CAJ | 학술논문

目的评估上消化道H.heilmannii感染的临床表现、内镜诊断、病理特征,探讨该菌在上消化道疾病中的致病特点,并与Hpylori相关性胃炎相比较.方法收集并分析2005至2007年间3107例胃镜受检者的临床资料、内镜表现及病理活检标本.结果共检出25例H.heilmannii感染,1060例H.pylori感染,3例混合感染.H.heilmannii感染患者中,20例有不同程度的上消化道症状,主要为上腹胀痛、恶心、食欲下降,5例无明显自觉症状;患者内镜下均有慢性胃炎的表现,其中单纯慢性浅表性胃炎7例,伴糜烂3例,萎缩肠化4例,十二指肠球炎2例,胆汁反流、溃疡、息肉各1例;尿素酶试验强阳性3例,阳性3例,弱阳性7例,阴性12例.组织学上,H.heilmannii散在或聚集于胃小凹、腺腔内或上皮表面的黏液层内,1 例标本中可见H.heilmannii侵入壁细胞内.所有H.heilmannii感染者均可见散在的淋巴细胞、浆细胞浸润,12例见中性粒细胞浸润,4例见腺体萎缩和肠化,6例见淋巴滤泡形成.炎症程度总体上较H.pylori感染轻,H.heilmannii相关胃炎中螺杆菌密度、淋巴细胞浸润和中性粒细胞活性程度低于H.pylori相关性胃炎组(P<0.05).结论 H.heilmannii感染主要引起慢性胃炎,其炎症程度轻于H.pylori相关性胃炎.
목적 평고상소화도H.heilmannii감염적림상표현、내경진단、병리특정,탐토해균재상소화도질병중적치병특점,병여Hpylori상관성위염상비교.방법 수집병분석2005지2007년간3107례위경수검자적림상자료、내경표현급병리활검표본.결과 공검출25례H.heilmannii감염,1060례H.pylori감염,3례혼합감염.H.heilmannii감염환자중,20례유불동정도적상소화도증상,주요위상복창통、악심、식욕하강,5례무명현자각증상;환자내경하균유만성위염적표현,기중단순만성천표성위염7례,반미란3례,위축장화4례,십이지장구염2례,담즙반류、궤양、식육각1례;뇨소매시험강양성3례,양성3례,약양성7례,음성12례.조직학상,H.heilmannii산재혹취집우위소요、선강내혹상피표면적점액층내,1 례표본중가견H.heilmannii침입벽세포내.소유H.heilmannii감염자균가견산재적림파세포、장세포침윤,12례견중성립세포침윤,4례견선체위축화장화,6례견림파려포형성.염증정도총체상교H.pylori감염경,H.heilmannii상관위염중라간균밀도、림파세포침윤화중성립세포활성정도저우H.pylori상관성위염조(P<0.05).결론 H.heilmannii감염주요인기만성위염,기염증정도경우H.pylori상관성위염.
Objective To evaluate the clinical manifestations, endoscopic features and the clinical pathological characteristics of H. heilmannii-associated gastritis, and to compare these variables with those of H. pylori-ussociated gastritis. Methods The clinical data, endoscopic findings and pathologic characteristics of 3107 patients, who underwent endoscopy from 2005 to 2007, were retrospectively analyzed. Results Twenty-five cases of H. heilmannii infection were identified, the infection rates of H. heilmannii and H. pylori were 0.80% (25/3107) and 4.12% (1060/3107) respectively. Three cases were mixed infections. Of 25 patients, 20 showed such gastroenterologic symptoms to a greater or less extent as abdominal distending pain,nausea and anorexia, and other 5 cases were asymptomatic. All 25 patients showed chronic gastritis by en-doscopy, including chronic superficial gastritis (7/25, 28% ), erosion ( 3/25, 12% ), chronic atrophic gastritis (4/25, 16%), bile reflux(1/25, 4%), ulcer (1/25, 4%), polyp (1/25, 4%) and duodenal bulbar inflammation (2/25, 8% ). In rapid urease test, 3 cases were hyper-positive, 3 cases positive, 7 ca-ses mild-positive and 12 cases negative. According to histological observation, H. heilmannii scattered or ac-cumulated within the gastric pits, glandular lumen or mucus. The organism was observed in parietal cells with cell damage in one case. Sporadic lymphatic and plasmic infiltration were found in all patients with H.heilmannii infection, infiltration of neutrophils (12/25), gland atrophy and intestinal metaplasia (4/25)and lymphoid follicles (6/25) were also observed. Compared with H. pylori-associated gastritis, H. heilman-nii-associated gastritis showed less inflammation, less helicobacter density, mononuclear cell infiltration and neutrophilic activity ( P < 0.05 ). Conclusion H. heilmanaii mainly induces chronic gastritis, which is less severe than H. pylori-associated gastritis.