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中华消化病与影像杂志(电子版)

中华消化病与影像杂志(电子版) ›› 2024, Vol. 14 ›› Issue (03) : 268 -274. doi: 10.3877/cma.j.issn.2095-2015.2024.03.017

综述

幽门螺杆菌阴性胃黏膜相关淋巴组织淋巴瘤的研究进展
安亚楠1, 王端然1, 郭甜甜1, 武希润1,†()   
  1. 1. 030001　太原，山西医科大学第二临床医学院
  • 收稿日期:2023-11-12 出版日期:2024-06-01
  • 通信作者: 武希润

Research progress of Helicobacter pylori negative gastric mucosa-associated lymphoid tissue lymphoma

Yanan An1, Duanran Wang1, Tiantian Guo1, Xirun Wu1,†()   

  1. 1. Second Clinical Medical School, Shanxi Medical University, Taiyuan 030001, China
  • Received:2023-11-12 Published:2024-06-01
  • Corresponding author: Xirun Wu
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引用本文：

安亚楠, 王端然, 郭甜甜, 武希润. 幽门螺杆菌阴性胃黏膜相关淋巴组织淋巴瘤的研究进展[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(03): 268-274.

Yanan An, Duanran Wang, Tiantian Guo, Xirun Wu. Research progress of Helicobacter pylori negative gastric mucosa-associated lymphoid tissue lymphoma[J/OL]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(03): 268-274.

随着医疗技术的发展，越来越多的证据表明，胃黏膜相关淋巴组织（MALT）淋巴瘤的发生与幽门螺杆菌（Hp）的感染密切相关。通过单纯根除Hp治疗已成为该疾病的一线治疗方案。但目前发现，还有绝大部分胃MALT淋巴瘤患者不存在Hp感染，Hp阴性的胃MALT淋巴瘤的发病机制、内镜临床表现和治疗方式与阳性患者存在不同。且治疗方案存在争议。本文总结了Hp为阴性的胃MALT淋巴瘤的发病机制、临床表现及治疗方案，并对未来治疗进行展望，为提高该疾病的治愈率以及降低不良反应发生率提供参考。

关键词: 胃黏膜相关淋巴组织淋巴瘤, 螺杆菌，幽门, 发病机制, 诊断与治疗, 预后

With the development of medical technology, more and more evidence shows that the occurrence of gastric mucosa-associated lymphoid tissue (MALT) lymphoma is closely related to the infection of Helicobacter pylori (Hp). Treatment by simple eradication of Hp has become the first-line treatment for the disease. However, it has been found that most patients with gastric MALT lymphoma do not have Hp infection, and the pathogenesis, endoscopic clinical manifestations and treatment methods of HP-negative gastric MALT lymphoma are different from those of positive patients. And treatment options are controversial. In this paper, the pathogenesis, clinical manifestations and treatment of HP-negative gastric MALT lymphoma are summarized, and the future treatment is prospected, so as to provide reference for improving the cure rate of this disease and reducing the incidence of adverse reactions.

