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背景:幽门螺杆菌(H.pylori)的研究已有20多年的历史,但关于根除治疗前后H.pylori感染与炎症的关系以及评价治疗效果时应用何种方法、在何部位取活检的研究不多,仍存在争议。目的:探讨并比较H.pylori感染根除治疗前后不同活检部位组织学检查和13C-尿素呼气试验(UBT)检查的准确性。方法:受试者在根除治疗前后于胃窦、胃体和胃角处分别取黏膜活检标本各1块,以Giemsa染色、改良甲苯胺蓝染色和免疫组化法检测H.pylori感染情况。并对部分H.pylori感染的组织学检查和13C-UBT进行评估。结果:治疗前胃窦、胃体、胃角H.pylori感染率分别为61.3%、66.0%和59.6%。对4810例证实有H.pylori感染的患者在根除治疗后随访6周,有22.0%的病例有细菌残留,胃窦、胃体和胃角处H.pylori感染率分别为17.4%、17.3%和18.3%,各组间无显著性差异(P>0.05)。H.pylori感染者根除治疗前99.7%有活动性炎症,99.0%有慢性炎症。根除治疗后尽管有细菌残留,但炎症活动性减低。组织学检查H.pylori感染的患者中,根除治疗前有78.3%13C-UBT阳性;根除治疗后,仅有49.6%13C-UBT阳性。结论:根除治疗前13C-UBT和组织学检查结果的符合度较高,但对抗H.pylori治疗效果的评价,组织学检测优于13C-UBT。
BACKGROUND: H.pylori has been studied for more than 20 years. However, the relationship between H.pylori infection and inflammation before and after eradication therapy and the method used to evaluate the therapeutic effect, More, there is still controversy. Objective: To investigate and compare the accuracy of histological examination and 13C-urea breath test (UBT) before and after H.pylori infection eradication treatment. Methods: A total of 1 mucosal biopsy samples were taken from the antrum, stomach and stomach of the subjects before and after eradication therapy. The infection of H.pylori was detected by Giemsa staining, toluidine blue staining and immunohistochemistry. Histological examination of some H. pylori infections and 13C-UBT were evaluated. Results: The H.pylori infection rates of gastric antrum, gastric body and stomach before treatment were 61.3%, 66.0% and 59.6% respectively. The infection rate of H.pylori in gastric antrum, gastric body and stomach was 17.4% and 17.3% respectively in 4810 patients with H.pylori infection after 6 weeks of follow-up after eradication therapy, 22.0% 18.3%, no significant difference between the groups (P> 0.05). 99.7% had active inflammation before eradication of H.pylori infection and 99.0% had chronic inflammation. Despite the presence of bacteria after eradication treatment, inflammatory activity is reduced. Histological examination of H. pylori-infected patients showed positive eradication of 78.3% 13C-UBT before eradication therapy and only 49.6% of 13C-UBT positive eradication therapy. Conclusions: The agreement between the 13C-UBT and the histological examination before eradication therapy is high, but the evaluation of anti-H.pylori treatment is superior to that of 13C-UBT in histological examination.