中国医师杂志
中國醫師雜誌
중국의사잡지
JOURNAL OF CHINESE PHYSICIAN
2012年
10期
1315-1318
,共4页
胆汁返流%胃炎/病因学%儿童
膽汁返流%胃炎/病因學%兒童
담즙반류%위염/병인학%인동
Bile reflux%Gastritis/etiology%Child
目的 探讨儿童胆汁反流性胃炎(BRG)的临床症状、胃镜下病变、病理组织学改变的特征及与幽门螺杆菌感染的关系.方法 对本院有上消化道症状(腹痛、腹胀、纳差、恶心、呕吐、呃逆、泛酸、早饱等)的287例患儿进行胃镜检查、胃组织活检、快速尿素酶试验及13C-尿素呼气试验,其中确诊为胆汁反流性胃炎58例为观察组(BRG组),非胆汁反流性胃炎229例为对照组(非BRG组),比较两组主要临床症状、胃镜下病变、病理组织学改变及H.pylori感染的情况.结果 BRG组患儿腹胀、呕吐、呃逆发生率均高于非BRG组[84.5％ (49/58) vs 66.8％ (153/229)、32.8％(19/58)vs17.9％ (41/229)、29.3％ (17/58) vs 16.6％ (38/229),x2=6.93,6.18,4.83,P＜0.05],但两组患儿腹痛、纳差、恶心及早饱症状发生率无明显差异(P＞0.05).两组患儿胃镜下胃黏膜充血水肿及黏膜斑比较差异无统计学意义(P＞0.05),BRG组胃黏膜糜烂及出血点发生率[37.9％ (22/58) vs22.7％ (52/229)、20.7％(12/58) vs 10.0％ (23/229)]高于非BRG组(x2=5.60,4.90,P＜0.05),微小结节发生率[22.4％ (13/58)]低于非BRG组[37.6％(86/229),x2=4.69,P＜0.05].两组患儿病理组织学中上皮细胞变性、增生和固有膜淋巴细胞及中性粒细胞浸润比较差异均无统计学意义(P＞0.05).两组小凹延长及黏膜血管扩张发生率[10.3％ (6/58) vs 3.1％ (7/229)和31.0％(18/58) vs 18.3％ (42/229)]比较差异均有统计学意义(x2=5.97,4.51,P＜0.05).BRG组固有膜淋巴滤泡形成发生率[12.1％ (7/58)]低于非BRG组[24.0％(55/229),x2=3.90,P＜0.05].BRG组H.pylori阳性率[22.4％ (13/58)]低于非BRG组[40.2％(92/229),x2=6.29,P＜0.05].结论 BRG患儿以腹胀、呕吐、嗝逆为特征性症状.胃镜特征性表现为胃黏膜糜烂、伴出血斑点,以胃窦黏膜改变最为明显.胃黏膜浅层血管扩张充血,小凹延长等病理学改变提示胆汁反流性胃炎的可能,而胆汁反流的胃炎患儿H.pylori感染相对较低.根据上述临床特征,可以有助于早期诊断BRG,从而指导临床治疗,提高治愈率.
目的 探討兒童膽汁反流性胃炎(BRG)的臨床癥狀、胃鏡下病變、病理組織學改變的特徵及與幽門螺桿菌感染的關繫.方法 對本院有上消化道癥狀(腹痛、腹脹、納差、噁心、嘔吐、呃逆、汎痠、早飽等)的287例患兒進行胃鏡檢查、胃組織活檢、快速尿素酶試驗及13C-尿素呼氣試驗,其中確診為膽汁反流性胃炎58例為觀察組(BRG組),非膽汁反流性胃炎229例為對照組(非BRG組),比較兩組主要臨床癥狀、胃鏡下病變、病理組織學改變及H.pylori感染的情況.結果 BRG組患兒腹脹、嘔吐、呃逆髮生率均高于非BRG組[84.5％ (49/58) vs 66.8％ (153/229)、32.8％(19/58)vs17.9％ (41/229)、29.3％ (17/58) vs 16.6％ (38/229),x2=6.93,6.18,4.83,P＜0.05],但兩組患兒腹痛、納差、噁心及早飽癥狀髮生率無明顯差異(P＞0.05).兩組患兒胃鏡下胃黏膜充血水腫及黏膜斑比較差異無統計學意義(P＞0.05),BRG組胃黏膜糜爛及齣血點髮生率[37.9％ (22/58) vs22.7％ (52/229)、20.7％(12/58) vs 10.0％ (23/229)]高于非BRG組(x2=5.60,4.90,P＜0.05),微小結節髮生率[22.4％ (13/58)]低于非BRG組[37.6％(86/229),x2=4.69,P＜0.05].兩組患兒病理組織學中上皮細胞變性、增生和固有膜淋巴細胞及中性粒細胞浸潤比較差異均無統計學意義(P＞0.05).兩組小凹延長及黏膜血管擴張髮生率[10.3％ (6/58) vs 3.1％ (7/229)和31.0％(18/58) vs 18.3％ (42/229)]比較差異均有統計學意義(x2=5.97,4.51,P＜0.05).BRG組固有膜淋巴濾泡形成髮生率[12.1％ (7/58)]低于非BRG組[24.0％(55/229),x2=3.90,P＜0.05].BRG組H.pylori暘性率[22.4％ (13/58)]低于非BRG組[40.2％(92/229),x2=6.29,P＜0.05].結論 BRG患兒以腹脹、嘔吐、嗝逆為特徵性癥狀.胃鏡特徵性錶現為胃黏膜糜爛、伴齣血斑點,以胃竇黏膜改變最為明顯.胃黏膜淺層血管擴張充血,小凹延長等病理學改變提示膽汁反流性胃炎的可能,而膽汁反流的胃炎患兒H.pylori感染相對較低.根據上述臨床特徵,可以有助于早期診斷BRG,從而指導臨床治療,提高治愈率.
