本文選題：近端胃胃炎 + 病因　； 參考：《河北醫(yī)科大學(xué)》2016年碩士論文

【摘要】：目的:慢性胃炎是消化內(nèi)科常見(jiàn)疾病,常見(jiàn)病因有:幽門(mén)螺桿菌(Helicobacter pylori,H.pylori)感染、飲食環(huán)境因素、自身免疫、酗酒、服用NSAID藥物、某些刺激性食物等。慢性胃炎往往以胃竇胃炎為主,但在臨床工作中我們也可發(fā)現(xiàn)近端胃胃炎。近端胃胃炎病因尚不十分清楚,本研究旨在探討近端胃胃炎的病因,為臨床治療近端胃胃炎提供合理、有效的參考。方法:1病例選擇選擇2015年1月至2016年1月于河北醫(yī)科大學(xué)第三醫(yī)院消化內(nèi)科就診,經(jīng)胃鏡檢查示近端胃胃炎患者60例和遠(yuǎn)端胃胃炎患者40例。1.1入選標(biāo)準(zhǔn):(1)所有患者均需接受胃鏡檢查及快速尿素酶試驗(yàn)(RUT);(3)經(jīng)胃鏡檢查示近端胃胃炎的患者:胃鏡下胃底+胃體上1/3可見(jiàn)黏膜紅斑、黏膜出血點(diǎn)或斑塊、黏膜粗糙伴或不伴水腫、充血滲出;病理組織學(xué)檢查可見(jiàn)中性粒細(xì)胞或淋巴細(xì)胞、漿細(xì)胞。(4)經(jīng)胃鏡檢查示遠(yuǎn)端胃胃炎的患者:胃鏡下胃竇+胃體下2/3可見(jiàn)黏膜紅斑、黏膜出血點(diǎn)或斑塊、黏膜粗糙伴或不伴水腫、充血滲出;病理組織學(xué)檢查可見(jiàn)中性粒細(xì)胞或淋巴細(xì)胞、漿細(xì)胞。胃炎診斷標(biāo)準(zhǔn)依據(jù)《中國(guó)慢性胃炎共識(shí)意見(jiàn)(2012,上海)》。1.2排除標(biāo)準(zhǔn):(1)有肝硬化門(mén)脈高壓性胃病患者;(2)曾行H.pylori根除治療者;(3)正在行抗焦慮抑郁治療者;(4)不同意參與本次研究者。2方法2.1分組:凡符合入選條件患者分為以下兩組:A組:近端胃胃炎組(60例)B組:遠(yuǎn)端胃胃炎組(40例)2.2實(shí)驗(yàn)方法近端胃胃炎組患者于近端胃大彎側(cè)及遠(yuǎn)端胃距幽門(mén)4-6cm胃竇大彎側(cè)各取活組織2塊進(jìn)行快速尿素酶試驗(yàn)檢測(cè)H.pylori,并于近端胃炎癥較重部位及遠(yuǎn)端胃4-6cm胃竇大彎側(cè)各取2塊活組織進(jìn)行病理檢查;遠(yuǎn)端胃胃炎組患者于近端胃大彎側(cè)及遠(yuǎn)端胃距幽門(mén)4-6cm各取活組織2塊進(jìn)行快速尿素酶試驗(yàn)檢測(cè)H.pylori,并于近端胃大彎側(cè)及遠(yuǎn)端胃炎癥較重部位各取2塊活組織進(jìn)行病理檢查。記錄患者姓名、性別、年齡、職業(yè)、吸煙、飲酒、文化程度、生活事件、生活是否規(guī)律、是否近期口服NSAID藥物、是否曾口服抑酸藥、胃鏡結(jié)果、病理結(jié)果、近端胃及遠(yuǎn)端胃H.pylori感染情況、焦慮抑郁評(píng)分以及主訴。2.3統(tǒng)計(jì)學(xué)分析采用SPSS21.0統(tǒng)計(jì)軟件進(jìn)行分析,計(jì)數(shù)資料以百分率表示,比較采用χ2檢驗(yàn),P0.05為差異具有統(tǒng)計(jì)學(xué)意義;計(jì)量資料數(shù)據(jù)方差不齊、非正態(tài)分布者以中位數(shù)+四分位間距表示,采用近似正態(tài)U檢驗(yàn),P0.05為差異具有統(tǒng)計(jì)學(xué)意義;危險(xiǎn)因素的分析采用二元Logistic回歸分析,B0,OR1為危險(xiǎn)因素,P0.05為差異具有統(tǒng)計(jì)學(xué)意義。結(jié)果:1兩組資料單因素分析:兩組病例在16-31、31-46、46-61、61-4個(gè)年齡分層均有分布,兩組患者在年齡分布上無(wú)統(tǒng)計(jì)學(xué)意義(P=0.205),近端胃胃炎組較遠(yuǎn)端胃胃炎組女性患者多,具有統(tǒng)計(jì)學(xué)意義(P=0.017),近端胃胃炎組較遠(yuǎn)端胃胃炎組腦力勞動(dòng)者多,具有統(tǒng)計(jì)學(xué)意義(P=0.000),近端胃胃炎組較遠(yuǎn)端胃胃炎組飲酒者少,具有統(tǒng)計(jì)學(xué)意義(P=0.020),近端胃胃炎組患者較遠(yuǎn)端胃胃炎組患者文化程度高,具有統(tǒng)計(jì)學(xué)意義(P=0.037),近端胃胃炎組患者較遠(yuǎn)端胃胃炎組患者近端胃H.pylori感染率高,具有統(tǒng)計(jì)學(xué)意義(P=0.000),近端胃胃炎組患者生活事件發(fā)生率高于遠(yuǎn)端胃胃炎組患者,具有統(tǒng)計(jì)學(xué)意義(P=0.000)(見(jiàn)Table1)。