幽门螺杆菌感染与慢性荨麻疹的相关性研究进展

慢性荨麻疹是一种常见的过敏性皮肤病,病因复杂,治疗棘手。机体内存在的慢性感染如幽门螺杆菌感染可能参与了慢性荨麻疹的发生与发展,针对幽门螺杆菌的治疗能够缓解部分患者的症状,关于两者之间相关性的研究较多,但结果尚存争议。本文对近年来有关幽门螺杆菌感染与慢性荨麻疹的相关性研究进展作一综述。     

幽门螺杆菌感染与慢性荨麻疹相关关系的研究进展

慢性荨麻疹是皮肤科的一种常见病、多发病，其病因复杂、诱发因素较多，治疗也较为棘手。有学者认为机体内存在慢性感染病灶是荨麻疹反复发作、久治不愈的原因。近年来幽门螺杆菌感染与慢性荨麻疹的发病关系引起皮肤界的重视，但结果尚有争议。本文主要就两者之间的研究进展作一简要综述。     

慢性荨麻疹与幽门螺杆菌感染相关性探讨

目的：探讨慢性荨麻疹的发病与幽门螺杆菌(Helicobacler pylori,HP)感染之间的关系。方法：取62例慢性荨麻疹患的胃液用荧光聚合酶链反应(FQ-PCR)检测HP，并以35例健康体检作为对照。对慢性荨麻疹组和健康对照组所测得的HP阳性用三联疗法予以治疗后6周复查HP，比较两组的转阴率。对HP检测阳性的慢性荨麻疹患，亦进行了HP的三联疗法治疗后HP转阴患的荨麻疹变化情况与同为慢性荨麻疹HP阳性患单用维生素。治疗1周后对荨麻疹发疹的影响的疗效对比。结果：慢性荨麻疹组与健康对照组之间HP感染率无明显差异，慢性荨麻疹组与健康对照组经三联疗法治疗HP后其转阴率无明显差异，用三联疗法使慢性荨麻疹组HP转阴后的荨麻疹发病情况与同为慢性荨麻疹HP阳性患单用维生素C治疗1周后对荨麻疹发病情况的疗效对比显示，两组间疗效无显性差异。结论：慢性荨麻疹的发病与HP感染无关。     

幽门螺杆菌与慢性荨麻疹关系的探讨

1998年6月～2001年10月笔者采用14C尿素酶呼气试验(14C-UBT)检测了62例慢性荨麻疹患者,并对幽门螺杆菌(HP)阳性患者进行了治疗,现报告如下。临床资料:慢性荨麻疹患者62例,男27例,女35例;平均年龄37.6岁(18～69岁),病程3个月～18年。对照组25名,为健康志愿者,男16名,女9名,平均年龄22.4岁。两组均作14C-UBT试验。操作过程按说明书进行。样品每分钟衰变数(DPM)≥200为阳性。对14C-UBT阳性患者用下列方案进行HP根除治疗:奥美拉唑40mg/d、阿莫西林2g/d和克拉霉素1g/d,疗程1周。疗效评定标准:治疗后2周内症状和体征消失为痊愈,治疗4周后…     

幽门螺杆菌感染与酒渣鼻、慢性荨麻疹

近年来幽门螺杆菌helieoharter pylori，HP)感染与皮肤病的关系已越来越引起临床重视，现有研究主要集中住HP感染与酒渣鼻、慢性特发性荨麻疹的相关性方面，但结果尚有争议。为进一步探讨HP感染在酒渣鼻、慢性荨麻疹中的作用，我们采用^14C尿素呼吸试验（^14C-UBT)对38例酒渣鼻、32例慢性荨麻疹患者进行HP检测，并对HP阳性者采用根除治疗方案，观察其症状改善程度，现将结果报告如下。     

幽门螺杆菌与慢性荨麻疹

为探讨幽门螺杆菌（HP）感染在慢性荨麻疹中的作用，采用^13尿素呼吸试验对28例慢性荨麻疹患者及25名健康对照进行HP检测。结果显示：28例荨麻疹患者中19例HP阳性（68％）；25名健康对照中15例HP阳性（60％）。分别对慢性荨麻疹组及健康对照组中的HP阳性者应用根除HP感染治疗方案，停药6周后，慢性荨麻疹组有17例HP转阴，3例荨麻疹有好转，其余症状和体征均未改善。提示HP感染与慢性荨麻疹发生无明显关系。     

