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目的研究上海地区不同职业家庭不同年龄组的儿童幽门螺杆菌(H.pylori)感染的流行病学情况,以探讨不同经济状况下,儿童感染H.pylori的年龄阶段以及家庭H.pylori人群的分布对儿童H.pylori感染的影响。方法1119名就读于上海地区市中心与郊区学校的学生,男性568名,女性551名,年龄7～l4岁。问卷调查每位学生的居住环境、常住人口、父母职业和受教育程度、家庭的经济收入,有无消化道症状及慢性胃炎、溃疡病史等,同时采用ELISA方法检测血中H.pyloriIgG抗体。结果无症状儿童中7岁年龄组的H.pylori感染率为30.91%,在7～12岁年龄阶段随着年龄的增加H.pylori感染率也逐渐上升,平均年递增3.28%;工人和农民家庭的儿童较小的年龄即有较高的H.pylori感染率;生活在父母感染H.pylori家庭中的儿童更容易感染H.pylori。结论经济水平较低的家庭中,儿童H.pylori感染率高,而且较小年龄即有感染;H.pylori感染有家庭聚集现象。     

幽门螺杆菌感染家庭内聚集和根除治疗相关性探讨

目的研究幽门螺杆菌(H.pylori)感染儿童家庭内聚集现象,探讨根除H pylori感染的相关性治疗.方法经胃镜检查、病理切片、快速尿素酶试验(RUT)、PCR-UreA-DNA确诊H pylori感染患儿226例,对其383位父母及部分家庭成员进行流行病学调查.应用洛赛克+克拉霉素+羟氨苄青霉素三联1周疗法,治疗92例患儿,分成与感染的父母同治组和未同治组,观察对照2组H pylori根除率差异性.结果 226个家庭383位父母及部分家庭成员中H pylori总阳性检出率为83.8%.41例患儿菌株血清基因型与73位父母基因型符合率为89%(65/73).与父母同治组H pylori根除率为95.2%(40/42);未同治组H pylori根除率为80%(40/50),χ2=4.67,P<0.05,二组间差异有显著性意义.结论 H.pylori感染有突出的家庭内聚集现象,父母及有密切接触的其他家庭成员是儿童感染的重要传染源;与感染父母或家庭成员的同步治疗,对提高患儿H pylori根除率与预防再感染有重要意义.     

过敏性紫癜伴幽门螺杆菌感染患儿肠道菌群变化的研究

目的 研究过敏性紫癜(HSP)伴有幽门螺杆菌(H.pylori)感染患儿肠道菌群的变化.方法 随机收集40例HSP患儿及40例正常儿童的粪便标本,先用快速免疫检测卡进行粪便幽门螺杆菌抗原(HpSA)检测,判定有无H.pylori感染.然后提取两组粪便标本目标细菌DNA,采用16SrRNA荧光定量PCR技术对两组粪便标本中的双歧杆菌和大肠杆菌进行定量分析和比较.并计算双歧杆菌/大肠杆菌(B/E)比值.结果 HSP患儿H.priori检出率为50.0%,正常儿童为27.5%(x2=4.266.P<0.05).双歧杆菌在HSP伴H.Pylori感染组和HSP非H.pylori感染组分别与正常儿童H.pylori感染组和非H.pylori感染组相比,数鼍明显减少(P<0.008 3);大肠杆菌在正常儿童H.pylori感染组和非H.pylori感染组分别与HSP非H.pylori感染组相比,数量明显升高(P<0.008 3),在HSP伴H.pylorii感染组与HSP非H.pylori感染组相比,数量明显升高(P<0.008 3).B/E值在HSP伴H.pylori感染组分别与HSP非H.pylori感染组、正常儿童H.priori感染组和正常儿童非H.pylon感染组相比,数值明显降低(P<0.008 3).结论 HSP患儿H.pylori检出率较正常儿童明显增多,HSP发病可能与H.pylori感染有关.HSP伴H.pylori感染和HSP非H.pylori感染患儿肠道双歧杆菌均较正常儿童减少,HSP伴H.pylori感染患儿肠道大肠杆菌较HSP非H.pylori感染息儿升高,HSP伴H.pylori感染患儿B/E值明显降低,提示HSP患儿肠道菌群失调明显.     

