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进一步探讨慢性胃病患者胃镜检查的适应证。方法 :经胃镜病理证实的 45 0 0例慢性胃病患者分为 <45岁和≥ 45岁两组 ,在此基础上进一步分为Hp阳性及Hp阴性组 ,比较同一年龄组不同Hp感染状态及不同年龄组间检查的结果 ,并对 <45岁、Hp阴性的消化性溃疡 (PU )易患因素作进一步分析。结果 :<45岁PU的Hp阳性率高 :十二指肠球部溃疡 (DU) 94.2 % ,胃溃疡 (GU ) 86 .4% ,而≥ 45岁Hp阴性的PU发生率升高(DU2 2 .7% ,GU33.3 % )。 <45岁组胃癌发生率显著低于≥ 45岁组 (P <0 .0 1) ,且在≥ 45岁组胃癌患者Hp多为阴性 (6 8.4% )。病理检查结果表明 ,>45岁组慢性萎缩性胃炎、肠上皮化生及异型增生的发生率及病程度显著低于≥ 45岁组 (P <0 .0 5 ,P <0 .0 1) ,且在≥ 45岁组上述病变在Hp阴性组多见。另外 ,<45岁、Hp阴性PU的发生主要与遗传、服用NSAIDs药物、饮酒或精神因素有关。结论 :慢性胃病患者胃镜检查适应证应该是≥ 45岁 ;<45岁Hp阳性 ;<45岁、Hp阴性 ,但症状持续、治疗无效 ,尤其是伴有进行性消瘦、纳差及贫血者 ;<45岁、Hp阴性 ,有PU家族史、长期服用NSAIDs药物、饮酒或精神紧张者。如此 ,约 2 0 %～ 30 %的患者可免于胃镜检查
To further explore the indications for gastroscopy in patients with chronic gastritis. Methods: 450 cases of chronic gastritis confirmed by endoscopy were divided into two groups (45 years old and ≥ 45 years old), and further divided into Hp positive and Hp negative groups. Age group, and further analysis of the <45-year-old, Hp-negative peptic ulcer (PU) predisposing factors. Results: The positive rate of Hp in patients with PU at 45 years old was 94.2% for duodenal ulcer (DU) and 86.4% for gastric ulcer (GU), while the incidence of Hp-negative PU was higher .7%, GU33.3%). The incidence of gastric cancer in 45-year-old group was significantly lower than that of 45-year-old group (P <0.01). Hp was mostly negative in patients with gastric cancer ≥ 45 years (6 8.4%). The pathological examination showed that the incidence and severity of chronic atrophic gastritis, intestinal metaplasia and dysplasia in the group of> 45 years old were significantly lower than those of the group of ≥ 45 years old (P <0.05, P <0.01) And in ≥ 45 years old group of the above lesions in the Hp negative group more common. In addition, <45 years of age, the occurrence of Hp-negative PU is mainly associated with genetic, taking NSAIDs drugs, alcohol or mental factors. Conclusion: Gastroscopy indications for patients with chronic gastropathy should be ≥ 45 years old; Hp positive <45 years old, Hp negative, but the symptoms persist, the treatment is ineffective, especially with progressive weight loss, anemia and anemia; < 45 years old, Hp-negative, with a family history of PU, long-term use of NSAIDs, alcohol or stress. Thus, about 20% to 30% of patients may be exempt from gastroscopy