幽门螺杆菌阴性消化性溃疡与出血关系的研究

目的探讨幽门螺杆菌(H.pylori)阴性消化性溃疡与出血之间的关系及其临床特点。方法选择急诊内镜诊断为胃溃疡和/或十二指肠溃疡患者160例,按照是否合并出血分为出血组和不伴出血组,各80例,并分析影响H.pylori阴性消化性溃疡合并出血的因素。结果出血组H.pylori阴性率为40%,不伴出血组H.pylori阴性率为14%,2组比较有显著性差异(P<0.05)。H.pylori阴性消化性溃疡合并出血与复合性溃疡、黏膜炎症和炎症程度存在明显的相关性,与十二指肠溃疡、胃溃疡、溃疡直径、溃疡分期、黏膜萎缩、肠化生和淋巴组织增生无明显相关性。结论 H.pylori阴性消化性溃疡在消化性溃疡出血中所占的比例较高,有复合性溃疡、黏膜炎症和炎症严重的患者可能更易并发消化道出血,需要引起消化专科医生的重视。     

抑制幽门螺旋菌中药的初步筛选

本研究对２２６例有上消化道症状患者进行的胃镜和病理学检查，诊断为慢性胃炎和消化性溃疡。同时取胃窦粘膜做幽门螺旋菌（ＨＰ）培养，其中１３６例ＨＰ阳性（６０．１８％）。经用２００种不同性味、不同作用的单味中药做对ＨＰ的抑菌试验，结果发现其中３８种中药材对ＨＰ有不同程度的抑菌作用，为慢性胃炎和消化性溃疡的临床辨证论治和清除ＨＰ提供参考。     

In vitro susceptibility of Helicobacter pylori to isoquinoline alkaloids from Sanguinaria canadensis and Hydrastis canadensis

Methanol extracts of the rhizomes of Sanguinaria canadensis, and the roots and rhizomes of Hydrastis canadensis, two plants used traditionally for the treatment of gastrointestinal ailments, were screened for in vitro antibacterial activity against 15 strains of Helicobacter pylori. The rhizome extracts, as well as a methanol extract of S. canadensis suspension-cell cultures inhibited the growth of H. pylori in vitro, with a MIC50 range of 12.5-50.0 microg/ml. Three isoquinoline alkaloids were identified in the active fraction. Sanguinarine and chelerythrine, two benzophenanthridine alkaloids, inhibited the growth of the bacterium, with an MIC50 of 50.0 and 100.0 microg/ml, respectively. Protopine, a protopine alkaloid, also inhibited the growth of the bacterium, with a MIC50 of 100 microg/ml. The crude methanol extract of H. canadensis rhizomes was very active, with an MIC50 of 12.5 microg/ml. Two isoquinoline alkaloids, berberine and beta-hydrastine, were identified as the active constituents, and having an MIC50 of 12.5 and 100.0 microg/ml, respectively.     

HP阳性消化性溃疡的中西医结合治疗

目的 :观察中西医结合治疗幽门螺杆菌阳性的消化性溃疡的临床疗效。方法 :5 5例幽门螺杆菌阳性的消化性溃疡患者随机分为两组。中西医结合组 ( 3 3例 ) ,用中医辩证论治加西药雷尼替丁。对照组 ( 2 2例 ) ,用阿莫西林 +雷尼替丁。结果 :溃疡愈合率 ,中西医结合组为 88% ,对照组为 64 % ,(χ2 =4.5 ,P <0 .0 5 ) ;H P清除率 ,中西医结合组为 75 % ,对照组为 5 0 % ,( χ2 =3 .87,P <0 .0 5 )。中西医结合组中溃疡愈合 ,HP根除的 2 5例患者 ,6个月以后胃镜复查 ,溃疡无复发 ,H P均阴性。结论 :中西医结合治疗 HP阳性的消化性溃疡有较好疗效 ,且副作用少。     

