十二指肠溃疡病人血清胃泌素水平与幽门螺杆菌关系的探讨

1991年7月至1992年7月,我们对60例十二指肠溃疡(DU)病人进行幽门螺杆菌(HP)及血清基础胃泌素检测,以25例正常人做对照,并对20例HP阳性DU进行清除HP治疗。旨在探讨HP阳性DU血清胃泌素水平及清除HP后的变化。     

CagA阳性幽门螺杆菌感染和血清胃泌素相关性探讨

众所周知，在胃、十二指肠疾病中幽门螺杆菌(Hp)感染可导致高胃泌素血症，胃酸分泌亢进，而致慢性胃炎和溃疡形成，本文着重探讨HpCagA 菌株和血清胃泌素的关系，研究HpCagA 菌株在胃十二指肠疾病中的致病作用。     

幽门螺杆菌相关性慢性胃炎中医辨证分型与胃泌素的关系

目的:研究幽门螺杆菌(Hp)相关性慢性胃炎中医辨证分型与空腹血清胃泌素(GAS)的关系.方法:将中医辨证为脾胃湿热型、脾胃虚弱型的42例慢性胃炎患者进行电子胃镜、病理组织学检查,并检测Hp及血清GAS.结果:Hp相关性慢性胃炎中脾胃湿热型占62.96%(P<0.05);空腹血清GAS(125.35 ng/L)高于脾胃虚弱型(96.59 ng/L,P<0.01).结论:高GAS血症可能是Hp相关性慢性胃炎脾胃湿热证型重要病理生理基础之一.     

幽门螺杆菌、胃泌素与慢性胃炎的关系

目的：对慢性浅表性胃炎（ＣＧＳ）患者行幽门螺杆菌（ＨＰ）及空腹血清胃泌素（ＳＧ）检测,对ＨＰ（＋）组和ＨＰ（－）组ＳＧ作对比,抗ＨＰ治疗前后ＳＧ、病理组织学作比较,探讨两者与ＣＳＧ的关系。方法：患者先行空腹作ＳＧ测定,再作胃镜检查,取胃罕粘膜３块,分另作快速尿素酶试验、Ｇｉｅｍｓａ染色及病理组织学检查。ＨＰ（＋）组抗ＨＰ治疗,１月后重复上述检查。结果：ＨＰ（＋）且ＳＧ明显高于ＨＰ（－）组（Ｐ〈０．     

分析不同年龄儿童胃泌素水平与幽门螺杆菌感染相关性研究

目的:探讨不同年龄儿童胃泌素水平与幽门螺杆菌(Hp)感染相关性及其调控的分子机制。方法:收集3～25 d、6个月～2岁、3～6岁幼儿血清,采用ELISA检测血清胃泌素水平,通过口服或肛门感染建立小鼠Hp感染模型,采用ELISA检测小鼠血清及胃泌素水平,并给予实验组小鼠p38抑制剂SB203580处理,采用Western Blotting检测不同分组小鼠Gas、ERK、p38、JNK1蛋白表达水平。结果:儿童血清中胃泌素水平与年龄无相关性,Hp感染阳性儿童血清胃泌素水平显著高于Hp感染阴性儿童(P<0.05)。口服组及肛门组小鼠血清胃泌素水平明显高于对照组,差异有统计学意义(P<0.05),口服组及肛门组小鼠血清胃泌素水平比较差异无统计学意义(P>0.05),口服组及肛门组小鼠胃组织中Gas、ERK、p38、JNK1蛋白表达显著高于对照组(P<0.05),而给予p38抑制剂SB203580后,Gas、ERK、p38、JNK1蛋白表达水平显著低于未给药处理的口服组及肛门组(P<0.05)。结论:年龄对儿童胃泌素水平影响可能不大,Hp通过MAPK信号通路调控胃泌...     

Hp相关性慢性胃炎中医证型分布及血清胃泌素-17水平的相关性分析

目的:探讨Hp相关性慢性胃炎中医证型分布及各证型间胃泌素-17(G-17)水平的相关性.方法:收集Hp相关性慢性胃炎患者400例,按慢性胃炎中医辨证分为脾胃湿热证、脾胃虚寒证、寒热错杂证、肝胃不和证、胃阴不足证、胃络瘀阻证6个证型,并测各证型内患者G-17水平.结果:Hp相关性慢性胃炎各证型例数由高到低分别为:脾胃湿热...     

