病態生理学的立場からみた胃炎の検討  [in Japanese] PATHOPHYSIOLOGICAL EVALUATION OF GASTRITIS  [in Japanese]

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Author(s)

    • 工藤 峰生 KUDO Mineo
    • 北海道大学第3内科 Third Department of Internal Medicine, Hokkaido University School of Medicine

Abstract

自覚症状の有無により有症状群55例と無症候群145例の合計200症例を対象としてH.pylori万と内視鏡的胃炎,病理組織学的胃炎との関連について検討を行った.またH.pylori感染と血清ペプシノーゲン,血清ガストリンとの関連についての検討も行った.H.pylori感染の有無と上腹部症状には関連性が認められなかった.胃粘膜における炎症細胞浸潤は単核球浸潤,好中球浸潤ともH.pylori陽性例で明らかに頻度が高く,程度も強かった.胃炎の進展により胃粘膜の萎縮や腸上皮化生を伴ってくるが,その原因の多くはH.pylori感染であると考えられた.血清ペプシノーゲンは胃粘膜の萎縮を示す他にH.pylori感染の有無を判定するマーカーとしての意義もあるものと考えられた.血清ガストリン値はH.pylori万感染例で高い傾向を示した.これらの結果よりH.pylori感染は胃炎の発生および進展に密接な関係を持つものと考えられた.

Two hundreds patients were examined using upper gastrointestinal endoscopy toevaluate gastritis in relation to Helicobacter pylori infection. Histological assessment forinflammatory cell infiltration, mucosal atrophy, and frequency of intestinal metaplasia wasperformed in gastric biopsy specimens according to the "Sydney system". Serologicalmarkers of gastritis, like pepsiniogen I, pepsinogen, II, and gastrin were also measured. H.pylori status was determined by histological examionation and serum anti H.pylori IgG antibody. There was no difference in the prevalance of H.pylori in gastritis patients between those with clinical symptom and without. The frequency of inflammatory cell(mononuclear cells and polymorphonuclear cells)infiltration in H.pylori positive patients was significantly higher than that in H.pylori negative patients. The frequency of H.pylori infection did not differ in those with atrophic gastritis from those without, whereas thefrequency of intestinal metaplasia became significantly higher in those with moderate andsevere atrophy. Although there was no significant difference rn serum pepsinogen I levelsbetween H.pylori positive and negative patients, serum pepsinogen II levels were significantly increased in H.pylori positive patents. The serum pepsinogen I-II ratio was significantly lower in H.pylori positive patients. Serum fasting gastrin levels weresignificantly increased in H.pylori positive patients. These results suggest that H.pylori infection plays an important rode in the pathogenesis of chronic and atrophic gastritis andin the development of intestinal metaplasia.

Journal

  • GASTROENTEROLOGICAL ENDOSCOPY

    GASTROENTEROLOGICAL ENDOSCOPY 38(3), 828-837, 1996-03-20

    Japan Gastroenterological Endoscopy Society

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