幽门螺杆菌相关性十二指肠溃疡短程三联治疗疗效的临床研究

目的：研究短程三联治疗幽门螺杆菌相关性十二指肠溃疡的疗效。方法：胃镜病理检查证实十二指肠单发溃疡活动期(A期)伴Hp感染的患分为一周组及维持组，均予三联抗幽门螺杆菌治疗。一周组治疗一周后即停止一切药物治疗，维持组则继续抗酸治疗四周，之后停药。两组均于治疗结束后四周及一年后复查胃镜及病理检查，了解所有患溃疡的愈合及幽门螺杆菌根除情况。结果：经三联抗幽门螺杆菌治疗结束后一年复查胃镜及病理检查，一周组溃疡愈合率83％，幽门螺杆菌根除率75％；维持组溃疡愈合率94％，幽门螺杆菌根除率80％。两组愈合率及幽门螺杆菌根除率相比较，差异无显性。经三联抗幽门螺杆菌治疗结束后一年，Hp根除组溃疡愈合率96％，Hp未根除组溃疡愈合率64％，差异有显性。结论：治疗十二指肠溃疡及预防复发，关健是根除Hp而不是长期抗酸治疗。     

Change in apoptosis in the gastric surface epithelium and glands after eradication of Helicobacter pylori

BACKGROUND: Change in apoptosis in gastric glands after eradication of Helicobacter pylori has never been reported. AIMS: The purpose of this paper is to investigate the change in apoptosis in gastric glands after eradication of Heliobacter pylori. PATIENTS AND METHODS: We studied 23 Heliobacter pylori-positive patients with duodenal and gastric ulcers, who were monitored for 6-12 months after eradication, and eight controls. Biopsies were taken from the antrum and body. Apoptosis was evaluated immunohistochemically using anti-single stranded DNA antibody. Apoptotic index was calculated by counting immunostained cells in surface epithelial and glandular cells. RESULTS: In the surface epithelium, Apoptotic indexes were significantly higher in patients than in controls. In the upper portion of fundic glands, apoptotic indexes were significantly higher in patients with gastric ulcers (14.2% (9.3, 17.8)) (median (1st quartile, 3rd quartile)) than in controls (8.0% (2.0, 9.0), p < 0.01) and decreased significantly after eradication (3.4% (2.0, 5.3)), p < 0.01). In pyloric glands, apoptotic indexes were no different between patients and controls. In the lower portion of fundic glands, apoptotic indexes were very low, both in patients and in controls. CONCLUSIONS: Our results showed that apoptosis, not only of surface epithelial cells but also of glandular cells in the upper portion of fundic glands, increased in Heliobacter pylori-positive patients with gastric ulcers and decreased to normal levels after eradication of Heliobacter pylori.     

幽门螺杆菌尿素酶减毒鼠伤寒杆菌疫苗诱导小鼠粘膜免疫应答的研究

目的:观察口服减毒鼠伤寒杆菌活菌重组疫苗后小鼠的粘膜免疫应答状况。方法:将已构建成功的表达幽门螺杆菌(H.pylori)尿素酶B亚单位(UreB)的重组减毒鼠伤寒杆菌SL3261/pTC01-UreB口服免疫Balb/c小鼠,12周后检测肠液和血清中的特异性抗体反应。结果:疫苗组小鼠的肠液和血清中可分别检测到针对UreB的特异性抗体IgA和IgG,病理学检查显示疫苗组小鼠较对照组小鼠胃粘膜炎症程度差异无统计学意义。结论:表达H.pyloriUreB的减毒鼠伤寒杆菌SL3261/pTC01-UreB能够诱导小鼠产生抗H.pylori的粘膜免疫,可用作抗H.pylori感染的口服疫苗。     