胃窦粘膜及胃液中生长抑素胃泌素含量与幽门螺杆菌相关性胃炎关系的研究

本文对３９例ＨＰ（＋），２３例ＨＰ（－）的慢性浅表性胃炎患者及８例正常对照组的胃窦粘膜组织及胃液经胃镜取材后用放射免疫分析方法（ＲＩＡ）分别测定了胃泌素、生长抑素含量。研究结果显示：①胃窦粘膜组织ＳＳ水平在ＨＰ（－）胃炎组显著高于ＨＰ（＋）胃炎组（Ｐ＜０．０１）而与正常组比较无显著性差异（Ｐ＞０．０５）。ＨＰ（＋）胃炎组较正常组ＳＳ水平为低（Ｐ＜０．０５）；②胃液ＳＳ水平在ＨＰ（－）胃炎组显著高于ＨＰ（＋）组（Ｐ＜０．０１）与正常组比无显著性差异（Ｐ＞０．０５）；③胃窦粘膜ＧＳ水平在ＨＰ（＋）组与ＨＰ（－）组及正常组之间比较均无统计学差异（Ｐ＞０．０５），而胃液ＧＳ水平在ＨＰ（＋）组显著高于ＨＰ（－）组（Ｐ＜０．０１）及正常组（Ｐ＜０．０５）；④组织ＳＳ水平与胃液ＳＳ水平呈正相关（ｒ＝０．２９８４，Ｐ＜０．０５），与胃液ＧＳ水平呈负相关（ｒ＝－０．３８６０Ｐ＜０．００１）。研究结果表明，ＨＰ感染胃窦粘膜可致其组织及胃液ＳＳ水平降低，胃液ＧＳ水平增高。提示：ＨＰ感染可能抑制了胃窦Ｄ细胞的功能，ＨＰ感染可使Ｇ细胞的腔分泌功能增强。     

幽门螺杆菌感染、慢性胃炎和功能性消化不良

众所周知 ,幽门螺杆菌 (Ｈｐ)感染是慢性活动性胃炎的主要病因。此证据的可靠程度超过Ｈｐ感染与消化性溃疡的联系 ,因前者符合Ｋｏｃｈ提出的判断病原微生物是某一疾病病因的基本条件 ,而后者溃疡的最终发生是胃酸 /胃蛋白酶的“自身消化”(Ｈｐ感染破坏了防御因子和攻击因子间的平衡 ,为溃疡发生创造了条件 ) ,并非Ｈｐ的直接作用。Ｈｐ相关性消化性溃疡均需根除Ｈｐ治疗已成为共识 ,但对于Ｈｐ相关慢性 (活动性 )胃炎病人根除Ｈｐ问题意见尚不统一。除有胃癌家族史者需根除治疗外 ,欧洲关于Ｈｐ处理的Ｍａａｓｔｒｉｃｈｔ 2 2 0 0 0共…     

血清胃泌素17水平与胃癌及癌前疾病的相关性研究

目的探讨血清胃泌素17(G17)水平与胃癌及癌前疾病的相关性。方法纳入2011年-2012年于中国医科大学附属第一医院消化内科就诊患者1 336例,应用酶联免疫吸附测定法(ELISA)检测血清G17水平及幽门螺杆菌Ig G(H.pylori-Ig G)抗体滴度。结果在60岁以上、H.pylori-Ig G阴性、萎缩性胃炎(AG)组及胃癌(GC)组中,女性患者血清G17水平均显著高于男性患者(P0.05)。在非AG组及异型增生(GD)组中,H.pylori阳性患者血清G17水平显著高于H.pylori阴性患者(P0.05)。在所有患者中,与SG组相比,GC、胃黏膜糜烂(GE)和胃溃疡(GU)组血清G17水平显著升高(P0.05);与浅表性胃炎伴糜烂(SG-IM)组相比,GD、GC、GE和GU组G17水平显著升高(P0.05);与AG组相比,GC、GE和GU组G17水平显著升高(P0.05)。在H.pylori阴性患者中,与SG组相比,GC组和GU组血清G17水平显著升高(P0.05);与SG-IM组相比,AG、GC、GE和GU组G17水平显著升高(P0.05);与GD组相比,GU组血清G17水平显著升高(P=0.007)。结论血清G17水平受患者性别及H.pylori感染等相关因素的影响,在从SG、SG-IM、AG、GD到GC的动态变化过程中呈逐渐升高的趋势,且GC患者较其他疾病明显升高。血清G17可能作为胃癌的生物标志物,有望成为胃癌筛查及早期诊断的一个重要观测指标。     

