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目的 观察胃癌高发区中幽门螺杆菌 (Hp)阳性者根除Hp 5年后胃黏膜组织的炎症变化 ,以探讨Hp感染与胃黏膜组织炎症及胃癌的关系。方法 对胃癌高发区山东省烟台市成年人群随机抽样 1 0 0 6例 ,做内镜、快速尿素酶试验及胃窦、胃体部黏膜组织学检查 ,将Hp阳性者随机分为治疗组 (奥美拉唑 2 0mg、克拉霉素 50 0mg、阿莫西林 1 0 0 0mg)及对照组 ,2组入选者分别于 1年后、5年后进行内镜复检 ,本研究是将 5年后复查胃镜及相同部位胃黏膜组织病理检查与 5年前结果进行比较并做 χ2 检验。结果 552例Hp阳性者随机分为治疗组及对照组各 2 76例 ,5年后Hp持续阴性者 1 61例 ,持续阳性者 1 98例。 2组结果统计显示 :(1 )入选前 2组胃窦部炎症及活动度发生率与体部相比差异无显著性 ,P值分别为 0 1 0 5及 0 0 84,但萎缩及肠化生发生率明显高于体部 ,P值均为0 0 0 0 ;(2 )根除Hp 5年后胃窦、胃体部炎症及活动度均明显减轻 ,P值均为 0 0 0 0 ;(3)根除Hp 5年后胃窦部肠化生减轻或未进展 ,而Hp持续阳性组肠化生发生率明显增加 ,P =0 0 32 ;(4)根除Hp 5年后窦、体部萎缩改善差异无显著性 ,两组比较P值分别为 0 2 2 3及 0 40 2。结论 根除Hp可使胃慢性炎症及活动度明显减轻 ,窦部肠化生得到显著控制 ,溃疡病发?
Objective To observe the changes of gastric mucosal inflammation in Hp-positive patients after 5 years of eradication of Hp in high-incidence areas of gastric cancer so as to investigate the relationship between Hp infection and gastric mucosal inflammation and gastric cancer. Methods A total of 106 adult patients with high incidence of gastric cancer in Yantai, Shandong Province were enrolled in the study. Endoscopy, rapid urease test and gastric mucosa histological examination were performed. Hp positive patients were randomly divided into treatment group Melazocine 20mg, clarithromycin 50mg, amoxicillin 100mg) and control group, two groups were selected one year later, 5 years after endoscopic retest, the study will be 5 years later Review of gastroscopy and gastric mucosa of the same site histopathological examination compared with the results of 5 years ago and do χ2 test. Results 552 cases of Hp positive were randomly divided into treatment group and control group, 2 76 cases each. After 5 years, 61 cases were persistent negative Hp, and 1 98 cases were persistent positive. The results of the two groups showed that: (1) There was no significant difference in the incidence of gastric antrum inflammation and activity between the two groups before admission, with P values of 0 105 and 0 0 84 respectively, but the atrophy and intestinal metaplasia (P <0.01). (2) After 5 years of eradication of Hp, inflammation and activity of gastric antrum and gastric body were significantly reduced, P values were 0 0 0 0; ( 3) After 5 years of eradication of Hp, intestinal metaplasia in the gastric antrum was reduced or not progressing while the incidence of intestinal metacercaria was still significantly increased in the Hp persistent positive group (P = 0 0 32); (4) There was no significant difference between the two groups, P values were 0 2 2 3 and 0 40 2 respectively. Conclusion Eradication of Hp can significantly reduce the chronic inflammation and activity of gastric mucosa, and significantly control the intestinal metacercaria.