Testoni Pier Alberto, Bonassi Umberto, Bagnolo Francesco, Colombo Elena, Scelsi Roberto
Division of Gastroenterology and Gastrointestinal Endoscopy, University Vita-Salute San Raffaele, IRCCS San Raffaele Hospital, Milano, Italy.
J Clin Gastroenterol. 2002 Sep;35(3):234-9. doi: 10.1097/00004836-200209000-00007.
histologic detection of shows high diagnostic accuracy in chronic nonatrophic gastritis. However, when atrophy occurs, the sensitivity of bacterial detection varies. This study assessed the routine histologic sensitivity for current infection in patients with atrophic gastritis, with and without intestinal metaplasia.
five hundred and ten consecutive patients with diffuse chronic atrophic gastritis, with (174 cases) and without (336 cases) intestinal metaplasia, were investigated following the Sydney System recommendations. In cases with negative tissue staining for Helicobacter-like organisms, serum immunoglobulin G (IgG) antibodies to were assayed.
the overall rate of positive staining for Helicobacter-like organisms was 51.8% (264 of 510 cases), 62.8% and 30.4% in cases without and with intestinal metaplasia, respectively. Serum IgG antibody determination was consistent with current infection in 180 (73.2%) of the 246 cases with negative histology. detection rate was significantly lower ( < 0.01) in Grade 3 than in Grade 1 atrophy. When intestinal metaplasia was present, histologic bacterial detection progressively decreased, from 46.3% to 20%, depending on severity. infection was found by histology in 42.2% and in 56.2% of cases with inactive and active disease, respectively. Overall, the diagnostic accuracy of histology was significantly lower ( <0.001) than that of histology combined with serology.
most (87.1%) diffuse chronic atrophic gastritis patients showed serum antibody IgG levels consistent with current infection, although histology was positive in only 59.5% of cases. Gastritis activity and current infection did not ever correlate in the presence of mucosal atrophy and/or intestinal metaplasia. Routine biopsy sampling, hematoxylin and eosin staining, and Giemsa staining therefore underestimated the true prevalence of infection.
组织学检测在慢性非萎缩性胃炎中显示出较高的诊断准确性。然而，当出现萎缩时，细菌检测的敏感性会有所不同。本研究评估了伴有和不伴有肠化生的萎缩性胃炎患者当前感染的常规组织学敏感性。
按照悉尼系统建议，对510例连续性弥漫性慢性萎缩性胃炎患者进行了研究，其中伴有肠化生的患者174例，不伴有肠化生的患者336例。对于胃幽门螺杆菌样微生物组织染色阴性的病例，检测血清免疫球蛋白G（IgG）抗体。
胃幽门螺杆菌样微生物染色阳性的总体比例为51.8%（510例中的264例），不伴有肠化生的病例中为62.8%，伴有肠化生的病例中为30.4%。在246例组织学阴性的病例中，180例（73.2%）血清IgG抗体检测结果与当前感染情况一致。3级萎缩患者的检测率显著低于1级萎缩患者（P<0.01）。当存在肠化生时，根据严重程度不同，组织学细菌检测率逐渐降低，从46.3%降至20%。组织学检测发现，非活动性疾病患者中感染率为42.2%，活动性疾病患者中感染率为56.2%。总体而言，组织学的诊断准确性显著低于组织学联合血清学（P<0.001）。
大多数（87.1%）弥漫性慢性萎缩性胃炎患者血清抗体IgG水平与当前感染情况一致，尽管组织学检测仅59.5%的病例呈阳性。在存在黏膜萎缩和/或肠化生的情况下，胃炎活动与当前感染并无关联。因此，常规活检取样、苏木精-伊红染色和吉姆萨染色低估了感染的真实患病率。
