第1批肺结核短程化疗研究5年随防报告

本文采用６及９个月ＨＲＥ短化方案与３ＳＨＰ／１５ＨＰ标化方案进行近、远期疗效的对照研究。前次报告已验证两个短化方案与标化方案的近期疗效极为相似。满疗程的４８１例进行随防观察，５年中失访５６例。复发１５例，其中１２例在停药后１年半内复发。６及９个月短化方案的细菌及Ｘ级总复发率分别为５．８％和１．１％，与标化组（３．９％）比较无显著性差异（Ｐ＞０．０５）；但６ＨＲＥ组复发高于９ＨＲＥ组（Ｐ＜０．０５）     

肺结核病人不固定化疗期的短化研究——短化治疗个体化研究

本文选取了２９０例初治涂肺结核病人，应用２ＳＨＲＺ／４ＨＲ方案将传统的固定化疗期改为不固定化疗期，以痰涂片转阴后连续３个月阴性为治愈停药标准，平均化疗期为４．７月，６个地累计痰菌阴转率９８．３％。停药后随访２年细菌学复发率１．９％，总失败率为３．６％，达到短化的“金标准”。即以４药强化２个月，继续治疗期以Ｈ，Ｒ治疗由化疗期改为不固定化疗期，平均缩短化疗期１．３个月，获得与固定化疗期６个月效果完全一     

初治涂阳肺结核门诊全监短程化疗研究

９３例初治涂阳培阳结核病人用２ＲＨＺ／Ｒ２Ｈ２方案按设计要求完成了治疗随访，所有病人采用门诊全监化疗，继续期疗期为痰培养阴转后巩固５个月，总疗期６－９个月（平均６．５个月），１例（１．１％）治疗失败，停药后２４个月随访期内３例（３．３％）复发，总失败一复发率为４．３％，４例（４．１％）因药物副反应更改方案。研究结果表明，对实施门诊全监化疗的地区，大部分病人可采用这种高效，安全，费用低的方案。     

血清学与呼气试验结合监测治疗幽门螺杆菌感染的疗效

为评价血清学及（１４）￣Ｃ－尿素呼气试验在治疗幽门螺杆菌（Ｈｐ）感染疗效监测价值，本研究中第一阶段对４２例Ｈｐ感染，患者在抗Ｈｐ治疗前、停药１、３、６、１２个月同期进行胃镜检查、（１４）￣Ｃ－尿素呼气试验及血清ＨｐＩｇＧ抗体测定。分析患者停药１年内随访期呼气试验及血清学变化规律，制定出以呼气试验高于界限值、血清学吸光度（Ａ）值比治疗前下降＜１５％为判断Ｈｐ阳转的疗效监测标准。第二阶段在另一批共６３例疗效监测患者中验证该标准，结果在停药６、１２个月呼气试验敏感性均为１００．０％，特异性分别为９５．５％及１００．０％；血清学敏感性均为１００．０％，特异性分别为５０．０％及８３．３％。结合两种方法的优缺点，提出在不同时期采用（１４）￣Ｃ－尿素呼气试验或血清学检测对治疗Ｈｐ感染进行疗效监测的联合方案。     

内镜下清创后喷洒胃康喷液治疗难治性溃疡41例近期疗效观察

自１９９７年以来，我们采用内镜下清创后喷洒胃康喷液（含口服胃康胶囊、雷尼替丁）治疗难治性溃疡４１例，并与单纯口服雷尼替丁、庆大霉素、丽珠得乐治疗的３９例进行双盲对照观察。现报告如下。临床资料：选择８０例病期在６个月以上、经内科治疗３个月反复不愈、内镜下证实边缘增生明显、幽门螺杆菌（ＨＰ）阳性的难治性溃疡患者，随机分为两组：①内镜治疗组（以下称治疗组，４１例）：男２９例，女１２例；年龄最大７１岁，最小２４岁，平均年龄４１３岁。病程６月～１年２５例，１年以上者１０例，５年以上者６例，十二指肠球部溃…     

