白光内镜下胃黏膜形态判断幽门螺杆菌感染的价值

目的 探讨白光内镜下胃黏膜形态判断幽门螺杆菌（H.pylori,Hp）感染的价值。方法 连续纳入2021年5月至2022年2月于广西壮族自治区柳州市妇幼保健院行胃镜检查的受试者439例,观察胃黏膜形态并取黏膜活检行病理及免疫组化检测Hp,根据胃黏膜形态判断Hp感染情况并与病理检查比较,分析镜下判断Hp的准确性。结果 Hp阳性者胃黏膜（regular arrangement of collecting venules,RAC）阴性、黏膜肿胀、萎缩、肠化生、白色浑浊黏液、皱襞肿大蛇形、弥漫性发红、点状发红、消化性溃疡发生率显著高于Hp阴性者（P<0.05）;Hp阴性者胃黏膜RAC阳性、脊状发红形态的发生率显著高于Hp阳性者（P<0.05）;增生性息肉、胃底腺息肉、隆起糜烂、凹陷性糜烂、陈旧性出血斑的发生率Hp阳性者与阴性者胃黏膜差异无显著性（P>0.05）。RAC阴性的受试者工作特征（receiver operator characteristic,ROC）曲线下面积（area under curve,AUC）、符合率、灵敏度、阳性预测值、阴性预测值均较高（0.832,9...     

白光胃镜下胃黏膜形态变化对幽门螺杆菌感染的诊断价值分析

目的探究白光胃镜下胃黏膜形态变化对幽门螺杆菌（H. pylori）感染相关性胃炎的诊断价值。 方法回顾性分析2018年7月至2020年7月在海南医学院第二附属医院进行白光胃镜检查和13-尿素呼气试验（¹³C-UBT）检查的1160例病例,依据¹³C-UBT检查结果分为2组：H. pylori感染组（812例）和无H. pylori感染组（348例）。比较2组白光胃镜下胃粘膜形态差异,进行Logistic回归分析筛选出H. pylori感染独立相关的胃黏膜形态特征,并应用受试者工作特征曲线（ROC）评价相关指标的预测价值。 结果H. pylori感染组白光胃镜下弥漫性胃黏膜充血、点状发红、胃黏膜肿胀、胃体皱襞肿大蛇形、胃体黏膜呈“龟纹样”等检出率均显著高于无H. pylori感染组。多因素Logistic回归分析显示,弥漫性胃黏膜充血（OR=116.280）、点状发红（OR=4.821）、胃黏膜肿胀（OR=3.432）、胃体皱襞肿大蛇形（OR=4.336）、胃体黏膜呈“龟纹样”（OR=9.346）是H. pylori感染的独立相关因子。ROC曲线分析显示,弥漫性胃黏膜充血、点状发红、胃黏膜肿胀、胃体皱襞肿大蛇形、胃体黏膜呈“龟纹样”预测H. pylori感染的曲线下面积分别为0.829（95%CI：0.796~0.859）、0.687（95%CI：0.648~0.725）、0.750（95%CI：0.713~0.785）、0.578（95%CI：0.537~0.619）、0.619（95%CI：0.578~0.619）,其中以弥漫性胃黏膜充血、胃黏膜肿胀较大,它们的敏感度和特异度分别为93.68%和72.17%、97.13%、52.96%。 结论白光胃镜下胃黏膜形态变化与H. pylori感染具有相关性,以弥漫性胃黏膜充血、胃黏膜肿胀对H. pylori感染的诊断价值较大。     

