幽门螺杆菌阳性功能性消化不良的治疗选择

目的：探讨根除幽门螺杆菌（HP）、改善胃动力及抗焦虑药对HP阳性功能性消化不良（FD）症状的效果。方法：HP阳性的FD160例随机的分为3个治疗组：胶体次枸橼酸铋（B）合并呋喃唑酮（F）及羟氨苄青霉素（A）三联疗法（BFA方案,60例）、西沙必利（CIS,60例）和多虑平（DXP,40例）,对其疗效作前瞻性随机对照研究。结果：CIS总有效率显著高于BFA（P＜0．05）,DXP总有效率介于两者之间。临床类型中,CIS对运动障碍型FD疗效优于BFA（P＜0．01）;而对溃疡型FD,BFA比CIS效果更佳（P＜0．05）;伴有焦虑、多疑、多梦及严重失眠的女性FD,DXP常常收到良好的效果,并优于BFA或CIS（P＜0．05）。不同年龄、性别及病程对疗效亦产生一定的影响。结论：HP阳性FD没有必要常规行根除HP治疗,但对溃疡型FD尤其病程较长者,根除HP治疗对改善FD症状有较好的效果。改善胃动力更适合于运动障碍型、年龄较小及病程较短的FD患者。上述治疗无效,尤其病程较长且同时伴有神经衰弱征候群的女性FD患者,推荐给予抗焦虑药治疗。     

缺铁性贫血患者抗幽门螺旋杆菌治疗的价值

目的：了解幽门螺旋杆菌（HP）感染对缺铁性贫血（IDA）发病的影响及抗HP治疗对改善贫血的价值。方法：对116例IDA患者补铁治疗并检测HP感染的情况。分组：A组为给予去除缺铁原因治疗和补铁治疗可以达到IDA痊愈者,B组为无明显缺铁原因但单纯补铁效果不好的IDA患者。对B组患者给予抗HP治疗,观察抗HP治疗前后患者Hb、平均红细胞体积（MCV）、平均红细胞血红蛋白含量（MCH）、血清铁蛋白（SF）的变化。结果：116例IDA患者中,A组74例给予去除缺铁原因治疗和（或）补铁治疗可以达到IDA痊愈,其中HP感染43例,感染率58.1%;B组42例无明显缺铁原因但是单纯补铁效果不好的IDA患者中HP感染者36例,感染率85.7%,2组间HP感染率的差异有统计学意义。对B组中HP阳性者给予抗HP治疗,抗HP治疗有效者Hb、MCV、MCH、SF较治疗前有明显提高。结论：HP感染可能与IDA的发生有关,清除HP的治疗可改善IDA的疗效。     

幽门螺杆菌感染与缺铁性贫血的相关性

采用14C尿素呼气试验检测60例缺铁性贫血（IDA）患者的幽门螺杆菌（HP），并对HP阳性患者行根除HP治疗，观察其血红蛋白上升情况及其他血液学指标的变化。结果显示，HP阳性48例，抗HP治疗后转阴41例，其中38例血红蛋白较治疗前升高（P〈0．05）；治疗后血红蛋白、RBC、血清铁、总铁结合力、铁蛋白与治疗前比较均有统计学差异（P均〈0．05）。认为HP感染和缺铁性贫血关系密切，抗HP治疗有利于血红蛋白的提高。     