不固定化疗期短程化疗研究初探

目的研究从现行６个月短化方案进一步缩短化疗期的疗效。方法改进初治涂阳患者６个月固定化疗期，采用涂片检查并以痰菌转阴后连续３个月阴性为治愈停药标准。结果２９０例涂阳肺结核经２ＳＨＲＺ／ｘＨＲ治疗，６个月时痰菌阴转率９８．３％，２８３例阴转治愈，平均化疗期４．７个月，２年随访率９４．３％，细菌学复发率１．９％。结论采用痰涂片检查，并以痰菌转阴后连续３个月阴性为阴转治愈标准，可将化疗期平均缩至４．７个月，且治愈率高，２年细菌学复发率低，为进一步缩短化疗期进行了有意义的探索。     

红霉素诱发地高辛中毒三例

红霉素诱发地高辛中毒三例岳桂英，赵成英例１男性，６１岁。因心悸、气短５年，下肢水肿３个月于１９８９年５月１２日就诊。近一个月来每日服用地高辛０．１２５ｍｇ。查体：体温３６．６℃；呼吸１８次／分，血压１５．９／１０．６ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ）...     

6月龄内婴儿麻疹11例临床分析

６月龄内婴儿麻疹１１例临床分析黄用福彭振云朱莉萍盛敏１９９４年１０月～１９９５年４月本地区麻疹流行，本科收治麻疹２３４例，６月龄内婴儿发病１１例，现报告如下。临床资料一、一般资料男８例，女３例，月龄３个月１例，４个月１例，５个月２例，６个月７例，平均...     

幽门螺杆菌感染及其根除治疗对血清胃泌素水平的影响

为了解幽门螺杆菌相关性胃炎及溃疡病与高胃泌素血症的关系，以及ＨＰ根除治疗对高胃泌素血症的影响，我们对９４例患者，进行空腹胃泌素测定，胃粘膜组织学及ＨＰ培养检查。应用胃病冲剂和三联疗法，进行治疗，疗程２８天。停药１月后重复上述检查。     

老年人血行播散性结核漏诊误诊三例

老年人血行播散性结核漏诊误诊三例毛利民，陈曼丽例１男性，８６岁。１９７５年６月２日因前列腺增生症行前列腺切除术，又因尿道狭窄曾３次行尿道扩张术，多年来尿常规：白细胞（中量～满视野）／ＨＰ。自１９８４年８月１４日不规则发热，体温３７．２～３９．１℃，咳...     

Long-Term Follow-up of Helicobacter pylori Serology after Successful Eradication

Objective : To determine the Helicobacter pylori IgG serology pattern 12–21 months after successful organism eradication and to assess the usefulness of IgG serology in the long-term follow-up of patients. Methods : We recruited patients from our 1990-91 study on IgG serology after H. pylori treatment. Forty-three of 45 patients (93%) agreed to participate. They had all been cured of H. pylori infection after triple antibiotic therapy and remained H. pylori negative at 1 yr posttreatment. H. pylori IgG antibody concentrations were measured in serum samples taken at 3-month intervals between 12 and 21 months posttreatment. [¹³C]-urea breath test was done at each blood draw to ensure continued eradication. Serology was determined by ELISA (Pylori Stat, BioWhittaker, Inc) and expressed as absorbance. Results: All 43 patients (100%) continued to be free of H. pylori and demonstrated a decline in their H. pylori IgG concentration compared with baseline. The overall decline in serology among all 43 patients was approximately 50%. Forty of 43 patients (93%) had a decline of more than 20% in H. pylori IgG concentration compared with baseline. However, 28 of 43 patients (65%) remained seropositive for more than 1 yr after successful H. pylori eradication. Conclusion : We conclude that a 20% decline in IgG concentration has an overall sensitivity of 93% for determining H. pylori eradication 12-21 months after H. pylori treatment. Serology is an attractive alternative to endoscopy or urea breath tests in monitoring patients after H. pylori treatment, but serum IgG levels should not be expected to reach seronegative range after successful H. pylori eradication.     