In vitro anti‐Helicobacter pylori activity of usnic acid

Eradication of Helicobacter pylori is an important objective in overcoming gastric diseases. Many regimens are currently available but none of them could achieve 100% success in eradication. Medicinal lichen is used in the treatment of gastric ulcer in local folk medicine in Anatolia (Turkey). The present study was performed to assess the in vitro effects of usnic acid from Usnea dasypoga against clinical isolates and standard H. pylori strains and their minimum inhibitory concentrations (MICs). A total of 38 strains was assayed for anti‐H. pylori activity. The agar dilution method was used for the determination of usnic acid and clarithromycin resistance. Six (16.2%) clinical isolates were resistant to usnic acid and five (13.5%) were resistant to clarithromycin. Dual susceptibility to usnic acid and clarithromycin rate was detected as very high (97.3%). Usnic acid has a strong and dose‐dependent activity against H. pylori strains. The synergism between usnic acid and clarithromycin may be effective in the treatment of H. pylori infection. Copyright © 2009 John Wiley & Sons, Ltd.     

In vitro inhibition of Helicobacter pylori growth and adherence to gastric mucosal cells by Pycnogenol

The emergence of antibiotic resistant H. pylori strains has necessitated the identification of alternative additive therapies for the treatment of this infection. The study tested whether a specific pine bark extract (Pycnogenol is effective in inhibiting the growth and adherence of H. pylori in vitro. Inhibition of H. pylori growth by Pycnogenol was tested in liquid medium as well as in an in vitro model by using sessile bacteria attached to AGS cells. Adherence was determined by co-incubation of gastric cells with Pycnogenol and H. pylori in vitro. Pycnogenol inhibited H. pylori growth in suspension with an MIC(50) of 12.5 microg/mL. Growth of H. pylori in infected cells was reduced to 10% of the control value by 125 microg/mL Pycnogenol. Adherence of H. pylori to gastric cells was reduced by 70% after 3 h incubation with 125 microg/mL Pycnogenol. The results show a significant, yet limited inhibition of growth and adherence of H. pylori to gastric cells by Pycnogenol. In vivo studies have to demonstrate the clinical relevance of these findings.     

Antibacterial effect of plant extracts against Helicobacter pylori

The aim of this work was to evaluate the antibacterial effect of plant extracts as alternative and[sol ]or as active agents supporting antibiotics for treating Helicobacter pylori infection. The effect of either, ethanolic or aqueous extracts from 17 plant materials were studied against one H. pylori standard strain and 11 clinical isolates using a disc diffusion test and by evaluating the minimum inhibitory concentration (MIC) on solid media. An inhibitory activity against H. pylori strains was recorded in a large percentage of tested plants. MIC values of ethanolic extracts were from two to four concentration steps lower than the aqueous ones. In particular, ethanolic extracts of Cuminum cyminum L. and Propolis expressed MIC90 values of 0.075 mg/mL. The results show a significant in vitro effect of plant extracts against H. pylori that could be considered a valuable support in the treatment of the infection and may contribute to the development of new and safe agents for inclusion in anti-H. pylori regimens.     

愈疡汤联合泰胃美治疗幽门螺杆菌阴性消化性溃疡的近期及远期疗效观察

目的　观察自拟愈疡汤与泰胃美联合治疗幽门螺杆菌 (Hp)阴性消化性溃疡的近期及远期疗效。方法　 84例Hp阴性消化性溃疡患者随机分为 2组 ,治疗组 44例用自拟愈疡汤合泰胃美治疗 ,对照组 40例单纯用泰胃美治疗。观察治疗 1周后 2组症状改善情况、治疗 6周后溃疡愈合情况及 1年后溃疡复发情况。结果　治疗 1周后 ,2组患者腹痛、反酸症状均有改善 ,但 2组比较无显著性差异 (P >0 .0 5 ) ;治疗组腹胀、口苦、乏力、纳呆症状的改善明显优于对照组 (P <0 .0 5或P <0 .0 1)。治疗组的溃疡近期愈合率高于对照组 (P <0 .0 5 ) ,1年复发率低于对照组 (P <0 .0 1)。结论　自拟愈疡汤与泰胃美联合治疗Hp阴性消化性溃疡症状改善明显 ,溃疡愈合率高 ,不易复发 ,副反应低 ,有较好的临床应用价值。     

