持续幽门螺杆菌感染对胃黏膜的作用及其转归的影响因素

目的　探讨幽门螺杆菌 (Hp)长期感染对胃黏膜的作用及其转归的影响因素。方法随访 114例 10年前诊断Hp感染的患者 ,分析对比 10年前后其Hp感染情况、胃镜和病理组织学变化。并检测了其中 80例Hp持续感染者血清抗HpCagA IgG和抗HpIgE ,分析它们与Hp长期感染不同转归的关系。结果　 114例患者中 34例 (2 9 8% )Hp转阴 ,80例 (70 2 % )Hp持续阳性。Hp感染持续 10年后消化性溃疡的发生率、胃黏膜慢性炎症程度、肠上皮化生 (IM )和糜烂的发生率均显著增加 ,其IM严重程度显著加剧。而Hp转阴者消化性溃疡的发生率、胃黏膜慢性炎症程度均显著低于 10年前 ,并显著低于Hp持续阳性者。Hp长期感染后发展为消化性溃疡 (PU)者血清抗HpCagA IgG和抗HpIgE阳性率显著高于持续保持慢性浅表性胃炎 (CSG)不变者 ,发生黏膜糜烂和IM者血清抗HpCagA IgG阳性率显著高于不发生黏膜糜烂和IM者 ,均P <0 0 0 5 ,而胃黏膜的慢性炎症程度是否加剧与CagA无关。结论　Hp持续感染可增加消化性溃疡的发生率 ,加剧胃黏膜的炎症程度 ,并促进肠上皮化生的形成和发展 ,根除Hp不仅能减轻胃黏膜的炎症程度 ,而且能阻止肠上皮化生的发生和发展。CagA阳性菌株和产生抗HpIgE的个体 ,其Hp长期感染后病变的转归均较阴性者严重 ,因此 ,对于这类患者应

Long-term effects of Helicobacter pylori infection on gatric mucosa and the influencing facter of outcome

Objective To study long-term effects of Helicobacter pylori (H. pylori) infection on gastric mucosa and nfluencing factors of outcomes of Long-term H.pylori infection.Methods The 114 patients who was H. pylori positive before decade were examined by endoscopy and pathology and the contents of serum Anti-Hp CagA-IgG and anti-Hp IgE of 80 patients who was persistent H. pylori infection for 10 years was examined.Results 34/114(29.8%) patients were H. pylori negative and 80/114(70.2%) patients persistent H. pylori positive. In H.pylori persistent positive patients, After decade the incidence of peptic ulcer was increased significantly, the incidence of intestinal metaplasia and erosion of gastric mucosa was increased significantly, the degree of gastritis and intestinal metaplasia was aggravated significantly. But in H. pylori negative patients, the incidence of peptic ulcer and the degree of gastritis were lower significantly in after decade than before decade and that of H. pylori persistent positive patients. In H.pylori negative patients, The erosion of gastric mucosa dissolved after decade, but the incidence and degree of intestinal metaplasia did not changed. After H. pylori persistent infection for 10 years , The positive rate of serum anti-Hp CagA-IgG and anti-Hp IgE were significantly higher in the patients that occured peptic ulcer than that retained gastritis(P<0.005). The positive rate of serum Anti-Hp CagA-IgG were significantly higher in the patients that occured erosion of gastric mucosa and intestinal metaplasia than that did not occured erosion of gastric mucosa and intestinal metaplasia (P<0.005). But There was not correlation between anti-Hp CagA-IgG and the aggravation of inflammation of gastric mucosa.After H. pylori persistent infection for 10 years, The positive rate of serum anti-Hp IgE were significantly higher in the patients that occured erosion of gastric mucosa and whose inflammation of gastric mucosa aggravated than that did not occured erosion of gastric mucosa and whose H inflammation of gastric mucosa did not aggravated(P<0.005).But There was not correlation between anti-Hp IgE and generation of intestinal metaplasia. Conclusions The H. pylori persistent infection can increase the incidence of peptic ulcer, aggravate inflammation of gastric mucosa, and accelerate the generation and progress of intestinal metaplasia. Eradication of H. pylori not only can reduce inflammation of gastric mucosa, but also prevent the generation and progress of intestinal metaplasia. CagA strain and anti-Hp IgE positive person have more severity outcome of long-term H. pylori infection than CagA - strain and anti-Hp IgE negative person.