莫沙必利改善夜间消化不良症状的随机、双盲、安慰剂平行对照研究

功能性消化不良（FD）的发病机制尚未完全明了。夜间上腹部症状是影响FD患者生活质量的重要因素。促动力药对夜间FD症状的治疗作用和机制不详。目的：探讨莫沙必利对FD患者夜间消化不良症状的治疗作用。方法：采用随机、双盲、安慰剂平行对照的前瞻性设计，连续选取主诉有夜间FD症状（上腹部疼痛、饱胀、嗳气）的患者，经一周安慰剂治疗筛选，无安慰剂治疗反应者分别给予莫沙必利（5mgtid）和安慰剂治疗。治疗前后分别行夜间症状评估以及夜间胃内DH值和胆红素联合检测。结果：共纳入43例有夜间FD症状的患者，28例对安慰剂治疗无反应。治疗后，莫沙必利组夜间上腹部疼痛、饱胀、暖气的症状积分均明显降低（R0．05），夜间胃内pH值和胆红素吸收值〉0．14的时间百分比均明显降低（P〈O．05）；而安慰剂组上述指标无明显差异（P〉O．05）。莫沙必利组夜间症状积分改善程度与夜间胃内pH值和胆红素吸收值〉O．14的时间百分比降低程度有明显相关性（P〈O．05）。结论：莫沙必利能显著改善夜间FD症状．其机制可能与减轻夜间胃十二指肠胆汁反流有关。     

老年功能性消化不良患者的情感障碍及其治疗

目的 探讨老年功能性消化不良（FD）患者与情感障碍的关系以及抗抑郁治疗的重要性。方法 对87例老年FD患者进行情感障碍的调查,并随机选择80例内科其他系统老年病人作对照。以Sung抑郁自评量表（SDS）作为抑郁状态诊断标准。对其中FD伴有抑郁状态的36例患者,在对症治疗疗效不佳的基础上加用选择性5－羟色胺再摄取抑制剂（SSRIs)氟西汀进行治疗。比较治疗前后抑郁状态改善程度。结果 （1）老年FD患者伴有情感障碍的患病率为41．4％（36／87）明显高于老年内科其他系统病人的患病率23．8％（19／80）,P＜0．05。（2）本实验中,氟西汀治疗抑郁状态总有效率为88．9％,且消化道症状改善较情感障碍症状改善为早。结论 情感障碍在老年FD患者发病中有重要地位。及时诊断及治疗抑郁状态非常重要。对老年FD伴情感障碍氟西汀有着很高的治疗价值。     

莫沙必利治疗餐后不适综合征和上腹痛综合征随机、双盲、安慰剂对照研究

背景：莫沙必利作为一种促胃肠动力药早已被推荐用于治疗功能性消化不良（FD），然而目前遵循罗马Ⅲ标准FD诊断分型和症状评估原则进行的莫沙必利治疗FD的临床研究尚不多见。目的：评估莫沙必利改善餐后不适综合征（PDS）和上腹痛综合征（EPS）症状的疗效和安全性。方法：病例连续选自2006年12月-2007年9月在上海仁济医院消化内科门诊就诊、符合罗马ⅢFD诊断标准中PDS和EPS诊断的患者。先经1周安慰剂筛选期，无安慰剂治疗反应者随机进入治疗流程组合A或B，给予莫沙必利5mg tid×1周或安慰剂1片tid×1周，然后进入1周药物清洗期（安慰剂1片tid），最后给予安慰剂或莫沙必利继续治疗1周。各阶段治疗前和治疗后分别行FD症状评估。结果：共纳入FD患者83例，安慰剂总有效率为19．3％，67例对安慰剂无治疗反应者进入莫沙必利疗效观察研究．随机进入治疗流程组合A或B者分别为34例和33例。与安慰剂治疗相比，莫沙必利可显著降低患者的总症状积分（14．4±6．8对1．4±1．3，P〈0．05），对PDS的餐后饱胀不适、早饱症状和EPS的上腹部疼痛和烧灼感症状均有显著治疗作用。莫沙必利对PDS和EPS治疗的总有效率分别为79．4％和60．6％，差异有统计学意义（P〈0．05）。结论：莫沙必利可明显改善FD患者的临床症状，对PDS和EPS均有治疗效果，对PDS的有效率优于EPS，是安全、有效的FD治疗药物。     

