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目的探讨内镜下十二指肠球部多发隆起病变与幽门螺杆菌(Hp)感染和胃上皮化生等组织学异常关系。方法连续调查86例经胃镜检查证实十二指肠球部多发隆起病变患者,并以40 例球部基本正常患者作为对照。病变组Hp阳性患者接受三联根除治疗(奥美拉唑20 mg、克拉霉素 250 mg、甲硝唑400 mg,每天2次),疗程7 d,停药后随访6个月后复查胃镜;病变组Hp阴性者接受奥美拉唑20 mg,每天1次治疗,疗程4～6个月,停药后2周复查胃镜。比较2次胃镜检查结果,包括胃镜下隆起病变程度及球部黏膜胃上皮化生等组织学异常,分析Hp感染与上述胃镜下表现及组织学异常关系。结果对照组患者组织学仅部分发现轻度慢性炎症,未发现球部Hp感染。病变组患者Hp检出率为58．1％,胃上皮化生检出率为57．0％。Hp阳性与Hp阴性患者胃镜下隆起病变程度差异无统计学意义(P>0．05),但胃上皮化生检出率更高,程度更严重(P<0．05)。76例患者复查胃镜,根除Hp或奥美拉唑治疗对Hp阳性或阴性患者球部多发隆起病变无明显作用,但根除Hp后 6个月,53．6％(15／28)患者胃七皮化生消失,61．0％(25／41)患者绒毛萎缩恢复正常,所有患者淋巴滤泡完伞消失(26／26),杯状细胞减少完全恢复(25／25),同时炎症和活动性显著减轻(P值均< 0．01)。奥美拉唑疗效不显著。结论十二指肠球部多发隆起病变患者半数以上有Hp感染。Hp感染与隆起病变伴随组织学炎症密切相关,而与其内镜下表现及严重程度无关。根除Hp可使炎症显著减轻,胃上皮化生范围缩小或消退。
Objective To investigate the relationship between histologic abnormalities of multiple lesions of the duodenal bulb and endoscopic Helicobacter pylori (Hp) infection and gastric epithelial metaplasia. Methods A total of 86 patients with multiple bulge lesions of duodenal bulb confirmed by endoscopy were enrolled in this study. Forty patients with basal normal were selected as controls. Hp-positive patients in the lesion group were treated with triple eradication therapy (omeprazole 20 mg, clarithromycin 250 mg, metronidazole 400 mg twice daily) for 7 days, followed by gastroscopy after 6 months of follow-up Group Hp-negative patients received omeprazole 20 mg once daily treatment for 4 to 6 months, 2 weeks after discontinuation of gastroscopy. The results of 2 gastroscopy were compared, including histopathological changes of gastric mucosal epithelial metaplasia and gastric mucosal uplift, and the relationship between Hp infection and the above endoscopic findings and histological abnormalities was analyzed. Results Histology of the control group only partially found mild chronic inflammation, and no Hp infection in the bulb was found. The detection rate of Hp in patients with lesions was 58.1%, and the detection rate of gastric epithelial metaplasia was 57.0%. There was no significant difference in the extent of endoscopic lesions between Hp-positive and Hp-negative patients (P> 0.05). However, the detection rate of gastric epithelial metaplasia was even higher (P <0.05). 76 patients underwent endoscopy, eradication of Hp or omeprazole treatment of Hp positive or negative patients with bulging bulge lesions had no significant effect, but 6 months after eradication of Hp, 53.6% (15/28) of patients with Stomach Qi Pi The disappearance of metaplasia, 61.0% (25/41) of patients with villous atrophy returned to normal, all patients with umbrella follicles disappeared umbrella (26/26), goblet cells reduced completely (25/25), while inflammation and activity Significantly reduced (P <0.01). Omeprazole curative effect is not significant. Conclusions More than half of patients with duodenal bulge lesions have Hp infection. Hp infection is associated with elevated histopathological inflammation, but not with its endoscopic appearance and severity. Eradication of Hp can significantly reduce the inflammation, gastric epithelial metaplasia narrowed or subsided.