Concordance between noninvasive tests in detecting Helicobacter pylori and potential use of serology for monitoring eradication in gastric ulcer

Our aim was to determine concordance between 13C-urea breath test and serology in detecting Helicobacter pylori and to study their potential use for monitoring eradication in patients with gastric ulcer. We prospectively studied 73 gastric ulcer patients. On endoscopy, biopsies were taken for hematoxylineosin staining and rapid urease testing. Blood samples were drawn for immunoglobulin G antibody determination by enzyme-linked immunosorbent assay (ELISA). A 13C-urea breath test was performed as well. Histology, serology, and urea breath tests were all repeated 1, 6, and 12 months after therapy completion in 56 infected patients. A proportion of positive agreement between serology and breath test results as high as 0.95 was found. McNemar statistic was 3 (p = 0.08), whereas kappa statistic was 0.83 (p < 0.0001). At month 6, significant differences in patients successfully treated relative to baseline serologic values were observed (chi2 = 11.7; p < 0.001). The area under the receiver operating characteristic (ROC) curve for diagnostic efficiency was 0.76, sensitivity was 74%, and specificity was 90% (for H. pylori eradication) when the fall of at least one category in serologic levels was considered as cut-off point. No further decreases in serologic levels were noted over the next 6 months, and 48.8% of patients remained seropositive 1 year after completion of successful treatment. A high concordance between serology and 13C-urea breath test results is observed when the two procedures are used for H. pylori infection diagnosis in patients with gastric ulcer. Also, serology can be successfully used for monitoring H. pylori eradication 6 months after therapy completion.     

Accuracy of a monoclonal antibody-based stool antigen test in the diagnosis of Helicobacter pylori infection

BACKGROUND: Recent availability of tests for Helicobacter pylori antigens in stool samples has provided potentially useful tools for epidemiological studies and clinical settings. The aim of this study was to evaluate a monoclonal antibody-based H. pylori antigen stool test in the primary diagnosis of H. pylori infection, and to study the test performance after patients were treated with lanzoprazole, and after eradication therapy. METHODS: The study included 122 dyspeptic patients. At gastroscopy, biopsy specimens were obtained for culture and histology. Stool antigen and [14C]-urea breath tests were performed concurrently. Positive culture alone or a positive [14C]-urea breath test in combination with positive histology defined the reference standard. Forty-three Hp +ve patients were treated with lanzoprazole for 2 to 4 weeks, and stool antigen tests were performed on days 1 and 7 post-treatment. After eradication therapy, 32 patients were re-examined for H. pylori infection. RESULTS: Prevalence of H. pylori was 44.3%. Sensitivity and specificity for the stool antigen test in the primary diagnosis of H. pylori infection were 98% and 94%, with positive and negative likelihood ratios of 16.7 and 0.02, respectively. All patients had positive stool tests immediately after lanzoprazole treatment, whereas 2 patients had negative stool tests after 7 days. Triple therapy rendered all patients stool test negative. CONCLUSIONS: The monoclonal antibody-based stool antigen test is an accurate tool in the primary diagnosis of H. pylori infection and after eradication therapy. Lanzoprazole treatment does not influence the clinical performance of the test.     

14C-urea breath test for assessment of gastric Helicobacter pylori colonization and eradication.