血液灌流治疗格林-巴利综合征临床疗效分析

目的观察血液灌流（HP）在格林-巴利综合征（GBS）患者中的临床疗效,初步探讨GBS患者血炎症因子的表达情况及血液灌流对其的清除效果。方法选择确诊的GBS患者76例,按Hughes分类进行分级,并随机分为HP组和非HP组,每组38例,健康人25名作为对照组。分别于治疗前后采血,ELISA方法检测血中肿瘤坏死因子-α（TNF—α）、白介素-18（IL-18）水平;同时观察治疗前后临床症状及肌力的改善程度,减少1个Hughes等级为GBS临床改善。结果血炎症因子变化：治疗前HP组和非HP组患者血TNF—α、IL-18水平均高于正常对照组（P〈0．001）,HP组和非HP组之间各因子水平差异无统计学意义（P〉0．05）;HP组治疗后血TNF—α、IL-18水平较治疗前降低（P〈0．001）,而非HP组治疗后各因子水平与治疗前相比差异无统计学意义（P〉0．05）。疗效及转归：HP组患者进步1级的时间为10．83d±9．38d,而非HP组为32．13d±11．30d,差异有统计学意义（P〈0．01）。呼吸机辅助呼吸者,HP组持续7d,而非HP组则持续18d。非HP组死亡3例,而HP组则无一例死亡。结论GBS患者急性期血清中存在有高表达的炎症介质,HP治疗后能够有效清除炎症介质,迅速缓解GBS患者的临床症状,显著缩短病程以及使用人工呼吸的间期,改善患者预后。     

抗幽门螺杆菌治疗对慢性特发性血小板减少性紫癜患者疗效观察

目的通过对特发性血小板减少性紫癜(ITP)患者行抗幽门螺杆菌(HP)感染的临床研究,观察ITP与HP感染之间的关系以及抗HP在ITP患者治疗中的作用。方法2003-07~2003-12对解放军301医院17例慢性ITP患者采用14C尿素呼气试验进行HP检测,女11例,男6例,病程4个月至8年,并对阳性患者行奥美拉唑、克拉霉素及阿莫西林三联根除HP治疗,观察血小板情况。结果本组17例患者中HP阳性13例,阴性4例,抗HP后转阴11例,其中8例血小板水平较前有所提高。结论抗HP治疗确实可提高部分慢性ITP患者的血小板数。     

赛乐特治疗功能性消化不良30例临床观察

目的 探讨抗抑郁药物赛乐特治疗功能性消化不良（FD）的临床效果。方法 将60例功能性消化不良病人随机分成两组，抗抑郁组给予赛乐特20mg／d；常规组根据个体化治疗原则，应用消化系统药物。两组均配合支持性心理治疗。治疗时间均为8周。入组者治疗前、后进行焦虑自评量表（SaS）和抑郁自评量表（SDS）测评及FD症状评分。结果 FD病人的SAS和SDS评分与常规组之间存在显著差异（P〈0．01）；治疗8周后抗抑郁组SAS和SDS评分显著低于常规组（P〈0．01），FD评分也明显低于常规组（P〈0．05）。结论 FD病人普遍存在情绪问题，抗抑郁药物适合治疗有抑郁情绪的FD病人，不仅改善情绪状态而且明显改善FD症状，疗效显著。     

胃舒康对功能性消化不良患者血浆胃动素、血清抗幽门螺杆菌抗体的影响

62例功能性消化不良（FD）患者随机分为胃舒康治疗组32例和吗丁啉组30例．治疗1月.分别观察其疗效及对治疗前后血浆盲动素（MTL）、血清抗幽门螺杆菌抗体（抗HPIgG）的影响。结果：治疗组的近期临床治愈率为43．8％，总有效率为93．8％．优于吗丁啉组的16.7％、80.0％（P＜0．05）。治疗后治疗组血浆MTL阻显升高，血清抗HPIgG显著下降．与治疗前相比有显著性差异（P＜0．01）；而吗了批组MTL水平、掠HPIgG滴度较治疗前均无明显变化（P＞0.05）、提示胃舒康治疗FD取得较好疗效的机制可能是促进内源性MTL释放．从而加速胃排空和清除HP.     

