摘要
目的探讨儿童胆汁反流性胃炎（BRG）的临床症状、胃镜下病变、病理组织学改变的特征及与幽门螺杆菌感染的关系。方法对本院有上消化道症状（腹痛、腹胀、纳差、恶心、呕吐、呃逆、泛酸、早饱等）的287例患儿进行胃镜检查、胃组织活检、快速尿素酶试验及”C-尿素呼气试验，其中确诊为胆汁反流性胃炎58例为观察组（BRG组），非胆汁反流性胃炎229例为对照组（非BRG组），比较两组主要临床症状、胃镜下病变、病理组织学改变及H．pylori感染的情况。结果BRG组患儿腹胀、呕吐、呃逆发生率均高于非BRG组[84．5％（49／58）vs66．8％（153／229）、32．8％（19／58）vs17．9％（41／229）、29．3％（17／58）vs16．6％（38／229），）（X^2=6．93，6．18，4．83，P〈0．05]，但两组患儿腹痛、纳差、恶心及早饱症状发生率无明显差异（P〉0．05）。两组患儿胃镜下胃黏膜充血水肿及黏膜斑比较差异无统计学意义（P〉0．05），BRG组胃黏膜糜烂及出血点发生率[37．9％（22／58）vs22．7％（52／229）、20．7％（12／58）vs 10．0％（23／229）]高于非BRG组（X^2=5．60，4．90，P〈0．05），微小结节发生率[22．4％（13／58）]低于非BRG组[37．6％（86／229），X^2=4．69，P〈0．05]。两组患儿病理组织学中上皮细胞变性、增生和固有膜淋巴细胞及中性粒细胞浸润比较差异均无统计学意义（P〉0．05）。两组小凹延长及黏膜血管扩张发生率[10．3％（6／58）vs3．1％（7／229）和31．0％（18／58）VS18．3％（42／229）]比较差异均有统计学意义（X^2=5．97，4．51，P〈0．05）。BRG组固有膜淋巴滤泡形成发生率[12．1％（7／58）]低于非BRG组[24．0％（55／229），X^2=3．90，P〈0．05]。BRG组H．pylori阳性率[22．4％（13／58）]低于非BRG组[40．2％（92／229），X^2=6．29，P〈0．05]。结论BRG患儿以腹胀、呕吐、嗝逆为特征性症状。胃镜特征性表现为胃黏膜糜烂、伴出血斑点，以胃窦黏膜改变最为明显。胃黏膜浅层血管扩张充血，小凹延长等病理学改变提示胆汁反流性胃炎的可能，而胆汁反流的胃炎患儿H．pylori感染相对较低。根据上述临床特征，可以有助于早期诊断BRG，从而指导临床治疗，提高治愈率。
Objective To compare the clinical symptoms,endoscopic lesions,pathological histolog- ical changes, and H. pylori infection between children with bile reflux gastritis （BRG） and non BRG. Methods 287 cases of children with upper gastrointestinal symptoms were diagnosed with gastritis by gas- troscopy. They included 58 cases of BRG and 229 cases of non- BRG. The clinical symptoms, endoscopic lesions,pathological histological changes, and H. pylori infection were compared between two groups, re- spectively. Results Between BRG and non-BRG groups,there werent statistically significant difference in the main clinical symptoms including abdominal pain, anorexia, nausea, and early satiety. Incidence of ab- dominal distension,vomiting,and hiccups was[84. 5% （49/58） vs 66. 8% （153/229） ,32. 8% （19/58） vs 17.9% （41/229）, and 29.3% （ 17/58 ） vs 16. 6% （ 38/229 ） ], respectively, with statistical significance （X^2 = 6. 93,6. 18,4. 83, P 〈 0. 05 ）. There weren1 statistically significant difference in endoscopic lesions congestion, edema, and mueosal plaques between two groups. Incidence of endoseopie gastrie erosions and bleeding of two groups was [ 37. 9% （ 22/58 ） vs 22. 7% （ 52/229 ）, 20. 7% （ 12/58 ） vs 10. 0% （ 23/ 229） ], respeetively; and BRG group was statistieally higher than non-BRG group（X^2 =5.60,4. 90, P 〈0.05）. For micronodular change, there were 13 cases （22.4%） in BRG group and 86 cases （37.6%） in Non-BRG group, and Non-BRG group was statistically higher than BRG group（ X^2 = 4.69, P 〈 0.05 ）. For histopathological changes including epithelial cell degeneration, hyperplasia and lamina propria lymphocyte and neutrophil infiltration, there wasnt statistically significant difference between BRG and non-BRG groups. Incidence about pit extension and mucosal vascular expansion of two groups was [ 10. 34% （6/58） vs 3.1% （7/229） and 31.0% （18/58） vs 18.3% （42/229） ] ,respectively; and BRG group was significantly higher than non-BRG group（x2 = 5.97,4. 51, P 〈 0. 05 ）. There were 7 cases （ 12. 1% ） in BRG group and 55 cases （24. 0% ） about lamina propria lymphoid follicles, and Non-BRG group was significantly higher than BRG group （X^2 =3.90, P 〈0. 05）. H. pylori positive rates were[22. 41% （ 13/58）, and 40. 17% （92/ 229） ] , respectively. BRG group and non-BRG group were found statistically significant（ X2 = 6. 29, P 〈 0.05 ）. Conclusions BRG children with the characteristic symptoms were abdominal distension,vomiting, and hiccup inverse. Endoscopic characteristic performance was gastric erosions, bleeding spots in antral mu- cosa changes apparently. Mueosal vascular expansion and pit extension may prompt gastric in children with duodenogastric reflux. H. pylori positive rates of those gastric in children with bile reflux were relatively low. The clinical features could help early diagnosis BRG and guide clinical treatment to improve the cure rate.
出处
《中国医师杂志》
CAS
2012年第10期1315-1318,共4页
Journal of Chinese Physician
基金
东莞市科技计划医疗卫生类科研一般项目（201210515007184）
关键词
胆汁返流
胃炎
病因学
儿童
Bile reflux
Gastritis/etiology
Child
