group increased significantly ( P =0 032) (4)After Hp eradication, the atrophy in both the antrum and body had no significant regression P value was 0 223 and 0 402, respectively Conclusions Hp eradication results in remarkable reduction in the severity and activity of chronic gastritis, marked resolution of intestinal metaplasia in the antrum On the other hand, continued Hp infection leads to progressive aggrevation of atrophy and intestinal metaplasia