幽门螺杆菌感染治愈一年后的萎缩与肠化生：一项前瞻性随机研究。

Atrophy and intestinal metaplasia one year after cure of H. pylori infection: a prospective, randomized study.

作者信息

Sung J J, Lin S R, Ching J Y, Zhou L Y, To K F, Wang R T, Leung W K, Ng E K, Lau J Y, Lee Y T, Yeung C K, Chao W, Chung S C

机构信息

Endoscopy Center, Chinese University of Hong Kong, Hong Kong.

出版信息

Gastroenterology. 2000 Jul;119(1):7-14. doi: 10.1053/gast.2000.8550.

DOI:10.1053/gast.2000.8550

PMID:10889149

Abstract

BACKGROUND & AIMS: Helicobacter pylori-infected gastric mucosa evolves through stages of chronic gastritis, intestinal metaplasia (IM), glandular atrophy (GA), and dysplasia before carcinoma develops. We studied if H. pylori eradication would alter the course of premalignant histologic changes in the stomach.

METHODS

Volunteers from the Yantai County in China underwent upper endoscopy with biopsy specimens obtained from the antrum and corpus. H. pylori-infected subjects were randomized to receive either a 1-week course of omeprazole, amoxicillin, and clarithromycin (OAC) or placebo. At 1 year, endoscopies with biopsies were repeated.

RESULTS

A total of 587 H. pylori-infected subjects were randomized to OAC (n = 295) and placebo (n = 292). At 1 year, H. pylori was eradicated in 226 subjects assigned to OAC. In the placebo group, 245 patients remained H. pylori infected. Analysis of paired samples obtained from the same patients showed that acute and chronic gastritis decreased in both the antrum and corpus after H. pylori eradication (P<0.001) and activity of IM decreased in antrum (P = 0.014). In the H. pylori-infected group, antral biopsy specimens had more pronounced acute gastritis (P = 0.01), whereas corpus specimens showed increased acute and chronic gastritis (P<0.001) and a marginal increase in GA (P = 0.052). When histologic changes were compared between the 2 groups, decrease in acute and chronic gastritis was more frequent after H. pylori eradication (P<0.001) but changes in IM were similar. In the H. pylori-infected group, increase in GA was seen in the corpus (P = 0.01).

CONCLUSIONS

At 1 year, H. pylori eradication is beneficial in preventing progression of pathologic changes of the gastric mucosa.

摘要

背景与目的

幽门螺杆菌感染的胃黏膜在癌变发生前会经历慢性胃炎、肠化生（IM）、腺体萎缩（GA）和发育异常等阶段。我们研究了根除幽门螺杆菌是否会改变胃内癌前组织学变化的进程。

方法

来自中国烟台县的志愿者接受了上消化道内镜检查，并从胃窦和胃体获取活检标本。幽门螺杆菌感染的受试者被随机分为接受为期1周的奥美拉唑、阿莫西林和克拉霉素（OAC）治疗或安慰剂治疗。1年后，重复进行内镜检查及活检。

结果

共有587名幽门螺杆菌感染的受试者被随机分为OAC组（n = 295）和安慰剂组（n = 292）。1年后，分配到OAC组的226名受试者的幽门螺杆菌被根除。在安慰剂组中，245名患者仍感染幽门螺杆菌。对同一患者的配对样本分析显示，根除幽门螺杆菌后胃窦和胃体的急性和慢性胃炎均有所减轻（P<0.001），胃窦内IM的活性降低（P = 0.014）。在幽门螺杆菌感染组中，胃窦活检标本的急性胃炎更为明显（P = 0.01），而胃体标本显示急性和慢性胃炎增加（P<0.001），GA略有增加（P = 0.052）。当比较两组的组织学变化时，根除幽门螺杆菌后急性和慢性胃炎的减轻更为常见（P<0.001），但IM的变化相似。在幽门螺杆菌感染组中，胃体的GA增加（P = 0.01）。