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。     

Helicobacter pylori infection and gastric emptying of solids in humans

Helicobacter pylori has been implicated in a number of upper gastrointestinal illnesses. In a controlled study, we have investigated the relationship between H. pylori infection and gastric emptying of solids in two groups of patients with chronic symptoms of dyspepsia. In the first group, 19 patients with non-ulcer dyspepsia and H. pylori infection underwent a standard test of gastric emptying after ingestion of 500 μCi of Tc-labelled chicken liver. The results were compared to a control group of 16 uninfected volunteers. We also studied a second group of 20 patients with previously diagnosed idiopathic gastroparesis for the prevalence of H. pylori infection and its relationship to symptom severity and rates of gastric emptying. In the first group of patients, the half-time of gastric emptying was significantly less among the infected patients compared to the uninfected volunteers (108 ± 9 vs. 142 ± 14 min, P < 0.05). In the second group of patients with gastroparesis, the prevalence of H. pylori was not significantly different among these patients than among 21 age and sex matched controls (20% vs. 38%, P = 0.32). Gastric emptying was markedly slow in all 20 patients in the second group but less so among the four with H. pylori infection. Symptom scores were no different between infected and uninfected patients. We conclude that H. pylori infection is not associated with abnormally slow gastric emptying. On the contrary, gastric H. pylori infection appears to be associated with mildly accelerated emptying of solids compared to normal controls. Idiopathic gastroparesis and dyspepsia related H. pylori infection are separate but sometimes overlapping disorders.     

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。     

根除幽门螺杆菌5种治疗方案的药物经济学评价

目的 探讨不同的方案根除幽门螺杆菌(Hp)所产生的经济效果。方法 151例幽门螺杆菌阳性感染的消化性渍疡和胃炎患者，随机分为5组，给予不同的短程三联治疗方案：A组(胶体次枸橼酸铋 阿莫西林 甲硝唑)、B组(胶体次枸橼酸铋 克拉霉素 甲硝唑)、C组(奥美拉唑 阿莫西林 克拉霉素)、D组(奥关拉唑 阿莫西林 甲硝唑)、E组(奥美拉唑 克拉霉素 甲硝唑)，运用药物经济学的成本-效果分析方法进行评价。结果A、B、C、D、E5组治疗胃炎Hp根除率分别为63．2％、70．9％、89．1％、77．6％、86．8％，治疗消化性溃疡Hp根除率分别为65．1％、73．0％、96．2％、80．4％、93．2％，5组方案对胃炎／消化性溃疡的成本-效果比(C／E)分别为3．14／3.05、4．10／3．98、4．25／3．94、2．91／2.81、2．78／2．59，增长的成本-效果比(△C／△E)分别为-／-、12．00／11．70、6．96／5．80、1．93／1．81、1．83／1．53。结论 E方案为根除Hp的最佳方案。     

尿素对幽门螺杆菌生长的影响研究

目的 :研究尿素对幽门螺杆菌生长的影响。方法 :在幽门螺杆菌培养基中分别加入 3种浓度 (5 mmol/ L,10 mmol/ L和 2 0 m mol/ L )的尿素 ,然后将培养基 p H分别调至 3.5、4 .5、5 .5。将 10株 Hp分别接种于这 9种培养基中 ,以确定最佳条件组合。之后采用最佳条件进行胃黏膜活检标本 Hp的培养。结果 :10株 Hp在 9种含尿素培养基中以尿素浓度为 10 mmol/ L、p H为 4 .5时生长最好 ,其他 8种与之比较差异极为显著 (P<0 .0 1) ,5 7份胃镜活检标本分别接种于尿素浓度为 10 mm ol/ L、p H为 4 .5时生长最好 ,其他 8种与之比较差异极为显著 (P<0 .0 1) ,5 7份胃镜活检标本分别接种于尿素浓度为 10 mmol/、p H 4 .5培养基和 p H 7.0不含尿素的普通 Hp培养基中 ,32份标本 (5 6 .1% )在尿素培养基中培养阳性 ,其中 2 2份 (38.6 % )在普通培养基中培养阳性。结论 :含有适当浓度尿素的培养基可用于胃黏膜 Hp的分离培养。     

慢性胃炎结节状改变的临床研究

目的 研究萎缩性胃炎和结节性胃炎的结节状改变的特征.方法 在2004年4月至2005年3月之间,通过临床特征、内镜及病理结果,来对比分析胃镜检查中发现的慢性胃炎的结节状改变.结果 本次研究显示慢性胃炎的结节状改变分为结节类型A（结节性胃炎）和B（萎缩性胃炎的结节状改变）.结节性胃炎的胃镜下表现为结节具有大小均一、分布密集的特点,多发生于年轻女性,几乎都以上腹部疼痛为主诉,并且感染了幽门螺杆菌,病理检查有淋巴滤泡而没有萎缩和肠上皮化生.而萎缩性胃炎的结节类型B,胃镜下表现为结节大小不一、分布松散,多发生于50岁以上男性,主诉具有多样性的特点,并且幽门螺杆菌检测部分阴性,病理的结果发现有中、重度萎缩和肠上皮化生,而少有淋巴滤泡.结论 拥有结节状改变类型A的结节性胃炎是一种新的特殊胃炎,不同于萎缩性胃炎的结节状改变,应该引起重视.