Effects of bile reflux on gastric mucosal lesions in patients with dyspepsia or chronic gastritis

AIM: To investigate the influences of bile reflux on profiles of gastric mucosal lesions in patients with dyspepsia or chronic gastritis.METHODS: A total of 49 patients diagnosed with dyspepsia and chronic gastritis underwent 24-h ambulatory andsimultaneous monitoring of intragastric bilirubin absorbance and pH values, and then they were divided into bile refluxpositive group and bile reflux negative group. Severity of pathological changes in gastric mucosa including activeinflammation, chronic inflammation, intestinal metaplasia, atrophy and dysplasia as well as Helicobacter pylori (H pylori) infection at the corpus, incisura and antrum were determined respectively according to update Sydney system criteria. The profiles of gastric mucosal lesions in the two groups were compared, and correlations between time-percentage of gastric bilirubin absorbance ＞0.14 and severity of gastric mucosal lesions as well as time-percentage of gastric pH ＞4 were analyzed respectively. RESULTS: Thirty-eight patients (21 men and 17 women, mean age 44.2 years, range 25-61 years) were found existing with bile reflux (gastric bilirubin absorbance ＞0.14) and 11 patients (7 men and 4 women, mean age 46.2 years,range 29-54 years) were bile reflux negative. In dyspepsia patients with bile reflux, the mucosal lesions such as active inflammation, chronic inflammation, intestinal metaplasia, atrophy or H pylori infection in the whole stomach, especially in the corpus and incisura, were significantly more severe than those in dyspepsia patients without bile reflux. Moreover, the bile reflux time was well correlated with the severity of pathological changes of gastric mucosa as well as H pylori colonization in the near-end stomach, especially in the corpus region. No relevance was found between the time of bile reflux and pH ＞4 in gastric cavity. CONCLUSION: Bile reflux contributes a lot to mucosal lesions in the whole stomach, may facilitate H pylori colonization in the corpus region, and has no influence on acid-exposing status of gastric mucosa in patients with dyspepsia or chronic gastritis.

Prevalence of bile reflux in gastroesophageal reflux disease patients not responsive to proton pump inhibitors

AIM:To determine the prevalence and characteristics of bile reflux in gastroesophageal reflux disease(GERD) patients with persistent symptoms who are non-responsive to medical therapy.METHODS:Sixty-five patients(40 male,25 female;mean age,50 ± 7.8 years) who continued to report symptoms after 8 wk of high-dose proton pump inhibitor(PPI) therapy,as well as 18 patients with Barrett's esophagus,were studied.All patients filled out symptom questionnaires and underwent endoscopy,manometry and combined pH-metry and bilimetry.RESULTS:There were 4 groups of patients:22(26.5%) without esophagitis,24(28.9%) grade A-B esophagitis,19(22.8%) grade C-D and 18(21.6%) Barrett's esophagus.Heartburn was present in 71 patients(85.5%) and regurgitation in 55(66.2%),with 44(53%) reporting simultaneous heartburn and regurgitation.The prevalence of pathologic acid reflux in the groups without esophagitis and with grades A-B and C-D esophagitis was 45.4%,66.6% and 73.6%,respectively.The prevalence of pathologic bilirubin exposure in these 3 groups was 53.3%,75% and 78.9%,respectively.The overall prevalence of bile reflux in non-responsive patients was 68.7%.Pathologic acid and bile reflux was observed in 22.7% and 58.1% of non-esophagitic patients and esophagitic patients,respectively.CONCLUSION:The high percentage of patients poorly responsive to PPI therapy may result from poor control of duodenogastroesophageal reflux.Many patients without esophagitis have simultaneous acid and bile reflux,which increases with increasing esophagitis grade.