慢性多灶萎缩性胃炎患者胃酸分泌与幽门螺杆菌感染及血清胃泌素的关系

目的 研究慢性多灶萎缩性胃炎(BAG)胃酸分泌与幽门螺杆菌(Hp)感染及血清胃泌素的关系.方法 将200例确诊的慢性胃炎患者根据病理结果分为轻度、中度、重度BAG组及对照组(非萎缩性胃炎组),监测各组患者24小时胃内pH值的变化情况,并检测其幽门螺杆菌及血清胃泌素的含量,各组间进行比较.结果 (1)150例BAG患者中,Hp感染阳性率70%,随着胃粘膜萎缩程度的加重,Hp感染阳性率逐渐上升;(2)各组间血清胃泌素值比较:轻度萎缩组与非萎缩性胃炎组比较差异无显著性(P＞0.05),其余各组问比较差异有显著性(P＜0.05;(3)各组pH值分析结果:BAC胃黏膜轻度萎缩时,pH≤2时间百分比较非萎缩性胃炎组升高,pH＞4时间百分比及pH平均值、pH中位值均较非萎缩性胃炎组降低,中度及重度萎缩时pH≤2时间百分比逐渐降低,pH＞4时间百分比及pH平均值、pH中位值逐渐升高.结论 BAG的发生与Hp感染有关,胃粘膜萎缩程度与Hp感染的严重程度有关;BAG胃黏膜轻度萎缩时,血清胃泌素含量无明显变化;中、重度萎缩时,血清胃泌素含量降低;BAc胃黏膜轻度萎缩时,胃酸分泌增多;随着胃黏膜萎缩程度的加重,胃酸分泌逐渐减少.     

小儿慢性胃炎辨证分型与内镜象及幽门螺杆菌感染的相关性研究

[目的]探讨小儿慢性胃炎中医证型与胃黏膜改变及幽门螺杆菌感染之间的内在关系.[方法]将符合入选条件的404例慢性胃炎患儿中医辨证分型后进行胃镜检查及尿素13C-呼气试验(13 C-UBT)检查,并登记造表,进行统计学处理.[结果]肝胃不和型胃炎主要表现为胃黏膜充血和微小结节形成,脾胃湿热型胃炎表现以黏膜斑和黏膜糜烂为主,胃络瘀血型胃炎则以胃黏膜出现出血斑点为主,脾胃虚弱型胃炎以胃黏膜水肿为主,胃阴不足型胃炎以胃黏膜花斑为主.13 C-UBT阳性率实证高于虚证,与证型无相关性;13C-UBT值实证高于虚证,尤以肝胃不和型和脾胃湿热型为最高.[结论]小儿慢性胃炎中医辨证分型与胃黏膜改变及幽门螺杆菌感染之间存在实质性联系,为辨证施治提供了理论基础.     

Helicobacter pylori eradication improves gastric histology and decreases serum gastrin, pepsinogen I and pepsinogen II levels in patients with duodenal ulcer

Background and Aim: The aim of this study was to assess the gastric histopathology and serum gastrin‐17 and pepsinogens profiles in patients with duodenal ulcer before and after Helicobacter pylori eradication in a population with a very high prevalence of H. pylori. At the same time we assessed the role of H. pylori density on these variables. Methods: Eighty Caucasian patients with H. pylori–associated duodenal ulcer before treatment and 1 year after randomized eradication were studied. Among patients with unsuccessful eradication two groups were distinguished according to the data obtained after treatment: the group with negative rapid urease test and decreased bacterial density according to morphological score (partial elimination group); the group with positive rapid urease test and high bacterial density (failed eradication group). Results: One year after successful eradication, serum levels of gastrin‐17, pepsinogen I and pepsinogen II decreased. Similar changes of serum pepsinogen I and pepsinogen II levels were observed in patients with partial elimination of H. pylori infection. In the group with successful eradication, inflammation, activity, atrophy and number of lymphoid follicles in the antral mucosa fell. In the group with partial elimination, antral mucosa activity and H. pylori score reduced. Other morphological changes were statistically non‐significant. Conclusion: Patients with duodenal ulcer after successful eradication have improvement of morphological and functional characteristics of gastric mucosa.     

