【作者】 王娜；

【导师】 姚希贤；

【作者基本信息】 河北医科大学 ， 内科学， 2002， 硕士

【摘要】 目的：观察H.pylori根除与应用“灭Hp浓缩袋装煎剂”(以下简称“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：对H.pylori阳性慢性胃炎患者均用丽珠胃三联(铋剂0.22，2次／d+替硝唑0.5，2次／d+克拉霉素0.25，2次／d)进行治疗，连服7 d。停药1个月复查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-S：1袋，3次／d；C组阴性对照组(15例)，采用胃舒平：3-5~#，2次／d；3个月后复查内镜，窦体分别取材做活检组织病理，观察慢性病变消退变化；同时应用免疫组化技术测定治疗前后胃窦黏膜COX-2蛋白表达，组织学采用慢性胃炎悉尼分类标准，免疫组化技术采用SP法，病理图象分析系统处理结果；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80.0％(12／15)急性炎症细胞明显消退，急性炎症细胞浸润较未根除者明显减少，炎症细胞积分从治疗前0.792±0.779下降到0.04167±0.141(P＜0.001)， 中文摘要胃窦劾膜COX上蛋白表达亦明显下降，COX上平均阳性细胞率从（4．54士12．28）o下降至oZ．33士8．3）0（＜0＊01）；＊＊＊－2平均免疫吸光度从0．111士0．0297下降至 0．084士0．0276 P＜0，05）。而单纯 H．pylon根除对胃炎慢性病变无明显影响，仅有29．2％门埋4）患者慢性炎症细胞侵润较治疗前降低，治疗前后炎症细胞平均积分亦无明显改变（l．896士0．675，l．667士0．76，P＞0．05h而予“灭 Hp煎剂”治疗 3个月后慢性病变显著好转，78．3O门 03）慢性炎症细胞侵润明显降低，炎症细胞平均积分从治疗前2刀87士0．577下降到1．304士0．598（P＜0＊01），对胃剩膜＊＊＊－2蛋白表达也有进一步抑制作用，COX上 平均阳性细胞率从H．pylon根除后的（31．58士5．9）％下降到（27．09士5．16）％瞩＜o．05卜 同时＊＊＊上平均免疫吸光度从0．1144士0刀282，下降至0刀753土0刀208（P＜0．05）；麦滋林S组虽对慢性炎症有所缓解，（1．933上0．704，1．4上0．806，2＜0．05），但仅66＊％慢性炎症细胞侵润程度缓解，较“灭Hp煎剂”疗效门8．3％）为低，对COX2蛋白表达亦无进一步抑制作用 （ 3石士 6．4％，3 0．5 5士6．58％，P＞ 0刀5）。“胃舒平”组（实为单纯 H．pylon根除）对慢性病变（1．967士0．581，2．3士0．592，P＞O．05）及COX上 蛋白表达均无明显作用 门2．刀士5．24％，33．33上5．6O，P＞0．05）。值得提出的是“灭即 煎齐”对慢性萎缩性病变有一定治疗作用，“灭Hp煎剂”组3例轻度萎缩、2例重度、l例中度肠化、l例轻度、l例中度异型增生性病变于治疗3个月后退级或减轻。 2 中文槽要 而对照组则仅有1例轻度萎缩、l例中度肠化、l例轻 度异型增生性病变缓解。但本实验由于萎缩性胃炎例 数较少，所以尚需大样本进一步研究。 结论：单纯H．pylon根除对急性活动性炎症具有确 切疗效，但对其所致慢性病变，虽经3个月观察并无明 显影响，所以，对Hp相关性慢性活动性胃炎首先应进 行H．pylon根除，并应对其慢性病变继续进行治疗／‘灭 Hp煎剂”对Hp相关性胃炎慢性病变具有良好治疗作 用，对萎缩性病变获得可喜治疗苗头，具有良好开发前 星 －gro更多还原

【Abstract】 Objective:To study the histological change of H.pylori eradication and using "Killing Hp decoction" for chronic gastritisMethodsrPatients of chronic gastritis infected with H. pylori were prospectively studied. After a 7-days triple therapy (Livzon Weisanlian: bismuth potassium citrate 0.22g bid, clarithromycin 0.25g bid and tinidazole 0.5g bid),the patients whose H.pylori was eradicated were allocated randomly into 3 groups. GroupA(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 (which could be considered only H.pylori eradicated); An endoscopy was performed at the frist and three months. The status of Hp eradication and the status of histological assessment were observed and recorded. Biopsy sampling for histology scored according to the updated Sydney classification, using a score from 0 to 3 for grading the degree. Histological assessment ofinflammatory cell infiltrates was performed on multiple biopsy specimens of the antrum and gastric body. COX-2 (cyclooxygenase-2) protein was stained by immunohistochemical method,and the computer image processing system was used;For the patients of no eradication after one course therapy,the H.pylori treatment was still continued.ResultsrH. pylori eradication has got a very good curative effect of 81.9%. A favourable histologic change of acute inflammatory infiltration, but not chronic inflammation was observed after one month therapy (p <0.001). The score of patients showed a decrease of activity (average values from 0.792 + 0.779 to 0.04167 + 0.141) (P <0.001); The mean percentage of the cells staining with COX-2 was significantly decreased after H.pylori eradication . (43.54+ 12.28%, 32.33 + 8.3%, P <0.001); The mean degree of the immune suck light was from 0.111 + 0.0297 to 0.084 + 0.0276( P <0.05).While the scores did not show significant modifications in chronic inflammation. (1.896 + 0.675,1.667+0.761, P >0.05) After "Killing Hp decoction" treatment for three months, the score corresponding to CG declined progressively (average values from 2.087 + 0.577 to 1.304 + 0.598, P<0.001), and the mean percentage of the cells staining with COX-2 has got further improvement which reached astatistically significant difference compared with the results obtained at the first month. (31.58+5.9%,27.09 +5.16% ,P <0.05) .The same effects were detected in the immune suck light degree (0.1144 + 0.0282,0.0753 +0.0208,P <0.05). And the scores of Marzulene-S -Granules group was from 1.933 + 0.704 to 1.4 + 0.806 ( P <0.05 ) ,Nevertheless, no changes were observed in COX-2 expression, (P > 0.05) and only 66.7% patients got well remission compared with group A(78.3%),and a nonsignificant trend was observed with visual scores in the Aluminium Hydroxide Compound group (P >0.05).Gastric atrophic lesion improved after "Killing Hp decoction" three-months treatment. This effect could be demonstrated by 3 mild atrophy,2 severe and 1 moderate intestinal metaplasia,!mild and 1 moderate hyperplasia taking a turn for the better,while in group control only 1 mild atrophy and 1 moderate intestinal metaplasia returned. Bigger exponent is needed to determine if "Killing Hp decoction" therapy prevents the development of atrophic gastritis.ConlusionsrH.pylori eradication is associated with a histologic improvement of gastric mucosa acute inflammatory component, which is observed immediately after eradication. But the chronic inflammation did not show any significant modifications , which needed to treat. We conclude that"Killing Hp decoction" showed good effects to the chronic inflammation and atrophic gastritis therapy. After H.pylori eradication we should continue to treat the pathologic lesions,and we suggest to use "Killing Hp decoction".更多还原