Key words: Gastric mucosa-associated lymphoid tissue lymphoma, Helicobacter pylori, Pathogenesis, Diagnosis and treatment, Prognosis
表1 存在基因突变的文献
文献信息 病例总数 基因突变统计
总数 Hp阴性 Hp阳性
Jung H 2023[5] 22 6 6 0
Liu H 2001[8] 21 9 9 0
Hiroshi Inagaki 2004[9] 115 21 11 10
Lévy M 2005[10] 53 17 12 5
Raderer M 2005[11] 6 1 1 0
Wundisch T2005[12] 65 10 10 0
Nakamura S 2006[13] 54 7 6 1
Taiji Akamatsu 2006[14] 14 6 3 3
Nakamura T 2008[15] 87 15 8 7
Wang G 2009[16] 48 15 NA NA
Asano N 2012[17] 18 7 7 0
Nakamura S 2012[18] 206 30 NA NA
Choi YJ 2013[19] 66 10 5 5
Raderer M 2015[20] 97 3 3 0
Strati P 2019[21] 26 3 3 0
Kim SH 2023[22] 2 2 2 0
Takigawa H 2021[38] 182 13 5 8
Takigawa H 2023[42] 137 17 14 3
汇总 1219 192 105 42
图1 溃疡合并结节型病变，主要分布于胃窦部且病变多发
图2 窄带成像放大内镜染色可见血管形态呈现树样外观
表2 Hp阴性胃MALT淋巴瘤内镜特点
文献信息 例数 年龄(岁) 病灶数目(单个/多个) 发病部位(近端/远端) 病变性质(浅表型/溃疡型/结节型) 浸润深度(黏膜及黏膜下层/肌层及以下) 分期(早期/进展期)
Nakamura S 2006[13] 10 58(41~80) NA 7/3 溃疡/其他类型4/6 3/7 7/3
Taiji Akamatsu 2006[14] 16 64.8(39~80) 12/4 10/2(4例弥漫) 0/16/0 14/2 14/2
Asano N 2012[17] 18 58.5 3/15 2/16 14/0/4 NA 18/0
Choi YJ 2013[19] 13 60.23 11/2 5/8 10/3/0 4/9 9/4
Park HS 2010[29] 11 55.7(36~73) 5/6 2/3(6例弥漫) 溃疡/结节6/3(2例混合) NA NA
Ryu KD 2014[30] 14 57 5/9 3/2(9例弥漫) 12/2/0 NA 10/4
Gong EJ 2016[31] 28 52(48~59) NA 12/16 20/8/0 27/1 25/3
Kim JS 2016[32] 12 58.5 2/10 4/2(6例弥漫) 9/3/0 NA 9/3
柳娟2019[33] 13 52(46~65) 3/10 6/1(6例弥漫) NA NA 4/9
汇总 135   41/56 51/53(31例弥漫) 浅表型65；溃疡型27；结节型7；其他8 48/19 96/28
表3 不同类型Hp阴性胃MALT淋巴瘤患者疗效对比
  无基因突变 存在基因突变
治疗方式 抗Hp治疗 抗Hp治疗 放射治疗
有效率 36.22% 8.77% 33.33%
表4 Hp阴性胃MALT淋巴瘤患者不同治疗措施疗效及随访观察
文献 例数 Hp阴性(例) 抗Hp治疗(例) 无基因改变 存在基因改变 基因改变(例) 联合其他治疗措施 随访时间 随访结局
抗Hp治疗 抗Hp治疗 放疗 治疗无效
Jung H 2023[5] 65 22 5 3/7CR 6 1 5 0 无 NA NA
Kuo SH 2017[6] 25 25 25 9/25CR 7 0 NA 7 12例无反应患者追加化疗 51(34.7~67.3)个月 无复发及转移
Taiji Akamatsu 2006[14] 57 16 9 1/9CR 3 0 0 3 无 48个月 无复发及转移
Nakamura T 2008[15] 86 16 17 1/17CR 8 1 5 2 NA 9.5(2.5~17)年 无复发及转移
Asano N 2012[17] 158 18 17 5/11CR 7 1 2 4 无 7年 无复发及转移
Nakamura S 2012[18] 420 44 44 6/44CR NA NA NA NA 无 6.5(3~14.6)年 无复发及转移
Choi YJ 2013[19] 66 13 5 2/5CR、1/5PR、2/5SD 7 0 NA 7 无 26~35个月 无复发及转移，SD患者无进展
Raderer M 2015[20] 97 24 13 5 /13CR、1/13PR、4/13SD、3/13PD 3 1(PR) 0 2 SD患者追加化疗 95(42~181)个月 2例CR分别于19、23个月后复发，1PR26个月后进展
Strati P2019[21] 64 26 26 10/26CR NA NA NA NA SD患者放疗后达CR 11年 2例复发
Kim SH 2023[22] 2 2 0 0 2 0 2 0 无 NA NA
Park HS 2010[29] 11 11 3 3/3CR NA NA NA NA 无 25(5~76)个月 无复发及转移
Gong EJ 2016[31] 345 28 28 16/28CR NA NA NA NA 7例追加放化疗 11.5 (6.2~16.8)个月 1例CR9个月后复发
Kim JS 2016[32] 54 12 6 3/6CR，2/6SD，1/6PD NA NA NA NA SD患者追加化疗 13(6~27)个月 1例17个月后复发
柳娟2019[33] 44 13 4 3/4CR，1/4SD NA NA NA NA SD患者追加化疗后达CR 8.1(5~10)个月 1例CR8个月后复发
Lu SN 2022[37] 1 1 1 1 NA NA NA NA NA 5个月 NA
Takigawa2021[38] 182 34 29 15/29CR 13 0 5 8 无 NA NA
Moleiro J 2016[39] 144 12 12 5/12CR NA NA NA NA 无 7(2~63)个月 无复发及转移
Li XW 2016[40] 73 4 4 2/4CR NA NA NA NA 无 62.9(1~226)个月 NA
Angelo Zullo[41] 110 110 110 11/110CR NA NA NA NA 无 14~48个月 1例14个月后复发
Stathis A 2009[43] 105 14 14 5/14CR NA NA NA NA NA 6.3年 3例复发
汇总 2115 451 312 110CR，3PR，10SD，4PD 57 4CR，1PR 19CR 33     12例复发，1例进展
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