胃炎患儿幽门螺杆菌感染危险因素的病例-病例对照研究

目的了解和探讨浙江省绍兴地区目前儿童幽门螺杆菌(H·pylori)感染率及临床状况,评价感染相关危险因素。方法2003—2005在浙江绍兴市人民医院用olympus GIF P30纤维胃镜对301例具有上消化道症状持续1个月以上的患儿进行胃镜检查,同时对患儿的年龄、性别、生活地区,环境因素(居住拥挤程度,卫生设施)、社会地位(母亲职业),经济条件(家庭收入),年幼时是否母乳喂养,患儿母亲受教育程度,密切接触患儿的监护人是否既往有胃部疾患史,患儿婴幼儿期是否有进食父母嚼后食物等因素进行调查分析。结果该地区儿童H·pylori的感染率为33·6%;消化性溃疡H·pylori的感染率为65·4%;年幼时进食父母嚼后食物会增加小儿H·pylori感染的风险,随母亲文化程度增高H·pylori感染风险降低;该地区儿童H·pylori感染与患儿年幼时是否母乳喂养,监护人是否有胃病史,母亲职业,家庭经济收入,生活地区等因素无统计意义上的关联。结论儿童H·pylori的感染率随年龄增大而增高;H·pylori感染与母亲文化程度,年幼时是否进食父母嚼后食物有关;儿童H·pylori感染易增加患溃疡的风险。     

无锡地区散居儿童幽门螺杆菌感染及相关因素流行病学调查

目的了解无锡地区儿童人群中幽门螺杆菌(H．pylori)感染率，探讨影响H．pylori感染的因素。方法采用酶联免疫分析法检测1126例0—12岁健康儿童及其父母粪便中的幽门螺杆菌抗原(HpSA)。并对每位人选者进行问卷调查，对其平时有无消化道症状、生活环境、生活习惯及家族史等情况进行了解。结果本地区儿童平均H．pylori感染率为19．1％，其中男性为19．6％，女性为18．5％，两者差异无显著性。有症状组阳性率为26．％，无症状组为10．6％。城区儿童H．pylori感染率为12．5％，城郊结合部儿童为19．3％，郊区、农村儿童为24．9％。结论无锡地区儿童中H．pylori感染率较高．有随年龄递增的趋势。幽门螺杆菌感染为引起无锡地区儿童胃十二指肠疾病的主要原因。     

昆明地区儿童幽门螺杆菌感染状况及危险因素分析

目的了解和探讨昆明地区儿童幽门螺杆菌感染状况及其危险因素。方法随机抽取2008年1月至2010年6月在儿科就诊无消化道症状并做血清H.pylori抗体检测的儿童进行问卷调查。通过单因素配对资料χ2分析及多因素logistic回归分析,筛选出危险因素。结果共478例儿童中H.pylori IgG阳性238例,感染率为49.8%。其中1～3岁、4～7岁、8～14岁H.pylori IgG阳性率分别为24.3%、42.4%、58.3%。学龄期儿童(>7岁)占总感染人数的64.7%。而年龄、共用牙刷口杯、共用餐具、家庭人口数多、经济收入低、人均居住面积小及父母亲和照顾者有胃病史等为H.pylori感染的危险因素。结论 H.pylori感染在儿童中,尤其学龄儿童较为常见,与年龄相关。H.pylori感染危险因素的筛查为预防提供指导。     