Systematic Review and Meta-analysis of Efficacy of Banxia Xiexin Decoction for Treatment of Bile Reflux Gastritis

[Objectives]The purpose was to study the clinical efficacy and safety of Banxia Xiexin decoction in treating bile reflux gastritis(BRG).[Methods]Randomized controlled trial was adopted to conduct scientific and standardized assessment on the risk of bias in the included articles.With overall effect and epigastric pain relief as indices,meta-analysis was performed,and sensitivity and safety analysis was conducted on the included literature.[Results]A total of 13 articles were included,involving a total of 1478 patients.The results of meta-analysis show that the efficacy of Banxia Xiexin decoction alone and Banxia Xiexin decoction-Western medicine combination is better than that of Western medicine alone.[Conclusions]Banxia Xiexin decoction is safe and effective in treating bile reflux gastritis.However,as the 13 articles included are all low in quality and there is a certain degree of publication bias,the objectivity of the results is affected to some extent.

Bile reflux and bile acids in the progression of gastric intestinal metaplasia

Gastric intestinal metaplasia(GIM)is a precancerous lesion of gastric cancer(GC)and is considered an irreversible point of progression for GC.Helicobacter pylori infection can cause GIM,but its eradication still does not reverse the process.Bile reflux is also a pathogenic factor in GIM and can continuously irritate the gastric mucosa,and bile acids in refluxed fluid have been widely reported to be associated with GIM.This paper reviews in detail the relationship between bile reflux and GIM and the mechanisms by which bile acids induce GIM.

Diagnostic value of confocal laser endomicroscopy in primary bile reflux gastritis

Objective To evaluate the accuracy of confocal laser endomicroscopy(CLE)in primary bile reflux gastritis(BRG).Methods From November 10 to December 15,2015,55 patients undergoing CLE examination and preliminarily diagnosed as BRG with traditional white-light endoscopy were enrolled.CLE score standard was designed.Dixon pathologic score was considered as

Comparative evaluation of intragastric bile acids and hepatobiliary scintigraphy in the diagnosis of duodenogastric reflux

AIM:To assess the diagnostic value of a combination of intragastric bile acids and hepatobiliary scintigraphy in the detection of duodenogastric reflux(DGR).METHODS:The study contained 99 patients with DGR and 70 healthy volunteers who made up the control group.The diagnosis was based on the combination of several objective arguments:a long history of gastric symptoms(i.e.,nausea,epigastric pain,and/or bilious vomiting) poorly responsive to medical treatment,gastroesophageal reflux symptoms unresponsive to protonpump inhibitors,gastritis on upper gastrointestinal(GI) endoscopy and/or at histology,presence of a bilious gastric lake at > 1 upper GI endoscopy,pathologic 24-h intragastric bile monitoring with the Bilitec device.Gas-tric juice was aspirated in the GI endoscopy and total bile acid(TBA),total bilirubin(TBIL) and direct bilirubin(DBIL) were tested in the clinical laboratory.Continuous data of gastric juice were compared between each group using the independent-samples Mann-Whitney U-test and their relationship was analysed by Spearman's rank correlation test and Fisher's linear discriminant analysis.Histopathology of DGR patients and 23 patients with chronic atrophic gastritis was compared by clinical pathologists.Using the Independent-samples Mann-Whitney U-test,DGR index(DGRi) was calculated in 28 patients of DGR group and 19 persons of control group who were subjected to hepatobiliary scintigraphy.Receiver operating characteristic curve was made to determine the sensitivity and specificity of these two methods in the diagnosis of DGR.RESULTS:The group of patients with DGR showed a statistically higher prevalence of epigastric pain in comparison with control group.There was no significant difference between the histology of gastric mucosa with atrophic gastritis and duodenogastric reflux.The bile acid levels of DGR patients were significantly higher than the control values(Z:TBA:-8.916,DBIL:-3.914,TBIL:-6.197,all P < 0.001).Two of three in the DGR group have a significantly associated with each other(r:TBA/DBIL:0.362,TBA/TBIL:0.470,DBIL/TBIL:0.737,all P < 0.001).The Fisher's discriminant function is followed:Con:Y = 0.002TBA + 0.048DBIL + 0.032TBIL 0.986;Reflux:Y = 0.012TBA + 0.076DBIL + 0.089TBIL-2.614.Eighty-four point zero five percent of original grouped cases were correctly classified by this method.With respect to the DGR group,DGRi were higher than those in the control group with statistically significant differences(Z =-5.224,P < 0.001).Twenty eight patients(59.6%) were deemed to be duodenogastric reflux positive by endoscopy,as compared to 37 patients(78.7%) by hepatobiliary scintigraphy.CONCLUSION:The integrated use of intragastric bile acid examination and scintigraphy can greatly improve the sensitivity and specificity of the diagnosis of DGR.