H pylori感染及根除对慢性糜烂性胃炎患者IL-18水平的影响

目的:探讨H pylori感染及根除对慢性糜烂性胃炎患者IL-18水平的影响,同时检测抗H pylori治疗前后抗体水平的变化.方法:60例上消化道患者分两组,慢性糜烂性胃炎组(实验组)40例,慢性浅表性胃炎组(对照组)20例.实验组H pylori阳性者予口服洛赛克20 mg和克拉霉素500 mg及阿莫西林1000 mg,1 wk后症状缓解者,开始口服洛赛克20 mg/d至4 wk实验结束,对照组仅口服洛赛克抗H pylori治疗,1 mo后复查~(13)C呼气实验和胃镜.H pylori免疫印迹法进行蛋白抗体分型,同时ELISA法检测H pylori-IgG,IL-18水平.结果:治疗前H pylori阳性者实验组血清IL-18水平高于对照组(267.18±148.23 ng/L vs 119.31±45.34 ng/L:P<0.05).抗H pylori治疗后慢性糜烂性胃炎患者的IL-18,抗体水平均有明显下降(267.18±148.23 ng/L vs 93.82±22.15 ng/L;31.36±23.26 kU/L vs 21.00±9.47 kU/L;P<0.05).H pylori感染类型及糜烂的严重程度与IL-18水平无明显的相关性.结论:抗H pylori治疗后IL-18水平的下降在慢性糜烂性胃炎糜烂的治疗过程中发挥重要作用.     

Correlation between CD4, CD8 cell infiltration in gastric mucosa, Helicobacter pylori infection and symptoms in patients with chronic gastritis

AIM: To evaluate the correlation between CD4, CD8 cell infiltration in gastric mucosa, Helicobacter pylori(H pylori) infection and symptoms or the assemblage of symptoms in cases with chronic gastritis. METHODS: Biopsy samples at the gastric antrum were obtained from 62 patients with chronic gastritis. CD4 and CD8 cell infiltration was evaluated by immunohistochemical assays on frozen sections of the biopsy samples. Fifteen symptoms referring to digestion-related activity and non-digestion related activity were observed. The correlation between lymphocyte infiltration and each symptom or symptom assemblage was analyzed by logistic regression and K-mean cluster methods. RESULTS: CD4 cell infiltrations in gastric mucosa were much more in patients with H pylori infection, while CD8 cell infiltrations were similar in patients with or without H pylori infection. Logistic regression analysis showed that the symptoms including heavy feeling in head or body (t = 2.563), and thirst (t = 2.478) were significantly related with CD4 cell infiltration in gastric mucosa (P<0.05), and cool limbs with aversion to cold were related with CD8 cell infiltration (t = 2.872, P<0.05). Further analysis showed that non-digestive related symptom assemblage could increase the predicted percentage of CD4 and CD8 cell infiltration in gastric mucosa, including lower CD4 infiltration by 12.5%, higher CD8 infiltration by 33.3%, and also non-H pylori infection by 23.6%. K-means cluster analysis of all symptoms and CD4 and CD8 cell infiltration in gastric mucosa showed a similar tendency to increase the predicted percentage of CD4, CD8 cell infiltration and H pylori infection. CONCLUSION: Based on correlation between the gastric mucosa lymphocyte infiltration, H pylori infection and clinical symptoms, symptoms or symptomatic assemblages play an important role in making further classification of chronic gastritis, which might help find a more specific therapy for chronic gastritis.     

慢性胃炎结节状改变与幽门螺杆菌感染的关系研究

目的　探讨慢性胃炎结节状改变与幽门螺杆菌 (Hp)感染的关系。方法　对 2 0 0 1～2 0 0 2年中胃镜检查发现的慢性胃炎结节状改变患者进行Hp检测 ,对Hp阳性患者 ,进行Hp根除治疗 ,随访 6个月 ,观察其胃镜下的改变。结果　 4 939例胃镜检查患者中共发现 1 3例慢性胃炎结节状改变 ,占检查总人数的 0 2 6 %。平均年龄 2 9岁 ,均为女性患者。主要症状均为上腹部疼痛。所有患者均有Hp感染。Hp根除成功后 ,症状和胃镜下结节状表现消失 ,病理证实胃黏膜下淋巴滤泡也随之消失。结论　慢性胃炎结节状改变可作为Hp阳性胃炎的内镜下的表现之一。     

Relationship among serum pepsinogens,serum gastrin,gastric mucosal histology and H. pylori virulence factors in a paediatric population