BACKGROUND AND OBJECTIVE: Urea breath test (UBT) is a reliable noninvasive technique for detecting gastric Helicobacter pylori colonization. 14C isotope-based test requires simple equipment and is inexpensive. We studied the utility of 14C-UBT in diagnosis of gastric H. pylori infection. METHODS: Presence of H. pylori was studied using antral histology and culture in patients with rapid urease test (RUT)-positive peptic ulcer. 14C-UBT was performed using a 185-kBq dose. Radioactivity in 15-min breath samples was measured using a beta-scintillation counter and result expressed as % dose recovered/mmol CO2. H. pylori was considered positive when any two tests were positive. All tests were repeated one month after completion of H. pylori eradication therapy. RESULTS: Among 41 patients (duodenal ulcer 36, gastric ulcer 5), H. pylori was detected by histology in 23 (56%) and by culture in 27 (66%). Overall, H. pylori was detected in 28 (68%) patients. Follow-up assessment was possible in 28 patients: 26 cleared the infection (all three tests negative). Mean 14C recovery values at 15 minutes associated with H. pylori-positive status were significantly higher (12.3 [SD 6.8] x 10(-3); n=30; p<0.001) than those associated with H. pylori-negative status (2.1 [0.9] x 10(-3); n=26). Using receiver-operating-characteristic analysis of 15-minute 14C recovery values, a cut-off of 6.5x10(-3) gave the best separation of H. pylori-positive and -negative cases. 14C-UBT had 93% sensitivity, 96% specificity and 95% accuracy. CONCLUSION: 14C-UBT appears to be a reliable noninvasive test for diagnosis of H. pylori infection.     

Long-Term Helicobacter pylori Recurrence after Successful Eradication with Triple Therapy

To establish the rate of Helicobacter pylori recurrence after a standard triple-therapy regimen (bismuth subsalicylate, tetracyeline, metronidazole) and determine which clinical factors affect reinfection, we prospectively followed 118 patients after successful H. pylori eradication. Elimination of H. pylori was confirmed by repeat endoscopy and urea breath test 4 wk after completion of therapy. Serial [¹³]urea breath tests were performed at 3-month intervals; antral biopsies were used to verify reinfection. Recurrence of H. pylori infection occurred in 4/118 (3.4%) patients. Three of the four relapses occurred in the 1st yr after treatment. Gender, age, ethnic group, alcohol consumption, cigarette use, and gastrointestinal diagnosis do not predict H. pylori recurrence. We conclude that the rate of recurrence after successful H. pylori eradication is low, and that when reinfection takes place, if occurs most commonly within the 1st yr after treatment.     

Follow up of serial urea breath test results in patients after consumption of antibiotics for non—gastric infections

AIM: The widespread use of antibacterial therapy has been suggested to be the cause for the decline in the prevalence of Helicobacter pylori infection. This study examine the serial changes of urea breath test results in a group of hospitalized patients who were given antibacterial therapy for non-gastric infections. METHODS: Thirty-five hospitalized patients who were given antibacterial therapy for clinical infections, predominantly chest and urinary infections, were studied. Most (91 %) patients were given single antibiotic of either a penicillin or cephalosporin group. Serial (13)C-urea breath tests were performed within 24 hours of initiation of antibiotics, at one-week and at six-week post-therapy. H. pylori infection was diagnosed when one or more urea breath tests was positive. RESULTS: All 35 patients completed three serial urea breath tests and 26 (74 %) were H. pylori-positive. Ten (38 %) H. pylori-infected patients had at least one negative breath test results during the study period. The medium delta (13)C values were significantly lower at baseline (8.8) than at one-week (20.3) and six-week (24.5) post-treatment in H. pylori-positive individuals (P=0.022). Clearance of H. pylori at six-week was only seen in one patient who had received anti-helicobacter therapy from another source. CONCLUSION: Our results suggested that one-third of H. pylori-infected individuals had transient false-negative urea breath test results during treatment with antibacterial agent. However, clearance of H. pylori infection by regular antibiotic consumption is rare.     