养胃煎联合胃三联疗法治疗幽门螺杆菌阳性慢性萎缩性胃炎30例临床观察

目的观察养胃煎联合胃三联疗法治疗幽门螺杆菌(Hp)阳性慢性萎缩性胃炎(CAG)的临床疗效。方法将60例CAG患者随机分为2组,对照组30例给予常规胃三联疗法连续治疗7 d;治疗组30例在对照组的基础上加用养胃煎连续服用30 d。2组均停药30 d后观察临床疗效、胃黏膜改善情况及Hp根除率。结果 2组临床疗效总有效率(治疗组93.3%,对照组70.0%)比较差异有统计学意义(P<0.05);胃黏膜改善总有效率(治疗组66.7%,对照组40.0%)比较差异有统计学意义(P<0.05);Hp根除率(治疗组96.7%,对照组80.0%)比较差异有统计学意义(P<0.05)。治疗组疗效优于对照组。结论养胃煎联合胃三联疗法口服治疗Hp阳性CAG临床疗效肯定,可明显改善受损的胃黏膜,提高Hp的根除率。     

胃炎汤治疗幽门螺杆菌阳性浅表性胃炎的临床观察

目的观察胃炎汤治疗幽门螺杆菌(H.pylori)阳性浅表性胃炎的临床疗效。方法将60例H.pylori感染相关的浅表性胃炎患者随机分为治疗组和对照组,每组30例,治疗组予中药胃炎汤口服,每日2次,疗程20 d。对照组用西药标准三联疗法,疗程7 d。结果治疗组症状改善优于对照组(P<0.05);胃镜、病理变化的总有效率治疗组(73%)与对照组(76%)相近;H.pylori根除率2组无显著性差异(P>0.05)。结论中药胃炎汤治疗H.pylori阳性浅表性胃炎的临床疗效肯定。     

胃食管反流病合并幽门螺杆菌感染的中医临床研究

目的:探讨Hp感染与胃食管反流病患者临床症状、食管炎症程度及中医证型分布的关系;根除Hp对胃食管反流病合并Hp感染中医临床疗效的影响。方法:回顾性调查胃食管反流病专科病例975例,比较Hp感染患者与无Hp感染患者在临床症状、食管炎症程度、中医证型分布方面的差异。将感染Hp的胃食管反流病患者分为根除组与未根除组,比较其中药辨证论治干预后的临床疗效。结果:975例胃食管反流病患者,合并Hp感染415例,感染率为42.56%;胃食管反流病合并Hp感染者与无Hp感染者临床症状、食管炎症程度均无显著性差异,合并Hp感染的胃食管反流病患者Barrett食管发病率较低与无Hp感染患者相比有显著性差异;GERD合并Hp感染患者中肝胃郁热证分布较多,中虚气逆证分布较少,与Hp阴性患者相比有显著性差异,且GERD合并Hp感染患者中未根除组烧心的表现少于Hp根除组;中医药辨证治疗合并Hp感染的胃食管反流病患者,根除组有效率为98.19%,未根除组为94.44%,两组间无显著性差异。结论:Hp感染对胃食管反流病患者临床症状、食管炎症程度无影响,胃食管反流病合并Hp感染患者中肝胃郁热证较多,中虚气逆证较少。中医药能够明显改善胃食管反流病患者的临床症状,与是否根除Hp无明显影响。     

奥美拉唑四联疗法治疗幽门螺旋杆菌阳性消化性溃疡的疗效观察

目的：探讨奥美拉唑四联疗法治疗幽门螺旋杆菌（HP）阳性消化性溃疡的临床疗效.方法：将我院收治的264例幽门螺旋杆菌阳性消化性溃疡的患者随机分为两组,治疗组132例,为奥美拉唑四联疗法组,对照组132例,为奥美拉唑三联疗法组.观察两组的临床疗效、HP根除率及不良反应.结果：治疗组总有效率为97.0%,溃疡面愈合率为95.5%,HP根除率为92.4%,对照组总有效率为89.3%,溃疡面愈合率为87.8%,HP根除率为84.0%,两组总有效率、溃疡面愈合率及HP根除率比较差异显著,具有统计学意义（P〈0.05）.两组均未见明显不良反应.结论：奥美拉唑四联疗法治疗幽门螺旋杆菌阳性消化性溃疡的疗效显著,临床用药安全性好,值得临床上进一步推广应用.     