2兩組資料多因素分析:兩組資料經(jīng)二元Logistic回歸分析發(fā)現(xiàn)生活事件、H.pylori感染為近端胃胃炎的危險(xiǎn)因素(P0.050,B0,OR1)(見(jiàn)Table2)。3兩組資料焦慮抑郁的比較:近端胃胃炎組患者較遠(yuǎn)端胃胃炎組患者焦慮抑郁評(píng)分高,具有統(tǒng)計(jì)學(xué)差異(P=0.000),遠(yuǎn)端胃胃炎組患者焦慮抑郁評(píng)分分布在0-3分,近端胃胃炎組患者焦慮抑郁評(píng)分除在0-3分內(nèi)有分布,在4-9分內(nèi)也有分布,但兩組資料在生活事件的構(gòu)成上無(wú)統(tǒng)計(jì)學(xué)差異(P=1.000)(見(jiàn)Table3-4,Fig.5-8)。4兩組資料遠(yuǎn)端胃和全胃H.pylori感染的比較:近端胃胃炎組中,遠(yuǎn)端胃感染H.pylori的患者有26例(43.3%),遠(yuǎn)端胃胃炎組中,遠(yuǎn)端胃感染H.pylori的患者有11例(27.5%),二者無(wú)統(tǒng)計(jì)學(xué)差異(P=0.108)(見(jiàn)Table5);近端胃胃炎組中,全胃感染H.pylori的患者有21例(35%),遠(yuǎn)端胃胃炎組中,全胃感染H.pylori的患者有3例(7.5%),近端胃胃炎組全胃H.pylori感染率高于遠(yuǎn)端胃胃炎組,具有統(tǒng)計(jì)學(xué)差異(P=0.002)(見(jiàn)Table6)。5兩組資料臨床特征比較:近端胃胃炎組患者臨床特點(diǎn)為上腹痛58例(96.7%)、上腹脹47例(78.3%)、早飽51例(85%)、食欲不振34例(56.7%)、惡心29例(48.3%),遠(yuǎn)端胃胃炎組上腹痛6例(15%)、上腹脹12例(30%)、早飽6例(15%)、食欲不振10例(25%)、惡心12例(30%),二者相比具有統(tǒng)計(jì)學(xué)差異(P=0.040);胃鏡下,近端胃胃炎組近端胃炎癥與遠(yuǎn)端胃胃炎組遠(yuǎn)端胃炎癥相比,近端胃胃炎主要表現(xiàn)為充血28例(46.7%)、水腫32例(53.3%)、紅斑23例(38.3%)、出血點(diǎn)24例(40%),糜爛13例(21.7%)比較少見(jiàn);遠(yuǎn)端胃胃炎組主要表現(xiàn)為糜爛16例(40%),充血5例(12.5%)、水腫5例(12.5%)、紅斑6例(15%)、出血點(diǎn)6例(15%)比較少見(jiàn),二者相比具有統(tǒng)計(jì)學(xué)差異(P=0.001);病理上,近端胃胃炎組主要為慢性非萎縮性胃炎53例(88.3%),慢性萎縮性胃炎7例(11.7%)、腸化生5例(8.3%)、異型增生2例(3.3%)比較少見(jiàn),遠(yuǎn)端胃胃炎組遠(yuǎn)端胃主要為慢性萎縮性胃炎28例(70%)、腸化生20例(50%)、也可有異型增生12例(30%),慢性非萎縮性胃炎13例(32.5%)比較少見(jiàn),二者相比具有統(tǒng)計(jì)學(xué)差異(P=0.000)(見(jiàn)Table7-9,Fig.1-4)。結(jié)論:1近端胃胃炎的病因?yàn)樯钍录.pylori感染。2近端胃胃炎臨床主要表現(xiàn)為上腹痛、上腹脹、早飽、惡心、食欲不振,胃鏡下主要表現(xiàn)黏膜充血、水腫、紅斑、糜爛、出血點(diǎn),病理以慢性非萎縮性胃炎為主。
[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.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R573.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前8條

