中药治疗幽门螺旋杆菌相关性胃病的研究进展

为了探讨中药治疗幽门螺旋杆菌的方法和疗效，综述了1997年至2002年近6年的文献资料。结果表明，中医药治疗幽门螺旋杆菌相关性胃病，无论采用主方加减、单方治疗或中西药合用均疗效显著，愈后复发率低，副作用少．长期应用无耐药性。     

90例慢性胃炎湿热证的临床病理指标观察

通过对90例慢性胃炎湿热证患者的胃液、幽门螺杆菌、胃镜下胃黏膜及腺体变化状况的观察，发现湿热证型者胃液中GSH—PX、PGE2指标较脾虚肝郁型、肝胃不和型偏高，以及Hp阳性率高、炎症以渗出水肿为主。为慢性胃炎中医证型辨证提供微观实质的依据。     

针灸治疗慢性胃炎临床方法对比分析

本文就近 1 0年来针灸治疗慢性胃炎概况进行了综合分析与归纳 ,并对针灸治疗本病的疗效与安全性评价、针灸治疗规律及针灸临床研究重点进行了分析 ,以期为临床更好地治疗慢性胃炎提供参考资料。     

The endoscopic evaluation of gastritis,gastric remnant residue,and the incidence of secondary cancer after pylorus-preserving and transverse gastrectomies

Background Pylorus-preserving gastrectomy (PPG) and transverse gastrectomy (TrG) have been accepted as function-preserving procedures for node-negative early gastric cancer. It is believed that a better quality of life is guaranteed after PPG or TrG compared to that after distal subtotal gastrectomy (DSG) with Billroth type-I reconstruction. However, objective evaluations of the gastric remnant following gastrectomy have not been widely reported, and the real advantages and disadvantages of PPG or TrG over DSG remain unclear. Moreover, the risk of secondary cancer after PPG or TrG is uncertain.Methods Between 1991 and 2000, 834 DSGs were carried out in our institute for preoperatively diagnosed patients with early gastric cancer. The degree of residual gastritis and the amount of diet residue in the gastric remnant were evaluated by annual gastrointestinal endoscopic investigations prospectively for 72 patients after PPG, 95 patients after TrG, and 60 patients after DSG. These analyses were performed using the RGB classification (residue, gastritis, bile). The incidence of disease greater than or equal to grade 2 was calculated, and the time trends of the incidence for each procedure were also studied for 3 years after gastrectomy. In addition, secondary cancer cases in the gastric remnant mucosa were checked for each procedure during this period, and the incidence of secondary cancer after each operation was calculated.Results The incidence of gastritis, of grade 2 or more, found in the gastric remnant was significantly lower after PPG (1.4%) and TrG (2.1%) than after DSG (43.3%). However, the incidence of moderate or greater residue in the gastric remnant, grade 2 or more, was significantly higher after PPG (45.8%) and TrG (40.0%) than after DSG (11.7%). The analysis of time trends of gastritis and diet residue reflected the significant advantage or disadvantage for each procedure 1 year after surgery. The analysis also included these factors without consideration of elapsed time following surgery. Two patients after PPG (2.8%) and three patients after TrG (3.2%) developed secondary cancer in the gastric remnant. No DSG-treated patient showed new cancer genesis in the remaining stomach.Conclusion PPG and TrG have the advantage over DSG in preventing postoperative gastritis in the gastric remnant. On the other hand, moderate or greater diet residue in the gastric remnant is more common after PPG or TrG than after DSG. For the risk of carcinogenesis in the remnant gastric mucosa, we could not conclude that there was any apparent difference between these range-limited gastrectomies and conventional DSG. Further study is necessary to determine the significant advantages and disadvantages of using PPG or TrG.     

胃黏膜良恶性病变幽门螺杆菌感染与p53、bcl-2、PCNA表达

［目的］探讨胃黏膜良恶性病变幽门螺杆菌(Hp)感染与突变型p５３、bcl-２、增殖细胞核抗原（PCNA）表达之间的关系。［方法］用免疫组织化学SP法对１１５例胃黏膜良、恶性病变［慢性浅表性胃炎(CSG)２５例，慢性萎缩性胃炎(CAG)２５例，异型增生(GED)２５例，胃癌(GCA)４０例］的胃镜活检标本进行幽门螺杆菌感染的检测和突变型p５３、bcl-２、PCNA表达的研究。［结果］在CSG、CAG、GED、GCA的各病变中幽门螺杆菌感染检出率分别为３６％(９／２５)、４８％(１２／２５)、７２％(１８／２５)、５８％(２３／４０)；与２０例正常胃黏膜Hp检测阳性率（２０％）作比较，除了CSG无统计学意义外，其余几组均有显著性差异(P＜０．０５)；突变型p５３检出率分别为０、０、２４％(６／２５)、５５％(２２／４０)；胃炎、异型增生、胃癌三者之比有显著性差异(P＜０．０５)；bcl-２检出率４４％（１１／２５）、５２％（１３／２５）、７６％（１９／２５）、５７．５％（２３／４０）；PCNA在CSG、CAG、GED、GCA中的表达呈现递增性，经Ridit检验P＜０．０５；Hp感染与PCNA表达强级(阳性细胞＞５０％)、p５３阳性病例均有显著相关性(P＜０．０１)。［结论］Hp的感染与突变型p５３、bcl-２、PCNA在胃黏膜异型增生，胃     