用PCR—RFLP和16SrDNA指纹图法分析幽门螺杆菌基因型

本文建立了PCR－RFLP和16srDNA指纹图法．对19株幽门螺杆菌（HP）进行基因型分析：HP尿素酶C基因的PCR扩增产物．分别用HindⅢ、HaeⅢ、AluⅠ酶切，结果显示：每个酶均将19株HP分为3种RFLP图谱．综合HindⅢ，HaeⅢ和AluⅠ酶切结果，19株HP分为10个酶切带型；PCR扩增HP标准株16SrRNA基因，地高辛标记制备550bp探针，19株HPDNA分别经HaeⅢ和EcoRⅠ酶切、电泳后，通过Southern杂交获16SrDNA指纹图，结果显示：HaeⅢ酶切分为14个杂交带型，EcoRⅠ酶切19株HP杂交带型均不同。本实验表明：上述两种方法重复性好，分群力高，可准确有效地对HP作出鉴定并将其分型。19株HP株间存在基因型差异。     

埃索美拉唑三联与奥美拉唑三联疗法治疗Hp阳性十二指肠溃疡对比研究

目的比较埃索美拉唑三联与奥美拉唑三联疗法治疗幽门螺杆菌（Hp）阳性十二指肠球部溃疡的临床疗效。方法将104例经内镜诊断并检测证实Hp阳性的十二指肠球部溃疡患者随机分为两组。埃索美拉唑组（52例）：埃索美托唑20mg＋阿莫西林1g＋克托霉素500mg，每日2次，共7d；奥美拉唑组（52例）：奥美拉唑20mg＋阿莫西林1g＋克拉霉素500mg，每日2次，共7d。疗程结束4周后复查胃镜并检测Hp，观察腹痛缓解率、溃疡愈合率、Hp根除率及用药后的不良反应等。结果埃索美拉唑组第1天和第2天腹痛缓解率分别为34．6％和59、6％，高于奥美托唑组的17.3％和38．5％（P〈0．05）。埃索美托唑组和奥美拉唑组溃疡愈合率分别为92.3％和88．5％，Hp根除率分别为88．5％和82．7％，差异无显著性（P〉0．05）。两组用药后不良反应少，有较好的安全性。结论埃索美拉唑三联疗法治疗Hp阳性的十二指肠溃疡安全有效．腹痛缓解速度优于奥美拉唑三联疗法。     

Whole CanA Gene Amplification of Helicobacter pylori and Its Fingerprinting by Restriction Fragment Length Polymorphism

To set up a method of amplification for the whole CagA gene of Helicobacter pylori and its fingerprinting by restriction fragment length polymorphism(RFLP),nested PCR was employed in combination with TD-PCR to amplify the gene and EcoRI and Hind Ⅲ were used to generate the RFLP fingerprinting.Target DNA fragments from 13 of 20 samples were successfully amplified and the relevant RFLP fingerprintings were obtained.It is concluded that the method can be used to amplify the whole CagA gene and CagA gene has apparent diversity of RFLP profile.     

Effect of Helicobacter pylori on ectopic gastric mucosa of Meckel's diverticulum in children after meckelectomy

Ninety-two children underwent meckelectomy in our department over the 10-year period 1981–1990. All histologic speciments of Meckel's diverticula were studied, most of them retrospectively, for evidence of active inflammation or ulceration in any ectopic gastric mucosa present and specifically searching for Helicobacter pylori (HP). Thirty-eight (group A) were excised as being responsible for the main clinical symptoms while 54 (group B) were resected incidentally. Ectopic gastric mucosa was found in 19 cases, 18 in the symptomatic group and 1 in the incidental group. In the 18 cases belonging to group A histologic findings indicating gastritis due to HP were present. Combined operative and laboratory findings in all 92 cases indicated that HP colonizes gastric mucosa electively and leads to infection, which seems to be responsible for the clinical symptoms of meckelitis.Presented at the 15th Annual International Meeting of Greek Association of Pediatric Surgeons, Porto Hydra, Greece, 27–30 September 1990     

