四联疗法补救治疗幽门螺杆菌感染的效果观察

<正>幽门螺杆菌(helicobacter pylori,H.pylori)主要寄生在胃,全球超过一半的人感染幽门螺杆菌,是胃炎、消化性溃疡和胃癌等的主要致病因素~[1]。临床上主要通过抗生素联合质子泵抑制剂根除幽门螺杆菌~[2]。目前根除幽门螺杆菌最主要的问题是幽门螺杆菌对抗生素产生耐药性~[3]。由于幽门螺杆菌对抗生素产生耐药性或患者治疗依从性较差,导致治疗失败     

根除H.pylori方案在不同性别患者中的疗效观察

幽门螺杆菌H.pylori是一种专寄生于胃黏膜的革兰阴性微需氧菌[1]。根除H.pylori后,上述疾病可以取得良好的治疗效果。但随着抗生素的广泛应用,H.pylori的耐药性也逐渐提高,H.pylori根除的难度逐渐增加,过去一些取得较好疗效的H.pylori根除方案,H.pylori根除率正在逐年降低,其原     

幽门螺杆菌感染相关疾病

幽门螺杆菌(H.pylori)是全球最常见的感染源之一,发展中国家的感染明显高于发达国家。儿童是幽门螺杆菌的易感人群,绝大多数H.pylori感染者的第一次感染在10岁以内。流学病学资料显示中国儿童的H.pylori流行率在西北部为52.3%,西南部为40.7%,东部为40.93%[1-3]。H.pylori感染途     

幽门螺杆菌感染常用治疗方案及治疗中存在的问题

幽门螺杆菌(Helicobacter pylori,H.pylori)感染是最常见的感染性疾病之一,其与多种上胃肠道疾病密切相关,对H.pylori感染治疗的研究始终是一个热点问题。本文简单介绍了目前临床常用的H.pylori根除治疗方案,并根据国内外的共识意见以及笔者的临床经验,对H.pylori感染治疗中存在的一些问题进行阐述。     

牙周基础治疗联合益生菌治疗难治性幽门螺杆菌感染的效果

目的探讨牙周基础治疗联合含益生菌的四联疗法治疗难治性幽门螺杆菌感染的疗效。方法将150例幽门螺杆菌(H.pylori)感染患者随机分为治疗组和对照组,前者给予雷贝拉唑、克拉霉素、阿莫西林、复合乳酸菌胶囊口服2周,后者给予牙周基础治疗联合上述四联疗法。停药4周后复查H.pylori,比较各组的H.pylori根除率、药物不良反应。结果治疗组H.pylori根除率(92.0%)与对照组(72.0%)相比,差异具有统计学意义(P0.05)。各组不良反应发生率均较低且差异无统计学意义。结论联用牙周基础治疗能显著提高H.pylori根除率。     

抗CtUBE IgY的制备及其抗幽门螺杆菌感染研究

文章以纯化的CtUBE为抗原粘膜免疫160日龄的海蓝褐蛋鸡,收集鸡蛋,经水提取法获得蛋黄水溶性蛋白组分(WSF),半饱和硫酸铵沉淀,超滤,Sephacryl S-200 HR柱层析纯化IgY,成功制备出纯度在98%左右,效价达1∶25600的抗CtUBE特异性IgY。以胃幽门螺杆菌感染蒙古沙土鼠胃炎模型评价抗CtUBE IgY对幽门螺杆菌感染的治疗效果,结果显示H.pylori感染的蒙古沙鼠经过抗CtUBE IgY的治疗,其胃壁炎症病变明显减轻。表明口服抗CtUBE IgY对H.pylori感染具有一定的治疗效果,该方法有可能替代抗生素治疗幽门螺杆菌感染。     

培养幽门螺杆菌-小鼠适应株的实验研究

目的培养幽门螺杆菌-小鼠适应株.方法 (1)先用4株cagA及vacA基因,均为阳性菌株的H.pylori给10只BALB/c小鼠灌胃,4周后剖杀,取小鼠胃黏膜培养及鉴定后得两株(小1、小2)H.pylori-小鼠适应株;(2)用细菌学检查观察小鼠的H.pylori定植情况.结果用4株cagA及vacA基因阳性菌株去感染小鼠,有三只感染成功,感染率为33.3%(3/9),两只传代成功.H.pylori感染小鼠胃黏膜H.pylori定植多位于胃小凹上部及胃腺腔内,数量不多.结论 cagA及vacA基因均为阳性的云南菌株,灌胃后能定植在BALB/c小鼠胃内,培养出H.pylori-小鼠适应株.     

