胃粘膜相关淋巴组织型淋巴瘤形态学研究

目的：研究胃粘膜相关淋巴细胞（ＭＡＬＴ）型淋巴瘤及共与胃粘膜套细胞淋巴瘤和滤泡性淋巴瘤的鉴别诊断。方法：应用ＨＥ染色和免疫组化ＡＢＣ法检测胃ＭＡＬＴ型淋巴瘤，内镜作幽门螺杆菌培养基尿素试验检测ＨＰ感染。结果：３１例胃ＭＡＬＴ型淋巴瘤中低度恶性２７例，高度恶性４例。细胞类型以ＣＣＬ型最常见。免疫表型以ＩｇＭ为主，缺乏ＩｇＤ，３１例中２８例有ＨＰ感染（占９０．５２％），结论：（１）低恶ＭＡＬＴ型淋巴瘤     

The chemokine receptor CCR7 is expressed on epithelium of non-inflamed gastric mucosa, Helicobacter pylori gastritis, gastric carcinoma and its precursor lesions and up-regulated by H. pylori

CCR7 chemokine-receptor expression on tumour cells of gastric carcinoma has been associated with lymph-node metastasis and is thought to play an important role in metastasis. However, so far it is unknown whether CCR7 is newly up-regulated on gastric carcinoma or already expressed in non-neoplastic gastric epithelium. Therefore, epithelial CCR7 expression was investigated in the process of gastric carcinogenesis: non-inflamed mucosa --Helicobacter pylori gastritis -- intestinal metaplasia/dysplasia -- gastric carcinoma. CCR7 was expressed by gastric epithelium in non-inflamed gastric mucosa (n = 5), H. pylori gastritis (n = 17), intestinal metaplasia (n = 10), dysplasia (n = 3) and on tumour cells in 20 of 24 patients with gastric carcinoma (13/14 intestinal-type; 7/10 diffuse-type) as tested by immunohistochemistry. As CCR7 expression by gastric epithelium was significantly stronger in H. pylori gastritis than in non-infected mucosa, the influence of H. pylori on CCR7 receptor expression of gastric epithelial cells was investigated by fluorescence activated cell sorter analysis. H. pylori strains up-regulated the CCR7 chemokine-receptor in CCR7-positive cell lines. No difference in CCR7 up-regulation between cag(+) and cag(-)H. pylori strains was found. Epithelial CCR7 up-regulation by H. pylori may alter the metastatic fate of gastric carcinoma. Additionally, CCR7 expression not only on gastric carcinoma, but also on non-neoplastic gastric epithelium, suggests a novel biological function.     

Association of Helicobacter pylori-dependent gastritis with gastric carcinomas in young Japanese patients: histopathological comparison of diffuse and intestinal type cancer cases

AIMS: The causal relationship of H. pylori gastric colonization with gastric cancer development has not as yet been fully elucidated. The prevalence of H. pylori infection increases with age in the asymptomatic population in Japan, and reaches a high plateau in those older than 40 years. The objective of this study was to assess the link between H. pylori and gastric carcinomas in patients younger than 40 years. METHODS AND RESULTS: Detection of H. pylori and assessment of background mucosa based on the Sydney system was performed histopathologically for 40 Japanese gastric cancer cases younger than 40 years and compared with 40 age- and sex-matched controls. H. pylori infection in gastric mucosa was detected significantly more frequently (P < 0.001) in patients with cancer (29/40; 72.5%) than in controls (11/40; 27.5%). Additionally, by histopathological comparison between intestinal (18 cases) and diffuse (70 cases) types of young gastric cancer patients, mucosal atrophy and intestinal metaplasia were found to coexist with acute and chronic inflammation in the background mucosa of both intestinal and diffuse types, being significantly more prevalent than in young controls. CONCLUSIONS: As well as the high prevalence of H. pylori in young subjects with gastric cancer, it is clear that persistent infection induces mucosal damage, resulting in atrophy and intestinal metaplasia. Thus, acute/chronic gastritis could play an essential role in the early development of neoplasia in the stomach.     

Assessment of different methods for staining Helicobacter pylori in endoscopic gastric biopsies

The recent implication of Helicobacter pylori in the pathogenesis of gastritis-peptic ulcer syndrome and its relevance for the development of upper gastrointestinal malignancy warrant efficient methods for the detection and demonstration of the organism in biopsy specimens. We have compared 5 staining methods, namely, haematoxylin and eosin (H & E), immunohistochemistry (IHC), the silver staining HpSS, the alcian yellow-toluidine blue (Leung) method (A-Y) and Genta staining, for the demonstration of the organism in gastric biopsies taken from antrum, body and fundus of 118 patients who presented to our hospital with upper gastrointestinal symptoms. We found no significant differences in the efficacy of H & E, IHC, HpSS and A-Y in the demonstration of H. pylori in all 3 gastric sites. The least reproducible stain in our hands was the Genta stain. We conclude that H & E is adequate for the initial assessment of gastric biopsies in symptomatic upper gastrointestinal patients. This is because it is a well-tested, cheap and easy staining method, requiring a relatively short period of time to perform, with highly reproducible results. It has an added advantage of enabling simultaneous assessment of morphological changes accompanying H. pylori infection. When the density of the organism is expected to be low, we recommend addition of HpSS staining because of its high sensitivity and low cost. The disadvantages of the other staining methods (IHC, A-Y and Genta) are discussed.     

