臺灣博碩士論文加值系統

中文摘要

本研究在探討造成十二指腸潰瘍發生以及復發之相關因子來設計實驗
。我們利用電子內視鏡進行上消化道檢查，證實是否有十二指腸潰瘍
的存在。在胃液酸度與十二指腸潰瘍的關係，我們抽取少許胃液，進
行胃液酸度pH值檢測，利用student's T test檢定後比較潰瘍患者及
非潰瘍患者之胃液酸度pH值，結果顯示潰瘍患者有較低的胃液酸度
（P < 0.05）。在幽門螺旋桿菌與十二指腸潰瘍的關係，我們採取少
許切片做CLO test以及H＆E stain來證實幽門螺旋桿菌存在與否。結
果顯示十二指腸潰瘍患者有較高的幽門螺旋桿菌感染率（P < 0.05）
。在自由基與十二指腸潰瘍的關係，我們分析急性潰瘍患者與非潰瘍
受檢者，十二指腸黏膜中Cu/Zn-SOD的含量，結果顯示在潰瘍活動期，
十二指腸黏膜有較高含量的Cu/Zn-SOD（P < 0.05）。在前列腺素E2
與十二指腸潰瘍的關係，我們分析急性潰瘍患者與非潰瘍受檢者，胃
黏膜組織中前列腺素E2的含量，結果顯示十二指腸潰瘍患者與非潰瘍
受檢者之胃黏膜組織中，前列腺素E2的含量，在統計學上，並無有意
義的差異 (P > 0.05)。在十二指腸潰瘍復發的因子上，我們討論再
生黏膜的組織成熟度並研究十二指腸黏膜之胃上皮化生及球部變形與
潰瘍復發的相關性，結果顯示再生黏膜的組織成熟度愈差者與胃上皮
化生的程度及球部變形的程度愈嚴重者，有較高的潰瘍復發率。我們
的結論是十二指腸潰瘍發生的因子是多樣性，包括攻擊因子如胃酸、
幽門螺旋桿菌及自由基等過多有關，但是防禦因子如前列腺素E2的含
量在十二指腸潰瘍上似乎不若胃潰瘍來得明確。此外更重要的是在
十二指腸潰瘍復發的研究上，發現十二指腸再生黏膜的組織成熟度與
十二指腸球部變形的程度及胃上皮化生的程度確實與十二指腸潰瘍的
復發有密切的相關性，而根除幽門螺旋桿菌，可能可以減少十二指腸
球部變形的程度以及胃上皮化生的程度，因而避免潰瘍的一再復發。

英文摘要
A study has been conducted by our institute to investigate
factors related to development and recurrence of duodenal
ulcer.TV-endoscopy was used in this study to confirm the
existence of duodenal ulcer ( DU ) . For studying the
relationship between gastric acidity and duodenal ulcer,
small amount of gastric juice were aspirated from patients
with or without duodenal ulcer during endoscopic examination
to check the intragastric pH using pH meter . The result
showed that there was significant lower gastric pH in duodenal
ulcer patients (P < 0.05) as compared with patients without
duodenal ulcer. For studying the infection rate of H. pylori
in patients with duodenal ulcer, gastric specimens were taken
during endoscopy to perform CLO test and H & E staining. The
infection rate of H. pylori were 89.4％in DU patients and 50.8％
in non-ulcer patients. The result showed that DU patients have
a higher infection rate (P < 0.05) as compared with patients
without duodenal ulcer. Regarding the relationship between
free radical and DU, we analyzed Cu/Zn-SOD content in duodenal
mucosa of acute DU patients and non-ulcer patients. The result
showed a significant higher content of Cu/Zn-SOD in DU patients
( P < 0.05). In conjunction to PGE2 and DU, we analyzed the PGE2
level of gastric mucosa in both acute DU patients and non-ulcer
patients and the result showed that there was no significant
difference between patients with and without duodenal ulcer
( P > 0.05). For further studying the recurrence of duodenal
ulcer, we discussed histological maturity of regenerating mucosa
and studied the correlation among the grade of gastric
metaplasia, deformity of duodenal bulb and the recurrence of
DU. The result showed that the less histological maturity of
regenerating mucosa, the higher the level of gastric metaplasia
and the more severe the deformity of duodenal bulb the patient
have, the higher rate of DU recurrence the patient would have.
In conclusion, there were multiple factors related to
development and recurrence of DU, they consist of aggressive
factors such as gastric acid, H. pylori and excessive free
radicals and protective factors, such as poor maturity of
regeneration mucosa. However, we found that PGE2 do not play
an important role in the DU development. Because the
correlation among histological maturity of regenerating mucosa,
the grade of gastric metaplasia, severity of deformity of
duodenal bulb and ulcer recurrence are highly associated. We
suppose that eradication of H. pylori could reduce the level
of gastric metaplasia and deformity of duodenal bulb and thus
prevent the recurrence of DU.