儿童新诊断免疫性血小板减少症与幽门螺杆菌感染的相关性研究

目的明确幽门螺杆菌(H.pylori)感染对儿童新诊断免疫性血小板减少症(ITP)的影响。方法选取2011年1月至2013年12月间首次住院并新诊断为ITP的495例患儿为病例组;随机选取无血小板减少及其他血液系统疾病的普通呼吸道感染住院患儿123例作为对照组。依据年龄将两组患儿分为1岁组(n=219)、1岁~组(n=161)、3岁~组(n=76)和7~14岁组(n=39)。回顾性分析各年龄段患儿H.pylori感染率,以及H.pylori感染阳性及阴性ITP患儿经过相同治疗后的预后情况。结果病例组中H.pylori感染率随着ITP患儿年龄的增长而增加,与对照组各年龄段H.pylori感染率比较差异均无统计学意义(均P0.05)。H.pylori感染阳性ITP患儿均未接受针对H.pylori的相关治疗,而针对血小板减少经丙种球蛋白和/或激素治疗后缓解率随着年龄的增长而呈现逐渐下降趋势,与各年龄段H.pylori阴性的ITP患儿治疗后缓解率比较差异均无统计学意义(均P0.05)。结论 H.pylori感染可能不是ITP患儿发病的一个主要致病因素;是否治疗H.pylori并不影响儿童急性ITP的治疗效果。     

中国儿童及青少年幽门螺杆菌感染流行病学 调查的系统评价和 meta 分析

目的系统评价中国儿童及青少年幽门螺杆菌(H.pylori)感染的流行病学特征。方法检索Pub Med、EMBASE、Cochrane图书馆、中国知网、万方数据库,检索起止时间为建库至2016年9月。2名研究者根据纳入与排除标准筛选文献,采用AHRQ量表评估文献质量,使用Stata 12.0软件进行meta分析。结果 7篇文献纳入meta分析,涉及16 950名儿童及青少年。中国自然人群儿童及青少年H.pylori总感染率为29%(95%CI:0.18~0.40);儿童及青少年H.pylori感染呈显著的地域分布性差异,在胃癌低发区,中国自然人群儿童H.pylori总感染率为20%(95%CI:0.13~0.28),在胃癌高发区H.pylori总感染率高达55%(95%CI:0.21~0.89);男性与女性H.pylori感染率无显著差异;≤1岁、~5岁、~10岁、~15岁、~18岁儿童及青少年的H.pylori感染率分别为17.8%、8%、19%、26%、45%,随年龄增长H.pylori感染率有上升趋势;农村儿童及青少年H.pylori感染风险是城市的1.25倍;有消化道症状的农村儿童及青少年H.pylori感染风险比无消化道症状者高2.2倍。结论中国自然人群儿童及青少年H.pylori总感染率为29%,呈现显著的地域分布性差异,胃癌高发区H.pylori感染率是胃癌低发区的2.8倍。仍需后续高质量、大样本量流行病学调查,以进一步明确中国儿童及青少年H.pylori感染情况。     

人类白细胞抗原-DQB1与儿童十二指肠溃疡和幽门螺杆菌感染的相关性研究

目的探讨人类白细胞抗原(HLA)-DQB1等位基因与儿童十二指肠溃疡(DU)和幽门螺杆菌(H.pylori)感染的遗传关联性。方法采用非同位素标记的聚合酶链反应-序列特异性寡核苷酸探针(PCR-SSO)杂交的方法,对上海地区汉族健康儿童80例、DU患儿58例的HLA-DQB1等位基因进行分型;并同时检测DU患儿H.pylori感染情况。结果在DU患儿中,HLA-DQB1×05031等位基因频率明显高于正常健康儿童(分别为:6.02%、0.63%,P<0.05,RR=9),而在H.pylori阳性和H.pylori阴性DU组之间差异无显著性。结论HLA-DQB1×05031与DU呈正相关,DU患儿与正常对照组儿童之间存在着遗传学的差异;虽然H.pylori感染是DU的重要致病因素,但HLA-DQB1×05031并不是通过H.pylori感染而影响DU的遗传易感性。     

