摘要：
目的 探讨胃镜下胃体龟裂现象与HP感染及病理学表现的关系,深入理解龟裂的临床意义,以期助于提高HP的检出率.方法 符合条件行胃镜检查的患者,分别从胃窦小弯侧、胃体大弯侧取黏膜各一块,经HE染色行病理学及HP检查.采集患者的病理诊断、HP抗体、快速尿素酶试验、内镜诊断及内镜下胃体龟裂现象等相关检查资料.尿素酶试验,病理组织学检测及HP抗体三项检测中有两项同时阳性者判定为HP阳性.结果 (1)行胃镜检查的437例患者入选,其中男210例,女227例;胃溃疡32例,十二指肠球部溃疡59例,十二指肠球部炎症51例,反流性食管炎62例,慢性胃炎276例.(2)HP胃内分布情况:437例患者中160例(36.61％)患者HP阳性,其中68.75％ (110/160)的患者在胃窦及胃体均发现HP,25.63％ (41/160)仅在胃窦发现HP,3.13％ (5/160)仅在胃体发现HP(5例患者内镜下均可见胃体龟裂).(3)胃体龟裂现象与HP感染的关系:有胃体龟裂现象组HP阳性率为62.58％(97/155),无胃体龟裂现象组的HP感染阳性率为22.34％(63/282),胃镜下胃体龟裂现象与HP感染有关(x2 =69.788,P =0.000).(4)胃体龟裂现象与病理组织学的关系:采用Wilcoxon秩和检验,胃体龟裂现象与胃的炎症程度有关(P＜0.01);胃体龟裂现象与胃的萎缩、肠化生及非典型性增生无关(P均＞0.05).(5)胃体龟裂现象与疾病的关系:胃体龟裂现象与十二指肠球部炎症有关(x2=4.414,P=0.036),胃体龟裂现象与胃镜下胆汁反流现象有关(x2 =4.289,P =0.038).胃体龟裂现象与胃溃疡、食管炎、慢性胃炎无关(P均＞0.05).结论 胃镜下胃体龟裂现象提示炎症程度重并与HP感染有关,提示胃体黏膜龟裂样改变可作为胃镜下提示HP感染的内镜下表现之一.胃体黏膜龟裂现象与胃黏膜的炎症程度有关,提示胃体黏膜龟裂样改变可作为胃镜下胃炎症程度较重的内镜下表现之一.%Objective To investigate the clinical significance of gastric cracks by investigating the relationship between stomach cracks under gastroscopy and H.pylori infection as well as its pathological manifestation,in order to improve the detection rate of H.pylori.Methods Gastroscopy patients were enrolled as our subjects excluding those with tumors,major diseases and under 18 years old.Mucosal biopsies were obtained from the lesser curvature of antrum and the greater curvature of body in each patient,then by HE staining,pathological and HP examination.The information including the pathological diagnosis,HP antibody,rapid urease test,endoscopic diagnosis and endoscopic gastric body cracking phenomenon were collected from all patient.H.pylori positivity was defined as a patient who showed two or more positive results in the Rapid Urea's Test,pathohistological examination and H.pylori antibody detection.Results (1) 437 patients with gastroscopy were included between December 2009 and December 2011,among whom 210 were male and 227 were female.There were 32 cases with gastric ulcer,59 cases with duodenal ulcer,51 cases with duodenitis,62 cases with reflux esophagitis,and 276 cases with chronic gastritis.(2) H.pylori distribution in stoma of all patients:160 of 437 patients(36.61％) are H.pylori positive,of which 68.75％ (110/160) was found H.pylori positive in both of gastric antrum and body,25.63％ (41/160) was H.pylori positive only in antrum,and 3.13％ (5/160) was H.pylori positive only in the body of stomach.(3)Relationship between the presence of cracks in gastric body and H.pylori infection:the H.pylori positivity was 62.58％ (97/155) and 22.34％ (63/282) respectively in the group with or without the presence of cracks in body.Cracks in gastric body examined by gastroscopy was related to H.pylori infection(x2 =69.788,P =0.000).(4) Relationship between the presence of cracks in gastric body and patho-histology:the presence of cracks in gastric body was related with severity of gastric inflammation by Wilcoxon rank sum test (P ＜ 0.0001),while there was no relationship between gastric body cracks and atrophy,intestinal metaplasia and atypical hyperplasia(P ＞ 0.05).(5) Relationship between the presence of cracks in gastric body and diseases:the presence of cracks in body was related with duodenitis,bile reflux under gastroscopy while there was no difference among in gastric body and gastric ulcer,esophagitis and chronic gastritis in terms of cracking appearance (P ＞ 0.05).Conclusion Our finding showed that cracking appearance in the gastric body is related with severity of inflammation in gastric mucosa bile reflux and duodenitis,suggesting that it can be one of the gastroscopic manifestations of more severe gastritis.
