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目的观察放大内镜直视下慢性胃炎患者幽门螺杆菌(Hp)感染时的胃黏膜微细形态变化。方法使用手动变焦电子放大内镜(Olympus GIF Q-240Z),对190例有不同上消化道症状患者的胃体集合静脉和胃窦小凹形态进行放大观察,并在所观察部位活检作病理组织学检查及快速尿素酶检测,以研究两者之间的相互关系。结果放大内镜下胃体下段集合静脉分为规则型(R)、不规则型(I)、消失型(D)三型,Hp感染率分别为6．0％、61．9％和72．4％,其中D型和I型的Hp感染率明显高于R 型(xRI2=36．86,XDR2=81．40,P值均<0．01)。胃小凹形态分为A、B、C、D、E五型,中度以上炎症的发病率分别为10．0％、23．1％、68．9％、10．0％和4．6％。黏膜萎缩及肠上皮化生主要发生在C、D、E三型。黏膜萎缩发生率分别为26．2％、90．0％和95．5％;肠上皮化生发生率分别为11．5％、65．0％和 95．5％。B、C、D三型存在Hp感染,其Hp感染发生率分别是29．0％(29／100)、66．7％(34／51)和 33．3％(6／18),三型间比较差异有统计学意义(XBC2=19．71,P<0．01;XCD2=6．07,P<0．05)。结论放大内镜下Hp感染的胃黏膜表现为集合静脉模糊、混乱或消失;胃小凹稀疏而粗大,开口扩张、表面发红。
Objective To observe the changes of gastric mucosal microfold morphology in patients with chronic gastritis treated with magnifying endoscopy under Helicobacter pylori (Hp) infection. Methods A total of 190 patients with different symptoms of upper gastrointestinal tract were treated with magnification endoscopy (Olympus GIF Q-240Z). The morphology of the vena cava and the antrum of the gastric antrum were magnified and biopsied for histopathological examination And rapid urease test to study the relationship between the two. Results The enlargement of the inferior vena cava under the endoscope was divided into three types: regular type (R), irregular type (I) and disappearing type (D). The infection rates of Hp were 6.0%, 61.9% and 72% respectively. 4%. The Hp infection rate of type D and type I was significantly higher than that of type R (xRI2 = 36.86, XDR2 = 81.40, P <0.01). Gastrogavage morphology was divided into A, B, C, D, E five types, the incidence of moderate inflammation were 10.0%, 23.1%, 68.9%, 10.0% and 4.6 %. Mucosal atrophy and intestinal metaplasia mainly occurs in C, D, E three types. Mucosal atrophy rates were 26.2%, 90.0% and 95.5%, respectively. The incidence of intestinal metaplasia was 11.5%, 65.0% and 95.5%, respectively. The prevalence of Hp infection was 29.0% (29/100), 66.7% (34/51) and 33.3% (6/18) in type B, C and D, The difference was statistically significant (XBC2 = 19.71, P <0.01; XCD2 = 6.07, P <0.05). Conclusions Magnified endoscopic Hp infection of the gastric mucosa showed a collection of veins fuzzy, confused or disappeared; gastric fossa sparse and coarse, open expansion, the surface redness.