三联疗法根除幽门螺杆菌治疗对肠道微生态的影响

目的 探讨抗幽门螺杆菌(Hp)治疗对患者肠道菌群状态(肠道微生态)及耐药性的影响。方法 分别称取60例患者治疗前后新鲜粪便0．5g，选择肠道菌群中具代表性的4种需氧菌和6种厌氧菌分别进行需氧和厌氧培养，从培养出的菌落中挑选相同的菌株进行治疗前后药敏试验。结果 (1)治疗后肠道菌群中肠杆菌、葡萄球菌、拟杆菌、双歧杆菌、消化球菌、梭菌、乳杆菌、真杆菌均较治疗前明显降低(P＜0．05)；(2)治疗后肠道菌群中大肠埃希氏菌、消化链球菌、赛氏葡萄球菌、普氏梭杆菌、肺炎致病性链球菌群、产气真杆菌等对庆大霉素、红霉素、环丙沙星、特美丁、头孢噻肟钠等药耐药率明显增加，且存在多重耐药(P＜0．05)；(3)治疗后超广谱β—内酰氨酶阳性的消化链球菌、表皮葡萄球菌、普氏梭杆菌、肺炎致病性链球菌群、赛氏葡萄球菌等较治疗前分别增加26．2％、33．3％、28．6％、35．3％、28．6％。结论 三联抗Hp治疗后肠道菌群失调、耐药菌株的增加、传播与扩散对广大人群存在潜在危险。     

Th免疫反应在以壳聚糖为佐剂的幽门螺杆菌疫苗免疫保护中的作用

目的：探讨以壳聚糖为佐剂的脚疫苗的免疫保护作用及其机理。方法：BALB／c小鼠随机分为7组：空白对照组、壳聚糖酸溶液组、壳聚糖颗粒组、却抗原组、脚抗原＋壳聚糖酸溶液组、却抗原＋壳聚糖颗粒组和脚抗原＋CT组，各组于第0、7、14和21天灌胃各免疫1次，末次免疫后4周给予SS1Hp菌攻击，隔日1次，共2次。在攻击前后分批处死小鼠，取胃黏膜检测坳和Th1、Th2细胞因子含量，同时检测血清中抗Hp IgG2a和IgG1含量。结果：①以壳聚糖为佐剂的坳疫苗的免疫保护率达60％，与以CT为佐剂的印疫苗的免疫保护率（58．33％）相似，显著高于单纯脚抗原组及其他不含Hp抗原组（P〈0．001～0．05）。②却攻击后胃黏膜内IFN-γ、IL-2和IL-12含量在含佐剂组显著高于无抗原和无佐剂组（P〈0．001～0．05）；③坳攻击后胃黏膜内IL-4含量在以壳聚糖颗粒为佐剂组显著高于以CT为佐剂组（P〈0．05），以壳聚糖溶液为佐剂组显著高于对照组、无佐剂组及佐剂中含CT组（P〈0．001～0．05）。结论：以壳聚糖为佐剂的坳疫苗对脚感染具有免疫保护作用，同时可促进Th1和Th2的混合免疫反应。     

幽门螺杆菌感染对胃黏膜上皮细胞端粒酶活性的影响及其与细胞凋亡的关系

目的探讨幽门螺杆菌(Hp)感染对端粒酶活性的影响及其与细胞凋亡的关系。方法慢性胃炎伴萎缩者16例,伴肠化生者15例,伴中、重度不典型增生者14例,胃癌19例共64例为研究对象。采用快速尿素酶试验、Warthin-Starry银染色检测幽门螺杆菌,采用S-P法检测人端粒酶催化亚单位(hTERT)蛋白表达,采用TUNEL染色法原位检测细胞凋亡。结果(1)萎缩性胃炎、肠化生、不典型增生和胃癌组织中hTERT蛋白表达率分别为25.00%、46.67%、64.29%和78.95%,呈递增趋势。Hp阳性患者hTERT蛋白表达率为77.42%,显著高于Hp阴性患者(33.33%,P<0.01)。(2)Hp阳性伴hTERT蛋白阳性患者细胞凋亡指数为9.57±5.01,显著高于Hp阴性伴hTERT蛋白阳性患者(6.01±5.31,P<0.05)。结论(1)端粒酶激活可能参与了胃黏膜上皮细胞恶性转化的全过程。Hp感染与端粒酶活性密切相关。Hp感染可能是激活端粒酶的重要机制之一。(2)Hp感染既可激活端粒酶,引发细胞永生化,又可以诱导胃黏膜上皮细胞凋亡,进而增加了胃黏膜的不稳定性和癌变的危险性,这可能是Hp致癌的主要机制之一。