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[目的]探讨根除幽门螺杆菌(Hp)及后续胃复春、叶酸联合治疗对胃癌前病变的病理转归,分析其中定标活检及胃蛋白酶原检测在随访中的应用价值。[方法]采用定标活检技术,选择经病理证实为胃癌前病变(包括萎缩、肠化及低级别上皮内瘤变)且Hp阳性的慢性萎缩性胃窦炎患者,予四联疗法根除Hp治疗,1个月后复查Hp根除失败者为A组(Hp未根除组);再选择Hp根除成功后的患者,按随机数字表法分为2组:B组(Hp根除组)不予后续治疗;C组(联合治疗组)予胃复春联合叶酸口服6个月;最后共纳入患者130例,A组40例,B组44例,C组46例,所有患者均在6个月后复查胃镜、病理,了解其病理转归;并在治疗前及随访结束检测血清胃蛋白酶原,了解其变化。[结果]随访结束比较萎缩改善率,A、B、C 3组分别为10%、34.09%、65.22%;肠化改善率,A、B、C 3组分别为16.67%、22.86%、54.55%;胃黏膜低级别上皮内瘤变消退率,A、B、C 3组分别为5.26%、9.52%、43.48%;B组与A组在萎缩改善方面相比差异有统计学意义(P<0.05);在肠化改善方面相比差异无统计学意义;而C组分别与A、B组相比,萎缩、肠化及低级别上皮内瘤变均有改善,差异均有统计学意义(P<0.05);3组胃蛋白酶原Ⅰ、Ⅱ及二者比值在入组前及随访结束比较,差异均无统计学意义。[结论]根除Hp后能改善胃黏膜萎缩,但肠化改善不明显;而进一步联用胃复春、叶酸治疗能明显改善萎缩与肠化,部分消退低级别上皮内瘤变。定标活检可保证随访时病理取材的相比性;而胃蛋白酶原检测对胃窦、胃角病变为主的癌前病变的筛查及随访价值有限。
[Objective] To investigate the pathological changes of gastric precancerous lesions with combined treatment of Helicobacter pylori (H.pylori) and subsequent reuptake of weifenchun and folic acid, and to analyze the value of calibration biopsy and pepsinogen in follow-up. [Method] The patients with chronic atrophic antral gastritis confirmed by histopathology as gastric precancerous lesions (including atrophy, intestinal metaplasia and low grade intraepithelial neoplasia) and positive for Hp were treated with quadruple therapy to eradicate Hp , One month after the review of Hp eradication failure for the A group (Hp not eradication group); then choose Hp eradication patients, according to random number table divided into two groups: B group (Hp eradication group) without follow-up treatment ; Group C (combined treatment group) to Wei Weichun with folic acid oral for 6 months; the final total of 130 patients were enrolled, A group of 40 cases, B group 44 cases, C group 46 cases, all patients were reviewed after 6 months Gastroscopy, pathology, to understand the pathological outcome; and serum pepsinogen before treatment and at the end of follow-up to understand the changes. [Results] The rates of improvement of intestinal metaplasia were 16.67%, 22.86% and 54.55% in group A, B and C respectively compared with those in group A, B and C at 10 and 34.09%, 65.22% ; The regression rate of gastric mucosal low-grade intraepithelial neoplasia was 5.26%, 9.52% and 43.48% in group A, B and C respectively; There was significant difference in the improvement of atrophy between group B and group A (P <0.05 ), While there was no significant difference in the improvement of intestinal metaplasia. Compared with group A and group B, the atrophy, intestinal metaplasia and low-grade intraepithelial neoplasia were improved in group C, the differences were statistically significant (P <0.05). There was no significant difference in the ratio of pepsinogen Ⅰ, Ⅱ between the three groups before and at the end of follow-up. [Conclusion] The eradication of Hp can ameliorate gastric mucosal atrophy, but there is no obvious improvement in intestinal metaplasia. However, combined with Weifuchun and folic acid treatment can obviously ameliorate atrophy and intestinal metaplasia and partially subside the low grade intraepithelial neoplasia. Calibration biopsy can ensure the pathological comparison of follow-up; and pepsinogen detection of gastric antrum, gastrectomy-based precancerous lesions screening and follow-up value is limited.