抗幽门螺杆菌药物的临床研究进展

目前用于根除幽门螺杆菌（Helicobacter pylori, HP）感染的药物主要有质子泵抑制剂、相关抗生素、铋剂、益生菌及中医药等。要提高HP的根除率,就必须坚持个体化治疗,选择最佳组合。本文对根除幽门螺杆菌的临床药物研究进展进行综述。     

根除幽门螺杆菌感染的药物治疗

幽门螺杆菌(Hp)是一种在胃上皮管腔表皮发现的革兰阴性菌,为胃溃疡及十二指肠溃疡、胃炎主要病因.根除幽门螺杆菌是治疗溃疡病的重点,幽门螺杆菌的耐药率影响治疗效果.根治Hp治疗方案包括抗生素、质子泵抑制剂、胃黏膜保护剂及益生菌联合用药,标准三联方案可以提高疗效,但受抗生素耐药性限制,临床还需序贯治疗和四联方案.本文介绍了临床治疗幽门螺杆菌感染常用药物的选择及联合应用,为早期控制其感染率,提高根除率提供参考.     

耐药幽门螺杆菌感染治疗的研究进展

幽门螺杆菌是革兰阴性、微需氧的细菌,生存于胃部及十二指肠的各区域内,与消化性溃疡、胃癌、胃淋巴瘤等疾病密切相关.对幽门螺杆菌感染,临床上常采用抗生素治疗,但因细菌对抗生素耐药性问题越来越严重,治疗效果不理想.本文综述幽门螺杆菌感染治疗的最新研究进展,指出不同治疗方案在治疗幽门螺杆菌感染方面的作用.     

左氧氟沙星三联治疗根除幽门螺旋杆菌临床疗效观察

目的观察以左氧氟沙星为基础的三联疗法根除幽门螺旋杆菌的疗效。方法选择202例幽门螺旋杆菌感染患者,随机分为2组,治疗组80例采用以左氧氟沙星为基础的三联疗法,对照组采用标准三联疗法,停药4周后进行13C呼气试验,统计幽门螺旋杆菌根除率,并同时记录患者不良反应情况。结果治疗组幽门螺旋杆菌根除率为90%,幽门螺旋杆菌根除率为68.8%,差异有显著性(P<0.05)。治疗组药物不良反应发生为率8.75%,对照组药物不良反应发生为率12.29%,无统计学差异(P>0.05)。结论对于幽门螺旋杆菌感染患者,以左氧氟沙星为基础的三联疗法,幽门螺旋杆菌的清除率明显优于标准三联疗法,而药物不良反应率相当,值得临床推广。     

Diagnostic methods for Helicobacter pylori detection and eradication

Helicobacter pylori is the principal cause of peptic ulcer disease and an important risk factor for the development of gastric cancer. The efficacy of 1 week triple therapies, which often have eradication rates of>90%, is undermined by poor patient compliance and bacterial antimicrobial resistance. The development of new anti-H. pylori therapies presents enormous challenges to clinical pharmacologists, not only in the identification of novel targets, but also in ensuring adequate drug delivery to the unique gastric mucus niche of H. pylori. Animal models of H. pylori infection have been developed but their clinical validity has yet to be established. Vaccination, to prevent or treat infection, has been demonstrated in animal models, but human studies have not been so encouraging.     

四联疗法治疗幽门螺杆菌阳性消化性溃疡疗效观察

目的观察四联疗法治疗HP阳性的十二指肠溃疡、胃溃疡HP根除率及疗效。方法经胃镜和快速尿素酶方法确诊的HP阳性十二指肠溃疡和胃溃疡共247例。予雷贝拉唑20 mg,2次/日+胶体果胶铋0.2,2次/日+克拉霉素0.5,2次/日+甲硝唑0.4,2次/日,口服一周,继而连服雷贝拉唑20 mg,一次/日共5周。疗程结束四周后胃镜及快速尿素酶试验复查。结果随访成功196例,HP总根除率81.6%,其中十二指肠溃疡根除率86%,胃溃疡根除率67.4%,溃疡病总有效率88.3%,其中十二指肠溃疡有效率89.3%,胃溃疡有效率84.8%,两组比较差异显著(P0.01)。结论含雷贝拉唑的四联疗法,对HP阳性的十二指肠溃疡HP根除及疗效优于HP阳性的胃溃疡。     

