Relationship between Helicobacter pylori Infection and Precancerous Lesions of Gastric Mucosa in Children in Central Plain Area of China

doi:10.12114/j.issn.1007-9572.2022.0187

Chinese General Practice ›› 2022, Vol. 25 ›› Issue (23): 2849-2855.DOI: 10.12114/j.issn.1007-9572.2022.0187

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Relationship between Helicobacter pylori Infection and Precancerous Lesions of Gastric Mucosa in Children in Central Plain Area of China

¹Department of Gastroenterology and Hepatology, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou 450003, China
²Department of Pathology, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou 450003, China
³Department of Pediatrics, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou 450003, China
⁴Department of Medical Imaging, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou 450003, China

Received:2022-01-21 Revised:2022-05-25 Published:2022-08-15 Online:2022-06-02
Contact: Songze DING
About author:
YU M, SONG X X, MA J, et al. Relationship between Helicobacter pylori infection and precancerous lesions of gastric mucosa in children in central plain area of China[J]. Chinese General Practice, 2022, 25 (23) : 2849-2855.

中原地区儿童幽门螺杆菌感染与胃黏膜癌前病变发生的临床研究

¹450003　河南省郑州市，郑州大学人民医院　河南省人民医院消化内科
²450003　河南省郑州市，郑州大学人民医院　河南省人民医院病理科
³450003　河南省郑州市，郑州大学人民医院　河南省人民医院儿科
⁴450003　河南省郑州市，郑州大学人民医院　河南省人民医院影像科

通讯作者: 丁松泽
作者简介:
于淼，宋晓霞，马菁，等. 中原地区儿童幽门螺杆菌感染与胃黏膜癌前病变发生的临床研究[J]. 中国全科医学，2022，25（23）：2849-2855. [www.chinagp.net] 作者贡献：于淼、丁松泽提出研究思路、设计研究方案并撰写论文；于淼、马菁、邵俏俏和余雪纯负责数据收集、整理和统计学分析；宋晓霞负责样本的病理评估；祁亚宾、胡若冰、卫珮如、肖伟、贾百灵指导研究过程的实施；程艳波指导患儿的选取及内镜表现的评估；孔令非、陈传亮、丁松泽监督研究。
基金资助:
国家自然科学基金联合基金项目(U1604174); 河南省科技攻关项目(SBGJ202002004); 河南省卫生计生科研创新人才工程项目(51282)

Abstract

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 significantly more than those uninfected patients (χ²=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

摘要：

背景

慢性幽门螺杆菌（H. pylori）感染是引起成年人胃黏膜癌前病变的主要原因，但其是否也可能发生在儿童中尚存在争议。

目的

探讨中原地区因上消化道症状住院的儿童H. pylori感染情况及其胃黏膜癌前病变情况。

方法

连续选取2018年8月至2021年7月因上消化道症状（如腹痛、腹胀、恶心、呕吐、打嗝、反酸等）于郑州大学人民医院就诊的18岁以下患儿1 015例。患儿均行上消化道内镜检查，并取胃黏膜活检组织行快速尿素酶试验和组织病理学检查。回顾性收集患者的临床资料及病理资料。依据H. pylori感染情况将患儿分为感染组与未感染组，比较感染组与未感染组患儿年龄、性别、内镜检查结果，不同年龄段患儿H. pylori感染率。比较感染组与未感染组患儿胃黏膜癌前病变发生率、胃黏膜活动性炎症发生率、胃黏膜中性粒细胞浸润程度、胃黏膜淋巴细胞浸润程度。比较感染组与未感染组不同年龄段患儿胃黏膜活动性炎症发生率、胃黏膜中性粒细胞浸润程度、胃黏膜淋巴细胞浸润程度。

结果

1 015例患儿中，感染H. pylori 854例（84.14%，即感染组），未感染H. pylori 161例（15.86%，即未感染组）。感染组患儿年龄大于未感染组，浅表性胃炎发生率低于未感染组，疣状胃炎发生率高于未感染组（P<0.05）。1 015例患儿中1~4岁54例，5~8岁199例，9~12岁435例，13~18岁327例。5~8、9~12、13~18岁患儿H. pylori感染率高于1~4岁患儿（P<0.05）；9~12、13~18岁患儿H. pylori感染率高于5~8岁患儿（P<0.05）。感染组患儿中经胃黏膜病理结果证实的癌前病变发生率为4.33%（37/854），其中包括17例胃黏膜萎缩、11例肠上皮化生和9例不典型增生。感染组患儿胃黏膜癌前病变发生率高于未感染组〔0.62%（1/161）〕（χ²=5.178，P<0.05）。感染组患儿胃黏膜活动性炎症发生率、胃黏膜中性粒细胞浸润程度、胃黏膜淋巴细胞浸润程度均高于未感染组（P<0.05）。5~8、9~12、13~18岁：感染组患儿胃黏膜活动性炎症发生率、胃黏膜中性粒细胞浸润程度高于未感染组（P<0.05）；9~12、13~18岁：感染组患儿胃黏膜淋巴细胞浸润程度高于未感染组（P<0.05）。