合并幽门螺杆菌感染对儿童原发性胆汁反流性胃炎病情的影响

目的探讨儿童胆汁反流性胃炎(BRG)合并幽门螺杆菌(Hp)感染对病情的影响。方法 151例原发性BRG患儿根据13C尿素呼气试验(UBT)、胃窦黏膜组织Hp快速尿素酶试验(RUT)和病理组织学检查结果分Hp阳性组和Hp阴性组。比较2组临床症状分度、胃镜下胆汁反流分级、活检组织病理学表现及分级Dixon评分。结果 Hp阳性组与Hp阴性组在发病年龄和性别方面比较无显著差异。Hp阳性组就诊时临床症状总体上较Hp阴性组重,以中度以上表现为多见。Hp阳性组胃镜下胆汁反流程度重于Hp阴性组,且与临床症状呈正相关;2组胃黏膜炎症活动性、淋巴滤泡增生、胃小凹增生、黏膜浅层血管扩张方面比较有显著差异,而在炎症程度、间质水肿、固有膜内平滑肌纤维增生、肠化生、腺体萎缩等方面则无显著差异。结论 BRG患儿合并Hp感染时临床症状、胃镜下及组织学表现更重,且胆汁反流程度加重,二者在发病中有协同关系。     

幽门螺杆菌唾液测试板与14C-尿素呼气试验检测幽门螺杆菌感染的比较

目的:比较幽门螺杆菌唾液测试板(HPS)与14C-尿素呼气试验(14C-UBT)检测幽门螺杆菌(Hp)感染的临床价值。方法:用HPS检测唾液中的尿素酶,同时行14C-UBT及胃镜检查行快速尿素酶试验(rapidurease test,RUT)、胃黏膜组织学检查(改良Giemsa染色)及细菌培养联合检测来判断胃黏膜Hp感染情况,并比较HPS与14C-UBT诊断Hp感染的阳性率、敏感性、特异性、准确性、阳性预测值及阴性预测值。结果:160例患者行Hp联合检测检出阳性患者102例,阳性率为63.75%,其中HPS检出76例,阳性率47.50%,14C-UBT检出94例,阳性率58.75%。HPS、14C-UBT诊断Hp感染的敏感性分别为72.55%、80.39%;特异性分别为96.55%、79.31%;准确性分别为81.25%、80.00%;阳性预测值分别为97.37%、87.23%;阴性预测值分别为66.67%、69.70%。对以上结果进行χ2检验,差异均无统计学意义。结论:HPS检测Hp感染的阳性率及准确性、敏感性、特异性与14C-UBT相近,且此法快速、简便,价格低廉,不需要任何其他仪器,是值得临床进一步验证的一种新的非侵入性Hp感染诊断方法。     

开立内镜联合京都胃炎分类在胃幽门螺杆菌诊断中的应用效果分析

目的 探讨开立内镜联合京都胃炎分类在胃幽门螺杆菌（Hp）诊断中的应用效果。方法 于开立胃镜下观察胃黏膜，采用京都胃炎分类进行评分，结合快速尿素酶Hp检测，综合评价开立内镜的诊断效能，对基于快速尿素酶与开立胃镜观察的胃黏膜各表现做多因素分析。结果 开立内镜联合京都胃炎分类对Hp的诊断效能相对于快速尿素酶的诊断准确性更高[曲线下面积（AUC）=0.913,95%CI:0.884～0.943，灵敏度为92.20%，特异度为90.50%，约登指数（YI）为0.827]。开立内镜SFI模式观察弥漫性发红的诊断相对于快速尿素酶准确性更高（AUC=0.893,95%CI:0.859～0.927，灵敏度为86.80%，特异度为91.30%,YI为0.781）。开立内镜观察下诊断的55例胃肠上皮化生黏膜中，病理报告胃肠上皮化生阳性的例数为46例，阳性符合率为83.64%。单因素分析结果显示，年龄、患者类型、检查类型、彩图数、萎缩、胃肠上皮化生、皱襞肿大、鸡皮样黏膜、弥漫性发红和京都胃炎评分是开立内镜联合快速尿素酶检测Hp感染的影响因素（P <0.05）。多因素Logistic回归分析结果显示，开立...     

