胃粘膜肠上皮化生与幽门螺杆菌CagA抗体的关系

为研究胃粘膜肠上皮化生与幽门螺杆菌(Hμ)细胞毒素相关蛋白(CagA)菌株感染的关系,对415例慢性胃炎患者进行了血清HpCagA抗体检测,并同时进行快速尿素酶试验、组织学检查,抗体检测和~14C-尿素呼气试验检测Hp感染。结果显示慢性浅表性胃炎组,慢性萎缩性胃炎组和慢性胃炎伴肠上皮化生组患者HpCagA抗体检出率分别为21.67％、21.92％和28.43％,无显著性差异(X~=1.86,>0.05);而3组患者Hp抗体检出率分别为56.67％、56.16％和70.59％,慢性胃炎伴肠上皮化生组Hp抗体检出串最高,与其他两组有显著性差异(X~=5.82,3.87,均P<0.05)。表明CagA不是胃粘膜肠上皮化生发生的特异性致病因子,可能CagA以外的其它HP致病因子参与了胃粘膜肠上皮化生的发生。     

根治幽门螺杆菌对胃黏膜萎缩和肠上皮化生的影响

目的随访观察根治幽门螺杆菌（Hp）后对胃黏膜萎缩和肠上皮化生的影响。方法分析157例经胃镜和组织病理学检查确诊为萎缩性胃炎伴Hp感染患者给予抗Hp治疗的临床资料,比较胃黏膜萎缩和肠上皮化生的程度改变。结果 102例根治Hp患者随访1年,根治前后比较胃黏膜腺体萎缩程度评分显著减少（P〈0.01）,肠上皮化生评分无明显改变（P〉0.05）。86例随访2年,胃黏膜腺体萎缩和肠上皮化生评分均有显著减少（均P〈0.01）。结论根治Hp后可使胃黏膜萎缩和肠上皮化生程度减轻。     

慢性萎缩性胃炎37例临床分析

目的总结慢性萎缩性胃炎、伴肠上皮化生、Hp感染患者的临床经验。方法对37检出慢性萎缩性胃炎、伴肠上皮化生、Hp感染患者的临床资料进行回顾性分析。结果胃黏膜糜烂的31例，胃窦部腺体萎缩的28例，胃体部腺体萎缩的6例；37例均有肠上皮化生轻柳p感染者26例，重度Hp感染者11例。结论在体检中尤其对那些年龄偏大、长期吸烟、饮酒等高危人群更应注意慢性萎缩性胃炎、肠上皮化生及Hp感染等病变的发生以便给予警示，及早采取各种综合措施。     

胃窦部幽门螺杆菌清除对萎缩性胃炎的影响

目的:通过对萎缩性胃炎患者幽门螺杆菌(Hp)清除治疗前后胃窦部黏膜病理改变的分析,确定Hp对其炎症程度、腺体萎缩和肠上皮化生的影响。方法:采用Hp相关的萎缩性胃炎患者接受Hp清除治疗,对其治疗前后胃窦部黏膜的病理变化进行分析。结果:在治疗成功组中,治疗后胃黏膜的炎症程度及活动性较治疗前明显减轻,但腺体萎缩及肠上皮化生未减轻。在治疗失败组中,治疗前后胃黏膜的炎症程度、活动性、腺体萎缩及肠上皮化生均没有变化,且随着Hp感染时间的延长,腺体萎缩和肠上皮化生还可加重。结论:Hp的清除治疗可使萎缩性胃炎患者胃黏膜的炎症程度及活动度减轻,对此类患者应行Hp清除治疗。     

根治幽门螺杆菌对胃黏膜肠上皮化生转归的影响

目的 研究根除幽门螺杆菌(Hp)感染对胃黏膜肠上皮化生的影响.方法 回顾性分析90例慢性胃炎并肠上皮化生伴Hp感染的患者资料.按照随访Hp根除结果 不同分为根除组(54例)与未根除组(36例).观察两组胃黏膜炎肠上皮化生的变化.结果 4年后成功根除Hp的患者肠上皮化生程度明显减轻,与持续Hp感染组比较,差异有统计学意义(P<0.05).且随访发现根除组肠上皮化生积分(1.25±0.48)分,低于未根除组的(2.23±0.35)分,Hp根除组肠上皮化生积分明显改善,两组相比较差异有统计学意义(P<0.05).结论 根除Hp可以减轻胃黏膜肠上皮化生程度,防止肠上皮化生的进一步发展.     