In vitro anti-Helicobacter pylori potential of methanol extract of Allium ascalonicum Linn. (Liliaceae) leaf: susceptibility and effect on urease activity

The crude methanol extract of the leaf of Allium ascalonicum was screened in vitro against fi ve strains of Helicobacter pylori (Hp) (ATCC 24376, UCH 97001, UCH 97009, UCH 98026 and UCH 99039) for antibacterial activity by the agar diffusion method in Mueller-Hinton agar supplemented with de fi brinated horse blood. All the strains were inhibited by the extract to varying degrees. The minimum inhibitory concentrations (MICs) of the extract against all the tested strains ranged from 6.25 to 12.5 mg/mL. The effects of increasing concentrations of the extract on the urease activity of three of the Helicobacter pylori strains were investigated further. The results showed that increasing the concentration of the extract decreased the urease activity of all the strains tested. Phytochemical screening of the plant showed that it contains alkaloids, cardiac glycosides and saponins. The anti-Hp activity observed is discussed in relation to the chemical constituents reportedly isolated from these plants and their traditional uses. The result of this work suggests that Allium ascalonicum has some therapeutic potential against Helicobacter pylori infection, which could be explored for patients with gastroduodenal disorders.     

Tanzanian medicinal plants used traditionally for the treatment of malaria: In vivo antimalarial and in vitro cytotoxic activities

Seventeen fractions of extracts obtained from 11 Tanzanian medicinal plants, which had previously been shown to possess a high antimalarial activity in vitro were submitted to the 4-day suppressive test in Plasmodium berghei-infected mice, and were investigated for cytotoxic activity in human carcinoma cell lines in vitro. Several fractions administered orally to the mice (500 mg/kg body weight/day) produced a significant reduction of parasitaemia. The most effective plant fractions investigated were those of the root and stem bark of Maytenus senegalensis (90% and 63% suppression of parasitaemia, respectively) and of the roots of Cissampelos mucronata (59% suppression). Highest cytotoxic activities were found with all fractions of Maytenus senegalensis (IC₅₀ 1 μg/mL) and with the PE fraction of the roots of Salacia madagascariensis (median IC₅₀=1.2 μg/mL for HT 29 and 2.3 μg/mL for KB).     

2型糖尿病并消化性溃疡患者幽门螺杆菌感染的临床研究

目的：探讨2型糖尿病并消化性溃疡患者HP感染状况及三联抗HP治疗效果。方法：2型糖尿病并消化性溃疡患者42例，消化性溃疡患者50例，用14C-尿素呼气试验测定其HP感染状况，对HP阳性者采用奥美拉唑20mg bid，克拉霉素250mg bid，甲硝唑400mg bid 1周疗法，停用抗菌素后4周复查14C-尿素呼气试验，计算其根除率，比较两者差异。结果：糖尿病并消化性溃疡患者的HP感染率为57．1％（24／42），非糖尿病消化性溃疡HP感染率为82．0％（41／50例），两者比较差异显著（P〈0．01）。糖尿病并消化性溃疡患者中21例完成了整个疗程，HP根除率为61．9％（13／21），显著（P〈0．05）低于非糖尿病消化性溃疡HP根除率87．8％（36／41）。结论：糖尿病并消化性溃疡患者的HP感染率低于非糖尿病消化性溃疡，三联抗HP治疗根除率低于非糖尿病消化性溃疡患者。     