三种内镜下胃黏膜形态表现诊断萎缩性胃炎及幽门螺杆菌感染的临床研究

目的探讨内镜下胃黏膜形态改变诊断萎缩性胃炎的临床价值;观察内镜下胃黏膜形态改变与幽门螺杆菌(Hp)感染的关系。方法常规因上消化道症状接受胃镜检查的门诊患者根据内镜下表现分三组:第1组为内镜下胃窦黏膜表面呈弥漫颗粒样改变的患者,在胃黏膜颗粒样改变的区域取活检两块做快速尿素酶检测及病理加嗜银染色检测;第2组为在胃窦部有大片灰白区域,其中可透见血管,活检两块做快速尿素酶检测及病理加嗜银染色检测;第3组为黏膜变薄变白的区域,明显低于周围发红黏膜,分界明显。分别在黏膜变薄和周围黏膜发红两个区域各活检两块做快速尿素酶检测及病理加嗜银染色检测。尿素酶和组织嗜银染色均阳性者判断为胃Hp感染。比较三组诊断萎缩性胃炎的准确性,比较三组胃黏膜形态表现Hp感染的差异性。结果第1组85例,病理结果:Hp阳性率88.3%,萎缩性炎25.8%,肠化生11.1%,异性增生4.4%;第2组108例,病理结果:Hp阳性率31.5%,萎缩性炎49%,肠化27.8%,异性增生10.2%;第3组15例,Hp阳性率26.7%,萎缩性炎93.3%,肠化60%,异性增生26%。第1组与第2组比较幽门螺旋杆菌感染及萎缩性胃炎均有差异性(P0.05),第3组与第1组及第2组之间比较萎缩性胃炎比率有显著性差异(P0.05)。结论界限明显的胃黏膜变薄伴血管透见表现可以作为萎缩性胃炎的内镜下特异性表现;随萎缩率增高,Hp感染率反而下降。     

白光及窄带成像内镜判断胃幽门螺杆菌感染及萎缩的研究进展

<正>幽门螺杆菌（H.pylori,Hp）是一种定植在胃黏膜的革兰氏阴性杆菌致病菌,是慢性萎缩性胃炎、消化性溃疡、胃癌及胃黏膜相关淋巴组织淋巴瘤等上消化道疾病的主要病因,其检测包括尿素呼气试验、血清幽门螺杆菌抗体检测和粪便抗原检测等非侵入方法和快速尿素酶试验和病理活检等侵入性方法[1]。慢性萎缩性胃炎常发生在Hp感染的基础上,是一种胃癌前疾病,确诊主要依靠病理组织活检。近年来,通过白光内镜、窄带成像内镜观察胃黏膜形态以判断Hp感染及萎缩的研究越来越多,展现出较高的敏感性及特异性,且具有及时、直观的特点,     

鄱阳湖区域血吸虫病患者胃黏膜病变与幽门螺旋杆菌感染状况分析

目的了解日本血吸虫病(简称血吸虫病)相关胃黏膜病变,探讨血吸虫感染是否会影响幽门螺杆菌(Hp)的感染,进而影响癌前病变的进展或胃癌的发生。方法将疫区志愿者653例按血吸虫感染情况分为2组:病例组(血吸虫病志愿者,IHA阳性)341例与对照组(非血吸虫病志愿者,IHA阴性)312例,对2组进行胃镜、病理检查,同时通过13 C呼气试验进行Hp检测。结果病例组胃镜下均有不同程度的胃黏膜改变,非萎缩性胃炎并糜烂、糜烂性食管炎、黏膜颗粒状改变,食管、胃底静脉曲张及门脉高压性胃病的发生率明显高于对照组,非萎缩性胃炎低于对照组(均P<0.05)。病例组完全性小肠上皮化生、不完全性小肠上皮化生及胃十二指肠黏膜下血吸虫卵沉积发生率均高于对照组(均P<0.05)。2组完全性大肠上皮化生、不完全性大肠上皮化生、异型增生及胃癌发生率比较差异均无统计学意义(均P>0.05)。病例组中Hp感染阳性159例,阳性率为46.63%;对照组中Hp感染阳性137例,阳性率为43.91%,2组比较差异无统计学意义(χ2=0.485,P=0.486)。结论血吸虫病患者胃黏膜病变的发生率与程度均高于非血吸虫病患者,但与胃癌及癌前病变无相关性;血吸虫感染并未增加Hp的感染概率。     

^13C-尿素呼气试验定值量在儿童幽门螺杆菌检测中的应用价值

幽门螺杆菌(Hp)感染与儿童消化性溃疡、慢性胃炎等疾病的发生密切相关.目前诊断Hp感染的方法较多,其中13C-尿素呼气试验(13C-UBT)是常用的非侵袭性的检测手段,适合在儿科中应用.本文通过对125例具有消化道症状的患儿进行13C-UBT,并与胃镜下胃黏膜快速尿素酶试验、组织学染色检查进行对照观察,以探讨13C-UBT的定值量在儿童Hp检测中的应用价值.     