结论

在中原地区，H. pylori感染患儿胃黏膜癌前病变的发生率为4.33%，胃黏膜癌前病变包括胃黏膜萎缩、肠上皮化生和不典型增生。

关键词: 幽门螺杆菌, 儿童，住院, 上胃肠道, 胃黏膜, 癌前病变, 组织病理, 体征和症状，消化系统, 河南

Miao YU,Xiaoxia SONG,Jing MA, et al. Relationship between Helicobacter pylori Infection and Precancerous Lesions of Gastric Mucosa in Children in Central Plain Area of China[J]. Chinese General Practice, 2022, 25(23): 2849-2855. DOI: 10.12114/j.issn.1007-9572.2022.0187.
于淼,宋晓霞,马菁等. 中原地区儿童幽门螺杆菌感染与胃黏膜癌前病变发生的临床研究[J]. 中国全科医学, 2022, 25(23): 2849-2855. DOI: 10.12114/j.issn.1007-9572.2022.0187.

Figures/Tables 9

References 29

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组别	例数	年龄〔M（P₂₅，P₇₅），岁〕	性别〔n（%）〕		食管炎〔n（%）〕	浅表性胃炎〔n（%）〕	浅表性胃炎伴糜烂〔n（%）〕	浅表性胃炎伴胆汁反流〔n（%）〕	疣状胃炎〔n（%）〕	消化性溃疡〔n（%）〕	萎缩性胃炎〔n（%）〕
组别	例数	年龄〔M（P₂₅，P₇₅），岁〕	女	男	食管炎〔n（%）〕	浅表性胃炎〔n（%）〕	浅表性胃炎伴糜烂〔n（%）〕	浅表性胃炎伴胆汁反流〔n（%）〕	疣状胃炎〔n（%）〕	消化性溃疡〔n（%）〕	萎缩性胃炎〔n（%）〕
感染组	854	11（9，13）	346（40.52）	508（59.48）	23（2.69）	255（29.86）	200（23.42）	251（29.39）	131（15.34）	80（9.37）	17（1.99）
未感染组	161	9（6，12）	65（40.37）	96（59.63）	5（3.11）	76（47.20）	36（22.36）	44（27.33）	4（2.48）	10（6.21）	1（0.62）
χ²（Z）值		6.392^a	0.001		0.001	18.546	0.085	0.279	19.413	1.670	0.778
P值		<0.001	0.973		0.975	<0.001	0.770	0.597	<0.001	0.196	0.378

组别	例数	年龄〔M（P₂₅，P₇₅），岁〕	性别〔n（%）〕		食管炎〔n（%）〕	浅表性胃炎〔n（%）〕	浅表性胃炎伴糜烂〔n（%）〕	浅表性胃炎伴胆汁反流〔n（%）〕	疣状胃炎〔n（%）〕	消化性溃疡〔n（%）〕	萎缩性胃炎〔n（%）〕
组别	例数	年龄〔M（P₂₅，P₇₅），岁〕	女	男	食管炎〔n（%）〕	浅表性胃炎〔n（%）〕	浅表性胃炎伴糜烂〔n（%）〕	浅表性胃炎伴胆汁反流〔n（%）〕	疣状胃炎〔n（%）〕	消化性溃疡〔n（%）〕	萎缩性胃炎〔n（%）〕
感染组	854	11（9，13）	346（40.52）	508（59.48）	23（2.69）	255（29.86）	200（23.42）	251（29.39）	131（15.34）	80（9.37）	17（1.99）
未感染组	161	9（6，12）	65（40.37）	96（59.63）	5（3.11）	76（47.20）	36（22.36）	44（27.33）	4（2.48）	10（6.21）	1（0.62）
χ²（Z）值		6.392^a	0.001		0.001	18.546	0.085	0.279	19.413	1.670	0.778
P值		<0.001	0.973		0.975	<0.001	0.770	0.597	<0.001	0.196	0.378

年龄（岁）	例数	H. pylori 感染率
1~4	54	22（40.74）
5~8	199	156（78.39）^a
9~12	435	383（88.05）^ab
13~18	327	293（89.60）^ab
χ²值		93.419
P值		<0.001

年龄（岁）	例数	H. pylori 感染率
1~4	54	22（40.74）
5~8	199	156（78.39）^a
9~12	435	383（88.05）^ab
13~18	327	293（89.60）^ab
χ²值		93.419
P值		<0.001

组别	1~4岁		5~8岁		9~12岁		13~18岁
组别	例数	发生率	例数	发生率	例数	发生率	例数	发生率
感染组	22	3（13.64）	156	23（14.74）	383	52（13.58）	293	59（20.14）
未感染组	32	2（6.25）	43	1（2.33）	52	2（3.85）	34	1（2.94）
χ²值		0.196		4.901		3.987		6.012
P值		0.658		0.027		0.046		0.014

Relationship between Helicobacter pylori Infection and Precancerous Lesions of Gastric Mucosa in Children in Central Plain Area of China

中原地区儿童幽门螺杆菌感染与胃黏膜癌前病变发生的临床研究

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组别	例数	无	轻度	中度
感染组	854	717（83.96）	116（13.58）	21（2.46）
未感染组	161	155（96.27）	6（3.73）	0