非溃疡性消化不良与幽门螺旋菌相关性慢性胃炎关系的研究

在本院251例连续胃镜病例中,对非溃疡性消化不良(NUD)与幽门螺旋菌(HP)相关性慢性胃炎的关系进行了前瞻性研究。发现:(1)NUD的HP检出率与同期当地正常人群无显著性差异。(2)NUD之HP阳性与阴性组之临床症状计分无显著性差异;NUD典型组与非典型组间HP检出率无显著性差异。(3)HP感染及胃窦粘膜炎症程度与症状计分无显著相关性。(4)DeNol与安慰剂治疗比较,两组治疗后症状计分无显著差异。结果提示,NUD之临床症状与HP相关性慢性胃炎之间无明确关系。     

Changes in patients’ symptoms and gastric emptying after Helicobacter pylori treatment

AIM: To investigate the changes in clinical symptoms and gastric emptying and their association in functional dyspepsia (FD) patients. METHODS: Seventy FD patients were enrolled and divided into 2 groups Helicobacter pylori (H. pylori)-negative group (28 patients), and H. pylori-positive group (42 patients). Patients in the H. pylori-positive group were further randomly divided into groups: H. pylori-treatment group (21 patients) and conventional treatment group (21 patients). Seventy two healthy subjects were selected as the control group. The proximal and distal stomach area was measured by ultrasound immediately after patients took the test meal, and at 20, 40, 60 and 90 min; then, gastric half-emptying time was calculated. The incidence of symptoms and gastric half-emptying time between the FD and control groups were compared. The H. pylori-negative and conventional treatment groups were given conventional treatment: domperidone 0.6 mg/(kg/d) for 1 mo. The H. pylori-treatment group was given H. pylori eradication treatment + conventional treatment: lansoprazole 30 mg once daily, clarithromycin 0.5 g twice daily and amoxicillin 1.0 g twice daily for 1 wk, then domperidone 0.6 mg/(kg/d) for 1 mo. The incidence of symptoms and gastric emptying were compared between the FD and control groups. The relationship between dyspeptic symptoms and gastric half-emptying time in the FD and control groups were analyzed. Then total symptom scores before and after treatment and gastric half-emptying time were compared among the 3 groups. RESULTS: The incidence of abdominal pain, epigastric burning sensation, abdominal distension, nausea, belching, and early satiety symptoms in the FD group were significantly higher than in the control group (50.0% vs 20.8%; 37.1% vs 12.5%; 78.6% vs 44.4%; 45.7% vs 22.2%; 52.9% vs 15.3%; 57.1% vs 19.4%; all P < 0.05). The gastric half-emptying times of the proximal end, distal end, and the whole stomach in the FD group were slower than in the control group (93.7 ± 26.2 vs 72.0 ± 14.3; 102.2 ± 26.4 vs 87.5 ± 18.2; 102.1 ± 28.6 vs 78.3 ± 14.1; all P < 0.05). Abdominal distension, belching and early satiety had an effect on distal gastric half-emptying time (P < 0.05). Abdominal distension and abdominal pain had an effect on the gastric half-emptying time of the whole stomach (P < 0.05). All were risk factors (odds ratio > 1). The total symptom score of the 3 groups after treatment was lower than before treatment (P < 0.05). Total symptom scores after treatment in the H. pylori-treatment group and H. pylori-negative group were lower than in the conventional treatment group (5.15 ± 2.27 vs 7.02 ± 3.04, 4.93 ± 3.22 vs 7.02 ± 3.04, All P < 0.05). The gastric half-emptying times of the proximal end, distal end, and the whole stomach in the H. pylori-negative and H. pylori-treatment groups were shorter than in the conventional treatment group (P < 0.05). CONCLUSION: FD patients have delayed gastric emptying. H. pylori infection treatment helps to improve symptoms of dyspepsia and is a reasonable choice for treatment in clinical practice.     