14C-UBT检测幽门螺旋杆菌感染慢性胃病的实验室分析

目的 了解14C-尿素呼气试验(14C-UBT)检测对幽门螺旋杆菌(Hp)感染所引起的慢性胃部疾病的诊断价值.方法 利用14C-UBT试验中β射线液闪式Hp测试法和胃活检组织尿素酶试纸法进行对照,对614例胃镜确诊慢性胃部疾病患者进行检测分析.结果 慢性胃溃疡、胃炎和糜烂性胃病患者14C-UBT测定的阳性检出率分别为48.9%、54.9%、43.6%,明显高于健康人的25.5%(P＜0.01).结论 14C-UBT的β射线液闪式Hp测试法敏感性好,结果准确,诊断符合率高,且方法简便、省时,有利于Hp感染胃肠疾病早期诊断指标.     

Relationship of gastroscopic features to histological findings in gastritis and Helicobacter pylori infection in a general population sample

BACKGROUND AND STUDY AIM: Various gastroscopic features may be interpreted as signs of gastritis, but the significance of such features in relation to histomorphology is uncertain. The aim of this study was to determine how macroscopic findings were related to histomorphological changes and the presence of Helicobacter pylori in the gastric mucosa, in a sample of the general population. SUBJECTS AND METHODS: 488 adult individuals, randomly selected from a general population, were screened with gastroscopy and biopsy. The macroscopic features recorded were erythema (diffuse, spotty, linear), erosions, absence of rugae in the gastric corpus, and presence of visible vessels. Gastritis was classified microscopically according to the Sydney system. The presence of H. pylori was determined histologically and using the urease test on fresh biopsy specimens. RESULTS: The sensitivity and specificity of absence of rugae for moderate to severe atrophic gastritis in the gastric corpus were 67 % and 85 %, respectively. Corresponding values for severe atrophy were 90 % and 84 %. The sensitivity and specificity of the presence of visible vessels for moderate to severe atrophy in the corpus were 48 % and 87 %, and for severe atrophy the values were 80 % and 87 %, respectively. Considering the antrum, the sensitivity and specificity of the presence of visible vessels for moderate to severe atrophy was 14 % and 91 %, respectively. With regard to chronic inflammation (moderate to severe in the corpus or antrum), none of the features, alone or in combination, showed a sensitivity of more than 56 %. No endoscopic features (alone or in combination) showed a sensitivity of more than 57 % for H. pylori infection. CONCLUSIONS: Except for the absence of rugae and visible vessels in the gastric corpus, macroscopic features as observed during gastroscopy are of very limited value in the evaluation of whether or not gastritis or H. pylori infection are present. This is in accordance with most previous studies in patient populations, and it must be emphasized that the diagnosis of gastritis should be based on histological examination of the gastric mucosa.     

内镜黏膜下剥离术治疗胃窦黏膜脱垂10例临床效果报道

目的探讨内镜黏膜下剥离术(ESD)治疗胃窦黏膜脱垂的疗效及安全性。方法对符合胃镜下所见的典型胃窦黏膜脱垂表现的患者,超声胃镜确认病变在黏膜层,排除肿瘤等疾病。经过质子泵抑制剂(PPI)连续治疗3个月,症状无明显好转,在患者知情同意的前提下行ESD。术后3个月门诊复诊,复查胃镜。结果 10例接受ESD术的胃窦黏膜脱垂患者,术中术后均未见出血、穿孔等并发症,术后3个月随访,患者症状明显改善,内镜下未见胃窦黏膜脱垂。结论 ESD术治疗胃窦黏膜脱垂是有效和安全的。     