1 張繼明;周寧;吳玉林;;長(zhǎng)期飲酒者胃鏡資料分析[J];臨床和實(shí)驗(yàn)醫(yī)學(xué)雜志;2013年16期

2 郭文娟;張艷麗;姚樹(shù)坤;尹立杰;顏玨;李紅磊;;功能性消化不良癥狀和近端胃功能的關(guān)系[J];世界華人消化雜志;2012年18期

3 牛威;趙漢清;仲愛(ài)芳;丁松柏;林芝;;抑郁癥患者兒童期受虐對(duì)多巴胺水平及相關(guān)因素的影響[J];精神醫(yī)學(xué)雜志;2012年03期

4 李瑋鵬;劉嘉勝;趙潔;張金山;;急性復(fù)合應(yīng)激對(duì)大鼠血清Ghrelin水平的影響[J];中國(guó)醫(yī)藥指南;2011年18期

5 徐珞;孫向榮;韓曉華;鐘鳳;Inge Depoortere;Theo Peeters;;Ghrelin在大鼠神經(jīng)系統(tǒng)中的表達(dá)對(duì)胃黏膜的保護(hù)作用[J];世界華人消化雜志;2006年08期

6 ;Roles of nitric oxide in protective effect of berberine in ethanol-induced gastric ulcer mice[J];Acta Pharmacologica Sinica;2005年11期

7 朱良如,謝小平,錢(qián)偉,侯曉華;5-羥色胺在胃機(jī)械感覺(jué)過(guò)敏中的作用[J];中華消化雜志;2005年03期

8 陳代陸,夏正武,王振華,盧國(guó)良;長(zhǎng)期饑餓應(yīng)激對(duì)大鼠腸神經(jīng)系統(tǒng)神經(jīng)遞質(zhì)的影響[J];臨床消化病雜志;2001年05期

，

本文編號(hào)：2102287