小儿胃十二指肠疾病中幽门螺杆菌感染与胃泌素相关性探讨

应用放免分析对２５例十二指肠溃疡（ＤＵ）和２４例慢性胃炎患儿进行空腹血清胃泌素检测。并对１５例幽门螺杆菌（ＨＰ）阳性的ＤＵ患儿作根治治疗后,复查ＨＰ及胃泌素,并进行对比研究。结果：ＨＰ阳必珠ＤＵ和慢性胃炎患儿血清胃泌素水平高于ＨＰ阴性者（均Ｐ〈０．０１）,也高于正常组（均Ｐ〈０．０５）。ＨＰ根治后患儿血清胃泌素水平较治疗前显著下降（Ｐ〈０．０５）。提示ＨＰ感染与患儿的高胃泌素血症有关,是引起上消化     

脾气虚证壁细胞线粒体,G细胞分泌颗粒与血清胃泌素,胃粘膜S…

对脾气虚证及肝胃不和证的慢性胃病患者２３例，进行了胃粘膜超微结构研究，胃粘膜超氧化物歧化酶（ＳＯＤ）活性、丙二醛（ＭＤＡ）含量的检测，以及餐后血清胃泌素测定。结果显示：脾气虚患者其壁细胞单位面积的线粒体数目，主细胞酶原颗粒，Ｇ细胞的分泌颗粒，以及餐后血清胃泌素比值均明显低于肝胃不和组（Ｐ＜０．０１）。提示脾气虚患者胃蛋白酶储备不足，Ｇ细胞分泌能力差，分泌功能低下。同时，线粒体的结构亦有明显损伤，认     

门奇断流术后远期胃分泌功能的实验研究

本实验采用Ｔｏｐｆｅｒ法、血红蛋白法和放射免疫法分别测定１８例门奇断流术后１年～７年病人胃液游离酸、胃蛋白酶排泌量及空腹血清胃泌素，观察断流术后远期胃分泌功能的变化。其结果表明，术后远期ＢＡＯ为２．６８±１．０１ｍＥｑ／ｈ，较对照组１．９０±０．４２ｍＥｑ／ｈ增多（Ｐ＜０．０２），术后远期ＭＡＯ７．５３±１．８６ｍＥｑ／ｈ，与对照组８．５４±１．７６ｍＥｑ／ｈ相仿（Ｐ＞０．０５）。术后远期ＢＰＯ、ＭＰＯ与对照组无差异。术后远期空腹血清胃泌素为６５１．０２±３３７．３９ｐｇ／ｍｌ，较对照组２７５．１８±５４．４８ｐｇ／ｍｌ明显增多（Ｐ＜０．００１）。综上，断流术后远期胃泌素增高，胃酸增多，胃相分泌亢进是胃粘膜病变发生的重要原因。所以，确切有效的幽门成形术，克服术后胃潴留至关重要，长期服用制酸剂和胃粘膜保护剂是必要的。     

脾气虚证壁细胞线粒体，G细胞分泌颗粒与血清胃泌素，胃粘膜SOD、MDA的变化

对脾气虚证及肝胃不和证的慢性胃病患者２３例，进行了胃粘膜超微结构研究，胃粘膜超氧化物歧化酶（ＳＯＤ）活性、丙二醛（ＭＤＡ）含量的检测，以及餐后血清胃泌素测定。结果显示：脾气虚患者其壁细胞单位面积的线粒体数目，主细胞酶原颗粒，Ｇ细胞的分泌颗粒，以及餐后血清胃泌素比值均明显低于肝胃不和组（Ｐ＜０．０１）。提示脾气虚患者胃蛋白酶储备不足，Ｇ细胞分泌能力差，分泌功能低下。同时，线粒体的结构亦有明显损伤，认为线粒体质和量的改变，可能是脾气虚证的病理形态改变的主要环节。此外，脾气虚证患者的胃粘膜ＭＤＡ含量高于肝胃不和及正常人（Ｐ＜０．０５），而胃粘膜ＳＯＤ活性则低于肝胃不和及正常人（Ｐ＜０．０５），提示脾气虚证的发病过程可能有氧自由基参与。     