Objective. Serum pepsinogens and gastrin have been proposed as markers of gastritis, but have seldom been studied in children. In this study the aim was to identify host- and Helicobacter pylori-related factors linked to variations in serum gastrin, PGI, PGII, and to evaluate the potential of these biomarkers for diagnosing gastritis, whether H. pylori-associated or not. Material and methods. Ninety-two dyspeptic children referred for endoscopy (peptic ulcer exclusion) were included in the study. H. pylori status (urease, culture, histology) was assessed, and genotype determined (PCR) in H. pylori-positive subjects. Serum gastrin, PGI and PGII levels were measured by standard radioimmunoassay (RIA). Results. PGI and PGII levels were significantly higher in H. pylori-positive subjects (p=0.007; p=0.012, respectively). Gastrin levels were significantly higher in H. pylori-negative subjects (p=0.035). PGI and PGII were associated significantly with higher antrum inflammation scores (p=0.002; p=0.016, respectively); only PGI was associated with age, after controlling for inflammation (p=0.033) and for activity (p=0.037). The contribution of virulence factors could not be assessed owing to the low number of virulent strains. After multivariate analysis, only antrum inflammation was independently associated with PGI level (p=0.012). Receiver operating characteristic (ROC) analysis showed a low PGI and PGII discriminant power for predicting antrum inflammation. Conclusions. Pepsinogen levels as measured in this study seem predominantly to reflect antral inflammation, but they are not an effective screening test for gastritis (H. pylori-positive or -negative) in dyspeptic children.     

老年慢性胃炎与幽门螺杆菌感染的关系

本文报道老年慢性胃炎伴幽门螺杆菌（ＨＰ）感染的情况，并与中青年慢性胃炎伴ＨＰ感染组对照。结果表明：老年ＣＡＧ伴ＨＰ感染的发病率较对照组高，而ＣＡＧ又是老年胃癌的癌前病变，因此彻底治疗ＨＰ感染对预防老年ＣＡＧ的癌变有一定的临床意义。     

幽门螺杆菌感染慢性胃炎患者红细胞免疫功能变化的研究

目的　探讨红细胞免疫在幽门螺杆菌感染慢性胃炎发病机制中的作用。方法　对 91例 Hp(+)慢性胃炎患者 [Hp(+)组 ],给予抗 Hp三联 +胃动力药治疗 2周 ;2 2例 Hp(- )慢性胃炎患者 ,给予胃粘膜保护剂 +胃动力药治疗 2周。治疗前及治疗结束后 2个月分别进行胃镜及 Hp检测 ,并测定两组红细胞免疫功能及胃粘膜屏障功能。结果　治疗前 Hp(+)组与 Hp(- )组红细胞免疫功能比较 ,前者 RBC- C3b RR偏低 ,而 RBC- ICR偏高 ,胃粘膜屏障功能较差 (P<0 .0 5 ) ;治疗后两组间无显著性差异 (P>0 .0 5 )。结论　慢性胃炎患者红细胞免疫功能降低 ,其与 Hp感染存在相关性。     

Effect of Hewei-Decoction on chronic atrophic gastritis and eradication of Helicobacter pylori

AIM: To demonstrate the effect of Hewei-Decoction (Decoction for regulating the stomach) on chronic atrophic gastritis (CAG) and eradication of Helicobacter pylori. METHODS: Ninety patients with CAG entering the investigation were divided into six differentiation syndromes, based on their major symptoms and signs. Hewei-Decoction was taken by all the patients orally for 4 or 8 wk. The efficacy was assessed by both the composite accumulation of reduced scores of major symptoms and the eradication of H pylori.X2 test was used to compare the efficacy between H pylori-positive and negative cases, and to disclose the relationship between efficacy and eradication of H pylori. RESULTS: In patients with six different syndrome types, the efficacy of Hewei-Decoction was 91.67% (11/12), 92.86% (13/14), 97.22% (35/36), 87.50% (14/16), 75.00% (6/8), 75.00% (3/4) respectively. The rate of highly efficacious was 58.33% (7/12), 50.00% (7/14), 77.78% (28/36), 62.50% (10/16), 12.50% (1/8) and 25.00% (1/4), respectively. The total efficacy was 91.11% (82/90), and the rate of highly efficacious was 60.00% (54/90). The eradication rate of H pylori was 67.86% (38/56). The therapeutic effect of Hewei-Decoction was better in H pylori positive cases than that in H pylori-negative cases with the total effect of 96.43% vs 82.35% (P<0.05). In 56 H pylori positive cases, the therapeutic effect was better in H pylori eradicated cases than that in H pylori-existent cases with the total effect of 97.37% vs 72.22% (P<0.01). CONCLUSION: Hewei-Decoction is effective in most cases of all the syndrome types. The results indicate that eradication of H pylori is one of the important mechanisms for alleviation of symptoms and signs. Also, the decoction is efficacious in H pylori-negative cases.