위 생검조직내 Helicobacter pylori의 검사 방법에 따른 검출율 및 H. pylori 감염과 연관된 병리조직학적 분석 = A Study on Prevalence of Helicobacter pylori Infection According to Detective Methods and Analysis of H. pylori-associated Histologic Parameters in Gastric Biopsy Specimens

국문 초록 (Abstract)

위점막 생검조직의 파라핀 포매조직 96예를 대상으로 하여 H&E염색, Giemsa염색과 H. pylori 면역조직화학염색을 시행하여 H. pylori의 검출 정도를 검사 방법별, 질환별로 비교하여 면역조직화학염색법의 유용성을 살펴보고자 하였으며, H. pylori 존재 유무에 따른 위점막 조직의 형태학적인 변화를 관찰하여 H. pylori 감염과 연관된 특징적인 조직학적 변화를 조사하고자 본 연구를 시행하였다. H. pylori 검출에 면역조직화학염색이 Giemsa 혹은 H&E 염색보다 유용하였고, 만성활동성 위염과 소화성 궤양에서 높은 검출율을 보여 이들 질환의 병인에 H. pylori가 관여함을 나타내었다. 그리고 조직소견상 중성구의 침윤과 림프여포 및 림프구 집락 형성은 H. pylori 감염을 시사하는 표지자로서 의의가 있음을 보여주었다.

다국어 초록 (Multilingual Abstract)

Objective: Helicobacter pylori(H. pylori) infection have been under study as an etiologic factor in the pathogenesis of gastritis, peptic ulcer, carcinoma or lymphoma. Microscopic examination of H. pylori on H&E section is not reliable, and special stains as Warthin-Starry, Giemsa or Genta stains have been used but are not simple and not easy to evaluate. Recently immunohistochemistry for H. pylori, known as the most senstitive method, has been developed.
Materials & Methods: The materials were 96 endoscopic biopsied gastric tissues consisted of 33 cases of chronic gastritis, 30 cases of chronic active gastritis, 18 cases of chronic peptic ulcer and 15 cases of carcinoma, respectively. H&E, Giemsa stainings and immunohiotochemistry for H. pylori(DAKO) were done on serial sections of 96 cases. Detection rates according to staining methods and gastric lesions were evaluated, and correlation between H. pylori-associated histologic changes of neutrophilic infiltration, lymphoid follicle or aggregates formation and intestinal metaplasia, and H. pylori immunoreactivity was analyzed.
Results:
1.On immunohistocheimistry for H. pylori, positive rate of chronic active gastritis was the highest as 93.3%, and chronic peptic ulcer 66.7%, carcinoma-adjacent mucosa 53.3%, chronic gastritis 48.5% in decreasing order.
2.Giemsa and H&E stainings showed limited value for H. pylori detection. Sensitivity of Giemsa staining compared with immunohistochemical staining was relatively low as 78.1% and false negative rate was high as 32.6%, and sensitivity and specificity of H&E staining compared with immunohistochemical staining were low as 85.9% and 62.5%, respectively, and false positive and negative rates were high as 37.5% and 14.0%, respectively.
3.Neutrophilic infiltration in the gastric mucosa was noted in 67.2% of H. pylori-positive group and in 9.4% of H. pylori-negative group, and its difference was statistically significant (p<0.05). H. pylori detection rate in neutrophilic infiltration-positive group was high as 93.5%.
4.Lymphoid follicle or aggregates were observed in 40.6% of H. pylori-positive group and in 9.4% of H. pylori-negative groups, and its difference was also significant (p<0.05). 89.7% of lymphoid follicle or aggregates-forming cases revealed positive reaction for H. pylori.
5.H. pylori positive rates of intestinal metaplasia-positive and -negative groups were 62.7% and 71.1%, respectively, and no significant difference between H. pylori infection and intestinal metaplasia was found.
Conclusions: Immunohistochemistry is regarded as the most useful method for detection of H. pylori in tissue sections, and high positive rate of H. pylori in chronic active gastritis and peptic ulcer suggests a possible role of H. pylori in the pathogenesis. Histologically neutrophilic infiltration and lymphpoid follicle or aggregates formation in the gastric mucosa are considered as an indirect indicators of H. pylori infection. Further study for the role of H. pylori infection in the gastric lesions should be performed.

목차 (Table of Contents)

• Ⅰ.서론
• Ⅱ.연구 재료 및 방법
• A.연구 재료
• B.연구방법
• Ⅲ.결과
• A.H. pylori 검출
• B.병리조직학적 소견과 H. pylori와의 연관성(Table 3, 4)
• Ⅳ.고찰
• Ⅴ.결론