胃粘膜-氧化氮合成酶与血清胃泌素在十二指肠溃疡的变化

为探讨一氧化氮合成酶（ＮＯＳ）在十二指肠溃疡（ＤＵ）的变化及其意义，我们观察了２９例幽门螺杆菌（ＨＰ）阳性的活动期ＤＵ患者。在抗ＨＰ治疗前后的胃粘膜ＮＯＳ活性及空腹血清胃泌素浓度的变化，并与１２例非溃疡性消化不良患者进行比较，结果显示：活动期ＤＵ患者胃粘膜ＮＯＳ活性及血清胃泌素浓度明显高于抗ＨＰ治疗后的愈合期ＤＵ患者（Ｐ＜０．００１和Ｐ＜０．０５）．愈合期ＤＵ患者胃粘膜ＮＯＳ活性及胃泌素浓度与对照组无显著差异（Ｐ＞０．０５）：ＨＰ根除者与未根除者ＮＯＳ变化无明显差异（Ｐ＞０．０５）．而胃泌素浓度在ＨＰ根除者明显下降（Ｐ＜０．００１）。提示：活动期ＤＵ患者ＮＯＳ活性升高可能具有调节胃泌素分泌而有益于溃疡愈合。     

胃病患者幽门螺杆菌根除与血清胃泌素水平变化的关系

本文研究了慢性萎缩性胃炎（ｎ＝２７）、胃溃疡（ｎ＝２５）、十二指肠溃疡（ｎ＝２１）患者ＨＰ感染和血清胃泌素水平的变化，并以２４例正常人作对照。结果表明，治疗４～６周后ＨＰ阳性率明显降低（Ｐ均＜０．０１），血清胃泌素水平在治疗前，萎缩性胃炎（５８．４６±２１．７４ｎｇ／Ｌ）、胃溃疡（６２．６９±２６．８５ｎｇ／Ｌ）和十二指肠溃疡（６６．３８±２９．９２ｎｇ／Ｌ）均明显高于正常人（３０．１２±１２．０４ｎｇ／Ｌ）（Ｐ＜０．０１），治疗４～６周后胃泌素水平均明显降低（Ｐ＜０．０１），提示ＨＰ感染是萎缩性胃炎、消化性溃疡的致病因素。并可引起胃泌素血症，ＨＰ的消除和疾病的治愈或好转，血清胃泌素水平随之降低或恢复正常     

辰、戌时辰四君子汤治疗对“脾虚证”大鼠血清胃泌素昼夜节律性的影响

观察研究了四君子汤在辰、戌时辰治疗“脾虚证”对大鼠血清胃泌素含量及其昼夜节律性的影响。结果发现,正常大鼠血清胃泌素含量有明显的昼夜节律性（Ｐ＜０．０１）,峰相位在０８：４０,“脾虚证”大鼠血清胃泌素含量下降（Ｐ＜０．０１）,节律性消失（Ｐ＞０．０５）,节律中值及振幅显著降低;辰时治疗能显著提高“脾虚证”大鼠血清胃泌素水平（Ｐ＜０．０５）,恢复其节律性（Ｐ＜０．０１）,提高节律中值及振幅;戌时治疗能够提高“脾虚证”大鼠血清胃泌素总体水平（Ｐ＜０．０５）,但对其节律性的恢复作用不明显。     

血清胃泌素在尿毒症胃粘膜病变中的作用

本文研究了２５倒尿毒症患者血清胃泌素对胃粘膜病变的影响，结果胃粘膜病理报告均为胃窦炎，尿毒症患者血清同泌素显著高于对照组（Ｐ＜０．０１），有胃粘膜糜烂出血者血清胃泌素水平高于无胃粘膜糜烂出血者（Ｐ＜０．０５），重度胃炎者血清胃泌素高于轻度胃炎者（Ｐ＜０．０５）．提示血清高胃泌素血症可能是尿毒症胃粘膜病变的原因。     

肺心病加重期及肺癌患者血浆内皮素和心钠素的初步研究

观察肺心病急性加重期和肺癌患者血浆内皮素（ＥＴ）及心钠素（ＡＮＰ）各３０例。结果表明：肺心病急性加重组（下简称肺心加重组）血浆ＥＴ及ＡＮＰ水平均较正常对照组显著升高（Ｐ＜０．０１及Ｐ＜０．０５），且ＥＴ水平与ＡＮＰ及ＰａＣＯ２呈正相关（ｒ＝０．７８，Ｐ＜０．０１；ｒ＝０．６６Ｐ＜０．０１），而与Ｐ３Ｏ；及ｐＮ呈负相关（ｒ＝－０．９５Ｐ＜０．０１；ｒ＝－０．５３Ｐ＜０．０５）；肺癌组ＥＴ，ＡＮＰ亦较对照组显著升高（Ｐ＜０．０５），且ＥＴ与ＡＮＰ呈正相关（ｒ＝０．７９Ｐ＜０．０１）。此结果提示在肺动脉高压、肺心病的形成和发展、肺癌的发生发展以及ＡＮＰ分泌调控中，内皮素可能起着重要作用。缺氧和高碳醚血症可能是ＥＴ合成、分泌的刺激因子。     