幽门螺杆菌药物治疗

幽门螺杆菌(Helicobacter Pylori,Hp),是一种定植于人胃黏膜并引起不同胃十二指肠疾病的革兰阴性螺旋形细菌,大部分 Hp能表达毒素相关蛋白(CagA)及产生空泡毒素(VacA)等直接损伤胃黏膜上皮细胞,也可诱导炎症反应而引起胃黏膜损伤.自1983年 Hp被发现以来便一直受到较高关注,Hp(特别是CagA阳性的菌株)与慢性活动性胃炎、消化性溃疡、低度恶性胃黏膜相关淋巴组织(MALT) 淋巴瘤的发生关系极为密切,1994年被 WHO列为人类I类致癌原.因此,对于有症状的Hp感染者,应权衡利弊后进行Hp根除治疗.Hp根除治疗对象包括:Hp阳性的消化性溃疡、早期胃癌术后、胃MALT淋巴瘤、有明显异常(指合并糜烂、萎缩、肠化或不典型增生)的慢性胃炎、有胃癌家族史者、部分功能性消化不良、胃食管反流病.     

幽门螺杆菌感染与慢性萎缩性胃炎病理改变的相关性

目的探讨幽门螺杆菌（Hp）感染与慢性萎缩性胃炎胃黏膜固有腺体萎缩、肠上皮化生、异型增生的相关性。方法230例患者均经胃镜和病理检查确诊为慢性萎缩性胃炎,采用快速尿素酶试验和黏膜组织Giemsa染色法进行Hp检测。根据Hp感染情况分组,比较胃黏膜固有腺体萎缩、肠上皮化生及异型增生在Hp阳性组与Hp阴性组之间的差异。结果Hp阳性组129例慢性萎缩性胃炎中黏膜腺体轻度萎缩84例（65.1%）,中重度45例（34.9%）;轻度肠上皮化生48例（37.2%）,中重度23例（17.8%）;轻度异型增生31例（24.0%）,重度6例（4.6%）。与Hp阴性组比较,Hp阳性组胃黏膜中重度腺体萎缩、肠上皮化生及重度异型增生的发生率均显著升高（P〈0.01）。结论幽门螺杆菌感染与慢性萎缩性胃炎黏膜腺体中重度萎缩、肠上皮化生及重度异型增生等癌前病变的关系较为密切。     

幽门螺杆菌感染与胃黏膜组织学的关系

目的:探讨幽门螺杆菌(Hp)感染对胃黏膜炎性反应、萎缩和肠上皮化生(IM)的影响。方法:近一年来我院胃镜检查同时行Hp及胃黏膜组织学检查者3 410例,入选Hp感染的患者2 146例,Hp总感染率为62.9%,分析Hp阳性组和阴性组在胃黏膜炎性反应、萎缩及IM的变化。结果:HP阳性组中胃黏膜的炎性反应、腺体的萎缩和肠化的总人数明显高于Hp阴性组的总人数,差异有统计学意义(P<0.05)。结论:Hp感染是引起胃黏膜活动性炎性反应、萎缩和肠上皮化生主要因素。     

幽门螺杆菌感染及其毒力因子对胃黏膜病理学改变影响的观察

目的：检测幽门螺杆菌(HP)感染患者血清中细胞毒相关蛋白CagA和空泡细胞毒素VacA抗体，观察不同菌株对胃黏膜组织学改变的影响。方法：利用免疫印迹法检测139例HP感染的胃十二指肠疾病患者血清中CagA和VacA抗体．这些患者胃黏膜病理变化均经胃镜证实。观察不同毒力的HP菌株对胃黏膜病理学改变的影响。结果：十二指肠球部溃疡及慢性萎缩性胃炎患者血清中CagA及VacA抗体的检出率明显高于慢性浅表性胃炎的患者，且CagA抗体阳性组患者胃黏膜炎症活动及萎缩的程度较CagA抗体阴性组差异有显著性，而在肠上皮化生方面差异则无显著性。结论：具有CagA及VacA基因的幽门螺杆菌可能在诱导胃黏膜炎症及萎缩方面起了较为重要的作用。     

