幽门螺杆菌感染与结石性胆囊炎及术后综合征的关系

目的 分析幽门螺杆菌(HP)感染与结石性胆囊炎及胆囊切除术后综合征(pCS)的关系.方法 选取行胆囊切除术结石性胆囊炎患者132例,年龄22 ～76[平均(48.60±12.36)]岁,根据是否发生PCS将患者分为PCS组和非PCS组,采用Giemsa染色、HP免疫组织化学和PCR法检测胆囊黏膜HP感染情况,观察胆汁HP IgG和HP PCR结果.同时,选取同期非结石性胆囊炎患者63例为对照组,年龄25 ～79[平均(49.50±12.62)]岁,比较两组患者相关参数的异同,以及PCS组和非PCS组患者之间参数异同.结果 结石性胆囊炎组患者胆囊黏膜Giemsa染色、胆囊黏膜HP免疫组化和HP PCR、胆汁HP IgG和胆汁HP PCR方法检测HP感染阳性率显著高于对照组(P＜0.05);PCS组患者胆囊黏膜Giemsa染色、胆囊黏膜HP免疫组化和HP PCR、胆汁HP IgG和胆汁HP PCR方法检测HP感染阳性率显著高于非PCS组(P＜0.05).结论 HP感染可能是结石性胆囊炎形成和其胆囊切除术后PCS发生的重要因素之一.     

幽门螺杆菌感染在胆囊结石形成中的作用

目的探讨胆管系统幽门螺杆菌（HP）感染与胆囊结石形成的关系。方法分别采用ELISA及免疫组化SP法检测68例胆囊结石（结石组）、19例胆囊息肉（非结石组）患者的胆汁及胆囊黏膜中的HP。结果两组胆囊黏膜、胆汁HP阳性率（20．6％、48．6％;26．3％、55．0％）比较,P〉0．05。结论单纯HP在胆囊结石形成过程中不起主要作用。     

胆色素结石患者胆道系统幽门螺杆菌研究

目的探讨幽门螺杆菌（Hp）感染与胆色素结石形成的关系。方法取35例胆色素性结石患者（实验组）及10例对照组患者胆汁进行需氧菌、厌氧菌及Hp培养，采用PCR方法检测胆囊管黏膜、胆管黏膜、胆汁和胆石核心中的Hp-DNA；所有黏膜用Warthin-Starry银染色法染色，Western印迹法检测胆汁中Hp感染相关蛋白。结果所有胆汁培养均未发现Hp生长。实验组胆石核心、胆汁和黏膜的Hp-DNA扩增阳性率分别为14．29％、31．43％和56．67％。Hp-DNA阳性胆汁中，检出细胞毒素相关抗原（Cag A）7例，细胞空泡毒素（Vac A）6例，同时检出Hp Vac A相关亚单位（相对分子质量37000）、糖蛋白（相对分子质量35000）、尿素酶B和尿素酶A。实验组30例胆管黏膜经Warthin-Starry染色后有7例（23．33％）镜下观察到类似Hp的菌体。对照组胆汁和黏膜Hp-DNA阴性，胆汁中未检出Hp感染相关蛋白，黏膜Warthin-Starry染色后，镜下未观察到类似Hp的菌体。结论胆色素结石患者胆道系统中存在Hp感染依据，并存在多种Hp感染相关蛋白，Hp感染可能参与胆色素性结石的形成。     

细胞毒素相关基因A阳性幽门螺杆菌感染与脑梗死的关系

目的：研究幽门螺杆菌（HP）及其细胞毒素相关蛋白A（CagA）阳性菌株感染与脑梗死的相关性。方法：采用病例对照研究研究,选择发病1周内的脑梗死住院患者（病例组,n=70）以及年龄和性别相匹配的门诊体检人群（对照组,n=30）,检测血清HP IgG抗体和HPCagA阳性菌株IgG抗体的浓度和阳性率,调查两组传统高危因素分布情况、生活习惯、幼时和成人期社会经济状况,探讨HP和CagA阳性菌株血清抗体浓度和阳性率与脑梗死及其病因学亚型的关系。结果：病例组血清HPIgG抗体阳性率和水平与对照组无显著差异,血清CagAIgG抗体阳性率（P〈0．05）和浓度（P〈0．01）均显著高于对照组。多因素回归分析显示,CagA菌株血清学阳性为脑梗死发病的独立危险因素。亚组分析表明,大动脉粥样硬化性脑梗死组血清CagA菌株IgG抗体的阳性率和浓度显著高于对照组（P〈0．05）。结论：产CagA的高毒力HP菌株感染可能是脑梗死的高危因素。     