幽门螺旋杆菌相关性慢性胃炎胃酸分泌及临床特征(附112例报告)

目的：了解幽门螺旋杆菌（ＨＰ）相关性慢性胃炎胃酸分泌及临床特征。方法：对１１２例ＨＰ阳性慢性胃炎与８３例ＨＰ阴性者进行临床症状及胃酸分泌、基础血清胃泌素水平的比较。结果：两组患者各种消化不良症状的发生率及胃酸分泌，基础血清胃泌素水平均无明显差异。结论：在慢性胃炎患者中，ＨＰ感染与消化不良症状的发生无明显关系，对胃酸分泌也无明显影响。     

正常人及胃、十二指肠溃疡病人的一小时基础胃液

<正> 虽然目前已比较普遍使用纤维胃镜早期诊断胃、十二指肠疾病,但测定胃液分泌功能特别是游离酸排出量仍然是必要的常规检查方法之一。胃游离酸的排出量与壁细胞数及其分泌功能状态有关。壁细胞分泌受神经及体液因素的支配。在安静状态下仅有部分壁细胞进行分泌活动,基础胃液就是测定在安静状态下受试者一小时胃液分泌量及游离酸排出量(以下简     

Gastric acid secretion in Helicobacter pylori positive and negative dyspeptic Nigerians

The pathological role of Helicobacter pylori is largely unproven in our region of high incidence of infection but very low incidence of serious gastroduodenal lesions. The aim of this study was to investigate the effect of H. pylori infection on gastric acid secretion. One week after gastroduodenoscopy, basal and pentagastrin (8 micrograms/kg) stimulated gastric acid secretion were measured in 39 dyspeptic Nigerians. H. pylori status was determined using urease test, culture, histology and serology, while gastritis was assessed using the Sydney system criteria. The median maximal acid output (MAO) and peak acid output (PAO) in mmol/h were significantly higher in H. pylori positive (29.3, range 7.4-81.6 and 34.4, range 7.6-144.0) than in H. pylori negative (16.6, range 4.2-44.1 and 22.4, range 5.6-48.6) patients, p = 0.019 and p = 0.029, respectively. Stimulated gastric acid secretion was significantly higher in patients with duodenal ulcer (n = 8) than in H. pylori negative (n = 11) patients, but was similar in non-ulcer dyspeptics (n = 20) and H. pylori negative patients. The median basal acid output was not significantly different between the groups of patients. Our patients (median age 32 years) had normal mucosa (12.1%), pangastritis with corpus predominance (12.1%), antrum-only gastritis (24.3%) and pangastritis with antral predominance (51.5%). In the subset of H. pylori positive patients (n = 28, 71.8%), there were no significant correlations between grade of antral chronic inflammation, gastritis index score, anti-H. pylori IgG titre and gastric acid secretion, p > 0.05. H. pylori infection increases MAO and PAO in our relatively young patients with antral predominant chronic gastritis.     

幽门螺旋杆菌感染对胃液pH的影响

目的探讨幽门螺旋杆菌感染如何影响胃酸的分泌.方法选择近端胃溃疡患者40例,远端胃溃疡80例,球部溃疡104例.所有患者均经胃镜检查证实,并经快速酶法和病理组织学证实幽门螺杆菌阳性.对近端和远端胃溃疡患者给予奥美拉唑胶囊0.02每日1次口服共6周,球部溃疡共4周,在此基础上,所有患者第1周加阿莫西林1.0和甲硝唑0.4每日2次口服,分别在治疗前、治疗后、治疗后1个月进行胃镜检查并测定胃液pH、氨浓度、血清胃泌素和胃炎积分,并与幽门螺杆菌阴性的40名正常人对照.结果胃液pH和血清胃泌素在胃溃疡(特别是近端胃溃疡)者较球部溃疡和对照组明显升高,幽门螺杆菌根治疗法后,胃溃疡和球部溃疡患者在根除者胃液pH和血清胃泌素水平降至对照组,未根治者这些因素无明显变化.结论本研究提示幽门螺杆菌感染抑制胃酸分泌,提高胃液pH引起高胃泌素血症,而根治幽门螺杆菌使胃酸分泌和血清胃泌素水平正常化.     