Noninvasive tests as a substitute for histology in the diagnosis of Helicobacter pylori infection

BACKGROUND: Rapid urease tests for Helicobacter pylori have a sensitivity of 80% to 90%. Therefore histologic examination of gastric biopsies is recommended as a "backup" diagnostic test in rapid urease test-negative patients. However, noninvasive tests (urea breath test, serology, whole blood antibody tests) may provide a more rapid diagnosis and be less expensive but offer similar accuracy. METHODS: Sixty-seven patients (no prior treatment for H pylori, no proton pump inhibitors, antibiotics, or bismuth within 4 weeks) undergoing endoscopy for evaluation of dyspepsia symptoms and testing rapid urease test-negative by antral biopsy were enrolled. All had the following tests: gastric biopsies (2 antral, 1 fundus; H&E and Alcian Yellow stain) examined for gastritis and H pylori; (13)C-UBT; capillary blood for whole blood rapid antibody tests: FlexSure HP, QuickVue, AccuStat, and Stat-Simple Pylori; serum for FlexSure HP; HM-CAP enzyme-linked immunoassay. H pylori infection was diagnosed (reference standard) if chronic gastritis was present on histology and at least 2 of the 3 following tests were positive: urea breath test, H pylori organisms unequivocally demonstrated in biopsies on special stain, and/or enzyme-linked immunoassay. The test and treatment costs per patient were calculated. RESULTS: Of 67 patients with a negative rapid urease test, 4 were positive for H pylori. None had active peptic ulcer disease. Histology only identified 1 patient with organisms visible on special stain. Using chronic active gastritis (neutrophilic and mononuclear infiltrate) as a diagnostic criterion for H pylori, 6 patients would have been judged positive. However, only 2 of these were truly positive by the reference standard (positive predictive value 33%). Negative predictive value for presence of organisms and chronic active gastritis was 95% and 97%, respectively. All of the noninvasive tests identified all 4 truly positive patients correctly. Urea breath test and FlexSure whole blood assay yielded a substantial number of false-positive results (positive predictive value 31% and 36%, respectively); positive predictive value for the other tests ranged from 50% to 80%. All tests except histology had a negative predictive value of 100%. Histology was the most costly test (p < 0. 001 compared with all other tests), followed by urea breath test and HM-CAP serology (p < 0.001 compared with all rapid antibody tests). CONCLUSIONS: Whole blood or serum antibody testing is a rapid, accurate, and cost-effective means for establishing H pylori status in rapid urease test-negative patients. Whole blood or serology rapid antibody testing should substitute for histology when the patient has not been previously treated for H pylori.     

A comparison of three fingerstick, whole blood antibody tests for Helicobacter pylori infection: a United States, multicenter trial

OBJECTIVE: We compared three whole blood antibody tests for Helicobacter pylori (H. pylori) in a United States, multicenter trial. METHODS: Patients referred for EGD at three medical centers were recruited. During EGD, biopsies were taken for histology and rapid urease testing (RUT). Immediately after endoscopy, patients underwent the antibody tests (FlexPack HP, Abbott Diagnostics; QuikVue, Quidel Corporation; AccuMeter, ChemTrak) using whole blood obtained by two to three fingersticks. Performance characteristics were calculated for each antibody test using the biopsy-based methods as a gold standard. RESULTS: A total of 131 patients participated; 50 (38%) patients had histological evidence of H. pylori infection. Using histology as a gold standard, the sensitivities of FlexPack HP, QuikVue, and Accumeter were 76%, 78%, and 84%, respectively. Specificity was 79% with FlexPack HP and 90% with QuikVue and Accumeter. There were no significant differences in the performance of the three antibody tests though there was a trend toward superior performance for AccuMeter compared to FlexPack HP (p = 0.019). However, RUT proved superior to FlexPack HP using histology as a gold standard (p = 0.008). Using either concordant histology and RUT results or a positive histology or RUT to define active H. pylori infection, there was no statistically significant difference between the antibody tests. CONCLUSIONS: There were no statistically significant differences in the performance of the three antibody tests. These tests proved only marginally sensitive in detecting patients infected with H. pylori. Clinicians should be aware of the limitations of these tests, particularly when using them as a sole means of testing for H. pylori.     