Review article: Helicobacter pylori infection and gastric outlet obstruction - prevalence of the infection and role of antimicrobial treatment

The prevalence of Helicobacter pylori infection in peptic ulcer disease complicated by gastric outlet obstruction seems to be, overall, lower than that reported in non-complicated ulcer disease, with a mean value of 69%. However, H. pylori infection rates in various studies range from 33% to 91%, suggesting that differences in variables, such as the number and type of diagnostic methods used or the frequency of non-steroidal anti-inflammatory drug intake, may be responsible for the low prevalence reported in some studies. The resolution of gastric outlet obstruction after the eradication of H. pylori has been demonstrated by several studies. It seems that the beneficial effect of H. pylori eradication on gastric outlet obstruction is observed early, just a few weeks after the administration of antimicrobial treatment. Furthermore, this favourable effect seems to remain during long-term follow-up. Nevertheless, gastric outlet obstruction does not always resolve after H. pylori eradication treatment and an explanation for the failures is not completely clear, non-steroidal anti-inflammatory drug intake perhaps playing a major role in these cases. Treatment should start pharmacologically with the eradication of H. pylori even when stenosis is considered to be fibrotic, or when there is some gastric stasis. In summary, H. pylori eradication therapy should be considered as the first step in the treatment of duodenal or pyloric H. pylori-positive stenosis, whereas dilation or surgery should be reserved for patients who do not respond to such medical therapy.     

Treatment of Helicobacter pylori

Recognition in the last 12 years that H. pylori is a common infection which causes the majority of peptic ulcers and many gastric cancers has revolutionised understanding of these diseases. However, genuinely novel treatments have in the main not yet emerged. Eradication of H. pylori is difficult because of the problems of delivering bactericidal levels of antibiotics to the gastric mucus where the organism resides, because of the emergence of resistance to nitroimidazoles and clarithromycin, and possibly because H. pylori can assume a resting coccoid form which is not susceptible to antibiotic treatment. To date, eradication treatment has been based upon the use of existing antibiotics employed in intensive multi-drug regimes of three basic types. Bismuth-based triple therapy employed ampicillin or a nitroimidazole, tetracycline and bismuth and achieved eradication rates of approximately 80%. Dual therapy in which amoxycillin was added to omeprazole was briefly popular because of its greater simplicity but fell from favour when it was realised that eradication rates were considerably lower. However, the recognition that proton pump inhibitors enhance eradication by either direct or indirect mechanisms led to the development of what is currently the most effective treatment - proton pump-based triple therapy in which a nitroimidazole or amoxycillin is combined with a proton pump inhibitor and clarithromycin. Such regimes achieve approximately 90% eradication. So far, the only therapy specifically developed for the treatment of H. pylori is ranitidine bismuth citrate (Pylorid). This new chemical entity based on ranitidine and bismuth citrate uses the antibacterial effects of bismuth to kill H. pylori but requires co-administration of another antibiotic to achieve reasonable eradication rates. In the future, further novel, specific anti-Helicobacter treatment can be expected, as a result of strategies targeted at key virulence factors or metabolic pathways such as the organism's urease, adhesin, cytotoxin, oxidase or nitro reductase activities. Some of these strategies will involve vaccination. Other possible approaches include targeting the coccoid form, achieving single treatment eradication and more effective gastric mucus delivery systems.     

