胃黏膜炎症活动度对幽门螺杆菌阳性糖尿病胃轻瘫患者的治疗影响研究

摘要

目的 观察根除幽门螺杆菌(Hp)对糖尿病胃轻瘫(DGP)患者的治疗作用及胃黏膜组织学改变对疗效的影响.方法 纳入100例Hp阳性DGP患者.治疗前胃镜及病理组织学检查以了解胃黏膜炎症情况.随机分为A、B两组.A组给予莫沙比利及雷尼替丁枸橼酸铋三联根除Hp治疗.B组采用莫沙比利及雷尼替丁枸橼酸铋治疗.记录患者治疗前、治疗4周及停药4周时的症状积分.结果 92例完成实验.A组治疗4周后症状积分明显下降(P＜0.01),与停药4周后相比差异无统计学意义(P＞0.05),二者均明显低于B组同期(P分别＜0.05,＜0.01).B组症状积分在治疗4周后明显下降(P＜0.01),停药4周后明显高于治疗4周后(P＜0.05).A组胃黏膜有活动性炎症的患者治疗4周后及停药4周后症状积分均明显低于B组(P＜0.05或0.01).非活动性炎症患者与B组差别无统计学意义(P＞0.05).中重度活动性炎症组停药4周后症状积分明扉低于轻度组(P＜0.05);轻度活动性炎症组及非活动性炎症组均较治疗4周后明显升高(P＜0.01),中重度活动性炎症组症状积分无明显变化(P＞0.05).结论 对Hp阳性的DGP患者,尤其是胃黏膜炎症活动度高者,根除Hp可明显提高疗效,并有效防止停药后症状复发.%Objective To observe the effiacy of helicobacter pylori (Hp) eradication in treatment of diabetic gastroparesis (DGP) and the influence of gastric mucosa inflummation activty on the symptomatic response.Methods 100 DGP patients with Hp infection were included and randomly divided into two groups.The gastric histological changes were examined before treatment.A group received mosapride and ranitidine bismuth triple Hp eradication theapy.B group was adminstered with mosapride and ranitidine bismuth.The symptom scores (SScs) were recorded before treatment ( 1 st time - point) ,4 weeks later ( 2nd time - point) and 4 weeks after eease of treatment (3rd time - point).Results 92 patients completed the study.Compare to the lstime- point.The SSe in A group decreased significantly ( P ＜0.01 ) at 2ndtime- point and not different 3ndtimepoint.Both of the SScs in A group were lower than those in B group at the same times significantly.In B group, the SScs at 2nd time - point was significantly lower than that at lst time - point ( P ＜0.01 ) and 3rdtime - point ( P ＜0.05 ).In A group, the SSes of active gastritis groups at 2nd and 3rd time - point were more mild than B group ( P ＜0.05 or 0.Ol ), there was no significant, difference between inactive gastritis group and B group ( P ＞0.05).At the 3rdtime -point, the SSes of moderatesevere active gastritis group was significantly lower than mild group ( P ＜0.05), the SSes of the mild active gastritis and the inactive gastritis group were higher than those at the 2ndtime -point ( P ＜0.O1 ) , while there was no significant difference in moderate- severe group ( P ＜ ＞ 0.05 ).Conclusion Hp eradication can increase the efficacy in treatment of Hp positive DGP patients and reduce the symptom recurrence remarkably, especially in those with high grade active gastritis.