幽门螺杆菌感染与儿童功能性消化不良的关系

目的探讨幽门螺杆菌(H.pylori)感染对功能性消化不良(FD)儿童症状、病理及胃排空的影响。方法FD儿童110例,H.pylori阴性组30例,H.pylori阳性组80例,H.pylori阳性组按不同的治疗方案分A组(吗丁啉组)30例,B组(H.pylori根除 吗丁啉治疗后复查H.pylori转阴者)42例。比较各组症状积分、胃窦粘膜病理积分和胃液体排空情况。结果H.pylori阳性组饱胀和食欲下降症状重于阴性组(P<0.05),根除H.pylori后上述症状明显改善。H.pylori阳性组胃窦液体排空慢于阴性组,根除H.pylori后排空加快(P<0.05)。结论H.pylori感染是FD患儿的致病因素之一,H.pylori感染可能影响FD儿童的胃排空,根除H.pylori可改善胃排空从而减轻临床症状。     

儿童腹型过敏性紫癜与幽门螺杆菌感染的关系探讨

目的：探讨腹型过敏性紫癜(HSP)的发病及反复发作与幽门螺杆菌(HP)感染的关系。方法对36例腹型HSP及32例非腹型HSP中的16例进行胃、十二指肠内镜检查并行快速尿素酶试验,另设30例健康儿童作为对照组。3组均进行14C尿素呼气试验、血清抗HP抗体检测。结果36例腹型HSP患儿HP阳性21例（58.3%）, 其中反复发作16例,HP阳性13例（81.3%）,首次发作20例HP阳性9例（45.0%）。32例非腹型HSP患儿HP阳性9例（28.1%）;对照组HP阳性2例（6.7%）。三组比较差异具有非常显著性意义（χ2=14.7,P<0.01）,反复发作与首次发作比较差异具有显著性意义（χ2 =4.49,P<0.05）。结论 腹型HSP的发病及反复发作与HP感染有关。［中国当代儿科杂志,2007,9（4）：367-369］     

Upper gastrointestinal disease, Helicobacter pylori and recurrent abdominal pain

Over a 5-y period, 396 children complaining of recurrent abdominal pain (RAP) underwent upper gastrointestinal endoscopy in order to identify any underlying organic pathology and determine the prevalence of Helicobacter pylori (H. pylori) infection. Histologically confirmed mucosal inflammation was found in 338 out of 396 children (85.4%); in 113 of 396 patients (28.5%), H. pylori was identified on the gastric mucosa. Significant discriminating factors between H. pylori positive and negative children with RAP included age (mean age for positive 11 y vs. 8.1 y for negative, p < 0.01) and gender (male gender predominance in the H. pylori positive, p < 0.001). No significant difference was found between H. pylori positive and negative groups regarding incidence and character of the presenting symptoms. All H. pylori positive children (100%) had abnormal histology compared with 225 out of 283 negative ones (79.5%). Histologically confirmed gastritis was the most prominent finding in H. pylori positive children compared with H. pylori negative (98.2% vs. 19%, p < 0.001). Conversely, oesophagitis was more common in H. pylori negative children (47.7% vs. 27.4%, p < 0.001). The incidence of peptic ulcer was higher in H. pylori infected patients than in the H. pylori negative group (5.3% vs. 1%, p < 0.05). Our data suggest that gastrointestinal pathology is more common than previously thought in children with RAP, while H. pylori infection is a relatively important factor in the etiology of upper gastrointestinal inflammation in RAP syndrome.     

幽门螺杆菌在儿童特发性血小板减少性紫癜的感染状况分析

目的探讨特发性血小板减少性紫癜(ITP)患儿幽门螺杆菌(Hp)感染状况及相关危险因素。方法用粪便检测Hp抗原及血清检测Hp抗体两者联合检测62例慢性ITP患者,88例急性ITP患者及150例健康儿童,两者均为阳性判断为Hp感染。对每个研究对象进行问卷调查。结果急、慢性ITP患儿、健康儿童三者感染率比较无统计学意义(P<0.05)。HP感染家族史、口嚼食物喂养史、啃手指/笔/玩具、低人均居住面积为ITP患儿Hp感染的易感因素;年龄小、有专用餐具为ITP患儿Hp感染的保护因素。结论本研究不表明Hp感染与ITP发病相关。     

