反流性食管炎和消化性溃疡关系的探讨

Relationship between reflux esophagitis and peptic ulcer

目的 通过反流性食管炎有无合并消化性溃疡病例的分析 ,探讨消化性溃疡 (PU)对反流性食管炎 (RE)的影响及其机制。方法 收集 9年间胃镜诊断的 75 6例原发性RE ,分为两组 ,一组合并消化性溃疡 (RE +PU) 6 9例 ,另一组未合并消化性溃疡 6 87例 (RE -PU) ,对两组胃窦黏膜 (75 6例 )和食管下段黏膜 (1 74例 )的组织学和幽门螺杆菌(Hp)感染情况进行分析。RE按中国烟台试行标准进行分级。结果 RE +PU组患者的平均年龄 (4 6 .33± 1 3.1 4 )岁 ,显著较RE -PU组 (4 2 .90± 1 3.6 8)岁为高 (P <0 .0 5 )。RE +PU组患者Ⅱ、Ⅲ级RE 2 5例 (2 5 / 6 9,36 .2 3% ) ,与RE-PU组 (1 2 4 / 6 87,1 8.0 5 % )比较差异显著 (P <0 .0 1 )。RE +PU组的胃窦黏膜Hp阳性率 (70 .5 9% )也较RE -PU组(4 3.6 2 % )为高 (P <0 .0 1 )。RE +PU组的食管下段黏膜Hp阳性率为 2 6 .92 % ,较RE -PU组 (1 0 .81 % )显著为高(P <0 .0 5 )。此外 ,1 74例Ⅰ、Ⅱ、Ⅲ级RE的食管下段黏膜Hp阳性率分别为 0、8.5 7%、39.5 3% ,三者间差异显著 (P<0 .0 1 )。结论 合并消化性溃疡的反流性食管炎患者年龄较大 ,胃窦黏膜Hp阳性率较高 ,食管下段黏膜病变程度较重 。

Objective To study effects and mechanism of peptic ulcer(PU) on reflux esophagitis(RE).Methods\ 756 cases of primary RE were divided into two group,69 cases of reflux esophagitis with peptic ulcer(RE+PU),another group included 687 cases with reflux esophagitis without peptic ulcer(RE-PU). Histological examination and helicobacter pylori (Hp) positive rate of mucous membrane of gastric pylorus(756 cases) and lower segment of esophagus(174 cases) in two groups were analysed.Results Rate of grade Ⅱ and Ⅲ of RE in the RE+PU group (25/69,36.23%)was significantly difference than RE-PU group (124/687,18.05%,P<0.01). Hp positive rate of mucous membrane of gastric pylorus in RE+PU group(70.59%) was significantly higher than RE-PU group(43.62%,P<0.01).Hp positive rate of lower segment of esophagus in 174 cases of RE were 0, 8.57% and 39.53% in grade Ⅰ,Ⅱ and Ⅲ,respectively. Also there were significantly difference in three grades(P<0.01). Conclusion Compared with RE-PU group, RE+PU group is year older, Hp positive rate of mucous membrane of gastric pylorus is higher ,with more severe lesions of lower segment of esophagus.