幽门螺杆菌感染与十二指肠胃上皮化生及胃泌素之间关系的研究

Study on relation among helicobacter pylori infection,gastric metaplasia in the duodenum and gastrin

目的 通过对幽门螺杆菌 (Hp)感染与十二指肠胃上皮化生 (DGM )及胃泌素 (GAS)关系的研究 ,探讨Hp导致十二指肠溃疡 (DU)的发病机制。 方法 检测了 12 1例患者内镜、病理、Hp感染及DGM情况。同时测定了其中 6 6例患者的血清GAS浓度。结果 球部有溃疡者 ,胃及球部Hp检出率均显著高于球部无溃疡者 (P <0 .0 0 1) ;但球部Hp检出率在DU与CU、GU与CG之间无差别 (P >0 .0 5 ) ;球部有溃疡者DGM的检出率显著高于球部无溃疡者 (P <0 .0 0 1) ,且前者的DGM程度更重 (P <0 .0 0 1) ,但在DU与CU、GU与CG之间无差别 (P >0 .0 5 ) ;胃部Hp阳性者DGM的发生率 (73.0 % )显著高于胃部Hp阴性者 (37.5 % ,P <0 .0 0 1) ,DGM(++)及以上者在Hp阳性组发生率 (47.2 % )也高于Hp阴性组 (2 1.9% ,P <0 .0 5 ) ;Hp阳性者血清GAS浓度显著高于Hp阴性者 (P <0 .0 1) ,但血清GAS浓度在Hp阳性的DU、CU、GU与CG之间无差别(P >0 .0 5 ) ;有DGM者血清GAS浓度也显著高于无DGM者 (P <0 .0 1) ,且随着DGM程度的加重 ,血清GAS浓度早递增趋势 ,两者呈正相关 (rs=0 .4 2 ,P <0 .0 1)。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。Hp可影响DGM的发生与发展 ,其中部分可能通过增加血清GAS分泌的作用。

Objective:To study on the relation among Helicobacter pylori (Hp) infection,gastric metaplasia in the duodenum (DGM) and gastrin(GAS),for elucidating the pathogenesis of Hp leading to duodenal ulcer (DU).Methods:One hundred and twenty-one patients were enrolled into this study and examined by endoscopy,Hp detection and DGM. Serum gastrin concentrations were also measured in 66 of 121 patients.Results:The rates of Hp detection ill stomach and in duodenal bulb were much higher in patients with DU and CU than in patients with GU and CG( P <0.001);However,the positive rates of Hp in duodenal bulb showed no significance between DU and CU,or GU and CG( P >0.05). The prevalence of DGM was much higher in patients with DU and CU than in patients with GU and CG( P <0.001);The extent of DGM was much greater in the former than in the latter( P <0.001) also,but no significance between DU and CU,or GU and CG( P >0.05). DGM was identified in 73.0% of patients with Hp in stomach,and 37.5% of patients without Hp( P < 0.001 ). The extent of DGM was significantly greater in those patients with Hp positive in stomach,in 47.2% of Hp positive patients having more than DGM(++),compared with 21.9% of the Hp negative patients( P <0.05). Serum gastrin concentrations were much higher in the Hp positive patients than in the Hp negative patients( P <0.01),but no difference among DU,CU,GU and CG with Hp ( P >0.05);Serum gastrin concent rations in the patients with DGM were much higher than that in the patients without DGM ( P <0.01);A significantly positive association was found between the serum gastrin concentrations and the extent of DGM (r s=0.42,P <0.01).Conclusions:Hp infection especially in duodenum and DGM are two major risk factors influencing appearance and development of DU. Hp may influence the prevalence and extent of DGM,partly by enhancing the serum gastrin concentrations.