熊去氧胆酸联合常规西医治疗胆汁反流性胃炎合并幽门螺旋杆菌感染的疗效及对IL-8、PGE2的影响

目的探讨熊去氧胆酸联合常规西医治疗胆汁反流性胃炎(BRG)合并幽门螺旋杆菌(Hp)感染的疗效及对白细胞介素-8(IL-8)、PGE2(前列腺素E2)的影响。方法选取2019年5月—2021年5月巴彦淖尔市医院收治的100例Hp呼吸试验为阳性的BRG患者进行研究,应用随机数表法将其分为观察组与对照组,每组50例。对照组采取常规西医治疗(克拉霉素+奥美拉唑+阿莫西林),观察组在常规西医治疗基础上增加熊去氧胆酸素治疗,对比两组患者临床疗效,并应用酶联免疫吸附法检测治疗前后血清白细胞介素-8(IL-8)、PGE2(前列腺素E2)表达水平,对比胃泌素(GAS)、胃动素(MTL)、胆囊收缩素(CCK)表达水平以及不良反应情况。结果观察组治疗总有效率明显高于对照组,差异有统计学意义(P<0.05);治疗后两组患者血清IL-8水平降低,观察组低于对照组,PGE2水平升高,观察组高于对照组(P<0.05);治疗后两组患者血清CCK水平降低,观察组低于对照组,MTL、GAS水平升高,观察组高于对照组,差异有统计学意义(P<0.05);两组患者均无严重不良反应发生,且轻度不良反应比较,差异无统计学意义(P>0.05),但观察组Hp根除率高于对照组(P<0.05)。结论对胆汁反流性胃炎合并Hp感染患者在常规西医治疗的基础上增加熊去氧胆酸能够提升其临床疗效,降低患者炎症反应,提升胃动力,调节胃肠激素,提升Hp根除率,且安全性较高。

线阵超声内镜引导精准内镜十二指肠乳头括约肌切开术对胆总管结石患者内镜逆行胰胆管造影术后胆囊功能的影响

目的探讨线阵超声内镜引导精准内镜十二指肠乳头括约肌切开术(EST)对胆总管结石患者内镜逆行胰胆管造影术(ERCP)的术后胆汁淀粉酶(BA)、胆汁细菌阳性率和隐匿性胰胆反流(OPBR)的影响。方法选择2021年6月-2023年2月在该院进行ERCP的146例胆总管结石患者作为研究对象,患者需要行EST,根据EST的不同分为两组,各73例。观察组接受线阵超声内镜引导精准EST治疗,对照组行传统EST治疗。观察两组患者手术情况。比较术前、术后1和3 d两组患者肝功能指标[总胆红素(TBiL)、综合胆红素(CB)和丙氨酸转氨酶(ALT)等]、炎症和应激指标[C反应蛋白(CRP)、高迁移率族蛋白B1(HMGB1)、皮质醇(Cor)和去甲肾上腺素(NE)等],以及BA和胆汁细菌阳性率。统计两组患者手术并发症和术后12个月复发情况。结果两组患者取石成功率和手术时间比较,差异均无统计学意义(P>0.05)。观察组术中出血量少于对照组,住院时间短于对照组,差异均有统计学意义(P<0.05)。术后1和3 d,两组患者TBiL、CB和ALT低于术前,差异均有统计学意义(P<0.05),组间比较,差异均无统计学意义(P>0.05)。术后1和3 d,两组患者血清CRP、HMGB1、Cor和NE水平及BA浓度高于术前,观察组低于对照组,差异均有统计学意义(P<0.05)。对照组术后1和3 d胆汁细菌阳性率高于术前,差异有统计学意义(P<0.05),观察组手术前后各时点胆汁细菌阳性率比较,差异无统计学意义(P>0.05),观察组术后1和3 d胆汁细菌阳性率低于对照组(P<0.05)。观察组OPBR发生率和术后12个月复发率(15.07%和1.37%)低于对照组(57.53%和10.96%),差异均有统计学意义(P<0.05)。结论线阵超声内镜引导精准EST相对于传统EST,能有效减少十二指肠乳头括约肌损伤,避免肠胆反流,抑制BA分泌及细菌增殖,降低OPBR的发生风险。

