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目的研究反流性食管炎(RE)胃黏膜病理改变和幽门螺杆菌(H.pylori)感染的差异。方法选取从2007年1月至6月在北京大学第三医院消化科行胃镜检查证实的RE患者178例,按洛杉矶标准进行分级后分为A、B、C、D4组,并取胃黏膜组织行病理检查,对比各组的H.pylori感染率、感染部位、感染程度的差异以及胃炎的类型(浅表性胃炎和萎缩性胃炎)及活动度的差异。结果(1)反流程度越重,患者年龄越大(A组与B组比较,P<0.05;A组与C组或D组比较,P<0.01;B组与C组或D组比较,P<0.01);(2)反流程度越重,胃窦的H.pylori感染率及感染程度越轻(分别为P=0.002及P=0.002),胃窦的炎症越轻(P=0.003);在反流程度不同的各组中,胃体的H.pylori感染率(P=0.106)、感染程度(P=0.071)以及胃体的炎症程度差异无统计学意义(P=0.427)。结论H.pylori感染与RE形成有负相关性;反流程度越重,胃窦的炎症越轻。
Objective To study the difference of gastric mucosal pathological changes and Helicobacter pylori (H.pylori) infection in patients with reflux esophagitis (RE). Methods 178 cases of RE patients confirmed by gastroscopy from the Department of Gastroenterology, Peking University Third Hospital from January 2007 to June 2007 were divided into A, B, C and D4 groups according to the standard of Los Angeles, and the gastric mucosa Histopathological examination was performed to compare the H.pylori infection rate, the location of infection, the degree of infection, and the type of gastritis (superficial gastritis and atrophic gastritis) and activity. Results (1) The heavier the degree of reflux, the older the patients (P <0.05 for group A and group B; P <0.01 for group A compared with group C or D; (P = 0.002 and P = 0.002, respectively), and the inflammation in the antrum was lower (P = 0.003). (2) The more severe reflux was, the lesser degree of infection and infection of H.pylori in the antrum There were no significant differences in H.pylori infection rate (P = 0.106), infection level (P = 0.071) and gastric inflammation in the groups with different reflux degrees (P = 0.427). Conclusions There is a negative correlation between H.pylori infection and the formation of RE. The more severe the reflux, the less inflammation of the antrum.