根除反复幽门螺杆菌感染对胃黏膜炎症和肠上皮化生的临床意义

目的探讨根除幽门螺杆菌(H.pylori)慢性感染对胃黏膜炎症和肠上皮化生(IM)的意义。方法随访150例2~6年前H.pylori感染的患者,其中83例行根除H.pylori治疗(治疗组),67例未完成治疗或仅接受对症治疗(对照组),分析对比其前后H.pylori感染情况、胃黏膜炎症及IM的变化情况。结果2~6年后,对照组中52例H.pylori呈阳性(78.8%);治疗组中20例H.pylori呈阳性(23.5%),胃炎活动性检出率明显减少,与对照组持续H.pylori感染者比较,差异有显著性(P<0.01),胃黏膜萎缩和肠化生的程度也显著减轻(P<0.05)。结论H.pylori感染与胃黏膜活动性炎症关系非常密切,根除H.pylori可以减轻胃黏膜的炎症和IM程度。     

胃幽门螺杆菌与胃粘膜疾病的临床病理研究

目的探讨幽门螺杆菌(HP)感染与胃炎、消化性溃疡、肠化生及胃癌的关系.方法对6318例胃粘膜活检病理切片进行Giemsa、AB(pH2.5)-PAS、HID-AB(pH2.5)染色和肠化生分型.结果HP感染与慢性浅表性胃炎、慢性萎缩性胃炎、胃及十二指肠溃疡、肠化生和胃癌显著相关(P＜0.001),与肠化生类型无显著关系(P＞0.05),与胃癌分型无关.结论HP感染与胃炎、消化性溃疡、肠化生及胃癌有相关性.     

十二指肠疤痕期溃疡与胃黏膜炎症及Hp感染的关系

目的观察十二指肠疤痕期溃疡胃黏膜的组织学改变及其与Hp感染的关系,为十二指肠溃疡的治疗提供进一步的指导。方法选择内镜确诊的865例十二指肠溃疡患者,包括活动期(A期)30例、愈合期(H期)258例、疤痕期(S期)577例,于内镜检查时行常规活检取胃窦黏膜作组织病理学检查,评价Hp感染及黏膜炎症程度。同时对578例接受质子泵抑制剂和抗生素治疗1周的患者进行随访。结果S期溃疡胃黏膜Hp感染明显低于A期和H期溃疡,但仍高达56.8%。有65%的病例胃黏膜可出现活动性炎症。各期溃疡对除菌治疗的反应相同,S期溃疡治疗后仍有29.8%的病例Hp检测阳性,7.5%病例出现溃疡复发。虽然胃黏膜萎缩的发生率以A期溃疡发生率较高,但肠上皮化生无论是在活动期溃疡,或在疤痕期溃疡,发生率及病变程度均无明显的差异。结论内镜下十二指肠S期溃疡在临床上并没有真正愈合,需要根据Hp和胃黏膜炎症的分析继续进行必要的除菌治疗。     

贵阳地区儿童时期幽门螺杆菌感染后胃镜检查和病理组织学特点及疗效研究

背景　随着儿童胃镜检查的普及,研究发现儿童时期幽门螺杆菌（H.pylori）感染与胃肠疾病的发生有密切关系,但针对儿童时期H.pylori感染后胃镜检查及病理组织学检查的研究相对较少。目的　探讨贵阳地区儿童时期H.pylori感染后胃镜检查、胃黏膜组织病理学特点及疗效。方法　随机选择贵阳市妇幼保健院/儿童医院消化科2016年6月-2018年9月收治的因腹痛、呕吐、消化道出血等症状入院的210例患儿为研究对象。依据H.pylori检测结果,H.pylori阳性者为阳性组,H.pylori阴性者为对照组,分析儿童时期H.pylori感染后胃镜检查、胃黏膜病理组织学特点及疗效。结果　210例患儿中阳性组104例、对照组106例,儿童时期H.pylori感染率为49.5%。H.pylori感染平均发病年龄为（7.2±1.3）岁。阳性组胃镜检查提示糜烂出血性胃炎58例、消化性溃疡23例、结节性胃炎13例、消化性溃疡伴结节性胃炎10例,对照组胃镜检查提示糜烂出血性胃炎84例、消化性溃疡18例、结节性胃炎3例、消化性溃疡伴结节性胃炎1例。阳性组糜烂出血性胃炎发生率低于对照组,结节性胃炎以及消化性溃疡伴结节性胃炎的发生率高于对照组（P<0.05）,轻度炎症发生率低于对照组,重度炎症发生率高于对照组（P<0.05）;阳性组淋巴细胞阳性发生率高于对照组（P<0.05）。阳性组给予标准三联疗法抗H.pylori治疗后,复查13C尿素呼气试验阴性93例、阳性11例。结论　贵阳地区儿童时期H.pylori感染率为49.5%,以学龄期儿童发病为主;H.pylori感染后胃镜检查以糜烂出血性胃炎、消化性溃疡、结节性胃炎为主要表现,糜烂出血性胃炎发生率明显降低,结节性胃炎以及消化性溃疡伴结节性胃炎的发生率明显升高,胃黏膜病理组织学检查结果以重度炎症为主,重度炎症改变及淋巴细胞浸润程度与H.pylori感染相关,标准三联疗法对H.pylori根除率为89.4％。     