2009-2019年浙江省温岭地区幽门螺杆菌耐药情况分析

目的分析2009-2019年浙江省温岭地区不同年龄组人群幽门螺杆菌(HP)的耐药情况,为HP个体化治疗提供参考依据。方法收集2009-2019年浙江省温岭地区胃镜检查患者胃黏膜标本,分离HP菌株,进行阿莫西林、左氧氟沙星、克拉霉素及甲硝唑耐药性测定,并以每10岁为一个年龄组进行分层,分析HP在不同年龄组人群的耐药情况以及不同年龄组人群耐药率的变化趋势。结果共收集95 448例胃镜检查患者胃黏膜标本,HP分离株28 774株,温岭地区HP对阿莫西林、克拉霉素、左氧氟沙星、甲硝唑的平均耐药率为0.37%、23.52%、30.62%和3.61%。克拉霉素和左氧氟沙星的耐药率随着年龄增加而上升。20岁以下年龄组人群对甲硝唑、克拉霉素和左氧氟沙星的耐药率增速较其他年龄组快。结论温岭地区HP抗菌药物耐药情况较为严重,低、高年龄组人群HP耐药率增加显著,应重点关注。     

幽门螺杆菌感染与胃粘膜林巴滤泡关系探讨

目的：为了探讨含有细胞毒素相关基因A（cagA）菌株感染与胃粘膜淋巴滤泡形成之间的关系,并对胃粘膜淋巴滤泡的发生与幽门螺杆菌（Hp）感染状况的关系等进行观察。方法：我们对655例慢性胃炎,消化性溃疡的患者进行胃镜检查,取胃窦粘膜组织作Hp检测和组织病理检查,并选择70份Hp培养阳性的临床分离菌,用PCR扩增法进行cagA基因的检测。结果：Hp感染患者中胃粘膜淋巴滤泡的发生率（60.14%）显著高于非Hp感染者（17.06%）;胃粘膜淋巴滤泡在活动性胃炎比非活动性胃炎中更易检测到;在Hp相关性胃肠病中,慢性胃炎、胃溃疡、十二指肠球溃这三者之间胃粘膜淋巴滤泡的发生率无显著性差异;另外,还观察到含cagA基因的Hp菌株与胃粘膜淋巴滤泡的增生两者之间无相关性。结论：胃粘膜淋巴滤泡的发生直接与Hp感染相关,并可作为一种Hp感染相关性胃肠病中一个较为恒定的形态特征;Hp作为一种抗原刺激胃粘膜产生淋巴滤泡的作用与Hp菌株的毒力（cagA基因）无关,任何Hp感染均可刺激胃粘膜产生淋巴滤泡。     

幽门螺杆菌根除对不同胃黏膜病变环氧合酶-2表达的影响

目的探讨Hpylori根除对慢性浅表性胃炎和萎缩肠化胃黏膜上皮细胞COX-2表达的影响。方法采用快速尿素酶试验和组织学碱性品红染色法检测胃黏膜Hpylori感染状况;应用免疫组织化学法检测胃黏膜上皮细胞COX-2的表达。结果17例Hpylori阳性慢性浅表性胃炎中11例见不同程度胃黏膜上皮细胞COX-2阳性表达,Hpylori根除后6例COX-2表达消失,2例减弱,2例无改变,1例增强,前后对照差异有显著性(P<0.05)。同时Hpylori根除后12例胃黏膜慢性炎症见不同程度减轻,与COX-2表达变化有较好相关性(P<0.05)。10例Hpylori感染萎缩性胃炎伴肠化生者9例COX-2表达阳性,Hpylori根除后1、2a复查COX-2表达减弱5例,消失2例,1例无变化,1例增强,前后对照差异有显著性(P<0.05),但胃黏膜组织学对照无明显改善。结论根除Hpylori可消除慢性浅表性胃炎胃黏膜上皮细胞COX-2表达,且与慢性炎症程度消退相关。而根除Hpylori虽可减弱萎缩肠化胃黏膜上皮细胞COX-2表达,但不能改善胃黏膜萎缩和肠化状态。     

