背景:幽门螺杆菌(H.pylori)感染已被公认为慢性胃炎和消化性溃疡的重要危险因素,根除H.pylori能加速消化性溃疡的愈合,但其对胃黏膜病理变化的影响尚有待进一步探索。目的:了解根除H.pylori对慢性胃炎胃黏膜病理变化和癌前状态的影响。方法:采用多中心随机对照临床试验和回顾性队列研究,样本选自胃癌高发区:上海郊区的金山区和奉贤区。共纳入360例经内镜检查证实有H.pylori感染的慢性胃炎伴或不伴十二指肠溃疡患者,随机分为两组。治疗组用三联疗法(质子泵抑制剂或H2受体阻滞剂加两种抗生素)治疗,对照组单纯慢性胃炎患者予西沙必利、十二指肠溃疡患者予西米替丁治疗。在第1年和第4年末随访胃镜,根据H.pylori是否根除将患者分为两组:H.pylori阳性组和H.pylori阴性组。所有胃黏膜活检标本由两位病理科医师统一复读。结果:至第4年末,有120例患者完成全部随访,其中H.pylori持续根除组54例,阳转组5例;H.pylori持续未根除组45例,阴转组16例。持续根除组第1年随访时,活动性炎症比例减少(P<0.05);第4年随访时,慢性炎症和肠化程度以及活动性炎症比例减少(P<0.05)。持续未根除组第1年随访时,慢性炎症程度增加(P<0.05):第4年随访时,慢性炎症和肠化程度以及活动性炎症比例增加(P<0.05),萎缩程度较第1年随访时增加(P<0 BACKGROUND: H.pylori infection has been recognized as an important risk factor for chronic gastritis and peptic ulcer. Eradication of H.pylori can accelerate the healing of peptic ulcer, but its effect on pathological changes of gastric mucosa remains to be further studied explore. Objective: To understand the eradication of H.pylori gastric mucosal pathological changes and precancerous conditions of chronic gastritis. METHODS: A multicenter randomized clinical trial and a retrospective cohort study were performed. Samples were selected from high incidence areas of gastric cancer: Jinshan and Fengxian districts of Shanghai suburbs. A total of 360 cases of chronic gastritis with or without duodenal ulcer confirmed by endoscopy after H.pylori infection were randomly divided into two groups. Treatment group with triple therapy (proton pump inhibitor or H2 receptor blocker plus two antibiotics) treatment, control group patients with chronic gastritis to cisapride, duodenal ulcer patients treated with cimetidine. Gastroscopy was followed up at the end of year 1 and year 4, and patients were divided into two groups according to whether H. pylori was eradicated: H. pylori positive group and H. pylori negative group. All gastric mucosal biopsy specimens were read in duplicate by two pathologists. Results: By the end of the 4th year, 120 patients had completed the follow-up. Among them, 54 patients were continuously eradicated by H.pylori and 5 patients were treated by Yangxu group. Among them, 45 patients were non-eradication group and 16 patients were negative conversion group. At the follow-up of the fourth year, the proportion of chronic inflammation and intestinal metaplasia and active inflammation decreased (P <0.05). Chronic inflammation continued to increase at the first year of follow-up in the non-eradication group (P <0.05). At the fourth year of follow-up, there was an increase in chronic inflammation and intestinal metaplasia and active inflammation (P <0.05) Follow-up increased (P <0