摘要
目的:观察H.pylori根除后应用灭Hp浓缩袋装煎剂(灭Hp煎剂)对慢性胃炎慢性病变(包括肠化、不典型增生等萎缩性病变)的影响.方法:H.pylori阳性慢性胃炎患者81例用丽珠胃三联(铋剂0.22g,2次/d+替硝唑0.5g,2次/d+克拉霉素0.25g,2次/d)治疗7d.停药1mo复查H.pylori,对H.pylori根除者随机分成ABC三组.A组(23例),采用灭Hp煎剂1袋,2次/d;B组阳性对照组(15例),采用麦滋林-S1袋,3次/d;C组阴性对照组(15例),采用胃舒平3-5片,2次/d;3mo后复查内镜,采用悉尼系统比较治疗前后胃黏膜组织学变化,采用免疫组化技术测定COX-2蛋白表达,计算机图像处理系统分析结果;对未根治者换药继续进行H.pylori根除,直到复查H.pylori转阴为止.结果:丽珠胃三联根除率为81.9%.单纯H.pylori根除者80.0%急性炎症细胞明显消退(0.79±0.78,0.042±0.14,P<0.001),胃窦黏膜COX-2蛋白表达亦明显下降[(43.5±12.3)%,(32.3±8.3)%,(P<0.001)];而对胃炎慢性病变并无明显影响(1.90±0.68,1.67±0.76,P>0.05);灭Hp煎剂治疗3mo后,78.3%慢性病变显著好转,慢性炎症细胞平均积分从治疗前2.09±0.58下降到1.30±0.60(P<0.001),对胃黏膜COX-2蛋白表达也有进一步抑制作用[(31.6±5.9)%,(27.1±5.2)%,(P<0.05)],明显优于上述阳阴性对照组(P<0.05);对肠化、不典型增生等萎缩性病变也表现为治疗后退级或减轻.结论:Hp相关性慢性活动性胃炎首先应进行H.pylori根除,并应对其慢性病变继续进行灭Hp煎剂治疗有良好治疗作用.
AIM:To study the histologic changes after H.pylori eradication with Killing Hp decoction for chronic gastritis. METHODS:Total 81 cases of chronic gastritis with H.pylori infection were prospectively studied. After a 7-day triple therapy (bismuth potassium citrate, clarithromycin and tinidazole), the patients were divided randomly into 3 groups. Group A (n =23): Killing Hp decoction, 1# Bid; GroupB (n =15): marzulene-s-granules, 1# Tid; Group C (n =15): aluminium hydroxide compound, 3-5# Bid; An endoscopy was performed at the frist and third months. Histological changes of gastric mucosa were compared before and after the treatment according to Sydney classification. COX-2 (cyclooxygenase-2) protein was detected by immunohistochemical method, and the computer image processing system was used. For the patients of no eradication after one course therapy, anti-H. pylori treatment continued. RESULTS:H.pylori eradication got a very good curative effect in 81.9 % of the patients. A favourable histologic change of acute inflammatory infiltration was found (average values from 0.79 ± 0.78 to 0.042 ± 0.14) (P <0.001).The mean percentage of COX-2 positive cells significantly decreased after H.pylori eradication (43.5±12.3) %, (32.3±8.3) %, P <0.001. No chronic inflammation was observed after one month therapy (1.90±0.68,1.67±0.76, P >0.05. Compared to the controls, after Killing Hp decoction treatment for three months, the score corresponding to chronic gastritis declined progressively (average values from 2.9±0.6 to 1.30±0.60, P <0.001), and the mean percentage of COX-2 positive cells staining got further decreased and reached a statistically significant difference, compared with the results obtainedat the first month. (31.6 ± 5.9) %,(27.09 ± 5.16) % , P <0.05. Gastric atrophic lesions were improved after “Killing Hp decoction” for three-month treatment. CONCLUSION:H. pylori related gastritis should be treated further with Killing Hp decoction after H.pylori eradication.
出处
《世界华人消化杂志》
CAS
2003年第5期558-561,共4页
World Chinese Journal of Digestology
