近端胃胃炎病因分析

发布时间：2018-07-06 09:10

本文选题：近端胃胃炎 + 病因　；参考：《河北医科大学》2016年硕士论文

【摘要】：目的:慢性胃炎是消化内科常见疾病,常见病因有:幽门螺杆菌(Helicobacter pylori,H.pylori)感染、饮食环境因素、自身免疫、酗酒、服用NSAID药物、某些刺激性食物等。慢性胃炎往往以胃窦胃炎为主,但在临床工作中我们也可发现近端胃胃炎。近端胃胃炎病因尚不十分清楚,本研究旨在探讨近端胃胃炎的病因,为临床治疗近端胃胃炎提供合理、有效的参考。方法:1病例选择选择2015年1月至2016年1月于河北医科大学第三医院消化内科就诊,经胃镜检查示近端胃胃炎患者60例和远端胃胃炎患者40例。1.1入选标准:(1)所有患者均需接受胃镜检查及快速尿素酶试验(RUT);(3)经胃镜检查示近端胃胃炎的患者:胃镜下胃底+胃体上1/3可见黏膜红斑、黏膜出血点或斑块、黏膜粗糙伴或不伴水肿、充血渗出;病理组织学检查可见中性粒细胞或淋巴细胞、浆细胞。(4)经胃镜检查示远端胃胃炎的患者:胃镜下胃窦+胃体下2/3可见黏膜红斑、黏膜出血点或斑块、黏膜粗糙伴或不伴水肿、充血渗出;病理组织学检查可见中性粒细胞或淋巴细胞、浆细胞。胃炎诊断标准依据《中国慢性胃炎共识意见(2012,上海)》。1.2排除标准:(1)有肝硬化门脉高压性胃病患者;(2)曾行H.pylori根除治疗者;(3)正在行抗焦虑抑郁治疗者;(4)不同意参与本次研究者。2方法2.1分组:凡符合入选条件患者分为以下两组:A组:近端胃胃炎组(60例)B组:远端胃胃炎组(40例)2.2实验方法近端胃胃炎组患者于近端胃大弯侧及远端胃距幽门4-6cm胃窦大弯侧各取活组织2块进行快速尿素酶试验检测H.pylori,并于近端胃炎症较重部位及远端胃4-6cm胃窦大弯侧各取2块活组织进行病理检查;远端胃胃炎组患者于近端胃大弯侧及远端胃距幽门4-6cm各取活组织2块进行快速尿素酶试验检测H.pylori,并于近端胃大弯侧及远端胃炎症较重部位各取2块活组织进行病理检查。记录患者姓名、性别、年龄、职业、吸烟、饮酒、文化程度、生活事件、生活是否规律、是否近期口服NSAID药物、是否曾口服抑酸药、胃镜结果、病理结果、近端胃及远端胃H.pylori感染情况、焦虑抑郁评分以及主诉。2.3统计学分析采用SPSS21.0统计软件进行分析,计数资料以百分率表示,比较采用χ2检验,P0.05为差异具有统计学意义;计量资料数据方差不齐、非正态分布者以中位数+四分位间距表示,采用近似正态U检验,P0.05为差异具有统计学意义;危险因素的分析采用二元Logistic回归分析,B0,OR1为危险因素,P0.05为差异具有统计学意义。结果:1两组资料单因素分析:两组病例在16-31、31-46、46-61、61-4个年龄分层均有分布,两组患者在年龄分布上无统计学意义(P=0.205),近端胃胃炎组较远端胃胃炎组女性患者多,具有统计学意义(P=0.017),近端胃胃炎组较远端胃胃炎组脑力劳动者多,具有统计学意义(P=0.000),近端胃胃炎组较远端胃胃炎组饮酒者少,具有统计学意义(P=0.020),近端胃胃炎组患者较远端胃胃炎组患者文化程度高,具有统计学意义(P=0.037),近端胃胃炎组患者较远端胃胃炎组患者近端胃H.pylori感染率高,具有统计学意义(P=0.000),近端胃胃炎组患者生活事件发生率高于远端胃胃炎组患者,具有统计学意义(P=0.000)(见Table1)。2两组资料多因素分析:两组资料经二元Logistic回归分析发现生活事件、H.pylori感染为近端胃胃炎的危险因素(P0.050,B0,OR1)(见Table2)。3两组资料焦虑抑郁的比较:近端胃胃炎组患者较远端胃胃炎组患者焦虑抑郁评分高,具有统计学差异(P=0.000),远端胃胃炎组患者焦虑抑郁评分分布在0-3分,近端胃胃炎组患者焦虑抑郁评分除在0-3分内有分布,在4-9分内也有分布,但两组资料在生活事件的构成上无统计学差异(P=1.000)(见Table3-4,Fig.5-8)。4两组资料远端胃和全胃H.pylori感染的比较:近端胃胃炎组中,远端胃感染H.pylori的患者有26例(43.3%),远端胃胃炎组中,远端胃感染H.pylori的患者有11例(27.5%),二者无统计学差异(P=0.108)(见Table5);近端胃胃炎组中,全胃感染H.pylori的患者有21例(35%),远端胃胃炎组中,全胃感染H.pylori的患者有3例(7.5%),近端胃胃炎组全胃H.pylori感染率高于远端胃胃炎组,具有统计学差异(P=0.002)(见Table6)。5两组资料临床特征比较:近端胃胃炎组患者临床特点为上腹痛58例(96.7%)、上腹胀47例(78.3%)、早饱51例(85%)、食欲不振34例(56.7%)、恶心29例(48.3%),远端胃胃炎组上腹痛6例(15%)、上腹胀12例(30%)、早饱6例(15%)、食欲不振10例(25%)、恶心12例(30%),二者相比具有统计学差异(P=0.040);胃镜下,近端胃胃炎组近端胃炎症与远端胃胃炎组远端胃炎症相比,近端胃胃炎主要表现为充血28例(46.7%)、水肿32例(53.3%)、红斑23例(38.3%)、出血点24例(40%),糜烂13例(21.7%)比较少见;远端胃胃炎组主要表现为糜烂16例(40%),充血5例(12.5%)、水肿5例(12.5%)、红斑6例(15%)、出血点6例(15%)比较少见,二者相比具有统计学差异(P=0.001);病理上,近端胃胃炎组主要为慢性非萎缩性胃炎53例(88.3%),慢性萎缩性胃炎7例(11.7%)、肠化生5例(8.3%)、异型增生2例(3.3%)比较少见,远端胃胃炎组远端胃主要为慢性萎缩性胃炎28例(70%)、肠化生20例(50%)、也可有异型增生12例(30%),慢性非萎缩性胃炎13例(32.5%)比较少见,二者相比具有统计学差异(P=0.000)(见Table7-9,Fig.1-4)。结论:1近端胃胃炎的病因为生活事件、H.pylori感染。2近端胃胃炎临床主要表现为上腹痛、上腹胀、早饱、恶心、食欲不振,胃镜下主要表现黏膜充血、水肿、红斑、糜烂、出血点,病理以慢性非萎缩性胃炎为主。
[Abstract]:Objective: chronic gastritis is a common disease in the digestive department. The common causes are Helicobacter pylori (H.pylori) infection, dietary environment factors, autoimmune, alcoholism, NSAID drugs and some stimulant foods. Chronic gastritis is often mainly gastroenteritis, but we can also find proximal gastrogastritis in clinical work. The etiology of gastrogastritis is still not very clear. This study aims to explore the etiology of proximal gastrogastritis and provide a reasonable and effective reference for clinical treatment of proximal gastrogastritis. Methods: 1 cases were selected from January 2015 to January 2016 in the digestive department of the Third Hospital of Hebei Medical University, and 60 cases of proximal gastrogastritis and distal stomach were examined by gastroscopy. 