HP相关性溃疡病胃酸分泌功能的研究

目的：探讨幽门螺旋杆菌（HP）感染对溃疡病胃酸分泌功能的影响。方法：对19例HP阳性的溃疡病患者于治疗前后进行了胃镜、HP、空腹血清鲁泌素（GAS）及五肽胃泌素胃液分析。并与10例HP阴性溃疡病的结果对比。结果：HP相关性溃疡HP清除前空腹血清GAS，基础胃酸分泌量（BAO）、最大胃酸分泌量（MAO）、高峰胃酸分泌量（PAO）均明显提高，清除HP后均明显降低。而HP阴性溃疡组GAS治疗前后无明显差异，BAO、MAO及PAO治疗前虽亦高于正常，治疗后亦有降低，但均无HP阳性组显著，有统计学意义。提示HP感染可使GAS及胃酸分泌增加，可能是HP相关性溃疡的重要病因之一。     

GASTRIC SECRETORY TEST WITH PENTAGASTRIN. STIMULANT REPORT OF A MULTICENTER STUDYIN PATIENTS WITH VARIOUS GASTRODUODENAL DISEASES

Pentagastrin stimulated gastric secretory tests (PSGST) were performed in 31 normal subjects and 569 patients with various gastro- duodenal diseas.es The mean basal acid output (BAO) and peak acid output (PAO) were higher in patients wi.th duodenal ulcer and[ combined ulcers, lower in patients with chronic atrophic gastritis and gastric carcinoma as compared with normal;s. The PSGST results in patients with chronic superficial gastritis and gastric ulcer were similar to those in normal subjects. Pa- tients with stomal ulcer had a higher PAO than those without stomal ulcer. The clinical value and significance of the test are discussed.     

胃酸分泌过多对反流性食管炎影响的评价

目的 评价胃酸分泌增加对反流性食管炎的影响。方法 内镜检查和食管内24h pH监测确诊的食管炎患者（E组）72例,食管炎伴发十二指肠球部溃疡患者（E＋DU组）45例,30名健康对照者接受胃酸分泌试验、下食管括约肌测压、反流性食管炎相关致病因素多元归逐步删除,自变量对因变量的作用分析。结果 E组患者BAO,MAO,PAO低于E＋DU组患者,E组下食管括约肌压力高于E＋DU组,而括约肌松弛率低于E＋DU组。影响反流性食管炎的3个主要因素排序,E组患者依次为下食管括约肌压力（78．5％）,白天反流（9．2％）和食管裂孔疝（8．7％）。E＋DU组患者三个主要影响因素依次为下食管括约肌（44．8％）,基础胃酸（41．5％）和夜间反流（8．6％）。结论 胃酸分泌过多时,下食管括约肌功能障碍和基础胃酸分泌量增加是导致反流性食管炎的两个重要因素。     

Demographic and endoscopic characteristics of patients with Helicobacter pylori positive and negative peptic ulcer disease

OBJECTIVE: To identify demographic and endoscopic characteristics of patients with Helicobacter pylori positive and negative chronic peptic ulcer disease. DESIGN: Cross-sectional study of peptic ulcer disease in prospectively recruited PATIENTS undergoing gastroscopy. PATIENTS: 277 consecutive patients referred for gastroscopy in 1996-1998. MAIN OUTCOME MEASURES: Rapid urease test, culture and histological examination for H. pylori infection; anti-H. pylori IgG antibodies in serum; demographic data, intake of non-steroidal anti-inflammatory drugs (NSAIDs) in the preceding 3 months, and size, number and location of ulcers. RESULTS: 54 patients (19%) had evidence of peptic ulcer disease (34 gastric ulcer, 14 duodenal ulcer and 6 both gastric and duodenal ulcer); 45 had active chronic peptic ulcer disease and were analysed in detail. H. pylori was present in 25 (56%) of these patients; 10 (22%) had used NSAIDs and 7 of the NSAID group also had H. pylori infection. Of the patients with gastric ulcers, those with non-H. pylori, non-NSAID ulcers were significantly younger than both those with H. pylori-associated ulcers (mean age, 48 v. 65 years, P = 0.02) and those with NSAID-associated ulcers (mean age, 48 v 68 years, P = 0.02). The average size and number of gastric ulcers did not differ between patients with and without H. pylori infection. Of patients with duodenal ulcers, those with H. pylori infection had significantly fewer ulcers (1.1 v. 1.8, P = 0.04), although ulcer size was similar in the infected and uninfected groups. CONCLUSIONS: Gastric ulcers may now be more common than duodenal ulcers. Gastric ulcers associated with H. pylori infection and/or NSAID use occurred mostly in older people, while non-H. pylori, non-NSAID gastric ulcers were more common in younger patients. In the duodenum, single ulcers were associated with H. pylori infection, and multiple ulcers were more frequent in the non-H. pylori, non-NSAID group.     