Eradication of Helicobacter pylori: current perspectives

Helicobacter pylori appears to be a necessary cofactor for the majority of non-drug-associated duodenal and gastric ulcers. H. pylori infection is a chronic and transmissible infectious disease whose eradication has proved difficult. The last decade has seen > 1000 clinical trials using different eradication regimens. Many of these trials had severe limitations, some of which will be discussed here. The current review also focuses on the regimens that were used in the past, the present regimens and possibilities for the future. Also highlighted are some other aspects of H. pylori management, such as eradication failures and drug resistance.     

clinical aspects of Helicobacter pylori eradication therapy in peptic ulcer disease

Background and aims : Although the role of H. pylori in peptic ulcer disease is no longer in dispute, certain aspects of eradication therapy in this condition have yet to be settled. Uncertainties still surround the relationship between Helicobacter pylori status and ulcer healing, the efficacy of eradication therapy in alleviating acute symptoms and healing ulcers, and the prognosis after eradication with respect to recurrence of symptoms, ulcers and complications. The present literature review, encompassing studies published up to October 1995, specifically addresses these issues.
Results : Pooled data show that eradication therapy heals 90% of duodenal ulcers and 85% of gastric ulcers, while individual studies repeatedly confirm that it is more effective at healing ulcers than conventional treatment with anti-secretory drugs. Recent reports indicate that triple therapy regimens for 1 week, provided they include an anti-secretory drug, are sufficient to achieve high rates of healing and rapid symptom relief. A detailed analysis of the data, particularly those from studies reporting healing rates in relation to H. pylori status after eradication therapy, provides strong evidence that eradication of H. pylori produces ulcer healing. Follow-up studies show that ulcer recurrence and complications are rare after eradication treatment in patients with either gastric or duodenal ulcer disease. However, while ulcer symptoms are infrequent during follow-up, a proportion of patients appear to develop gastrooesophageal reflux after eradication.
Conclusions : H. pylori eradication is highly effective in promoting ulcer healing and preventing subsequent ulcer recurrence. These beneficial effects of eradication therapy are observed in patients with either gastric or duodenal ulcers which are associated with H. pylori infection.     

Strategy for treatment of Helicobacter pylori infection in adults. I. Updated indications for test and eradication therapy suggested in 2000

Since the report of culture of Helicobacter pylori in 1983, there has been increasing agreement that H. pylori infection is etiologically associated with a number of important diseases including chronic active gastritis, peptic ulcer disease, mucosa-associated lymphoid tissue (MALT) lymphoma, gastric polyps, gastric cancer, as well as suggestions that it may be involved in diseases outside the upper gastrointestinal tract. There have been a number of national and international consensus meetings to propose guidelines to treat H. pylori infection. The recommendations of these conferences are reviewed here and updated to include new indications and concepts regarding H. pylori eradication therapy. Eradication therapy is considered the standard of care for active or inactive peptic ulcer patients including those who use non-steroidal anti-inflammatory drugs (NSAIDs). Other strong indications include MALT lymphoma, hyperplastic polyps, hyperplastic gastropathy, post-endoscopic resection for gastric malignancy, and acute H. pylori gastritis. Other considerations include plan to use chronic NSAID therapy, plan for chronic anti-secretory therapy, and some extra-gastroduodenal diseases such as chronic ureterica. Non-investigated dyspepsia is an indication for diagnostic evaluation and eradication therapy for those with H. pylori infection, whereas non-ulcer dyspepsia (NUD) in which peptic ulcer disease has been excluded is not an indication for evaluation per se. Intervention studies are now in progress to test the hypothesis that prevention of gastric malignancy is an outcome of H. pylori eradication. Because the prevalence of H. pylori infection and the associated diseases such as peptic ulcer or gastric cancer differ among countries as well as different approvals for treatment are required by governments or insurance agencies, the acceptable indications of eradication therapy will, by necessity, vary among countries.     

幽门螺杆菌个体化精准根治的研究进展

幽门螺杆菌（Helicobacter pylori,Hp）感染与消化道疾病及全身多个系统的发病相关,其感染率高、致病力强,威胁着人们的身体健康。近年来由于抗生素的滥用,抗生素耐药呈逐年上升趋势,从而导致Hp根除率下降,成为临床棘手的问题。近年来,为了努力提高Hp根除率,国内外学者做了积极探索,提出了“个体化”精准根除治...     

Eradication of Helicobacter pylori: current perspectives

Helicobacter pylori appears to be a necessary cofactor for the majority of non-drug-associated duodenal and gastric ulcers. H. pylori infection is a chronic and transmissible infectious disease whose eradication has proved difficult. The last decade has seen > 1000 clinical trials using different eradication regimens. Many of these trials had severe limitations, some of which will be discussed here. The current review also focuses on the regimens that were used in the past, the present regimens and possibilities for the future. Also highlighted are some other aspects of H. pylori management, such as eradication failures and drug resistance.