激光13c -尿素呼吸试验定量评价胃黏膜细菌定植、炎症严重程度和萎缩

E. Stepanov, V. Ivashkin
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引用次数: 0

摘要

目的:比较13C-UBT检测结果与胃炎、消化性溃疡患者胃十二指肠镜下胃、十二指肠黏膜形态学分析资料。分析基于13C-UBT的二极管激光光谱(DLS)结果与年龄、分科、炎症过程的活动性和严重程度、萎缩和化生程度的相关性。材料和方法。525名患者在根除治疗开始前进行了13C-UBT DLS, 196名患者在根除治疗完成后10-12周进行了DLS。呼吸测试是根据使用BSIA专利套件(英国)的标准方案进行的。在内镜检查期间,134例患者接受了胃体上三分之一、胃窦(沿大弯曲距幽门5厘米内)和十二指肠球部的活检,并进行了苏木精-伊红染色、pas -反应和Giemsa的组织学检查。根据改进的Sydney系统对胃粘膜状态进行组织学评估,并根据4点视觉模拟量表(0至3+)评估形态学变化。共525例患者(男性301例,女性224例),年龄15 ~ 80岁(中位39.8±15.1岁)。239例(45.5%)诊断为慢性胃炎、慢性十二指肠炎(含糜烂性)。在286例(54.5%)患者中,消化性溃疡被诊断为胃溃疡(42例(8%),十二指肠溃疡(238例(45.3%)),合并病变(9例(1.7%))。根据13C-UDT DLS结果,447例患者检测到H. pylori感染。糜烂性胃炎(15%)、糜烂性十二指肠炎(21%)和慢性非糜烂性胃炎(23%)中未发现幽门螺杆菌。胃和十二指肠消化性溃疡检出幽门螺杆菌分别为93%和97%。呼气试验结果与胃黏膜表面的幽门螺杆菌定量含量呈直接的线性关系。激光13C-UBT参数与粘膜单核浸润的严重程度有明显的相关性(关联强度为0.78)。激光13C-UBT的平均值与粘膜嗜中性粒细胞浸润程度的总评估值比较,没有发现明显的相关性。激光13C-UBT的结果几乎没有变化,但粘膜萎缩程度轻微;呼吸试验有随萎缩性变化增加而降低的趋势。13C-UBT指标与胃黏膜幽门螺杆菌的定量含量、胃十二指肠黏膜单核浸润的严重程度、萎缩变化的严重程度相关。
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Laser Based 13C-urea Breath Test in Quantitative Assessment of Bacterial Colonization, Severity of Inflammation and Atrophy in Gastric Mucosa
Aim: to compare the results of 13C-UBT with the data of morphological analysis of the gastric and duodenal mucosa obtained during gastroduodenoscopy in gastritis and peptic ulcer. To analyze the dependence of the results of diode laser spectroscopy (DLS) based 13C-UBT on age, nosology, activity and severity of the inflammatory process, the degree of atrophy and metaplasia.Materials and methods. The 13C-UBT DLS was performed in 525 patients before the start of eradication therapy and in 196 patients 10–12 weeks after its completion. The breath test was carried out according to a standard protocol using the BSIA patent kit (Great Britain). During endoscopy, 134 patients underwent a biopsy from the upper third of the body of the stomach, the antrum (within 5 cm from the pylorus along the greater curvature) and the duodenal bulb with histological examination with hematoxylin-eosin staining, PAS-reaction and Giemsa. Histological assessment of the state of the gastric mucosa was carried out according to a modified Sydney system with an assessment of morphological changes according to a 4-point visual analog scale (0 to 3+).Results. A total of 525 patients (301 men and 224 women) aged 15–80 years (median 39.8 ± 15.1 years) were examined. 239 (45.5 %) patients were diagnosed with chronic gastritis, chronic duodenitis (including erosive forms). In 286 (54.5 %) patients, peptic ulcer was diagnosed with localization in the stomach — in 42 (8 %), in the duodenum – in 238 (45.3 %), combined lesions — in 9 (1.7 %) cases. Based on the results of 13C-UDT DLS, H. рylori infection was detected in 447 patients. H. рylori was not found in erosive gastritis in 15 %, erosive duodenitis in 21 % and chronic non-erosive gastritis in 23 %. In peptic ulcer of the stomach and duodenum, H. pylori was detected in 93 % and 97 %.A direct linear relationship between the results of the breath test and the quantitative content of H. рylori on the surface of the gastric mucosa was obtained. The parameters of laser 13C-UBT clearly correlate with the degree of severity of mononuclear infiltration of the mucosa (the strength of the connection is 0.78). When comparing the average values of laser 13C-UBT with the total assessment of the degree of mucosal neutrophilic infiltration, no significant relationship was found. With a slight severity of mucosal atrophy, the result of laser based 13C-UBT practically does not change; there is a tendency of a decrease in the breath test with an increase in atrophic changes.Conclusion. Indicators of 13C-UBT correlate with the quantitative content of H. pylori bacteria in the gastric mucosa, the severity of mononuclear infiltration of the gastroduodenal mucous, the severity of atrophic changes. 
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1.90
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