Effect of treatment with cimetidine for one year on gastrin cell and parietal cell function and sensitivity to cimetidine in patients with duodenal or gastric ulcers.

Twenty-two duodenal and 16 gastric ulcer patients were treated with 400 mg cimetidine twice daily for one year after their ulcers had healed. No change in gastric acid secretion was observed before and after treatment in 20 duodenal and 13 gastric ulcer patients. Similarly, the inhibitory effect of 200 mg cimetidine on gastric acid secretion was unaltered in 11 duodenal and 6 gastric ulcer patients studied and cimetidine blood concentration were unchanged in 9 duodenal and 4 gastric ulcer patients after one year. In 7 duodenal and 6 gastric ulcer patients the serum gastrin response to a standard test meal before and after treatment was identical.     

幽门螺杆菌感染对十二指肠溃疡患者血清胃泌素、一氧化氮合酶影响的研究

目的:探讨幽门螺杆菌(Helicobacter pylori,H.ylori)对十二指肠溃疡(DU)患者血清胃泌素、胃粘膜一氧化氮合酶(NOS)的影响及其意义,从而为治疗H.pylori相关性疾病寻求新的措施.方法:本文观察了59例H.pylori阳性活动期DU患者,采用三联疗法(奥美啦唑20mg bid,克拉霉素0.25tid,甲硝唑0.2tid,疗程2周)根除H.pylori,在抗H.pylori治疗前后对胃粘膜NOS和空腹血清胃泌素进行检测,并与年龄相比拟的39例非溃疡性消化不良患者进行比较.结果:H.pylori阳性活动期DU患者胃粘膜NOS及空腹血清胃泌素浓度,在治疗前显著高于治疗后愈合期DU患者(P＜0.001和P＜0.005),而愈合期DU患者的胃粘膜NOS和空腹胃泌素浓度与对照组相比,无显著性差异(P＞0.05);空腹血清胃泌素浓度在H.pylori根除后明显下降.结论:H.pylori感染可引起胃粘膜NOS生成增加、活性增强,由此调节着胃泌素的分泌,导致溃疡等胃肠疾病的发生;临床上可通过寻找特异性抑制NOS试剂,为临床治疗DU开辟新的领域.     

兰索拉唑用药前后幽门螺杆菌在胃内分布的变化

目的: 探讨抑酸药兰索拉唑对幽门螺杆菌Helicobacter pylori(简称H.pylori)在胃内分布的影响.方法: 检查43例有H.pylori感染的十二指肠溃疡患者在服用兰索拉唑前后的胃镜活检组织切片,活检部位分别为窦小弯及体大弯,对活检组织切片做HE及Warthin-Starry嗜银染色,观察窦体两部位H.pylori检出率、密度及胃炎活动程度的变化.结果: (1)窦小弯用药前、用药后4周及3个月H.pylori的检出率分别为93.02%,58.14%和86.05%,用药后4周H.pylori检出率及密度明显低于用药前及用药后3个月(均P<0.01).(2)体大弯用药后4周和3个月H.pylori的密度较用药前增加.(3)窦小弯用药后4周胃炎活动性的检出率明显低于用药前及用药后3个月,胃炎活动程度也轻于后两者.(4)体大弯用药后4周和3个月胃炎活动性检出率较用药前增加,胃炎活动程度也加重.(5)窦小弯及体大弯用药前后胃炎活动性与H.pylori检出率之间变化呈正相关(分别为r=0.995 1,r=0.960 8).结论: 兰索拉唑可使幽门螺杆菌在胃内的定植部位发生改变,窦小弯H.pylori检出率下降、密度减少,而体大弯密度增加,此种影响在用药后1个月左右最为明显,胃炎活动性与H.pylori检出率的变化关系密切.