Changes of coronary risk factors after eradication of Helicobacter pylori infection

Several epidemiological studies have shown a positive correlation between chronic gastric infection with Helicobacter pylori (HP) and coronary artery disease. A number of reports also claimed that there are strong relationships between HP infection and coronary risk factors. However, clinical studies concerning the changes of coronary risk factors after eradication of HP infection are few and contradictory. We conducted a prospective study aiming to compare sugar, lipid and fibrinolytic profiles before HP eradication with those after HP eradication. HP infection was confirmed by endoscope-based examinations and eradicated by a standard OAC (omeperazole-amoxicillin-clarithromycin) regimen. We measured and compared pre- and post-eradication blood sugar, lipid profiles (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglyceride) and fibrinolytic profiles (tissue-plasminogen activator, plasminogen activator inhibitor-1, fibrinogen, and D-dimer levels). Forty-eight patients (male:female, 25:23; mean age, 50.8 +/- 11.3 years) with gastric HP infection were enrolled in this study. Although HP infection was confirmed to have been successfully eradicated, no significant changes of blood fasting sugar, lipids or fibrinolytic profiles were found in patients after treatment. Coronary risk factors including fasting sugar, lipid and fibrinolytic profiles were not changed after successful HP eradication treatment. The relationship between HP infection and coronary artery disease needs to be clarified.     

功能性消化不良的亚型调查及其与幽门螺杆菌关系的探讨

目的：了解功能性消化不良（ＦＤ）的不同亚型比例,探讨其与幽门螺杆菌（ＨＰ）等因素的关系。方法：对１８６例ＦＤ患者以问卷形式询问病史,按症状给予分型,用尿素酶试验、涂片染色、培养法检测ＨＰ。结果：各亚型的比例及ＨＰ阳性率分别显：反流型１１．２９％、１４．２９％;溃疡型１３．９８％、４６．１５％;运动障碍型４８．３９％、４１．１１％;复合型２６．３４％,３８．７８％,ＦＤ的ＨＰ总阳性率为３８．１７％。结论：ＦＤ中以运动障碍亚型最为多见。部份亚型之间有重叠。ＦＤ与ＨＰ感染无关。反流型中的ＨＰ阳性率较低。     

Helicobacter pylori colonization does not influence the symptomatic response to prokinetic agents in patients with functional dyspepsia

Functional dyspepsia (FD) is very common, but the pathogenesis of Helicobacter pylori leading to FD is still debated. The aim of this study was first to evaluate the impact of H. pylori colonization on the efficacy of Paspertase® (a metoclopramide plus exogenous enzymes regimen for FD patients) and, second, to compare the prevalence of H. pylori infection in FD patients with the general population. Seventy-four consecutive FD patients were enrolled undergoing Paspertase® treatment. The symptomatic response was evaluated according to 1–4 scales of six main dyspeptic symptoms (i.e. epigastric pain/discomfort, early satiety, heartburn, nausea/vomiting, abdominal fullness/bloating, and belching). Nine hundred and seventy healthy subjects undergoing a paid physical check-up were included to study the status of H. pylori colonization. The demographic data and basal symptom scores between 43 H. pylori -positive and 31 H. pylori -negative patients were not significantly different. Total and individual symptom scores improved significantly after 4 weeks of Paspertase® therapy ( P < 0.05), irrespective of H. pylori infection. The prevalences of H. pylori were very similar in FD patients and the general population (58.1 vs 58.0%, NS). In conclusion, these observations suggest that H. pylori colonization is not significant in FD patients of Taiwan while a short-term prokinetic medication is effective for these patients, irrespective of H. pylori status.     

