非幽门螺杆菌性胃炎：一种与幽门螺杆菌感染无关的独特实体。

Helicobacter-negative gastritis: a distinct entity unrelated to Helicobacter pylori infection.

机构信息

Miraca Life Sciences Research Institute, Irving, TX, USA; Departments of Medicine (Gastroenterology) and Pathology, UTSW - Dallas VAMC, Dallas, TX, USA.

出版信息

Aliment Pharmacol Ther. 2015 Jan;41(2):218-26. doi: 10.1111/apt.13007. Epub 2014 Nov 6.

DOI:10.1111/apt.13007

PMID:25376264

Abstract

BACKGROUND

Helicobacter-negative gastritis is diagnosed when no organisms are detected in a gastric mucosa with typical features of Helicobacter gastritis (Hp-gastritis). If Helicobacter-negative gastritis consisted mostly of 'missed' Helicobacter infections, its prevalence should represent a constant percentage of these infections in a population, and their clinico-epidemiological features would overlap.

AIM

To compare the epidemiologic patterns of Hp-positive and Hp-negative gastritis.

METHODS

From a pathology database, we extracted demographic, clinical and histopathological data from patients with gastric biopsies (1.2008-12.2013). We allocated patients to high (≥12%) and low (≤6%) H. pylori prevalence regions defined by ZIP code-based data. The prevalence of H. pylori-positive and -negative gastritis by sex, age and state were expressed as a per cent of the total study population stratified accordingly.

RESULTS

Of 895 323 patients, 10.6% had Hp-gastritis and 1.5% Helicobacter-negative gastritis. Hp-gastritis, but not Helicobacter-negative gastritis, was more common in males than females (OR 1.17, 95% CI: 1.16-1.19). While Hp-gastritis was more prevalent in high than in low-prevalence areas (OR 3.65, 95% CI: 3.57-3.74), Helicobacter-negative gastritis was only minimally affected by the underlying H. pylori prevalence (1.7% vs. 1.5%). The age-specific prevalence of Hp-gastritis peaked in the 4th to 5th decades; Helicobacter-negative gastritis exhibited a low and relatively flat pattern. The geographic distribution of H. pylori-positive and -negative gastritis showed no significant correlation. Intestinal metaplasia was found in 13.0% of patients with Hp-gastritis and in 6.1% of those with Helicobacter-negative gastritis (OR 0.43, 95% CI: 0.40-0.47).

CONCLUSION

These data suggest that Helicobacter-negative gastritis is, in the vast majority of cases, a nosologically and epidemiologically distinct entity that deserves further investigation.

摘要

背景

当胃黏膜具有典型的幽门螺杆菌胃炎（Hp 胃炎）特征而未检测到任何病原体时，诊断为幽门螺杆菌阴性胃炎（Helicobacter-negative gastritis）。如果幽门螺杆菌阴性胃炎主要由“漏诊”的幽门螺杆菌感染组成，那么其患病率应代表人群中此类感染的恒定百分比，且其临床流行病学特征会重叠。

目的

比较幽门螺杆菌阳性和阴性胃炎的流行病学模式。

方法

我们从病理学数据库中提取了 2013 年 12 月至 2013 年 12 月期间接受胃活检的患者的人口统计学、临床和组织病理学数据。我们根据邮政编码数据将患者分配到高（≥12%）和低（≤6%）幽门螺杆菌患病率地区。按性别、年龄和状态分层，以总研究人群的百分比表示幽门螺杆菌阳性和阴性胃炎的患病率。

结果

在 895323 名患者中，10.6%患有 Hp 胃炎，1.5%患有幽门螺杆菌阴性胃炎。与女性相比，男性更常见 Hp 胃炎（比值比 1.17，95%置信区间：1.16-1.19），但并非幽门螺杆菌阴性胃炎（比值比 1.17，95%置信区间：1.16-1.19）。虽然 Hp 胃炎在高患病率地区比低患病率地区更为普遍（比值比 3.65，95%置信区间：3.57-3.74），但幽门螺杆菌阴性胃炎受潜在幽门螺杆菌患病率的影响极小（1.7%比 1.5%）。Hp 胃炎的年龄特异性患病率在第 4 至 5 个十年达到峰值；幽门螺杆菌阴性胃炎的患病率较低且相对平坦。Hp 阳性和阴性胃炎的地理分布无明显相关性。肠化生在 Hp 胃炎患者中的发生率为 13.0%，在幽门螺杆菌阴性胃炎患者中的发生率为 6.1%（比值比 0.43，95%置信区间：0.40-0.47）。