目錄
致謝-------------------------------------------------- Ⅰ
中文摘要---------------------------------------------- Ⅱ
英文摘要---------------------------------------------- Ⅲ
圖表目錄---------------------------------------------- Ⅳ
第一章 前言
第一節 十二指腸潰瘍的定義---------------------- 1
第二節 十二指腸潰瘍的盛行率-------------------- 1
第三節 十二指腸潰瘍的診斷---------------------- 2
第四節 十二指腸潰瘍的型態---------------------- 2
第五節 十二指腸潰瘍發生的相關因子-------------- 2
第二章 胃液酸度與十二指腸潰瘍的相關性
第一節 實驗材料和方法-------------------------- 4
第二節 結果------------------------------------ 4
第三節 討論------------------------------------ 5
第三章 幽門螺旋桿菌與十二指腸潰瘍的相關性
第一節 實驗材料和方法-------------------------- 6
第二節 結果------------------------------------ 6
第三節 討論------------------------------------ 7
第四章 過氧化物歧化(superoxide dismutase)與十二指腸
潰瘍的相關性
第一節 實驗材料和方法------------------------- 10
第二節 結果----------------------------------- 10
第三節 討論----------------------------------- 11
第五章 前列腺素E2與十二指腸潰瘍的相關性
第一節 實驗材料和方法------------------------- 13
第二節 結果----------------------------------- 13
第三節 討論----------------------------------- 14
第六章 再生黏膜組織成熟度與十二指腸潰瘍復發的相關性
第一節 再生黏膜組織成熟度的分類--------------- 16
第二節 再生黏膜組織成熟度與十二指腸潰瘍復發
的關係--------------------------------- 17
第三節 討論----------------------------------- 18
第七章 十二指腸黏膜之胃上皮化生，球部變形與十二指腸
潰瘍復發的相關性
第一節 實驗材料和方法--------------------------19
第二節 結果------------------------------------20
第三節 討論------------------------------------22
第八章 總結------------------------------------------25
第九章 參考文獻--------------------------------------39

圖表目錄

圖一 十二指腸潰瘍的定義---------------------------- 27
圖二 十二指腸球部潰瘍的內視鏡分類------------------ 28
圖三 CLO test--------------------------------------- 28
圖四 Helicobacter pylori (H & E stain)--------------------- 29
圖五 幽門螺旋桿菌之致病機轉------------------------ 30
圖六 十二指腸黏膜中Cu/Zu-SOD含量之比較------------ 31
圖七 胃黏膜中PGE2含量之比較----------------------- 32
圖八 十二指腸再生黏膜成熟度之分類------------------ 33
（A~D）
圖九 十二指腸黏膜胃上皮化生之程度------------------ 35
（A~F）
表一 再生黏膜胃上皮化生程度與球部變形嚴重度之相關性
-------------------------------------------- 38

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