Yang H B, Sheu B S, Su I J, Chien C H, Lin X Z
Department of Pathology, National Cheng Kung University Hospital, Tainan, Taiwan.
Dig Dis Sci. 1997 Sep;42(9):1835-40. doi: 10.1023/a:1018894606541.
This preliminary study attempted to test whether pretreatment gastric histology of H. pylori infection may affect the success of dual therapy and to identify which parameter of gastric histology could be improved after dual therapy. One hundred forty-five dyspeptic patients with H. pylori infection received a two-week course of dual therapy (Amoxicillin 500 mg every 6 hr plus omeprazole 20 mg twice a day). In each patient, three pairs of gastric biopsies, sampled from the antrum, lower body, and upper body near the cardia, were collected before treatment and four weeks after completion of dual therapy. The density of H. pylori (score 1-5) and parameters of the modified Sydney system were applied to test the severity of H. pylori-related gastric histology in each specimen. The total bacterial load (score 1-15) was a sum of the density of H. pylori sampled from three biopsies. The overall rate of H. pylori eradication rate by dual therapy is 73.1% (106/145). Univariate analysis of parameters in pretreatment histology disclosed that the presence of mucosal atrophy (P < 0.01), lymphoid follicles (P < 0.005), and higher-density H. pylori (P < 0.001) predisposed to dual therapy failure. Multivariate analysis by stepwise logistic regression further confirmed that both the density of bacteria and the presence of lymphoid follicles are the two major factors related to the outcome of dual therapy (P < 0.001). Four weeks after dual therapy was completed, only patients with successful eradication significantly improved in these gastric histology parameters: acute activity, chronic inflammation, eosinophil infiltration, and mucosal atrophy. However, the lymphoid follicle and intestinal metaplasia were not significantly improved during the study period. The eradication rates among three subgroups with different total bacterial loads (group I: 1-5; II: 6-10; III: 11-15) disclosed a downward trend (I: 89.1%; II: 73%; III: 52.7%). It is concluded that dual therapy could improve gastric histology especially among patients with successful eradication of H. pylori. Evaluating pretreatment histologic parameters, including the density of H. pylori and the presence of lymphoid follicles, is valuable in predicting the success of dual therapy.
这项初步研究试图检验幽门螺杆菌感染的预处理胃组织学是否会影响双重疗法的成功率，并确定双重疗法后胃组织学的哪些参数可以得到改善。145例幽门螺杆菌感染的消化不良患者接受了为期两周的双重疗法疗程（阿莫西林500毫克，每6小时一次，加奥美拉唑20毫克，每天两次）。在每位患者中，治疗前和双重疗法完成后四周收集了三对胃活检样本，分别取自胃窦、胃下体和贲门附近的胃上体。应用幽门螺杆菌密度（评分1 - 5）和改良悉尼系统的参数来检测每个样本中幽门螺杆菌相关胃组织学的严重程度。总细菌负荷（评分1 - 15）是从三次活检样本中抽取的幽门螺杆菌密度之和。双重疗法的幽门螺杆菌总体根除率为73.1%（106/145）。对预处理组织学参数的单因素分析表明，黏膜萎缩（P < 0.01）、淋巴滤泡（P < 0.005）以及高密度幽门螺杆菌（P < 0.001）的存在易导致双重疗法失败。通过逐步逻辑回归进行的多因素分析进一步证实，细菌密度和淋巴滤泡的存在是与双重疗法结果相关的两个主要因素（P < 0.001）。双重疗法完成四周后，只有根除成功的患者在这些胃组织学参数上有显著改善：急性活动度、慢性炎症、嗜酸性粒细胞浸润和黏膜萎缩。然而，在研究期间，淋巴滤泡和肠化生没有显著改善。三个不同总细菌负荷亚组（I组：1 - 5；II组：6 - 10；III组：11 - 15）的根除率呈下降趋势（I组：89.1%；II组：73%；III组：52.7%）。结论是双重疗法可以改善胃组织学，特别是在成功根除幽门螺杆菌的患者中。评估预处理组织学参数，包括幽门螺杆菌密度和淋巴滤泡的存在，对预测双重疗法的成功很有价值。
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