功能性消化不良根除幽门螺杆菌后症状改善相关因素分析

目的 探讨将治疗前胃黏膜组织学特征作为幽门螺杆菌（Hp）阳性功能性消化不良（FD）患者根除Hp后症状改善疗效预测指标的可能性,以提高消化不良患者的治疗水平.方法 连续调查240例进行胃镜检查Hp阳性FD患者,其中190例接受三联抗Hp治疗,另50例作为对照,给予奥美拉唑治疗,疗程均为7 d.治疗前胃黏膜组织学按新悉尼系统标准进行评估.治疗后1个月（治疗组和对照组）和6个月（治疗组）用C13-尿素呼气试验评估Hp.治疗前、治疗后1个月和6个月用消化不良调查表对症状程度进行评分,并计算仍有症状率,分析治疗前胃黏膜组织学与根除Hp后症状改善之间的相关性.结果 Hp阳性FD患者分别有35.3%和42.6%在根除Hp后1个月和6个月消化不良症状改善显效,且根除Hp者症状缓解率显著高于Hp根除失败者（P＜0.01）;也高于对照组（P＜0.01）.治疗前胃黏膜组织学指标中,炎症、活动性程度和Hp密度在根除Hp后症状改善显效的FD患者均显著高于有效和无效者（P＜0.05）.多元回归分析支持上述组织学因素与根除Hp后症状显著改善相关.结论 Hp阳性FD患者根除Hp后确实有部分患者症状显著改善.Hp阳性FD患者根除治疗前胃黏膜炎症、活动性程度和Hp密度能够预示根除Hp后症状改善的疗效.     

功能性消化不良与功能性便秘胃排空情况及其相互关系的研究

目的了解功能性消化性不良（P-D）、功能性便秘（FC）的胃排空情况,并探讨其相互关系。方法选择符合罗马Ⅲ标准的FD患者63例,单纯FC患者34例,FD＋FC患者46例,无消化道症状的健康体检者40例作为对照组,上述所有患者及健康体检者利用^（13）C-辛酸呼气试验（OBT）进行胃排空时间测定。结果①FD组中胃排空延迟发生率占57．1％（36／63）,单纯Fc组中胃排空延迟发生率占58．8％（20／34）,FC＋FD组中胃排空延迟发生率占65．2％（30／46）,FD组、单纯FC组与FC＋FD组间比较无统计学差异（P〉0．01）,三组与对照组均有显著差异（P〈0．01）;②单纯FC组与对照组中无重度胃排空延迟病例出现,而FD（占38．1％）、FC＋FD（占34．8％）组中重度胃排空延迟病例所占比例较大,均与单纯FC、对照组有显著差异（P〈0．05）。结论胃动力异常与FD、FC的发病密切相关;FC患者重叠FD症状的几率较高;FD与FC尽管均存在胃动力异常,但严重程度不一,指导临床,需区别对待。     

不同幽门螺杆菌根除方案对功能性消化不良影响的临床研究

背景:功能性消化不良(FD)是常见的功能性胃肠病,幽门螺杆菌(H.pylori)是FD的重要致病因素之一。目的:探讨不同H.pylori根除方案对FD患者临床症状的疗效。方法:160例H.pylori(+)FD患者随机分为10d序贯治疗组(60例)、7d三联治疗组(60例)和对照组(40例)。所有患者于停药4周后复查~(14)C-尿素呼气试验以评估H.pylori根除率。患者于治疗前、治疗后第3、6、12个月评估FD症状。结果:10d序贯治疗组、7d三联治疗组和对照组的H.pylori根除率分别为93.2%、74.1%和48.6%(符合方案分析)以及91.7%、71.7%和42.5%(意向治疗分析),各组相比差异有统计学意义(P0.05)。治疗后第6、12个月,10d序贯治疗组和7d三联治疗组中H.pylori根除者的FD症状改善率显著高于对照组(P0.05),但两治疗组之间无明显差异。结论:10d序贯治疗和7d三联治疗的FD症状改善率无明显差异,但前者H.pylori根除率高于后者,临床可推荐10d序贯疗法治疗H.pylori(+)FD患者。