应用血清学及13C-尿素呼吸试验对幽门螺杆菌家庭感染状况的研究

目的　研究一级亲属幽门螺杆菌 (helicobacterpylori,HP)感染状况以及其对儿童HP感染的影响。方法　应用血清学及13 C -尿素呼吸试验 (13 C -ureabreathtest,13 　C -UBT)测定反复腹痛儿童及父母的HP感染情况。结果　13 C -UBT及血清HP -IgG测定家庭的HP感染率分别为 41 .6 %和 76 .5 % ,显著高于腹痛儿童的HP感染率 2 9.5 %和 5 4.8% (P <0 .0 5和P <0 .0 0 5 )。儿童13 C -UBT及血清学阳性时 ,其家庭HP感染率分别为83.7%和 85 .7% ,显著高于其儿童阴性时的家庭HP感染率 2 3.9%和 6 5 .3% ;家庭13 C -UBT及血清学阳性时 ,其儿童HP感染率分别为 5 9.4%和 6 1 .4% ,也显著高于其家庭阴性的儿童HP感染率 8.3%和 33.3% ,P <0 .0 0 5。血清学检查的敏感性为 94.2 % ,特异性 36 .1 %。结论　一级亲属有HP带菌的家庭中儿童HP症状性感染率高 ,HP感染有明显的家庭聚集性。血清HP -IgG检测敏感性好 ,特异性差 ,13 C -UBT比血清学检测更能反应HP家庭实时感染状况。     

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??Objective??To investigate the current rate of Helicobacter pylori infection in asymptomatic children residing in Beijing urban area and to discuss the risk factors that predispose children to such infection. Methods??A total of 1196 asymptomatic children aged from 1 month to 18 years were selected from urban schools in Beijing areas. A face to face interview was conducted with a specially designed standard questionnaire. We performed enzyme-linked immunoadsorbent assay ??ELISA?? for H.pylori stool antigen test to determine H.pylori infection status. Results??The overall prevalance of H.pylori was 10.6%. On univariate analysis??risk factors for H.pylori infection included age??poor hygienic habits??lower socioeconomic status??and positive family history of gastrointestinal diseases. Multivariate logitstic regression identified that age??poor hygienic habits??economic status??number of people in the same house??house area??and positive family history of gastrointestinal diseases were the independent risk factors of H.pylori infection. Conclusion??H.pylori infection rate among these children is high??and increases with age. H.pylori infection clusters within families and is closely associated with personal and familial hygienic habits.     

儿童幽门螺杆菌感染与HLA-DQB1等位基因遗传多态性研究

目的　研究HLA -DQB1基因位点上是否存在幽门螺杆菌(H .pylori)感染及其相关胃炎的易感基因或抵抗基因,从免疫遗传角度探讨H .pylori感染后临床结局多样性的可能发生机制。方法　对1 999年9月至2 0 0 0年7月上海第二医科大学附属瑞金医院收治的1 3 3例慢性胃炎及80名健康儿童(对照组) ,进行H .pylori检测,应用PCR SSO杂交方法确定其HLA -DQB1等位基因型别。结果　80名对照组儿童中H .pylori阳性3 3名,H .pylori阴性47名;1 3 3例慢性胃炎患儿中,H .pylori阳性85例,H .pylori阴性48例。DQB1 0 3 0 3 2等位基因频率在血清学H .pylori阳性者中低于血清学H .pylori阴性的健康儿童( 1 0 . 61 %vs 2 5. 53 % ,P <0 . 0 5)。DQB1 0 60 2等位基因频率在H .pylori阳性胃炎患儿低于H .pylori阴性胃炎患儿( 4 . 71 %vs 1 2 . 50 % ,P <0 . 0 5)。结论　DQB1 0 3 0 3 2对H .pylori感染可能具有抵抗保护作用,DQB1 0 60 2缺乏可能是H .pylori相关性胃炎发生的宿主遗传因素。     

