Page 37 - 2022-23-中国全科医学

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450003，China
4.Department of Medical Imaging，People's Hospital of Zhengzhou University，Henan Provincial People's Hospital，Zhengzhou
450003，China
*
Corresponding author：DING Songze，Chief physician；E-mail：dingsongze@hotmail.com
【Abstract】 Background Helicobacter pylori （H. pylori） infection induced precancerous lesions of gastric mucosa
mostly in adulthood. However，it is debatable whether these pathological changes could also occur in children. Objective To
investigate the relationship between H. pylori infection and precancerous lesions of gastric mucosa in children hospitalized due to
upper gastrointestinal symptoms in central plain area of China. Methods A total of 1 015 children under the age of 18 years old
were enrolled. These children attended the People's Hospital of Zhengzhou University for upper gastrointestinal symptoms such as
abdominal pain，bloating，nausea，vomiting，hiccups，and acid reflux from August 2018 to July 2021. All children underwent
gastroscopy，from which gastric mucosal biopsy tissues were taken for rapid urease test and histopathological examination. The
clinical and pathological data of the patients were collected retrospectively. The children were divided into infected and uninfected
groups according to H. pylori infection status. The age，sex，endoscopic diagnosis，and H. pylori infection rate were compared
between children in infected and uninfected groups. The incidence of precancerous lesions of gastric mucosa，inflammatory
activity and the degree of inflammatory cell infiltration were compared between infected and uninfected groups，meanwhile these
tests were also compared in children of different age groups. Results Among the 1 015 children，854 （84.14%） were infected
with H. pylori and 161 （15.86%） were not infected. H. pylori-infected children were significantly older than those of non-
infected subjects（P<0.05）. Endoscopy examination revealed that the proportion of chronic superficial gastritis in H. pylori-
infected group was significantly higher than that in uninfected group，while nodular gastritis was more common in H. pylori-
uninfected patients（P<0.05）. Among the enrolled children，54 were 1-4 years old，199 were 5-8 years old，435 were 9-12
years old，and 327 were 13-18 years old. H. pylori infection rate in groups of 5-8，9-12 and 13-18 year-old children was
significantly higher than that in group of 1-4 year-old children；and the infection rate in groups of 9-12 and 13-18 year-old
children was also significantly higher than that in group of 5-8 year-old children（P<0.05）. Among H. pylori-infected patients，
37 out of 854 children had precancerous lesions of gastric mucosa（with incidence rate of 4.33%），of which 17 patients had
atrophy，11 patients had intestinal metaplasia and 9 patients had dysplasia，and only one of the 161 H. pylori-uninfected patients
（0.62%） had atrophic gastritis. The incidence of precancerous lesions of gastric mucosa in H. pylori-infected patients were
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significantly more than those uninfected patients（χ =5.178，P=0.023）. The level of active inflammation and inflammatory cell
infiltration of gastric mucosa in H. pylori-infected children were higher than that in non-infected children（P<0.05）. In groups of
5-8，9-12 and 13-18 year-old children，the prevalence of active inflammation and neutrophil granulocyte infiltration in gastric
mucosa were significantly higher than that in uninfected patients（P<0.05）. In H. pylori-infected patients，children in groups
of 9-12 and 13-18 years old showed more severe lymphocyte infiltration over the uninfected patients（P<0.05）. Conclusion
In children，gastric mucosal precancerous lesions occur in 4.33% of H. pylori-infected patients in central China，this include
atrophic gastritis，intestinal metaplasia and dysplasia；the data revealed an obvious critical issue requiring future investigation
and intervention for this group of population.
【Key words】 Helicobacter pylori；Child，hospitalized；Upper gastrointestinal tract；Gastric mucosa；Precancerous
lesions；Histopathology；Signs and symptoms，digestive；Henan

幽门螺杆菌（Helicobacter pylori，H. pylori）感染是 化病学分会 H. pylori 学组提出了“以家庭为单位防控幽
引起胃恶性肿瘤的主要原因。研究表明全世界约有 1/3 门螺杆菌感染”的新理念 ［11-12］ ，这包括对感染家庭中
的无症状或健康儿童血清学检查结果显示为 H. pylori 感 儿童的 H. pylori 感染状况进行调查和分析。基于此，本
染 ［1］ 。大多数 H. pylori 感染的儿童没有明显的临床症状， 研究对中原地区儿童 H. pylori 感染情况进行了调查，分
有胃肠道症状的儿童 H. pylori 感染率较高，且受社会经 析其与胃黏膜炎症、癌前病变的关系，有助于了解 H.
济地位、生活习惯、卫生条件、地区等因素的影响 ［2-4］ 。 pylori 流行地区胃黏膜癌前病变的模式和流行情况，为
由于 H. pylori 感染通常在儿童中不引起或仅引起轻微的 今后儿童群体疾病预防和控制提供参考及建议。
胃黏膜病变 ［5-7］ ，因此关于 H. pylori 感染与儿童胃黏膜 1 资料与方法
癌前病变关系的研究较少。但逐渐有研究显示，胃黏膜 1.1 一般资料 连续选取 2018 年 8 月至 2021 年 7 月
萎缩和肠上皮化生也存在于儿童中 ［8-10］ 。 因上消化道症状（如腹痛、腹胀、恶心、呕吐、打嗝、
国家消化系疾病临床医学研究中心和中华医学会消 反酸等）于郑州大学人民医院就诊的 18 岁以下患儿