Helicobacter pylori infection, glandular atrophy, intestinal metaplasia and topography of chronic active gastritis in the Nepalese and Japanese population: The age, gender and endoscopic diagnosis matched study

Background: The incidence and mortality from gastric cancer is high in Japanese but extremely low in Thailand. It is different among Asian countries. The aim of this study is to investigate the difference of peptic ulcer disease, glandular atrophy, intestinal metaplasia and topography of chronic active gastritis between the Nepalese and Japanese population. Materials and methods: Nepalese patients were paired with Japanese patients by age, gender and endoscopic diagnosis in order to compare the prevalence of H. pylori infection (N=309) and the difference of H. pylori related peptic ulcer disease (N=48). Glandular atrophy and intestinal metaplasia scores were also compared between the Nepalese and Japanese population in H. pylori positive cases (N=152) and negative cases (N=145) using paired cases by age, gender and endoscopic diagnosis. Paired H. pylori-positive Nepalese and Japanese population were also used to compare the ratio of corpus gastritis to antrum gastritis (C/A ratio) (N=152). Results: Among peptic ulcer diseases, gastric ulcer was frequent in Japanese and duodenal ulcer was frequent in Nepalese. The prevalence of H. pylori infection in the Nepalese and Japanese population were similar. Glandular atrophy and intestinal metaplasia scores in the H. pylori positive Japanese were significantly higher than those of Nepalese in all positions according to triple site biopsy. Furthermore, there were significant differences in glandular atrophy and intestinal metaplasia scores between in the H. pylori-negative Nepalese and Japanese population except intestinal metaplasia score in the greater curvature of the upper corpus. Japanese C/A ratio was significantly higher than that of Nepalese. Corpus predominant gastritis (C/A ratio>1.00) was characteristic in the elderly Japanese. Nepalese was antrum predominant (C/A ratio<1.00) in every age group. Conclusions. Gastric ulcer was a common disease in Japanese, in contrast duodenal ulcer was common in Nepalese. H. pylori infected Japanese patients showed severe atrophic and metaplastic gastritis in comparison with Nepalese. These results may be associated with the high incidence of gastric cancer in Japanese. Corpus predominant gastritis was found in the elderly Japanese and antrum predominant gastritis was found in every age Nepalese. Key words: H. pylori, atrophy, metaplasia, corpus-predominant gastritis, Nepal.     

抗-Hp CagA IgG血清对胃癌细胞的增殖作用及对癌基因表达的影响

目的　探讨人抗幽门螺杆菌抗体 (抗 - Hp Cag A Ig G)与胃癌发病的关系及对癌基因 ras P2 1、c- fos和 c- myc表达的影响。方法　收集经胃镜检查诊断为消化性溃疡的患者血清 75例和正常健康人血清 6例 ,用 EL ISA法分别测定血清中抗 - Hp Cag A Ig G水平 ,并观察抗 - Hp Cag A(+) Ig G的患者血清对体外培养的胃癌细胞株HGC80 3的增殖作用 ,以及用流式细胞术检测经不同血清刺激后的 HGC80 3细胞株癌基因 ras P2 1、c- fos和 c- myc表达的情况。结果　消化性溃疡患者中抗 - Hp Cag A(+) Ig G血清对人胃癌细胞 HGC80 3具有明显的促增殖作用 (P<0 .0 1) ,并能增加 ras P2 1的表达 (P<0 .0 1)。结论　受 Hp感染的消化性溃疡患者血清中 ,高滴度的人抗 - Hp Cag A(+) Ig G对胃癌细胞具有促增殖作用 ,提示抗 - Hp lag A(+) Ig G很可能是 Hp Ig G促增殖作用的重要组成部分。     