RA患者血清免疫球蛋白、急性时相蛋白、IL-27水平变化及意义

目的探讨血清免疫球蛋白、急性时相蛋白及IL-27在类风湿关节炎（RA）发病中的作用。方法选择56例RA患者（RA组）和同期健康体检者30例（对照组）,分别采用免疫散射比浊法测定血清免疫球蛋白（IgM、IgG、IgA）、急性时相蛋白[C反应蛋白（CRP）、α1-酸性糖蛋白（AAG）、触珠蛋白（HP）、铜蓝蛋白（CER）、转铁蛋白（TRF）、C3]及类风湿因子（RF）,ELISA法检测血清IL-27水平,魏氏法测定红细胞沉降率（ESR）;并对各指标之间的关系行Pearson相关性分析。结果RA组血清IgG、IgA、CRP、AAG、HP、CER、C3及IL-27均明显高于对照组,TRF明显低于对照组（P均〈0．05）;RA组血清IgG、IgA、CRP、AAG、HP、CER及C3与CRP、ESR均呈直线正相关（P均〈0．05）,TRF与CRP、ESR呈直线负相关（P均〈0．05）,CRP、AAG、HP、CER、TRF及C3与RF无明显相关性（P〉0．05）,IL-27与CRP、ESR及RF均无明显相关性（P〉0．05）。结论IgG、IgA、CRP、AAG、HP、TRF、C3及IL-27均参与了RA的发病过程,检测此类指标有助于RA的早期发现与诊断。     

老年冠心病患者炎症反应与肺炎衣原体感染相互关系的研究

目的 探讨老年冠心病患者肺炎衣原体（Cpn）感染与白细胞介素-1β（IL-1β）、C反应蛋白（CRP）及纤维蛋白原（Fg）间的相互关系。方法 采用数量免疫荧光法检测急性心肌梗死（AMI）组、心绞痛（AP）组及对照组患者各30例外周血Cpn IgG抗体，同时应用放免法检测血清IL-1β浓度，应用免疫浊度法测定血浆Fg及血清CRP水平。结果 AMI组、AP组血清抗Cpn IgG抗体阳性率显著高于对照组（均P〈0.01）,且AMI组与AP组间也有显著性差异（P〈0.01）。AMI组、AP组的血清IL-1β、CRP及血浆Fg水平显著高于对照组（均P〈0.01），Cpn感染者特异性抗体IgG滴度与血中IL-1β、CRP及Fg水平明显相关。结论 老年冠心病患者Cpn感染率明显增高，Cpn可能通过介导炎症反应及诱生急性相蛋白在冠心病的发生、发展中起作用。     

基于胆结石患者胆汁、粪便和血清标本的4种诊断华支睾吸虫感染方法的评价

目的 比较并评价粪便改良加藤厚涂片法（Kato-Katz法）、胆汁离心镜检法、血清胶体金免疫层析法（colloid gold labeled immunochromatographic,CGIA）和酶联免疫吸附试验（enzyme-linked immunosorbent assay,ELISA）检测粪便、胆汁、血清诊断华支睾吸虫感染的价值. 方法 收集92例胆结石患者的胆汁、血清和粪便,分别采用镜检法检查胆汁华支睾吸虫卵、用Kato-Katz法检查粪便华支睾吸虫卵,用CGIA法和ELISA法检测血清华支睾吸虫IgG抗体,计算并分析各检测方法的阳性率、灵敏度、特异性、阳性预测值、阴性预测值和Youden指数. 结果 Kato-Katz法联合胆汁离心镜检法共确诊感染49例,阳性率为53.3％.与之相比,Kato-Katz法、胆汁离心镜检法、CGIA和ELISA的符合率分别为80.4％、84.8％、90.2％和96.7％.Kato-Katz法、胆汁离心镜检法、CGIA和ELISA法的灵敏度分别是63.3％、93.9％、98.0％和93.9％;特异性分别为100％、100％、69.8％和86.0％;阳性预测值则分别是100％、100％、78.7％和88.5％,阴性预测值分别为70.5％、93.5％、96.8％和92.5％,Youden指数为0.63、0.94、0.68和0.80. 结论 胆汁离心镜检是胆结石手术患者诊断华支睾吸虫感染的首选方法;但对于无法获得胆汁的受检者而言,血清IgG抗体检测在排除华支睾吸虫感染、粪便Kato-Katz法在确诊感染方面有较好的临床应用价值.     