组别	1~4岁				5~8岁				9~12岁				13~18岁
组别	例数	无	轻度	中度	例数	无	轻度	中度	例数	无	轻度	中度	例数	无	轻度	中度
感染组	22	19（86.36）	3（13.64）	0	156	133（85.26）	21（13.46）	2（1.28）	383	331（86.42）	44（11.49）	8（2.09）	293	234（79.86）	48（16.38）	11（3.76）
未感染组	32	30（93.75）	2（6.25）	0	43	42（97.67）	1（2.33）	0	52	50（96.15）	2（3.85）	0	34	33（97.06）	1（2.94）	0
Z值	0.912				2.212				2.009				2.456
P值	0.362				0.027				0.045				0.014

组别	例数	轻度	中度	重度
感染组	854	350（40.98）	432（50.59）	72（8.43）
未感染组	161	91（56.52）	66（40.99）	4（2.48）

[1]	GAO Rongjian, WU Haili, BI Jianhong, KANG Kai, GUO Xing, LIU Juan, LI Xiaoli, MENG Cunying. Related Factors of Pathological Upgrading in Gastric Mucosal Lesions after Endoscopic Submucosal Dissection [J]. Chinese General Practice, 2023, 26(26): 3325-3329.
[2]	LIU Rongmei, MAO Yanna, LIU Gendang, ZHAO Yukun, YU Mingyang, ZHAO Qiuping. Number and Costs of Hospitalizations Due to Hypertension and Related Comorbidities and Complications in County-level Healthcare Institutions in a Poverty-stricken County in Henan from 2017 to 2019 [J]. Chinese General Practice, 2023, 26(16): 2020-2026,2035.
[3]	YU Rong, DONG Weiguo, TIAN Shan, WANG Ting. Clinical Research Progress on Carcinogenesis of Different Pathological Types of Colorectal Polyps [J]. Chinese General Practice, 2023, 26(14): 1790-1794.
[4]	DU Junyan, PAN Jie, ZHOU Qingjie, TANG Qingqing, YANG Ningmin, ZHANG Jianzhong. The Helicobacter Pylori Antibiotic Resistance in Wenzhou, Zhejiang from 2013 to 2020 [J]. Chinese General Practice, 2023, 26(07): 825-829.
[5]	Qiaoqiao SHAO, Jing MA, Xuechun YU, Miao YU, Yabin QI, Ruobing HU, Peiru WEI, Wei XIAO, Bailing JIA, Songze DING. Efficacy of Rabeprazole Combined with Amoxicillin or Furazolidone Dual Therapy in Eradicating Helicobacter pylori Infection [J]. Chinese General Practice, 2022, 25(29): 3640-3645.
[6]	Kun XIE, Dan HU, Lang PENG, Yahui LI, Jiaying CHEN. Capabilities for Diagnosing and Treating Common Diseases in Primary Care Physicians in Henan: Current Overall Status and Solutions to Problems [J]. Chinese General Practice, 2022, 25(19): 2399-2403.
[7]	QIU Jiayu, XU Jun, PAN Xiaolin. Interpretation of 2021 ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding　 [J]. Chinese General Practice, 2021, 24(36): 4549-4554.
[8]	WANG Shuhan，TIAN Qingfeng，ZHANG Han，LIU Beibei. Comprehensive Ability and Its Correlation with Chronic Diseases in Older Adults　 [J]. Chinese General Practice, 2021, 24(36): 4569-4573.
[9]	ZHU Chunyan，GUO Qing，TIAN Qingfeng，LIU Xiaoguang，ZHANG Qian. Prevalence and Influencing Factors of Comprehensive Disability in the Elderly in Henan Province　 [J]. Chinese General Practice, 2021, 24(12): 1500-1505.
[10]	CHEN Zhengxu，MENG Lingchao，YUAN Liufei，CHANG Zhu，ZHANG Wang，LIANG Shimin，TIAN Yuhui. Cognition of Hierarchical Medical System among Residents and Its Influencing Factors in Henan Province　 [J]. Chinese General Practice, 2020, 23(7): 799-802.
[11]	LONG Mei，ZHU Li，BAO Linlin，PAN Peiying. Gastroscopic and Pathological Characteristics of Helicobacter Pylori Infection in Childhood and the Treatment Effect Analysis in Guiyang　 [J]. Chinese General Practice, 2020, 23(36): 4562-4566.
[12]	YAO Fengju，ZHANG Weiping，ZHANG Ruiling，LIU Changjun，WANG Hailing，GUO Zhengjun，WANG Yujie. Management and treatment of severe mental disorders in Henan Province [J]. Chinese General Practice, 2020, 23(21): 2702-2708.
[13]	LI Hongjie，ZHANG Yan，YU Zijuan，WANG Ronghua，ZHAO Jing，DU Cancan，TIAN Yutong，LIU Zhen. Status Quo of Active Aging among Rural Elderly and Its Influencing Factors　 [J]. Chinese General Practice, 2020, 23(16): 1989-1995.