幽门螺杆菌感染与慢性荨麻疹的相关性研究

为了探讨幽门螺杆菌(HP)感染与慢性荨麻疹的相关性，我们研究了110例慢性荨麻疹患者的血清HP-IgG浓度、消化道症状及抗HP治疗的疗效，并以30例正常人作为对照。发现慢性荨麻疹患者的血清抗体浓度明显高于对照组，经抗HP治疗后取得较好疗效。结果显示，HP感染可能与某些慢性荨麻疹的发生有关。     

慢性荨麻疹患者幽门螺杆菌的检测及其意义

近年来有报道认为部分慢性荨麻疹的发生与幽门螺杆菌 (Ｈｅｌｉｃｏｂａｃｔｅｒｉｕｍｐｙｌｏ ｒｉ,Ｈｐ)感染有关 ,我们对 76例慢性荨麻疹患者进行了1 4 碳 尿素呼气试验 (1 4 Ｃ ｕｒｅａｂｒｅａｔｈｔｅｓｔ,1 4 Ｃ ＵＢＴ)检测Ｈｐ的感染 ,并对ＨＰ阳性的慢性荨麻疹患者采用三联疗法进行了治疗。现报道如下。资料和方法　临床资料 :慢性荨麻疹患者 76例 ,男 35例 ,女 41例 ;年龄 12～ 6 3岁 ,平均 2 9.6± 7.3岁 ,病程 3个月至 8年。其中伴恶心、腹痛、呕吐等胃肠症状者 2 6例。检查时均有皮肤风团存在。所有病例均曾用过多种抗组胺…     

幽门螺杆菌感染与慢性荨麻疹间关系的临床观察

目的探讨慢性荨麻疹(CU)与幽门螺杆菌(Hp)感染的相关性及临床治疗方案的选择。方法选取确诊CU患者95例与健康体检者35例,行14C-尿素呼气试验(14C-UBT)明确Hp感染情况。对存在Hp感染的CU患者进行随机分组,A组(对照组)给予基础抗组胺药物(口服盐酸西替利嗪片10mg,1次/d),疗程4周;B组(治疗组):给予基础抗组胺药物,疗程4周同时予根除Hp三联疗法(口服埃索美拉唑镁片20mg,2次/d;阿莫西林胶囊1.0g,2次/d;克拉霉素胶囊0.5g,2次/d),疗程1周,观察药物应用后反应情况及停药后疗效。结果健康体检者中Hp阳性率为31.43%,CU患者为64.21%,两组比较差异有统计学意义(P<0.05)。证实有Hp感染的CU患者对照组治愈率为27.59%,有效率为55.17%;治疗组分别为58.62%和75.86%;两组治愈率比较差异有统计学意义(P<0.05)。治疗组Hp根除率为93.10%,对照组为3.45%,两组比较差异有统计学意义(P<0.05)。结论 Hp感染与CU间存在一定的相关性。对有Hp感染的CU患者可采用基础抗组胺药物加根除Hp三联疗法药物进行治疗。     

梅州城区幽门螺杆菌感染与慢性荨麻疹的关系探讨

目的探究梅州城区幽门螺杆菌感染与慢性荨麻疹的关系。方法选取我院在2016年1月—2017年1月期间收治的常住或工作在梅州城区的慢性荨麻疹患者共90例,设为试验组,同期选取在我院进行健康检查者90例,设为正常组。将试验组中幽门螺杆菌阳性的患者随机分为对照组和观察组,对照组患者给予氯雷他定分散片治疗,观察组患者在上述治疗的基础上同时给予克拉霉素缓释胶囊、兰索拉唑肠溶胶囊和阿莫西林分散片,分析幽门螺杆菌的感染与慢性荨麻疹的关系。结果试验组患者幽门螺杆菌感染阳性率显著高于正常组,差异有统计学意义(P0.05);观察组患者治疗效果显著优于对照组,差异有统计学意义(P0.05)。通过临床随访3个月还发现,对照组复发率为28.95%,高于观察组的13.33%。结论梅州城区幽门螺杆菌感染与慢性荨麻疹存在一定的相关性,且抗幽门螺杆菌药物对于治疗慢性荨麻疹有一定的作用,临床上值得进一步推广应用。     