胆结石患者胆汁中幽门螺杆菌细胞毒素相关蛋白的检测及意义

目的 探讨幽门螺杆菌(Hp)与胆结石形成的相关性,寻找Hp在胆汁中存在的证据,同时对胆汁中细菌检测方法进行研究分析.方法 选择36例胆结石患者,其中28例采用胆管穿刺、8例采用内镜下选择性胆管插管抽取胆汁,用酶联免疫吸附法(ELISA)定量检测胆汁中Hp-CagA IgG,与对照组16例进行比较.结果 结石组与对照组、伴有和不伴有急性胆管炎的胆结石患者胆汁中Hp-CagA IgG检出的阳性率均有显著性差异(P<0.05),而术中胆管穿刺与内镜下选择性胆管插管抽取的胆汁中Hp-CagA ISG检出的阳性率无显著性差异(P>0.05).结论 Hp可能存在于胆道,并与胆结石的形成有一定的关系;经内镜选择性胆管插管抽取胆汁进行Hp-CagA IgG的检测是可行的.     

糖尿病与胆结石形成相关性的临床研究

应用高效液相色谱法（HPLC）紫外检测52例胆结石、糖尿病、糖尿病胆结石患者与15例正常对照者血清七种结合胆汁酸的含量，结果发现：三种疾病患者均存在着不同程度的胆汁酸代谢的改变。，糖尿病及糖尿病胆结石组与正常对照组比较血清TCBA量均增加（P＜0.01）。糖尿病及糖尿病胆结石组TG、CHO、LDL值均升高（P＜0．05．0．01）。提示：糖尿病患者存在着明显的脂质代谢紊乱及胆汁酸池体积缩小，与胆结石的形成密切相关。     

老龄患者胆总管结石与幽门螺杆菌感染的关系

幽门螺杆菌（HP）是1种存在于胃黏膜的革兰氏阴性需氧菌,与多种疾病有关,包括胃肠道疾病、特发性血小板减少性紫癜、缺铁性贫血、冠状动脉粥样硬化性心脏病、痤疮、湿疹等”。1998年Flgum发现胆结石患者存在幽门螺杆菌感染,而且幽门螺杆菌可以使胆汁中的直接胆红素转变成为间接胆红素,间接胆红素与钙结合则形成胆结石。我们通过检测^14C呼气试验DPM值、血清及胆汁HP-IgG抗体,了解老龄胆总管结石患者中幽门螺杆菌的感染率。     

Influence of fever on biliary elements of guinea pigs

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Common presence of Helicobacter DNA in the gallbladder of patients with gallstone diseases and controls

BACKGROUND: Several species of Helicobacter colonise the biliary tract of animals and cause hepatobiliary diseases. Helicobacter species have also been identified in the gallbladder of a high proportion of Chilean patients with gallbladder cancer. AIM: To determine the presence of Helicobacter species, particularly Helicobacter pylori and Helicobacter bilis, in the gallbladder of patients with non-malignant gallbladder diseases and control patients. PATIENTS AND METHODS: DNA was extracted from gallbladder samples from 122 consecutive patients undergoing cholecystectomy. The presence of Helicobacter genus-specific or Helicobacter pylori and Helicobacter bilis species-specific DNA was determined by polymerase chain reaction and sequence analysis. The presence of Helicobacter pylori-specific immunoglobulin G in the serum (n=84) and bile (n=104) samples was determined by enzyme linked immunosorbent assay. RESULTS: Helicobacter DNA was detected in 61 (50.0%) gallbladder samples: 29 of 60 (48.3%) patients with symptomatic gallstone, six of 10 (60.0%) patients with asymptomatic gallstones, 11 of 15 (73.3%) patients with other biliary diseases, and 15 of 37 (40.5%) control patients, respectively. Among them, 39 samples were positive for Helicobacter pylori but none were positive for Helicobacter bilis. Sequence analysis of Helicobacter genus-positive samples showed that 56 samples were Helicobacter pylori and five were Helicobacter species 'Liver 3' strain. Overall, there was no significant difference in the detection rate of Helicobacter DNA or the levels of serum and bile Helicobacter pylori-specific immunoglobulin G in the various biliary disease groups compared with control patients. Neither was there any significant difference in the blood biochemistry and liver function tests between patients with positive and negative Helicobacter DNA detection. CONCLUSION: Helicobacter species' DNA are commonly present in the gallbladder of patients with gallstone diseases and in controls, implying that Helicobacter infection alone may not play a significant role in the formation of gallstones. However, our results do not exclude the possibility of Helicobacter infection as a cofactor in the development of gallstones.     