40 cases of.1.1 in gastritis were selected: (1) all patients were required to undergo gastroscopy and rapid urease test (RUT); (3) patients with proximal gastrogastritis were examined by gastroscopy: the gastric fundus and the gastric body under gastroscope showed 1/3 mucous erythema, mucous bleeding spots or plaques, mucous membrane with or without edema, hyperemia and exudation; histopathological examination showed neutrality. Granulocyte or lymphocyte, plasma cell. (4) patients with distal gastrogastritis by gastroscopy: mucous erythema, bleeding spots or plaques in gastric antrum + gastric body under gastroscope and 2/3, mucous membrane with or without edema, hyperemia and exudation; histopathological examination of neutrophils or lymphocytes and plasma cells. The standard of gastritis diagnosis is < Chinese slow Sexual gastritis consensus opinion (2012, Shanghai) >.1.2 exclusion criteria: (1) patients with cirrhosis of the portal hypertensive gastropathy; (2) H.pylori eradication treatment; (3) being treated with anti anxiety and depression treatment; (4) disagree to participate in the study group.2 method 2.1 group: all the eligible patients were divided into two groups: group A: the proximal gastrogastritis group (60 cases) B group: The distal gastrgastritis group (40 cases) 2.2 experimental methods in the proximal gastric gastritis group, 2 pieces of the active tissues were detected by rapid urease test on the proximal gastric large flexion and the distal gastric distance from the pylorus 4-6cm antrum, and the H.pylori was detected by the rapid urease test. The pathological examination was performed on the heavy parts of the proximal gastritis and the distal gastric antral gastric antrum on the large side of the gastric antrum, and the distal stomach was examined. The patients in the gastritis group were detected H.pylori by rapid urease test in 2 segments of the proximal gastric large flexion and the distal gastric distance from the pylorus 4-6cm, and 2 biopsies were taken in the proximal stomach and distal gastritis, and the patient's name, sex, age, occupation, smoking, drinking, education, life events, and life events were recorded. Whether or not the life is regular, whether or not oral NSAID drugs, whether or not oral antiacid drugs, gastroscopy results, pathological results, proximal gastric and distal gastric H.pylori infection, anxiety and depression scores and.2.3 statistical analysis of the main complaint were analyzed with SPSS21.0 statistical software, the count data were expressed as a percentage, compared with the x 2 test, P0.05 was a differential. Statistical significance; measurement data data variance is not homogeneous, non normal distribution of the median + four division spacing, the use of approximate normal U test, P0.05 is the difference has statistical significance; the analysis of risk factors using two yuan Logistic regression analysis, B0, OR1 as a risk factor, P0.05 is statistically significant difference. Results: 1 two groups of data Single factor analysis: two groups of cases were distributed in the 16-31,31-46,46-61,61-4 age stratification, the two groups were not statistically significant in age distribution (P=0.205), the proximal gastgastritis group was more than the distal gastrogastritis group, and had statistical significance (P=0.017). The proximal gastrogastrostomy group was more than the distal gastrogastritis group, and had statistical statistics. Significance (P=0.000), the proximal gastgastritis group was less than the distal gastgastritis group, and had statistical significance (P=0.020). The patients in the proximal gastgastritis group were more educated than the distal gastgastritis group, and had statistical significance (P=0.037). The proximal gastric gastritis group had a higher incidence of H.pylori infection in the proximal gastric gastritis group than the distal gastgastritis group, and had statistical significance. (P=0.000) the incidence of life events in the proximal gastgastritis group was higher than that in the distal gastgastritis