Kokkola Arto, Kosunen Timo U, Puolakkainen Pauli, Sipponen Pentti, Harkonen Matti, Laxen Frank, Virtamo Jarmo, Haapiainen Reijo, Rautelin Hilpi
Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland.
APMIS. 2003 Jun;111(6):619-24. doi: 10.1034/j.1600-0463.2003.1110604.x.
Background. Only a few reported studies focus on the natural history and course of advanced and severe chronic atrophic gastritis. Methods. In this study we followed 47 men (mean age 62 years) with advanced (moderate or severe) Helicobacter pylori-positive atrophic corpus gastritis. Duration of endoscopic follow-up was 6 years and follow-up based on serum levels of pepsinogen I and antibodies to H. pylori covered a period of 10 years. None of the patients was treated for H. pylori infection prior to end of follow-up. Results. The median H. pylori antibody titre declined (IgG from 4000 to 1300; IgA from 200 to 50) in the study population, and 11 men (23%) converted to seronegative (p=0.0005, Fisher's exact test). There was a small but significant (p=0.0004, Page's test) declining trend in mean atrophy score of the corpus during follow-up (from 2.5 to 2.2). However, no significant changes were observed in grade of atrophy or intestinal metaplasia of the antral mucosa or in grade of intestinal metaplasia in the corpus. The mean SPGI level remained at the initial low level during the entire follow-up. Conclusions. H. pylori antibodies disappear spontaneously within 10 years in almost one fourth of patients with advanced atrophic corpus gastritis. The disappearance of H. pylori antibodies is accompanied by no or more than a mild improvement of the gastric mucosa.
背景。仅有少数已发表的研究关注进展期和重度慢性萎缩性胃炎的自然病史和病程。方法。在本研究中，我们对47名男性（平均年龄62岁）进行了随访，这些男性患有进展期（中度或重度）幽门螺杆菌阳性的胃体萎缩性胃炎。内镜随访时间为6年，基于胃蛋白酶原I血清水平和幽门螺杆菌抗体的随访时间为10年。在随访结束前，所有患者均未接受幽门螺杆菌感染治疗。结果。研究人群中幽门螺杆菌抗体滴度中位数下降（IgG从4000降至1300；IgA从200降至50），11名男性（23%）转为血清学阴性（p=0.0005，Fisher精确检验）。随访期间胃体平均萎缩评分有小幅度但显著的下降趋势（p=0.0004，Page检验）（从2.5降至2.2）。然而，胃窦黏膜萎缩程度或肠化生程度以及胃体肠化生程度均未观察到显著变化。整个随访期间，血清胃蛋白酶原I水平维持在初始的低水平。结论。在几乎四分之一的进展期胃体萎缩性胃炎患者中，幽门螺杆菌抗体在10年内会自发消失。幽门螺杆菌抗体消失时，胃黏膜无改善或仅有轻微改善。