胆囊切除术后胆汁反流性胃炎中西医研究现状

胆汁反流性胃炎(BRG)的病因众多,可能与胃肠动力紊乱、幽门螺杆菌感染、胆系疾患、外科手术等有关。其中,胆囊切除与BRG的发生关系密切,目前认为,胆囊切除术后BRG发病机制与术后胆囊功能缺失、神经体液调节异常、幽门-十二指肠运动失调、胆汁酸代谢异常等有关。目前中西医结合治疗已成为趋势。本文对近年来胆囊切除术后BRG的中西医发病机制及治疗现状进行综述,以期为临床治疗胆囊切除术后BR G提供诊疗思路。

肝胃同治中药复方对胆汁反流大鼠胆汁酸代谢的影响

目的观察并探讨柴胡疏肝散与旋覆代赭汤的组合中药复方对胆汁反流大鼠外周血胆汁酸代谢的影响。方法选取74只SD雄性大鼠,24只假手术组行腹腔切开和缝合术、50只进行全胃切除+食管十二指肠吻合术造模,造模成功后分为模型组和中药组。术后2周、4周、8周的模型组与假手术组使用生理盐水分别灌胃0周、2周、6周;术后8周中药组以生药量9.3 g/(kg·d)的肝胃同治复方予以灌胃,连续给药6周。各组大鼠灌胃量均为10 mL/(kg·d),经腹腔注射2%戊巴比妥钠麻醉后,开腹取食管和腹主动脉血。对食管组织进行脱水、包埋、切片和苏木素—伊红染色,观察大鼠食管组织病理学改变及癌前病变和癌变的出现率,同时用液相色谱—串联质谱法测定大鼠血清中11种胆汁酸的水平。结果术后2周到术后8周,模型组大鼠食管黏膜损伤严重程度递增,食管癌前病变和癌变的出现率逐渐上升,模型组术后8周食管癌变出现率显著高于术后2周的模型组(P<0.05);中药组大鼠食管黏膜损伤改善,食管癌变出现率与模型组相比较显著降低(P<0.05)。血清胆汁酸结果显示,与同期假手术组相比,模型组术后2周牛磺胆酸水平升高(P<0.05),牛磺鹅脱氧胆酸、脱氧胆酸水平下降(P<0.05);术后4周牛磺熊脱氧胆酸、牛磺脱氧胆酸水平升高(P<0.05),术后8周牛磺胆酸水平升高(P<0.05);与术后8周模型组比较,中药组甘氨胆酸、牛磺胆酸、牛磺鹅脱氧胆酸、牛磺脱氧胆酸水平都有所下降,但无统计学意义(P>0.05);胆酸、脱氧胆酸、熊脱氧胆酸、鹅脱氧胆酸、石胆酸、牛磺石胆酸水平有所升高,但无统计学意义(P>0.05)。结论肝胃同治中药复方具有防治胆汁反流引起食管癌变的效应,并可影响血清胆汁酸的代谢。

