V Conferencia Española de Consenso sobre el tratamiento de la infección por Helicobacter pylori

Helicobacter pylori infection is very common in the Spanish population and represents the main cause of chronic gastritis, peptic ulcer, and gastric cancer. The last iteration of Spanish consensus guidelines on H. pylori infection was conducted in 2016. Recent changes in therapeutic schemes along with increasing supporting evidence were key for developing the V Spanish Consensus Conference (May 2021). Fourteen experts performed a systematic review of the scientific evidence and developed a series of recommendations that were subjected to an anonymous Delphi process of iterative voting. Scientific evidence and the strength of the recommendation were classified using GRADE guidelines. An eradication therapy, when prescribed empirically, is considered acceptable when it reliably achieves, or preferably surpass, 90% cure rates. Currently, only quadruple therapies (with or without bismuth) and generally lasting 14 days, accomplish this goal in first- and second-line therapies. A non-bismuth quadruple concomitant regimen (proton pump inhibitor, clarithromycin, amoxicillin, and metronidazole) or a quadruple bismuth-based combination (proton pump inhibitor, bismuth, tetracycline, and metronidazole), are recommended as first-line regimens. Rescue therapies after eradication failure and management of H. pylori infection in peptic ulcer disease were also reviewed.     

左氧氟沙星为基础的三联疗法根除幽门螺旋杆菌的疗效探讨

目的：探讨左氧氟沙星为基础的三联疗法根除幽门螺旋杆菌的临床治疗效果。方法方便选择2013年9月—2015年3月期间该院收治的120例Hp感染者作为实验对象，随机数字表法将患者分为对照组（n=60例）和观察组（n=60例），对照组采用标准三联法治疗，观察组采用以左氧氟沙星为基础的三联疗法治疗，观察两组患者Hp根除情况及恶心呕吐、腹部不适等不良反应发生情况。结果观察组Hp根除率显著高于对照组，差异有统计学意义（P<0.05），观察组总不良反应发生率为8.33%（5/60)，对照组总不良反应发生率为13.33%（8/60)，观察组不良反应发生率低于对照组，差异不具有统计学意义（P>0.05）。结论 Hp患者采用以左氧氟沙星为基础的三联疗法治疗，临床疗效较好，能够有效提高Hp根除率，并且不良反应发生率低，安全可靠，值得临床推广使用。     

口腔幽门螺杆菌与牙周病相关性研究进展

近年来众多研究认为口腔为幽门螺杆菌第二储存地,牙周病患者口腔中幽门螺杆菌检测阳性率高于牙周健康者,并且其阳性率与牙周病变严重程度呈正相关。口腔幽门螺杆菌可造成牙周组织细胞的凋亡,促进牙周病变。同时因为其与胃病相关,使得牙周病患者口腔幽门螺杆菌的研究一直受众多学者关注。本文就口腔幽门螺杆菌与牙周病相关性研究进展做一综述。     

2369例高校职工幽门螺杆菌感染检测结果分析

目的 观察高校教职工人群胃幽门螺杆菌(HP)感染情况,加强对其感染的防控工作。方法 空腹采集教职工体检人群静脉血,检测胃幽门螺杆菌抗体滴度,观察其感染情况。结果 人群HP总阳性率为43.31%。其中:男性阳性率为45.82%,女性阳性率为40.53%,差异有统计学意义(P<0.05)。按年龄段分组比较其感染情况,各年龄组阳性率男性普遍高于女性,但只有41～50岁组男性与女性比较差异有统计学意义(P<0.05)。41～50岁年龄组和51～60岁年龄组阳性率高于其他年龄组,差异有统计学意义(P<0.05)。结论 胃幽门螺杆菌感染率较高,且男性感染率高于女性。应加强对该疾病的预防保健工作,提高人群防病治病的健康意识。     

Helicobacter pylori infection,chronic atrophic gastritis and risk of stomach and esophagus cancer: Results from the prospective population-based ESTHER cohort study

Helicobacter pylori (H. pylori) infection is considered as principal cause of gastric cancer. It is further associated with a reduced risk of esophageal adenocarcinomas. In a large prospective population-based cohort study including 9,949 subjects with average observation time of 13.8 years, we assessed the risk of invasive gastric and esophageal cancer according to H. pylori infection and presence of chronic atrophic gastritis (CAG). Incidence rates and hazard ratios (HR) derived by Cox proportional hazards models and adjusted for relevant confounders were derived by seroprevalence of H. pylori and cytotoxin-associated gene A (CagA) antibodies and presence of CAG based on serological markers at baseline, respectively. During follow-up, 30 cases of noncardia gastric cancer and 33 cases of esophageal cancer were observed. Infection by H. pylori without and with expression of CagA was associated with a 5.2-fold (95% confidence interval 1.00–27.1) and an 18.2-fold (4.3–77.4) increase of noncardia gastric cancer incidence. A 0.65-fold decreased risk of esophageal adenocarcinomas (HR 0.35, 0.12–0.97) was observed among H. pylori-infected individuals. In participants infected with CagA expressed H. pylori, the presence of mild/moderate and severe CAG was associated with a 6.4-fold (1.3–31.0) and an 11.8-fold (3.1–45.4) increase of gastric cancer incidence, respectively. The results of this prospective population-based cohort study may contribute relevant evidence to the ongoing research of H. pylori-related cancers. The results may furthermore enhance the empirical basis for risk stratification among H. pylori-infected people and for recommendations regarding H. pylori screening and treatment among older adults in a Western population.     