Diagnosis of Helicobacter pylori infection in patients with bleeding ulcer disease: rapid urease test and histology.

INTRODUCTION: The endoscopic diagnosis of Helicobacter pylori infection in patients with bleeding peptic ulcer is limited by a decreased sensitivity in standard invasive tests, rapid urease test and histology. There is controversy about the convenience of using one, neither, or both diagnostic tests. AIMS: To evaluate the results of simultaneously performed rapid urease test and histology in the diagnosis of Helicobacter pylori infection (H. pylori) in patients with bleeding peptic ulcer. PATIENTS AND METHODS: We included 173 patients, 98 male and 75 female, with an average age of 62 years (18-88), with upper gastrointestinal bleeding secondary to duodenal ulcer (115) or gastric ulcer (58), diagnosed within 24 hours after hospital admission. None of the patients had received treatment for H. pylori, proton pump inhibitors or antibiotics in the two weeks prior to the upper gastrointestinal bleeding episode. H. pylori infection was investigated in all patients by two antral biopsy samples for histological study (hematoxilin-eosin) and one or two antral biopsies for rapid urease test (Jatrox-H.p.-test). In cases with a negative urease test and histology, a 13C urea breath test was performed. Infection was considered present when at least one invasive test or the breath test was positive, whereas both invasive tests and the breath test had to be negative to establish an absent infection. RESULTS: 152 patients (88%) showed H. pylori infection, 104 patients (90%) with duodenal ulcer and 48 patients (83%) with gastric ulcer. In all 119 cases (78%) were diagnosed by the urease test and 112 cases (74%) by histology. Both methods were used to diagnose 134 of 152 cases (88%) (p < 0.05), these being positive in 97 cases and negative in 39 cases. In 18 of these 39 cases, the breath test was positive. CONCLUSIONS: Histology and urease test have similar diagnostic values for the identification of H. pylori in patients with bleeding peptic ulcer. Due to its rapid results, the urease test should be the method of choice. However, additional biopsies should be performed, and, when negative, a histological study should be carried out, since a combination of both methods allows a more precise diagnosis.     

Simplified 10-Day Bismuth Triple Therapy for Cure of Helicobacter pylori Infection: Experience From Clinical Practice in a Population With a High Frequency of Metronidazole Resistance

Objective : To evaluate the cure rate of Helicobacter pylori infection, including the impact of in vitro metronidazole resistance (M-R), and the side effects of a simplified 10-day bismuth triple therapy in routine clinical practice. Methods : From September 1995 to March 1996,248 consecutive H. pylori -positive patients received 10 days of bismuth subnitrate 150 mg, oxytetracycline 500 mg, and metronidazole 400 mg, all t.i.d. Before treatment, upper endoscopy, including biopsy specimens for microbiological analysis and IgG serology were performed. M-R was found in 45% of females and 36% of males. At least 2 months after treatment, H. pylori status was assessed by the ¹⁴C urea breath test (  n = 131  ), endoscopy (  n = 37  ), urea breath test and endoscopy (  n = 63  ), or solely by IgG serology (  n = 7  ). Ten patients withdrew. IgG serology was performed again after 1 yr. Results: H. pylori infection was cured in 205 patients: 86% by all-patients-treated analysis and 83% by intention-to-treat analysis. When patients were classified according to pretreatment metronidazole susceptibility, cure of infection was achieved in 76% of females harboring M-R strains versus 96% of those with sensitive strains (   p = 0.002  ) and in 81% versus 88% (   p = 0.34  ) of males with M-R versus sensitive strains, respectively. Twelve patients (5%) had to stop treatment prematurely because of severe side effects, but eight of them were treated successfully. One case of H. pylori infection (0.6%) was detected at 1-yr follow-up. Conclusions : Ten-day bismuth triple therapy t.i.d. was effective in curing H. pylori infection in the context of routine clinical practice. The efficacy was reduced in females harboring M-R strains.