慢性特发性荨麻疹与幽门螺杆菌关系和治疗的研究

目的探讨慢性特发性荨麻疹(chronic idiopathic urticaria,CIU)与幽门螺杆菌(Helicobacter pylori,HP)关系及其治疗效果.方法 300例CIU患者进行14碳-尿素呼气试验(14C urea-breath test,14C-UBT),176例HP阳性者随机分为三组,其中58例予抗过敏治疗、59例抗过敏联合三联疗法治疗、59例中药联合三联疗法治疗,观察内容包括瘙痒、风团数量、风团大小、风团持续时间,比较各组治疗效果、分析CIU与HP之间关系.另外57例CIU患者进行自身血清抗体检测,其中35例HP阳性者予抗过敏联合三联疗法治疗,相同治疗方法与呼气试验组比较转阴率.108例健康体检者作为对照(其中65例进行呼气试验,43例血清抗体检测),以便对HP阳性率进行分析.结果CIU患者HP阳性率明显高于健康组(P＜0.01).联合三联疗法(抗过敏联合三联疗法、中药联合三联疗法)与单纯抗过敏治疗相比,治疗效果明显优于后者(P＜0.05),转阴率也明显高于后者(P＜0.01).治疗后HP转阴与未转阴患者疗效比较,前者明显优于后者(P＜0.05).结论 CIU与幽门螺杆菌关系密切,中药联合三联疗法治疗CIU效果好.     

Psychosomatic Treatment of a Case of Chronic Urticaria

A 35-year-old Japanese woman presented with urticaria in January of 1992. As her symptoms gradually became worse, she came to our hospital in March of that year. I treated her with various combinations of antihistaminics and antiallergics. However, her symptoms did not respond and continued to deteriorate. Although her blood was analyzed in an attempt to identify antigenic or physical factors, no positive data were obtained. Because three kinds of psychological tests showed that the patient was highly anxious and depressive, I additionally treated her with psychotropics and psychotherapy in May of 1994. After a month, the symptoms began to disappear. She has since been free from the symptoms while taking medicine only twice a week. Our group recently presented the efficacy of psychotropics in patients with chronic urticaria. This case suggests that highly anxious or depressive cases with chronic urticaria should be treated not only dermatologically, but also psychologically.     

Mast cells and IgE-containing cells in gastric mucosa of Helicobacter pylori infected and non-infected patients with chronic urticaria

BACKGROUND: Several studies have indicated that antibiotic therapy aimed at eradication of Helicobacter pylori has effects on symptoms of chronic urticaria (CU) patients. However, the possible connections and pathomechanism by which H. pylori might be linked to CU have remained largely unknown. The IgE-mediated pathway might be a possible link between H. pylori infection and CU. We therefore clarified the role of H. pylori as an inducer of IgE response. MATERIALS AND METHODS: Gastroscopy was performed and mucosal biopsy specimens were taken to evaluate the histology, as well as the presence of H. pylori bacteria, mast cells and IgE-containing cells in the antral mucosa, in 21 CU patients. Controls (n = 48) included 19 patients with lichen planus, nine patients with atopic dermatitis and 20 patients with no skin or allergic disease. RESULTS: The mean densities of IgE-containing cells were significantly higher in H. pylori-infected patients and in patients with skin disease compared to non-H. pylori-infected patients with no skin or allergic disease. No significant difference was found in the number of IgE-containing cells between H. pylori-infected and non-infected patients with CU. There was no significant difference in the mean densities of mast cells in the different patient groups. CONCLUSIONS: Our findings suggest that H. pylori gastritis leads to increased IgE production. However, we could not show a significant difference in IgE staining between H. pylori-infected and non-infected patients with CU.     