목적 탐토인동담즙반류성위염(BRG)적림상증상、위경하병변、병리조직학개변적특정급여유문라간균감염적관계.방법 대본원유상소화도증상(복통、복창、납차、악심、구토、애역、범산、조포등)적287례환인진행위경검사、위조직활검、쾌속뇨소매시험급13C-뇨소호기시험,기중학진위담즙반류성위염58례위관찰조(BRG조),비담즙반류성위염229례위대조조(비BRG조),비교량조주요림상증상、위경하병변、병리조직학개변급H.pylori감염적정황.결과 BRG조환인복창、구토、애역발생솔균고우비BRG조[84.5％ (49/58) vs 66.8％ (153/229)、32.8％(19/58)vs17.9％ (41/229)、29.3％ (17/58) vs 16.6％ (38/229),x2=6.93,6.18,4.83,P＜0.05],단량조환인복통、납차、악심급조포증상발생솔무명현차이(P＞0.05).량조환인위경하위점막충혈수종급점막반비교차이무통계학의의(P＞0.05),BRG조위점막미란급출혈점발생솔[37.9％ (22/58) vs22.7％ (52/229)、20.7％(12/58) vs 10.0％ (23/229)]고우비BRG조(x2=5.60,4.90,P＜0.05),미소결절발생솔[22.4％ (13/58)]저우비BRG조[37.6％(86/229),x2=4.69,P＜0.05].량조환인병리조직학중상피세포변성、증생화고유막림파세포급중성립세포침윤비교차이균무통계학의의(P＞0.05).량조소요연장급점막혈관확장발생솔[10.3％ (6/58) vs 3.1％ (7/229)화31.0％(18/58) vs 18.3％ (42/229)]비교차이균유통계학의의(x2=5.97,4.51,P＜0.05).BRG조고유막림파려포형성발생솔[12.1％ (7/58)]저우비BRG조[24.0％(55/229),x2=3.90,P＜0.05].BRG조H.pylori양성솔[22.4％ (13/58)]저우비BRG조[40.2％(92/229),x2=6.29,P＜0.05].결론 BRG환인이복창、구토、격역위특정성증상.위경특정성표현위위점막미란、반출혈반점,이위두점막개변최위명현.위점막천층혈관확장충혈,소요연장등병이학개변제시담즙반류성위염적가능,이담즙반류적위염환인H.pylori감염상대교저.근거상술림상특정,가이유조우조기진단BRG,종이지도림상치료,제고치유솔.
Objective To compare the clinical symptoms,endoscopic lesions,pathological histological changes,and H.pylori infection between children with bile reflux gastritis (BRG) and non BRG.Methods 287 cases of children with upper gastrointestinal symptoms were diagnosed with gastritis by gastroscopy.They included 58 cases of BRG and 229 cases of non-BRG.The clinical symptoms,endoscopic lesions,pathological histological changes,and H.pylori infection were compared between two groups,respectively.Results Between BRG and non-BRG groups,there werent statistically significant difference in the main clinical symptoms including abdominal pain,anorexia,nausea,and early satiety.Incidence of abdominal distension,vomiting,and hiccups was[84.5％ (49/58) vs 66.8％ (153/229),32.8％ (19/58) vs 17.9％ (41/229),and 29.3％ (17/58) vs 16.6％ (38/229)],respectively,with statistical significance (x2 =6.93,6.18,4.83,P ＜0.05).There weren(t) statistically significant difference in endoscopic lesions congestion,edema,and mucosal plaques between two groups.Incidence of endoscopic gastric erosions and bleeding of two groups was [37.9％ (22/58) vs 22.7％ (52/229),20.7％ (12/58) vs 10.0％ (23/ 229)],respectively; and BRG group was statistically higher than non-BRG group(x2 =5.60,4.90,P ＜ 0.05).For micronodular change,there were 13 cases (22.4％) in BRG group and 86 cases (37.6％) in Non-BRG group,and Non-BRG group was statistically higher than BRG group(x2 =4.69,P ＜ 0.05).For histopathological changes including epithelial cell degeneration,hyperplasia and lamina propria lymphocyte and neutrophil infiltration,there wasnt statistically significant difference between BRG and non-BRG groups.Incidence about pit extension and mucosal vascular expansion of two groups was [10.34％ (6/58) vs 3.1％ (7/229) and 31.0 ％ (18/58) vs 18.3 ％ (42/229)],respectively ; and BRG group was significantly higher than non-BRG group(x2 =5.97,4.51,P ＜ 0.05).There were 7 cases (12.1％) in BRG group and 55 cases (24.0％) about lamina propria lymphoid follicles,and Non-BRG group was significantly higher than BRG group (x2 =3.90,P ＜0.05).H.pylori positive rates were[22.41％ (13/58),and 40.17％ (92/ 229)],respectively.BRG group and non-BRG group were found statistically significant (x2 =6.29,P ＜0.05).Conclusions BRG children with the characteristic symptoms were abdominal distension,vomiting,and hiccup inverse.Endoscopic characteristic performance was gastric erosions,bleeding spots in antral mucosa changes apparently.Mucosal vascular expansion and pit extension may prompt gastric in children with duodenogastric reflux.H.pylori positive rates of those gastric in children with bile reflux were relatively low.The clinical features could help early diagnosis BRG and guide clinical treatment to improve the cure rate.