养胃颗粒联合西药治疗胆汁反流性胃炎疗效观察及对血清炎症因子的影响

目的:观察养胃颗粒联合西药治疗胆汁反流性胃炎(BRG)的疗效及对血清炎症因子的影响。方法:选取80例BRG患者,按随机数字表法分为对照组及观察组各40例。对照组给予莫沙必利、铝碳酸镁口服,观察组在对照组基础上加用养胃颗粒。2组疗程均为8周。观察2组临床疗效及不良反应发生情况,比较2组治疗前后中医证候评分、血清炎症因子[表皮生长因子(EGF)、白细胞介素-32 (IL-32)、转化生长因子-β1 (TGF-β1)、一氧化氮(NO)]水平的变化。结果:观察组临床疗效总有效率为95.00%,高于对照组的80.00%(P<0.05)。治疗后,2组脘腹痞满、食欲不振、疲乏无力、恶心欲吐、大便稀溏中医证候评分均较治疗前下降(P<0.05),观察组上述5项中医证候评分均低于对照组(P<0.05)。治疗后,2组EGF、IL-32、TGF-β1水平均较治疗前下降(P<0.05),NO均较治疗前上升(P<0.05);观察组EGF、IL-32、TGF-β1水平低于对照组(P<0.05),NO高于对照组(P<0.05)。观察组不良反应发生率为12.50%,与对照组10.00%比较,差异无统计学意义(P>0.05)。结论:养胃颗粒联合西药治疗BRG疗效确切,可缓解临床症状,改善炎症水平,安全性较高。

Randomized controlled trial of uncut Roux-en-Y vs Billroth Ⅱ reconstruction after distal gastrectomy for gastric cancer: Which technique is better for avoiding biliary reflux and gastritis?

AIM To identify which technique is better for avoiding biliary reflux and gastritis between uncut Roux-en-Y and Billroth Ⅱ reconstruction. METHODS A total of 158 patients who underwent laparoscopyassisted distal gastrectomy for gastric cancer at the First Hospital of Jilin University(Changchun, China) between February 2015 and February 2016 were randomized into two groups: uncut Roux-en-Y(group U) and Billroth II group(group B). Postoperative complications and relevant clinical data were compared between the two groups. RESULTS According to the randomization table, each group included 79 patients. There was no significant difference in postoperative complications between groups U and B(7.6% vs 10.1%, P = 0.576). During the postoperative period, group U stomach p H values were lower than 7 and group B p H values were higher than 7. After 1 year of follow-up, group B presented a higher incidence of biliary reflux and alkaline gastritis. However, histopathology did not show a significant difference in gastritis diagnosis(P = 0.278), and the amount of residual food and gain of weight between the groups were also not significantly different. At 3 mo there was no evidence of partial recanalization of uncut staple line, but at 1 year the incidence was 13%. CONCLUSION Compared with Billroth II reconstruction, uncut Rouxen-Y reconstruction is secure and feasible, and can effectively reduce the incidence of alkaline reflux, residual gastritis, and heartburn. Despite the incidence of recanalization, uncut Roux-en-Y should be widely applied.

国医大师周信有辨治胆汁反流性胃炎经验

胆汁反流性胃炎是消化系统的常见病与多发病,病理兼夹多样。周信有教授临证指出,本病病位在胆、肝、胃,倡导分三期辨证认识其病因病机。初期胆腑失和,乖戾犯胃;中期肝胆郁滞,旺木克土;后期胃络受损,气虚血瘀。周信有教授临证遵从“复方多法、综合运用、整体调节”的诊疗思路,对于临床典型症候群,制定出“痛分新久,以通为用”“口苦心烦,泻热和胃”“治胆安胃,理气解郁”的治则治法,从而达到标本兼治、胆胃和调之功。

Biliary reflux detection in anomalous union of the pancreaticobiliary duct patients

AIM： To demonstrate the imaging findings of biliopan creatic and pancreatico-biliary reflux in patients with anomalous union of the pancreatico biliary duct （AUPBD） on gadoxetic acidenhanced functional magnetic resonance cholangiography （fMRC）.