中西医结合治疗幽门螺杆菌相关性稍化性溃疡78例疗效观察

目的：观察清幽愈疡汤配合奥美拉唑、阿莫西林、克拉霉素治疗幽门螺杆菌（Hp）相关性消化性溃疡的临床疗效。方法：将156例患者随机分为两组各78例。对照组采用口服奥美拉唑、阿莫西林、克拉霉素治疗;治疗组在对照组治疗基础上加服中药自拟清幽愈疡汤（党参、柴胡、枳壳、白芍、丹参、香附、蒲公英、黄连、海螵蛸、白芨、田七粉、甘草）治疗。两组均以6周为总疗程。观察证候疗效、胃镜疗效、Hp根除率、复发率。结果：证候疗效临床痊愈率治疗组为80．77％,对照组为70．51％,总有效率治疗组为98．72％,对照组为88．46％,两组总有效率比较,差异有显著性意义（P〈O．05）。胃镜疗效临床痊愈率治疗组为78．21％,对照组为66．67％,总有效率治疗组为97．44％,对照组为87．18％,两组总有效率比较,差异有显著性意义（P〈O．05）。Hp根除率治疗组为93．59％,对照组为80．77％,两组比较,差异有显著性意义（P〈O．05）。2年后复发率治疗组为11．48％,对照组为34．62％,两组比较差异有非常显著性意义（P〈O．01）。结论：清幽愈疡汤配合奥美拉唑、阿莫西林、克拉霉素治疗幽门螺杆菌相关性消化性溃疡疗效显著。     

中医药干预幽门螺杆菌阳性慢性胃炎研究进展

本文通过总结H.pylori阳性慢性胃炎的中医证候调查结果,及目前中药抗H.pylori的药理学、临床试验研究进展,阐明中医药的潜在优势,为后续研究提供参考.     

In vitro susceptibility of Entamoeba histolytica and Giardia lamblia to plants used in Mexican traditional medicine for the treatment of gastrointestinal disorders

In our search for new antiprotozoal chemotherapy, we collected a selection of 26 plants used in Mexican traditional medicine for the treatment of gastrointestinal disorders. Methanolic extracts of these species were screened for their antiprotozoal activity against Entamoeba histolytica and Giardia lamblia trophozoites using in vitro tests. Among the tested extracts, the derivates of following species showed selectivity and significant antiprotozoal activity: Chiranthodendron pentadactylon, Annona cherimola and Punica granatum were the most active on Entamoeba histolytica with IC50 < 30 microg/ml. Dorstenia contrajerva, Senna villosa and Ruta chalepensis were the most active toward Giardia lamblia with IC50 < 38 microg/ml. The potency of Chiranthodendron pentadactylon (IC50 2.5 microg/ml) on Entamoeba histolytica was close that of to emetine, but far less than metronidazole, drugs used as control. The results of the antiprotozoal screening support the popular uses of the studied species for the treatment of diarrhoea and dysentery in Mexican traditional medicine.     

序贯与三联疗法根除幽门螺杆菌的临床应用比较

 目的 比较由雷贝拉唑联合阿莫西林、克拉霉素以及替硝唑组成的10 d序贯疗法与三联疗法根除幽门螺杆菌的疗效、依从性、安全性及经济学比较。方法 将幽门螺杆菌阳性的90例消化性溃疡患者随机分为以雷贝拉唑为基础的10 d序贯疗法组(n=45)和三联疗法组(n=45),治疗结束4周后复查¹⁴C-UBT,评估幽门螺杆菌根除情况,并对各方案进行成本-效果分析。结果 共85例患者按方案完成治疗。10 d序贯疗法组幽门螺杆菌根除率按意向治疗(ITT)和按方案(PP)分析均高于三联疗法组(ITT：91.1%对73.3％,P<0.05;PP：95.3％对78.6％,P<0.05);10 d序贯疗法组不良反应发生率(PP：14.0％对11.9％,P<0.05)与三联疗法组相似;成本-效果分析显示,序贯治疗组的成本-效果比值（C/E）低于对照组。结论 以雷贝拉唑为基础的10 d序贯疗法具有疗效高、可提高幽门螺杆菌根除率等优势。     

中西医结合治疗消化性溃疡疗效观察

消化性溃疡是胃黏膜的保护因子和侵袭因子失衡所致。局部气血凝滞,为疮疡发生的主要病机,治宜疏肝健脾,清化湿热,凉血化瘀,生肌敛疮。中西医结合具有双向免疫调节作用,改善胃黏膜血液循环、促进胃肠运动、减轻黏膜炎症、加速黏膜修复的作用。治疗76例,治愈50例,好转24例,无效2例,明显优于对照组。