PCR快速检测幽门螺杆菌

应用ＰＣＲ扩增１５个幽门螺杆菌分离株的ＤＮＡ，扩增产物经琼脂糖凝胶电泳均显示一条２９８ｂｐ的区带，而１２株与幽门螺杆菌相关的肠道杆菌都不能扩增出该片段。ＰＣＲ可检出少至１００个幽门螺杆菌细胞，并能检出胃粘膜活检标本中的此菌，全部实验可在５小时内完成。     

幽门螺杆菌感染与缺血性脑卒中发病风险相关性的Meta分析

目的 系统评价幽门螺杆菌（Hp）感染与缺血性脑卒中（IS）发病风险的相关性。方法 计算机检索PubMed、EMBASE、The Cochrane Library、CBM、CNKI、WanFang、VIP等数据库。搜集Hp感染与IS发病风险相关性的观察性研究,检索时限从建库至2020年12月。由2名研究者独立筛选文献、提取信息并评价纳入研究的质量及偏倚风险,采用Stata软件进行meta分析。结果 共纳入26项比较,发表在24篇文献中,涉及111 059例患者,包括19项病例对照研究,7项队列研究。文献质量均评价为中高水平。meta分析结果显示:Hp感染可增加IS的发病风险 [OR（95%CI） = 1.52（1.31～1.77）,P＜0.01]。以研究类型[病例对照研究（OR = 1.69）]、Hp感染检测指标[Hp - IgG（OR = 1.42）、CagA - IgG（OR = 2.09）、C - 14（OR = 3.30）]、卒中病因分型[大动脉粥样硬化型（OR = 2.69）]为分类依据进行亚组分析,发现Hp感染可以增加IS的发病风险。结论 Hp感染与IS发病风险具有一定的相关性,但该结论尚需更多高质量病因学研究进一步证实。     

抗幽门螺杆菌感染二种三联疗法的临床比较

目的　选择高效安全价廉适宜基层医院应用推广的根除幽门螺杆菌 (Hp)的方案。观察二种三联疗法(洛赛克、克拉霉素、阿莫西林、简称LCA ;善胃得、替硝唑、阿莫西林、简称ZTA)抗Hp感染的疗效 ,并与对照组 (泰胃美、简称Tag;普瑞博思、简称Pre)作比较。方法 :对 165例确诊为Hp感染的胃炎及溃疡病者 ,随机分治疗组 83例 (A组 42例、B组 41例 )和对照组 82例 (A1 组 41例均为溃疡、B1 组 41例均为胃炎 )。A组用LCA方案共一周 ,B组用ZTA方案二周 ;A1 组用Tag四周 ,B1 组用Pre十天。除A1 组 1例B1 组 2例失访外 162例治疗后 6周作呼吸试验 ( 1 3C-UBT、部分1 4C -UBT)等以观察近期疗效 ;14 6例 (A组 40例B组 37例 ,A1 组 36例B1 年组 33例 )一年后作胃镜等复查 ,确定Hp根除率及评价远期疗效。结果 :近期Hp根除率治疗组 91.6% (A组 95 .2 %、B组 87.8% )比对照组 35 .4% (A1 组 40 .4%、B1 组 30 .8% )高 (P <0 .0 1) ;远期Hp根除率治疗组 81.8% (A组 85 .0 %、B组 78.4% )明显高于对照组 30 .4% (A1 组 33.3%、B1 组 2 7.3% ) (P <0 .0 1) ;溃疡组 ,治疗A组Hp根除率 82 .6% ,B组 76.5 %均明显高于A1组 33.3% (P <0 .0 1) ;溃疡愈合率治疗组 87.5 % (A组 91.3%、B组 82 .4% )明显高于对照组 5 2 .8% (P <0 .0 1)     

健脾清热中药治疗Ⅰ型幽门螺杆菌相关性胃炎的研究

目的　研究健脾清热中药对Ⅰ型幽门螺杆菌相关性胃炎的疗效。方法　 10 0例Ⅰ型幽门螺杆菌感染的慢性胃炎患者随机分成 2组。研究组 (A组 ) 5 0例 ,服用健脾清热中药 (汤剂 ) 5 0ml 3 日 ,雷尼替丁 15 0mg 2 日 ;对照组(B组 ) 5 0例 ,口服甲硝唑 40 0mg 2 日 ,阿莫西林 10 0 0mg 2 日 ,雷尼替丁 15 0mg2 日 ,疗程均为 2周。停药 4周后给予1 4　C -UBT试验。结果　临床症状缓解率A组高于B组 (P <0 .0 5 ) ,HP的根除率两组间不存在显著差异 (P >0 .0 5 ) ,而A组产生的治疗副作用少。结论　健脾清热中药外加雷尼替丁是一种根除Ⅰ型幽门螺杆菌和缓解慢性胃炎症状的有效组合。     

幽门螺杆菌感染与缺血性心脑病的关系探讨

目的：探讨幽门螺杆菌（HP）感染与缺血性心脏病（IHD）的关系以及可能的发病机理。方法：应用酶联免疫法测定IHD组（142例）和对照组（50例）血清特异性HP抗体（HPIgG),用全自动生化仪测定血清TC,TG＜ApoA1,ApoB,Lp(a),HDL-c,LDL-c含量,应用全自动凝血仪测定血中纤维蛋白原浓度（Fbg),化学比色法测定血清中NO和NOS含量。结果：IHD组血清HPIgG阳性率明显高于对照组（65．49％VS28．00％,P＜0．0001）,经多元回归分析显示HP感染与IHD发病呈明显的正相关（P＝0．0004）,HPIgG阳性者的TG,ApoB,NO,NOS含量明显增高（P＜0．05）,TC,Lp(a),LDL-c,Fbg含量有增高趋势。结论：HP感染与IHD的发生有明显的相关性,其可能的发病机理为HP感染改变了脂质代谢和血管的内皮功能来增加发生IHD的危险。