胆汁反流发病机制与诊断及治疗研究进展

胆汁反流是由于胆汁逆行运动到胃及其以上部位,长期的胆汁反流除了引起胆汁反流性胃炎外,还可导致肠化、Barrett食管,甚至是胃癌、食管癌、咽喉癌的高危因素。长期频繁的胆汁反流应视为病理性胆汁反流,胆汁反流分为原发性反流和继发性反流。临床上胆汁反流常见的症状包括腹胀、口苦、上腹痛、恶心呕吐等。原发性胆汁反流无胃手术即可发生,而继发性胆汁反流通常在胃肠手术后发生。本文对胆汁反流发病机制与诊断和治疗进展进行综述。

基于玄府学说探析胆汁反流性胃炎

胆汁反流性胃炎临床易反复发作、难以治愈,与多种致病因素相关,中医药在缓解其临床症状等方面具有一定优势。“玄府”起源于《黄帝内经》,其学说经刘完素等多位医家的研究总结逐渐完善,脏腑玄府理论与脾胃疾病密切相关,若机体玄府郁闭,则气液宣通失调,百病由生。本文主要从脾玄府、肝玄府、脑玄府三方面论述玄府学说与胆汁反流性胃炎病机的相关性,提出疏肝健脾、醒脑开玄的治则,为临床治疗胆汁反流性胃炎提供思路。

中药汤剂加减治疗胆汁反流性胃炎的有效率分析

目的分析中药汤剂加减治疗胆汁反流性胃炎的有效率。方法方便选取2022年10月—2023年7月于南京市江宁中医院接受治疗的128例胆汁反流性胃炎患者作为研究对象,用随机数表法将其分为两组,各64例。对照组用传统西药治疗,观察组用中药汤剂加减治疗,比较两组临床疗效、中医证候与胃镜积分、症状改善情况、胃肠激素水平。结果治疗后,观察组治疗总有效率(96.88%)高于对照组(85.94%),差异有统计学意义(χ^(2)=4.873,P=0.027)。治疗前,两组患者中医证候积分、胃镜积分、各项症状评分、胃泌素(Gastrin,GAS)以及胃动素(Montilin,MTL)水平对比,差异无统计学意义(P均>0.05)。治疗后,观察组中医证候积分、胃镜积分、症状评分、GAS及MTL水平均低于对照组,差异有统计学意义(P均<0.05)。结论在胆汁反流性胃炎患者治疗中,使用中药汤剂治疗并结合患者临床症状调整中药汤剂的剂量能有效改善患者的临床症状,降低患者胃肠激素水平。

荜铃胃痛颗粒联合雷贝拉唑对胃食管反流患者食管动力学的影响

目的 观察荜铃胃痛颗粒联合雷贝拉唑对胃食管反流(GER)患者食管动力学的影响。方法 选取2020年6月—2021年6月南方医科大学南方医院白云分院收治的GER患者160例,依据随机数字表法分为观察组(n=80)和对照组(n=80)。对照组给予雷贝拉唑治疗,观察组在对照组基础上给予荜铃胃痛颗粒治疗,2组均治疗8周。比较2组临床疗效,治疗前后临床症状评分、食管动力学指标[食管上段括约肌(UES)压力、食管下段括约肌(LES)压力]及不良反应。结果 观察组总有效率为95.00%,高于对照组的85.00%(χ^(2)=4.444,P=0.035)。治疗8周后,2组胃灼感、反酸、反食评分低于治疗前,且观察组低于对照组(P<0.01);2组UES与LES压力高于治疗前,且观察组高于对照组(P<0.01)。观察组与对照组不良反应总发生率比较差异无统计学意义(11.25%vs. 7.50%,χ^(2)=0.662,P=0.416)。结论 荜铃胃痛颗粒联合雷贝拉唑可提高疗效,有效改善GER患者临床症状及食管动力学,且未明显增加不良反应。