Clinical study of the relationship between Helicobacter pylori and chronic urticaria and prurigo chronica multiformis: effectiveness of eradication therapy for Helicobacter pylori

Eighty two patients with chronic urticaria and 17 patients with prurigo chronica multiformis were referred to our department from October 2004 to February 2007 and were tested for Helicobacter pylori antigen using the polyclonal H. pylori stool antigen test (enzyme‐linked immunosorbent assay method). H. pylori antigen was detected in 25 (30.5%) of the 82 patients with chronic urticaria and in 10 (58.8%) of the 17 patients with prurigo chronica multiformis. Those findings were not significantly higher than the positive rate for H. pylori stool antigen in healthy age‐matched controls. In patients positive for H. pylori antigen, seven of the 25 with chronic urticaria had complications of gastritis (six patients) or gastric ulcers (one patient). Three of the 10 patients with prurigo chronica multiformis had complications of gastritis (two patients) or gastric ulcers (one patient). We examined the therapeutic efficacy of antibacterial treatment for the 17 patients with chronic urticaria and the eight patients with prurigo chronica multiformis who were positive for H. pylori antigen and accepted the treatment based on informed consent. We evaluated the effectiveness of treatment by scoring the skin conditions and by using the Skindex‐16, a measure of quality of life. The eradication therapy for H. pylori was more effective for treating prurigo chronica multiformis and the skin symptoms started to improve within 3–14 days after the therapy. However, that therapy was not always effective for treating chronic urticaria. We suggest that H. pylori may be an important pathogenetic factor, especially for prurigo chronica multiformis, and that eradication therapy should be considered to treat intractable cases.     

幽门螺杆菌感染致慢性荨麻疹诱发或加重的机制探讨

目的观察幽门螺杆菌(Helicobacter pylori,Hp)感染的BALB/c小鼠模型外周血及胃黏膜组胺和类胰蛋白酶的变化,以探讨Hp在诱发慢性荨麻疹(CU)或使病情加重过程中的机制。方法 90只健康BALB/c小鼠随机分成3组(实验1组、实验2组和对照组),每组各30只。实验1、2两组分别灌胃高毒力株(VacA+CagA+)和低毒力株(VacA-CagA+)Hp菌悬液,对照组灌胃牛血清白蛋白(BAS)。分别采用组胺荧光测定法、类胰蛋白酶免疫组化法及ELISA法检测三组标本灌胃前后外周血、胃黏膜组胺和类胰蛋白酶含量。结果实验1、2组小鼠外周血及胃黏膜组胺含量均高于对照组(P<0.01),实验1、2两组小鼠外周血组胺含量无显著性差异(P>0.01),但实验1组小鼠胃黏膜内组胺含量低于实验2组(P<0.01);实验1、2两组小鼠外周血及胃黏膜类胰蛋白酶含量均高于对照组(P<0.01),实验1组小鼠胃黏膜类胰蛋白酶含量低于实验2组(P<0.01),但外周血类胰蛋白酶含量高于实验2组(P<0.01)。结论 Hp感染可导致小鼠模型外周血及胃黏膜组胺和类胰蛋白酶含量均增加,这可能是Hp诱发或加重CU的重要原因之一。     

幽门螺杆菌感染与酒渣鼻的相关性

为了研究幽门螺杆菌(HP)感染与酒渣鼻的相关性 ,研究了42例酒渣鼻患者的血清HP IgG浓度、消化道症状及抗HP治疗的疗效 ,并以33例寻常痤疮作对照。发现酒渣鼻患者的血清抗体及消化道症状阳性率及抗HP治疗的疗效明显高于对照组 ,且6例接受胃镜及组织学检查的酒渣鼻患者的检查结果均显示有异常。结果提示 ,HP感染与酒渣鼻可能存在一定的相关性。     

当归饮子加减方联合阿伐斯汀治疗慢性荨麻疹疗效观察

目的观察当归饮子加减方联合阿伐斯汀治疗慢性荨麻疹的疗效及安全性。方法慢性荨麻疹患者160例随机分成4组:联合组37例给予当归饮子加减方,水煎服,1剂/d,早晚分服,阿伐斯汀8 mg,2次/d;阿伐斯汀组38例给予阿伐斯汀8 mg,2次/d;当归饮子组36例给予当归饮子加减方水煎服1剂/d早晚分服。安慰剂组40例给予维生素E胶囊100 mg,2次/d。4组患者均4周为1个疗程,治疗开始后每周随访并评估疗效。结果 4组慢性荨麻疹患者4周治疗有效率比较:联合组与阿伐斯汀组、当归饮子组比较差异有统计学意义(P<0.05)。症状、体征总积分下降值的比较,除联合组和阿伐斯汀组在治疗后第1周差异无统计学意义(P>0.05)外,其余各组间都有统计学意义(P<0.05)。结论当归饮子加减方联合阿伐斯汀治疗慢性荨麻疹疗效确切。