消化性溃疡的复发与幽门螺杆菌感染168例分析

目的:观察消化性溃疡的复发与幽门螺杆菌(HP)感染的关系。方法:回顾性分析我院168例消化性溃疡病人的临床资料,从胃镜检查、碳14(一种检测HP的呼气试验)测试、病理组织活检及治疗后随访3年结果进行分析。结果:HP阳性率为82.8％,其中胃溃疡最高,为88.9％,其次为十二指肠球部溃疡、复合性溃疡、幽门前区溃疡,检出率分别为85.3％、60％、57.1％,经统计学处理P<0.01,提示HP感染与溃疡部位有相关性。随访发现溃疡病伴有HP感染的复发率较高,达30％,而单纯的消化性溃疡、无HP感染的3年复发率为5％左右。结论:HP感染是消化性溃疡复发的重要因素。     

Serum prolidase activity and oxidative status in Helicobacter pylori infection

OBJECTIVES: During the course of Helicobacter pylori infection, increased oxidative stress plays an important role in the pathogenesis of gastroduodenal mucosal inflammation, which can cause gastric mucosal atrophy that characterized by the replacement of the gastric mucosal glands by collagen fibers. In the present study, we aimed to determine serum prolidase activity and oxidative status, and to find out if there is any association between serum prolidase activity and oxidative status in H. pylori infection. DESIGN AND METHODS: Forty H. pylori-positive and 32 H. pylori-negative subjects were enrolled. Serum prolidase activity was measured spectrophotometrically. Oxidative status was determined using total antioxidant capacity and total oxidant status measurement and calculation of oxidative stress index. RESULTS: Total antioxidant capacity level was lower in H. pylori-positive group than H. pylori-negative group (p<0.001), whereas total oxidant status, oxidative stress index and prolidase activity were higher (all p<0.05). Significant correlation was observed between serum prolidase activity, and total antioxidant capacity, total oxidant status and oxidative stress index (p<0.01, r=-0.367; p<0.05, r=0.283; p<0.01, r=0.379; respectively) in H. pylori-positive subjects. CONCLUSION: H. pylori infection may be associated with increased oxidative stress and increased serum prolidase activity. Increased oxidative stress seems to be associated with increased serum prolidase activity and this association may help to provide a better understanding about the pathogenesis of H. pylori infection.     

Phospholipases A2 in gastric juice of Helicobacter pylori--positive and negative individuals.

Gastric juice is known to have phospholipase A2 catalytic activity. Helicobacter pylori (H. pylori) has been reported to produce phospholipase A2, which is believed to hydrolyse the protective layer of gastric mucosal phospholipids and to promote mucosal damage. The current study aimed at identifying secretory phospholipase A2 subtypes (pancreatic group I phospholipase A2 and synovial-type group II phospholipase A2) in gastric juice and their relation to the presence of H. pylori in gastric mucosal biopsies in the same individuals. Gastric juice was collected from 29 individuals during gastroscopy. Biopsies were taken from the antrum and body of the stomach to determine the H. pylori status. We found catalytically active phospholipase A2 and both group I and group II phospholipases A2 in the gastric juice samples. The catalytic activity and the mass concentrations of group I and group II phospholipases A2 correlated significantly with the pH value in gastric juice. The gastric juice of H. pylori positive individuals did not contain higher amounts of phospholipases A2 than the juice of H. pylori negative individuals. Rather, the mass concentration of group II phospholipase A2 in gastric juice seemed to be somewhat lower in individuals with H. pylori infection than in uninfected individuals. The results of the current study show that both group I and group II phospholipases A2 are present in gastric juice. The main sources of phospholipases A2 in gastric juice are probably other than H. pylori.     

Epidemiology and clinical role of childhood Helicobacter pylori infection

Colonization of Helicobacter pylori depends on virulence factors of the organism, host factors and environmental factors. The prevalence of H. pylori differs between developing and Western developed countries, suggesting that the socioeconomic status influences the acquisition of the infection. The prevalence of Japanese children has been almost equal to that of Western countries. Although a main mode of transmission remains unclear, childhood is critical for acquisition of the infection. H. pylori causes gastritis (especially nodular gastritis) and duodenal ulcers in children but rarely gastric ulcers. No pediatric cases with H. pylori-associated gastric cancer have been reported. However, precancerous lesions including mucosal atrophy can develop in the infected children. Further studies in children are needed on strategy for H. pylori infection including prophylaxis of gastric cancer.