清肝宁胃方辅助莫沙必利治疗对胃镜下胆汁反流情况与胃肠激素表达影响的前瞻性研究

目的 探讨清肝宁胃方辅助莫沙必利治疗对胆汁反流性胃炎(Bile reflux gastritis, BGR)患者胃镜下胆汁反流情况与胃肠激素表达的影响,以期为临床治疗提供一定参考。方法 应用前瞻性随机对照研究方法选取2020年1月—2023年1月我院BGR患者118例,以计算机生成的随机数字表分为中西医结合组(59例)、西医组(59例)。西医组给予莫沙必利,中西医结合组给予清肝宁胃方辅助莫沙必利,均治疗1个月。比较两组疗效、不良反应与治疗前、治疗1个月后中医证候积分、胃镜下胆汁反流情况、血清炎症因子[白细胞介素-8(Interleukin 8,IL-8)、肿瘤坏死因子-α(Tumor Necrosis Factor-α,TNF-α)、C反应蛋白(C-reactive protein, CRP)]、胃肠激素[胃泌素(Gastrin, GAS)、胃动素(Motilin, MTL)]水平。结果 (1)疗效:经治疗,中西医结合组总有效率为93.22%,高于西医组的79.66%(P<0.05);(2)中医证候积分与胃镜下胆汁反流情况:两组治疗1个月后中医证候积分较治疗前降低,且中西医结合组较西医组低,胃镜下胆汁反流情况较治疗前改善,且中西医结合组优于西医组(P<0.05);(3)炎症因子与胃肠激素:两组治疗1个月后血清IL-8、TNF-α、CRP及GAS水平较治疗前降低,且中西医结合组较西医组低,MTL水平较治疗前提高,且中西医结合组较西医组高(P<0.05);(4)不良反应:中西医结合组不良反应发生率5.08%与西医组8.47%相比,差异无统计学意义(P>0.05)。结论 应用清肝宁胃方辅助莫沙必利治疗BGR患者可改善胃镜下胆汁反流情况与胃肠激素表达,减轻机体炎症反应与临床症状,增强疗效,且安全性好。

基于倾向性匹配的胆汁反流对胃黏膜影响及CDX2表达分析

背景胆汁反流的发病率逐年上升,其对胃粘膜癌前病变的作用存在争议.拟采用倾向性评分匹配方法减少混杂因素的干扰,以探讨胆汁反流对胃黏膜的影响及作用机制.目的通过回顾性研究探讨胆汁反流对胃粘膜损伤的作用,评估其对组织病理学的影响以及分子表达.方法收集2023-07/2023-12嘉兴市中医院155例慢性胃炎伴胆汁反流患者,随机选取同期227例慢性胃炎患者为对照组.通过倾向性评分匹配(propensity score matching,PSM)调整混杂因素后,依据新悉尼系统行组织学分级,并以免疫组化方法检测胃粘膜尾型同源框基因2(caudal type homeobox 2,CDX2)表达,分析两组胃粘膜组织病理学改变以及与CDX2表达相关性.结果PSM 1:1匹配后两组基线资料无统计学差异,匹配后慢性胃炎伴胆汁反流组胃黏膜慢性炎症反应、炎症活动性、萎缩、肠上皮化生(intestinal metaplasia,IM)严重程度均高于慢性胃炎组,差异有统计学意义(P<0.05).Spearman相关性检验结果显示CDX2阳性表达与IM显著正相关(r=0.629,P<0.01),与萎缩、胆汁反流呈正相关(r=0.269,r=0.282,P<0.01).结论胆汁反流可加重胃黏膜损伤,是胃粘膜炎症反应、萎缩、IM的危险因素.同时胆汁反流可能通过影响CDX2表达参与IM过程.