免疫球蛋白在胆囊胆固醇结石形成中的作用研究

目的:探讨胆囊胆汁和胆囊组织中免疫球蛋白在胆囊胆固醇结石形成中的作用。方法:采用放射免疫分析(RIA)方法分别测定了56例胆囊胆固醇结石及24例非胆石对照患者胆囊组织和胆囊胆汁中sIgA、IgG、IgM、IgE的含量。结果:胆囊胆固醇结石组胆囊组织和胆囊胆汁中sIgA、IgG、IgM、IgE均与对照组有显著性差异(P<0.01或P<0.05),并且胆囊胆固醇结石组胆囊组织中sIgA、IgM、IgE与胆囊胆汁中的sIgA、IgM、IgE成显著正相关关系。多发结石组胆囊胆汁中IgG与单发结石组有显著性差异(P<0.05),而其sIgA、IgM、IgE及胆囊组织中sIgA、IgG、IgM、IgE与单发结石组虽无显著性差异,但均有升高。结论:本实验结果提示:胆囊组织及胆囊胆汁中免疫球蛋白sIgA、IgG、IgM、IgE与胆囊胆固醇结石的形成密切相关,并在胆囊胆固醇结石的形成过程中起着重要作用,为胆囊胆固醇结石形成过程中的重要促成核因子。     

Effects of sphingolipid synthesis inhibition on cholesterol gallstone formation in C57BL/6J mice

Background: Sphingolipids play a very important role in cell membrane formation, signal transduction and plasma lipoprotein metabolism. The first rate‐limiting step in the sphingolipid biosynthetic pathway is catalyzed by serine palmitoyltransferase (SPT), and myriocin is a potent and specific inhibitor of SPT. We investigated the impact of SPT inhibition on cholesterol gallstone formation in C57BL/6J mice. Methods: Three groups of eight‐week‐old C57BL/6J mice were utilized. Each group consisted of 20 mice; group A, B, and C were fed normal chow, lithogenic diet with phosphate buffered saline, and lithogenic diet with myriocin (0.3 mg/kg), respectively, for 6 weeks. The ceramide levels in both serum and bile were assessed by high performance liquid chromatography analysis. Protein expression of ERK, JNK and p38 in the extracted gallbladder were determined by Western‐blot analysis. Results: Myriocin treatment caused a significant decrease in the rate of cholesterol gallstone formation. The lithogenic diet mice (group B) showed the highest ceramide activities in both the serum and bile among all the tested groups and there was significant suppression of the ceramide levels in both the serum and bile of the myriocin‐treated mice (group C, p < 0.05). Phosphorylation of p38 in the gallbladder was increased in the lithogenic‐diet mice and the expression of phosphorylated p38 was significantly suppressed in the myriocin treated mice. Conclusions: SPT inhibition by myriocin suppressed gallstone formation and the levels of ceramide in both the serum and bile. p38 in the cellular signaling pathways might be associated with cholesterol gallstone formation.     

Properties of immunoglobulin A in serum of individuals with liver diseases and in hepatic bile

In comparison with normal individuals, sera of patients with alcoholic cirrhosis and other liver diseases had two to four times higher levels of immunoglobulin A and three to ten time higher levels of polymeric immunoglobulin A. The possible participation of the liver in the selective removal of polymeric immunoglobulin A from serum into bile was investigated by analyzing immunoglobulin A in serum and bile specimens obtained from a group of patients with T-tube drainage of the common bile duct. Gel filtration revealed three principal fractions of biliary immunoglobulin A: secretory immunoglobulin A with J chain and secretory component; polymeric immunoglobulin A associated with J chain; and monomeric immunoglobulin A devoid of J chain and secretory component. Secretory component-complexed immunoglobulin A composed only 50% or less of the total biliary immunoglobulin A. In comparison with immunoglobulin G, polymeric forms of immunoglobulin A appeared to be selectively transported into bile whereas monomeric immunoglobulin A was not. These data suggested that the liver selectively transports polymeric immunoglobulin A from serum into bile by both secretory component-dependent and -independent mechanisms.     