嗜酸性细胞胃炎中的肥大细胞

目的研究嗜酸性细胞胃炎中的肥大细胞的分布及其意义。方法27例嗜酸性细胞胃炎常规切片．分别做pH6.40.5％甲苯胺蓝染色显示肥大细胞和2％硫染色人细胞异染颗粒，此镜观察。结果：在胃粘膜、粘膜下层及溃疡的肉芽组织中．均可见未释放型和释放型两种肥大细胞分布。不同部位不同类型的肥大细胞，被激活后均参与相应部位的炎性反应、引起粘膜溃疡和肉芽肿形成。结论本病的发生．主要与肥大细胞的分布和激活有着重要的关系。肥大细胞释放的各种介质、虽然双本病的发生起到重要作用，同时也具有一定的抗癌作用，这种病变属于一种迟发性免疫反应性疾病.     

中西医结合治疗幽门螺杆菌相关性胃炎60例疗效观察

采用中西医结合方法治疗幽门螺杆菌相关性胃炎６０例，并与单纯中药治疗５８例及丽珠得乐治疗６０例对照。结果：治疗组中显效４３例（占７１．６％），好转１６例（占２６．７％），无效１例（占１．７％），总有效率为９８．３％；中药组中显效２１例（占３６．２％），好转２４例（占４１．４％），无效１３例（占２２．４％），总有效率为７７．６％；得乐组中显效２３例（占３８．３％），好转２５例（占４１．７％），无效１２例（占２０．０％），总有效率为８０．０％。经统计学处理，３组显效率及总有效率对比，治疗组与对照组间有显著差异（Ｐ＜０．０１）。     

Helicobacter pylori - dependent intragastric urea biodegradation in children: Diagnostic and pathogenetic importance

Abstract The objective of the present work was to study the relationship between intragastric urea hydrolysis generated by Helicobacter pylori urease and acid-peptic disease in childhood. Intragastric urease activity was examined by urea and ammonia concentration measurement in gastric juice in 91 children with upper abdominal complaints. Helicobacter pylori infection was detected from 70 (76.9%) of 91 patients, including all of the 15 subjects with peptic ulcer disease. Helicobacter pylori -related gastritis in children was associated with a decrease of urea and an increase of ammonia in gastric juice ( P < 0.001) in comparison with H. pylori-negative children. The gastritis score was correlated with the concentrations of urea and ammonia in the gastric juice of patients infected with H. pylori. There was a significant correlation between the histologically detected dissemination of organisms and gastric ammonia levels. Similar results were obtained concerning correlation between gastric juice ammonia and anti- H. pylori specific immunoglobulin G versus highly purified antigen of H. pylori containing urease. Present findings prove that H. pylori plays an essential role in the pathogenesis of gastritis and that ammonia is one of the main pathogenic factors of acid-peptic disease.     

慢性萎缩性胃炎伴肠化生与胃癌ras基因表达的比较

目的：探讨胃癌发生发展不同阶段癌基因表达特点并予以定量分析，对阐明胃癌发生发展机理及早期诊断胃癌具有重要意义。方法：应用ras基因产物共有多肽序列单克隆抗体PAP免疫组化对照研究了13例慢性萎缩性胃炎伴肠化生（大肠型），32例胃窦癌及15例正常胃窦粘膜ras基因表达特点。结果：慢性萎缩性胃炎伴肠化生粘膜ras基因产物免疫反应阳性细胞形态较规则，呈卵圆形或低柱状，免疫反应强度及阳性细胞数量均较胃癌增强（多）（P均＜0．05）阳性细胞成片分布肠化粘膜下部及基底部，不穿越基底层；胃癌中免疫反应阳性细胞形态不规则，核分裂相明显，成团或散在分布，免疫反应强弱不等，呈异质性表达。正常胃窦粘膜可见谈棕黄色单个分布的ras产物阳性细胞。结论：ras基因在胃癌前病变慢性萎缩性胃炎伴肠化生中已激活，对ras产物精确定量分析有助于胃癌前病变的诊断。     

自拟胃炎冲剂抗幽门螺杆菌感染37例临床观察

目的 观察自拟胃炎冲剂抗幽门螺杆菌(Hp)的临床疗效.方法 将67例Hp感染的慢性胃炎伴胃黏膜萎缩糜烂的患者随机分为两组,对照组采用西医PPI三联疗法治疗,治疗组存PPI三联疗法治疗的基础上联合白拟胃炎冲剂,两组均连续治疗4周.结果 治疗组对Hp的根除率显著高于对照组,两组差异具有统计学意义(P<0.05).结论 自拟胃炎冲剂埘Hp感染的慢性胃炎伴胃黏膜萎缩糜烂的患者有效.