group, with statistical significance (P=0.000) (Table1).2 two group data analysis: two groups of data were analyzed by two yuan Logistic regression analysis of life events, H.pylori infection was the risk factor of proximal Gastro gastritis (P0.050, B0, OR1) (Table2).3 two groups The comparison of data anxiety and depression: the scores of anxiety and depression of the patients in the proximal gastgastritis group were higher than those in the distal gastgastritis group, with statistical difference (P=0.000). The scores of anxiety and depression in the distal gastgastritis group were 0-3 points, the scores of anxiety and depression in the patients of the proximal gastgastritis group were distributed in 0-3 points, but the data were also distributed in 4-9 minutes, but the data of the two groups were also distributed. There was no statistical difference in the composition of life events (P=1.000) (see Table3-4, Fig.5-8).4 two groups of distal gastric and whole stomach H.pylori infection: in the proximal gastric gastritis group, there were 26 cases (43.3%) of distal gastric infection in the patients with H.pylori, and 11 cases (27.5%) of distal gastric infection in the distal gastric gastritis group, and there was no statistical difference between the two patients (P=0) (P=0). .108 (see Table5); in the proximal gastrogastritis group, 21 cases (35%) were infected with H.pylori in the whole stomach. In the distal gastrogastritis group, 3 cases (7.5%) were infected with the whole stomach infection, and the rate of H.pylori infection in the whole stomach of the proximal gastrogastritis group was higher than that in the distal gastrogastritis group. The statistical difference (P=0.002) (Table6) the clinical features of the two groups of.5 two groups: the proximal gastric stomach and stomach. The clinical characteristics of the patients were 58 cases of upper abdominal pain (96.7%), 47 cases of upper abdominal distention (78.3%), 51 cases of early satiety (85%), 34 cases of anorexia (56.7%), 29 cases of nausea (48.3%), 6 cases of abdominal pain in the distal gastrogastritis group, 12 cases of upper abdominal distention, premature satiety, poor appetite and nausea (P=0.040); gastroscope, under gastroscope, Proximal gastritis in the proximal gastgastritis group was compared with distal gastritis in the distal gastgastritis group. Proximal gastgastritis was mainly manifested in 28 cases of hyperemia (46.7%), edema in 32 cases (53.3%), erythema 23 (38.3%), bleeding point in 24 cases (40%) and erosion 13 (21.7%), and distal gastric gastritis group mainly manifested as erosive 16 (40%), congestive 5 cases (12.5%), edema cases) 6 cases of erythema (15%), 6 cases of bleeding point (15%) were relatively rare, and the two were statistically different (P=0.001); pathological, proximal gastric gastritis group was mainly chronic non atrophic gastritis 53 cases (88.3%), chronic atrophic gastritis 7 cases (11.7%), intestinal metaplasia 5 cases (8.3%), dysplasia 2 cases (3.3%), distal gastric gastritis group was mainly chronic atrophy of stomach. There were 28 cases of constrictive gastritis (70%), 20 cases of intestinal metaplasia (50%), 12 cases of dysplasia (30%), 13 cases of chronic non atrophic gastritis (32.5%), and 13 cases (P=0.000) (Table7-9, Fig.1-4). Conclusion: 1 proximal gastric gastritis because of life events, H.pylori infection of.2 proximal Gastro gastritis is mainly manifested in upper abdominal pain, Upper abdominal distension, early satiation, nausea, loss of appetite, gastroscopic manifestations of mucosal congestion, edema, erythema, erosion, bleeding point, pathology is chronic non atrophic gastritis.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R573.3

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