Predicting Gallstone Pancreatitis with Laboratory Parameters: A Meta-analysis

Objectives: In order to define the usefulness of biochemical laboratory values in distinguishing gallstone from non-gallstone acute pancreatitis, we performed a meta-analysis. Methods: Studies that utilized the bilirubin, alkaline phosphatase, alanine aminotransferase (ALT), and aspartate transaminase in the evaluation of the gallstone pancreatitis were included. Results: Using receiver operating characteristic curves for each of these four parameters, we determined that the ALT level was the most clinically useful parameter. The higher the serum level of ALT, the greater its specificity and positive predictive value in diagnosing gallstone pancreatitis. At ALT levels greater than or equal to 150 IU/L (approximately a 3-fold elevation), the probability of gallstone pancreatitis is 95%. Our analyses of total bilirubin and alkaline phosphatase serum levels indicate that these tests are not useful in the diagnosis of gallstone pancreatitis. Aspartate transaminase levels are nearly as useful as ALT. Conclusions: A ≥3-fold elevation of ALT in the presence of acute pancreatitis has a positive predictive value of 95% in diagnosing acute gallstone pancreatitis.     

胆囊结石症的血清脂质、瘦素、胆囊收缩素和胆脂水平分析

目的 探讨胆囊胆固醇结石患者血清脂质、瘦素、胆囊收缩素(CCK)和胆脂水平变化与胆囊胆固醇结石形成的关系及临床意义.方法 按胆囊结石成分将患者分为胆固醇结石组(99例)和非胆固醇结石组(57例),测定该两组及正常对照组(52名)的血脂、脂蛋白、载脂蛋白(Apo)、瘦素、CCK水平和胆汁中胆固醇、磷脂和胆汁酸浓度,比较分析三组间血脂、胆脂、瘦素和CCK的水平差异.结果 胆固醇结石组血清三酰甘油、总胆固醇和载脂蛋白B(Apo-B)均高于正常对照组(P值分别为0.000、0.002和0.017),非胆固醇结石组血清三酰甘油、总胆固醇明显高于正常对照组(P值分别为0.000和0.001);两结石组患者的血清高密度脂蛋白与CCK均显著低于正常对照组(P值均为0.000).男性患者血清瘦素水平显著高于正常对照组(P=0.016).两组患者胆汁中的胆固醇饱和指数(CSI)均大于1.结论 血清CCK、三酰甘油、胆固醇、高密度脂蛋白、Apo-B和瘦素水平变化可能与胆囊结石的形成有关.     

幽门螺杆菌、胃泌素与慢性胃炎的关系

目的：对慢性浅表性胃炎（ＣＧＳ）患者行幽门螺杆菌（ＨＰ）及空腹血清胃泌素（ＳＧ）检测,对ＨＰ（＋）组和ＨＰ（－）组ＳＧ作对比,抗ＨＰ治疗前后ＳＧ、病理组织学作比较,探讨两者与ＣＳＧ的关系。方法：患者先行空腹作ＳＧ测定,再作胃镜检查,取胃罕粘膜３块,分另作快速尿素酶试验、Ｇｉｅｍｓａ染色及病理组织学检查。ＨＰ（＋）组抗ＨＰ治疗,１月后重复上述检查。结果：ＨＰ（＋）且ＳＧ明显高于ＨＰ（－）组（Ｐ〈０．     

不同PCR引物检测胆囊结石中纳米细菌效果的研究

目的评价不同PCR引物检测胆囊结石患者胆汁和结石中纳米细菌(NB)的临床价值.方法 对30例结石标本,43例胆汁标本采用间接免疫荧光染色,透射电镜扫描和PCR检测标本中的NB.结果 PCR引物1,2检测NB阳性率分别为56.1%和86.4%,培养物间接免疫荧光染色(CIIFS)阳性率为54.5%,对比评价表明引物1特异性更高,与CIIFS结果一致率高,两者阳性率无统计学差异(P > 0. 05),引物1检测NB的敏感性为75.0%,特异性为66.7%,阳性预测价值为73.0%,阴性预测价值为69.0%.引物1未培养组阳性率为29.6%,培养组阳性率为50%,两者阳性率有统计学差异(P<0.05),培养后可明显提高NB的检出率.引物1结石组阳性率为46.7%,胆汁组阳性率为63.9%,两者阳性率无统计学差异(P>0.05).结论 PCR引物1检测胆囊结石患者NB结果与CIIFS有较高的一致性,培养后可明显提高NB的检出率,为NB相关疾病的检测提供了一种快速,可靠的方法,具有重要的参考价值.