Factors influencing the epidemiology of Helicobacter pylori infection in children

The epidemiology of Helicobacter pylori infection was studied in 245 healthy children (between 3 and 20 years of age) who presented for day surgery at Arkansas Children's Hospital. H pylori infection was identified serologically using an enzyme-linked immunosorbent assay to detect the presence of IgG against the high molecular weight, cell-associated antigens of H pylori. Demographic information collected included age, gender, race, family income, type of housing, location of housing, water supply, health status, upper gastrointestinal symptoms, and keeping pets. One hundred eighty-nine white children and 56 black children were studied; 139 were boys and 106 were girls. The data were analyzed by logistic regression analysis. H pylori infection increased significantly with age (P less than .05). The frequency of H pylori infection was higher in blacks than whites (P less than .01), and this difference remained after adjusting for age, gender, and family income. Family income was used as a measure of socioeconomic class and was an important factor related to infection; the rate of acquisition of H pylori in those children with family income less than +5000/year was twice that of those with incomes greater than +75,000/year (P less than .001). There were no significant differences in H pylori infection related to gender, type of housing, location of housing, or source of water supply. It is concluded that the rate of acquisition of H pylori infection increases with age, is higher in blacks than whites, and is inversely related to socioeconomic class.     

Seroprevalence of Helicobacter pylori infection among children and their parents in eastern Turkey

OBJECTIVES: To determine the seroprevalence of Helicobacter pylori infection among healthy children in eastern Turkey, to assess risk factors for seroconversion, and to assess the role of parental infection status in the transmission of H. pylori. METHODS: A commercial enzyme immunoassay test for IgG to H. pylori was used. Demographic information obtained included age, gender, socio-economic status and living conditions. RESULTS: One hundred and fifty-two (43.9%) of 346 children were seropositive. There was no significant difference in rates of seroprevalence between boys and girls (P > 0.05), but a significant rise was noted with increasing age (P < 0.001). We found a strong inverse correlation between family income and seropositivity (P < 0.001). Seroprevalence also varied significantly with the educational level of the mother (P < 0.001). There were no significant differences in seroprevalence associated with place of residence, water supply and the number of persons per room (P > 0.05). The prevalence of infection in the corresponding parents was 85.4% for mothers and 76.3% for fathers. Seroprevalence was higher in children whose mother was infected (P < 0.001). CONCLUSIONS: In eastern Turkey, as in other developing countries, H. pylori infection occurs early and increases with age. Infected parents, especially infected mothers, may have a important role in the transmission of H. pylori within families.     

Helicobacter pylori infection with iron deficiency anaemia and subnormal growth at puberty

The purpose of this study was to determine whether Helicobacter pylori infection can contribute to growth deficit, especially in pubescent children who need large amounts of iron for growth. A structured questionnaire was sent to the parents of 532 healthy children aged 10 to 15 years (mean 12.9) to obtain demographic information on the parents and the environment. Of the 532 questionnaires sent out, 375 (70.5%; 170 girls and 205 boys) were returned. After collecting blood samples from participants, haemoglobin, serum iron, total iron binding capacity, serum ferritin, and serum IgG antibodies to H pylori were measured. The effects of risk factors such as H pylori infection, iron deficiency anaemia, sex, socioeconomic status, type of house, and crowding index on growth were analysed using multiple regression analysis. Of 63 H pylori positive children, 18 (28.6%) were below the 25th centile values for height, compared with 63 of 312 (20.2%) H pylori negative children. The prevalence rate of H pylori infection was 15.5% (53 of 343) in children without iron deficiency anaemia and 31.3% (10 of 32) in those affected. The relative risk of short stature was 2.2 (95% confidence interval (CI), 1.0 to 4.8) for iron deficiency anaemia, and 1.4 (95% CI, 0.8 to 2.4) for H pylori infection. The mean height was significantly lower in the group having both H pylori infection and iron deficiency anaemia. Therefore, H pylori infection accompanied by iron deficiency anaemia, rather than H pylori infection per se, might delay pubertal growth.