A five-year follow-up study on the pathological changes of gastric mucosa after H. pylori eradication

Objectives To investigate the relationship between H.pylori infection,gastric cancer and other gastric diseases through the changes in gastric mucosa and the status of different gastric diseases within 5 years after H.pylori eradication in H.pylori-positive subjects in a high incldence region of gastric cancer. Methods One thousand and six adults were selected from the general population in Yantai,Shandong province,a high Incidence region for gastric cancer in China.Gastroscopy and Campylobacter-like organism(CLO)testing were performed on all subjects,Biopsy samples from the gastric antrum and body were obtained for histology and assessment of H.pylori infection.All H.pylori-positive subjects were then randomly divided into two groups:treatment group receiving Omeprazole Amoxicillin Clarythromycin(OAC) triple therapy and placebo as controls.These subjects were endoscopically followed up in the second and fifth year.We compared the endosopic appearance and histology of the biopsy specimens from the same site obtained at the first and last visits.Results All 552H.pylori-positive subjects were randomly and evenly divided into treatrment group or control group.During the five-year follow-up,the numbers of patients who continued to be negative or positive for H.pylori were 161 and 198,respectively.Statistical analysis revealed that:①At the initial visit,there were no significant differences in the severity and activity of inflammation,atrophy and intestinal metaplasia between the biopsy specimens from the antrum and body resopectively in both groups. ②The severity and activity of inflammation in both the antrum and body were markedly reduced after H.pylori eradication(P=0.000).③Within five years after H.pylori eradication,intestinal metaplasia in the antrum either regressed or had no progression,while the proportion of intestinal metaplasia in the H.pylori-positive group increased significantly(P=0.032).④After H.pylori eradication,the atrophy in both the antrum and body had no significant regression.The P value was 0.223 and 0.402,respectively.Conclusions H.pylori eradication results in remarkable reduction in the severity and activity of chronic gastritis,marked resolution of intestinal metaplasia in the antrum.On the other hand.continuous H.pylori infection leads to progressive aggravation of atrophy and intestinal metaplasia.     

幽门螺杆菌cagA基因与胃粘膜损伤及增殖间关系的探讨

目的：探讨幽门螺杆菌（Ｈｐ）细胞毒素相关蛋白基因（ｃａｇＡ基因）与胃粘膜损伤及增殖的关系。方法：采用聚合酶链反应（ＰＣＲ）法检测５０例患者Ｈｐ的ｃａｇＡ基因，并经ＨＥ染色评定胃粘膜炎症程度、肠化生、淋巴小结及萎缩的发生率，免疫组化检测胃粘膜细胞核增殖抗原指数（ＰＣＮＡ　ＬＩ％）。结果：３７／５０例含有ｃａｇＡ基因，消化性溃疡ｃａｇＡ基因阳性率高于慢性胃炎（Ｐ＜０．０１）；ｃａｇＡ基因阳性者炎症程度和ＰＣＮＡ　ＬＩ％均高于阴性者（Ｐ　＜０．０５）；但两组肠化生﹑淋巴小结及萎缩发生率差异无显著性（Ｐ　＞０．０５）。结论：ｃａｇＡ基因阳性Ｈｐ感染后可增加胃粘膜的炎性损伤及细胞增殖。ｃａｇＡ基因为Ｈｐ毒力指标之一，但并非致病的单一指标。     

胃窦粘膜生长抑素含量与胃、十二指肠疾病的关系

应用放射免疫方法测定１６６例接受胃镜检查者的胃窦部粘膜的生长抑素（ＳＳ）含量，比较几种胃、十二指肠疾病患者与正常人的差异，并探讨胃窦粘膜ＳＳ含量与胃窦部病理改变及幽门螺杆菌（ＨＰ）感染之间的关系。结果显示：胃溃疡、慢性萎缩性胃炎、胃癌患者胃窦部粘膜ＳＳ含量明显低于正常对照组；胃窦部粘膜出现肠上皮化生和不典型增生改变者ＳＳ含量明显低于不伴这些改变者；ＳＳ含量与ＨＰ感染关系不明显。