胃微生物与人体共生关系的研究进展

近年来,共生功能体(holobionts)这一概念被越来越多的科研学者频繁提出。微生物与宿主在共同进化的过程中通过长期互作形成一个整体,其稳态的打破可诱发疾病。目前人们对胃部菌群方面的认识已经从H.pylori的致病作用转化为多种微生物共同存在和协同作用,研究也从单一致病菌的关联性研究转化为探讨宿主-微生物复杂且动态的共生关系,并对共生关系在胃部疾病的发生发展中的作用提出新观点。由于饮食、用药、环境、遗传等各方面都对菌群结构及丰度产生影响,因此对治疗方法也需要调整和提出新的思路。新的科研方法使人们对胃部菌群的认识更深刻更广泛,对H.pylori作用的重新认识与非H.pylori细菌在胃内作用的新发现出现很多争议,单一病因与整体微生态变化对疾病发生进展的作用以及菌群特征分析是否可以成为胃部疾病新的诊断方法成为热点话题。本文就胃微生物与人类共生关系的研究发展做一综述,以期在预防和治疗胃部疾病上提供新思路。     

幽门螺杆菌细胞空泡毒素毒性片段基因的表达及其重组蛋白免疫学鉴定

目的采用基因工程技术获得具有良好免疫反应性的重组细胞空泡毒素的毒性亚单位蛋白。方法利用PCR技术从Hp基因组中扩增VacA基因毒性片段,插入原核表达载体pQE30上,测序后,转化表达宿主菌DH5α,SDSPAGE分析表达情况,Western blot检测其免疫反应性。NiNTA^2＋树脂纯化后,用重组蛋白免疫兔,Helico Blot试剂盒检测兔血清VacA抗体以鉴定其免疫原性。结果测序表明目的序列完整,与Genbank中的多株中国菌株相比有高度的同源性。SDS—PAGE显示表达产物相对分子量为27000。表达量为30％以上。该蛋白可被Hp全菌抗血清所识别,纯化后可得到纯度为93％以上蛋白质,并证实有良好的免疫原性。结论Hp VacA基因毒性片段表达成功,获得高纯度重组蛋白并具有良好的免疫反应性与免疫原性,为研制疫苗和制备诊断VacA（＋）株感染试剂盒提供了可靠材料。     

Preclinical immunogenicity and protective efficacy of an oral Helicobacter pylori inactivated whole cell vaccine and multiple mutant cholera toxin: A novel and non-toxic mucosal adjuvant

Mucosal vaccines against Helicobacter pylori consisting of either whole cell bacteria or recombinant antigens can induce immune protection against challenge in mice only when co-administrated with a strong mucosal adjuvant such as cholera toxin (CT) or Escherichia coli heat labile enterotoxin (LT). The strong enterotoxicity of these adjuvants however preclude their use in human vaccines. The recently developed multiple mutant CT (mmCT) is a strong, yet practically non-toxic novel mucosal adjuvant which here was admixed with a formalin-inactivated H. pylori whole cell vaccine (WCV) as a potential vaccine candidate against H. pylori infection. We report that intragastric immunizations with H. pylori WCV together with mmCT, similar to immunization with WCV together with CT, resulted in 50–125-fold reduction in colonization of H. pylori in the stomach of mice associated with rises in both serum IgG and intestinal-mucosal IgA anti-H. pylori antibody responses and strong T cell and IFNγ and IL-17A cytokine responses. Data presented in this study also supports that the proposed vaccine can be grown in a bioreactor and would be effective against infection caused by a multitude of pathogenic H. pylori strains isolated from patients from various continents. The results warrant immunization studies in humans to evaluate the safety, immunogenicity and efficacy of the proposed H. pylori WCV and mmCT.     

从痈论治消化性溃疡

消化性溃疡具有病程长,易复发的特点,对于消化性溃疡的治疗,应始终抓住"扶正祛邪兼顾"的治疗思想,引入中医外科疮疡内治法"消、托、补"的治疗原则,药力直达病所,消痈生肌、祛瘀生新以达到抑灭幽门螺杆菌,清除坏死组织,促进溃疡面肉芽组织增生及黏膜上皮细胞修复,治愈消化性溃疡病。在清热解毒消痈的同时,不忘顾护脾胃之气;对局部痈疡修复的同时,不忘调节人体正气,以加速创口愈合,祛腐生新,减少溃疡的复发。     

抗幽门螺杆菌中药筛选及漱口液的初步研制

目的筛选抗幽门螺杆菌的中药,研制抗口腔幽门螺杆菌的中药漱口液,以减少幽门螺杆菌在口腔的聚积,预防及辅助治疗胃肠道幽门螺杆菌的感染。方法筛选对幽门螺杆菌有抑制作用的单味中药,根据中药特性组成由黄连、黄芩、黄柏、大黄、厚朴和黄连、黄柏构成的两个中药漱口液配方。运用纸片扩散法、打孔法及琼脂稀释法测定两个中药漱口液配方及其组成的各个单味药的抑菌作用和最小抑菌浓度(MIC)。用SPSS软件对结果进行统计学分析。结果在琼脂稀释法的抑菌试验中由黄连、黄柏组成的二号方漱口液抑菌浓度最小,抑菌作用最强;由黄连、黄柏组成的二号方漱口液在纸片扩散法和打孔法的抑菌试验中抑菌效果最好(P<0.05)。结论黄连和黄柏组成的复方抑菌作用最强,抗口腔幽门螺杆菌的漱口液初步研制成功。