胃十二指肠疾病患者中cagA阳性幽门螺杆菌的普遍易感性

明确cagA阳性幽门螺杆菌（H.pyloril)胃十二指肠疾病患者中的感染情况。方法：用聚合酶链反应（PCR）方法扩增从30例十二指肠球部溃疡、30例慢性胃炎和6例胃癌虱活检组织中分离培养出的H.pylori菌株的cagA基因片段,用酶联免疫吸附测定（ELISA）方法检测血清抗H.pylori抗体,用免疫印迹（Western blot)方法检测血清抗cagA抗体。结果：用PCR方法测得的cagA基因阳性率为：十二指肠球部溃疡70％（21／30）,慢性胃炎73％（22／30）,胃癌83％（5／6）。66份血清标本抗H.phlori抗体均为阳性。用Western blot方法测得的抗cagA抗体阳性率为：十二指肠球部溃疡83％（25／30）,慢性胃炎77％（23／30）,胃癌83％（5／6）。结论：在我国人群中,cagA基因不能作为消化性溃疡的标志物,cagA阳性H.pylori在消化性溃疡和慢性胃炎患者中存在普遍易感性。     

CagA+Hp感染与消化性溃疡

目的本文旨在探讨十二指肠球部溃疡、胃溃疡等与产细胞毒相关蛋白A幽门螺旋杆菌(CagA+Hp)感染的关系.方法分为三组即无症状对照组、十二指肠球部溃疡及胃溃疡组,Hp感染以快速尿素酶试验(RUT)、14C-呼气试验(14C-URT)和(或)病理特殊染色确定,CagA+Hp感染则进一步通过检测血清CagA IgG加以确定.分别计算各组Hp及CagA+Hp的感染率及Ca-gA+Hp占Hp感染的比例,并作组间比较.结果消化性溃疡时,Hp及CagA+Hp的感染率以及CagA+Hp与Hp感染者之比率均明显高于正常对照组,统计学差异显著(P＜0.01).结论Hp与十二指肠球部溃疡及胃溃疡的发生高度相关,其感染率达90%以上,其中产CagA型Hp又占九成以上,可见CagA+Hp感染与消化性溃疡关系密切,这在消化溃疡的防治中应引起足够的重视.     

幽门螺杆菌细胞毒素相关蛋白A与胃十二指肠溃疡关系的病例对照研究

目的本文从流行病学角度研究西安地区幽门螺杆菌细胞毒素相关蛋白A(CagA)阳性Hp菌株感染与胃十二指肠溃疡发病的关系.方法采用病例对照研究方法,病例组与对照组的配比比例为1:2.病例组为本院消化科自1997-10/1998-10连续住院的患者,经内镜检查及病理检查证实为活动期胃溃疡和(或)十二指肠溃疡.对照组分为两组,对照1组为同期住院的本科及其他科住院的非胃十二指肠疾病患者,对照2组为同期普查健康人群.病例组与对照组的配比因素为性别、民族、年龄(相差5岁以内).采用问卷调查,内容涉及与胃十二指肠溃疡发病可能有关的32个因素,对所有因素进行量化,应用SAS软件进行处理.CagA阳性Hp感染的检测结果分析采用X2检验.对所调查因素首先进行1:1及1:2单因素条件Logistic回归分析,有显著性意义的因素,计算近似相对危险度(odds ratio,OR)及其95%的可信区间(confidenceinterval,CI).两因素协同作用采用分层分析方法.对单因素分析时作用较大及调查结果较准确的因素,用多因素条件Logistic回归分析.血清中抗CagA抗体的检测采用斑点金免疫渗滤法(DIGFA).结果①在胃溃疡组与对照1组及对照2组的配对研究中,胃溃疡组的CagA阳性Hp感染率显著高于两个对照组,OR分别为5.0与6.5,P分别＜0.05及＜0.01.②在十二指肠溃疡组与对照1组及对照2组的配对研究中,十二指肠溃疡组的CagA阳性Hp感染率显著高于两个对照组,OR分别为9.33与11.00,P分别＜0.05及＜0.01.③1:1及1:2单因素及多因素Logistic回归分析表明,CagA阳性Hp感染、吸烟、饮酒、食酸辣食物、生活不规律、精神因素等因素与胃十二指肠溃疡发病呈正相关,而按时进餐与胃十二指肠溃疡发病呈负相关.CagA阳性Hp感染与胃溃疡及十二指肠溃疡的发生具有密切的相关性(OR=16.61-84.49).④双因素分层分析中,吸烟、饮酒、生活不规律、精神因素、食酸辣食物等因素与CagA阳性Hp感染之间作用相互独立,但在胃十二指肠溃疡病的发生中具有协同作用.结论消化性溃疡的发生是众多因素共同作用的结果,CagA阳性Hp菌株感染是引起胃溃疡及十二指肠溃疡多因素病因学中一个非常重要的、危险的因素.重视CagA阳性Hp菌株的研究,对预防和治疗消化性溃疡具有重要的临床意义和社会意义.     

上海市嘉定地区2870例消化道溃疡内镜下改变临床分析

目的探讨消化性溃疡的分布规律,以内镜下改变及病理学分析为节点,揭示溃疡的特点,更好地指导今后的临床及科研工作。方法收集2 870例胃镜检查人群的基本信息,包括性别、年龄、胃镜检查结果及相关病理结果。行胃溃疡、十二指肠球部溃疡、复合性溃疡分组并对收集资料进行分析。结果经胃镜检查确诊为消化性溃疡,总检出率为13.62%,男女之比约为2.6∶1,年龄(49.41±15.26)岁,3~6月份检出率显著高于其他季度,3年消化性溃疡的年检出率差异无统计学意义,消化性溃疡直径1 cm占74.15%,幽门螺杆菌(Helicobacter pylori,H.pylori)阳性占71.64%。十二指肠球部溃疡、胃溃疡、复合性溃疡、食管溃疡检出率占消化性溃疡的48.19%、46.48%、4.18%、1.15%。十二指肠溃疡与胃溃疡之比约为1.04∶1。溃疡部位以十二指肠球部前壁溃疡、胃窦部前壁溃疡、十二指肠球部溃疡+胃窦者、食管下段最多见,恶性溃疡占胃溃疡、复合性溃疡、食管溃疡的8.92%、2.50%、27.27%。十二指肠溃疡、胃溃疡、复合性溃疡、食管溃疡H.pylori感染率分别为74.84%、66.94%、86.67%、72.73%。结论根据上海市嘉定地区消化性溃疡病的检出率分析有必要在50岁以上人群中全面开展胃镜工作,全面提高消化性溃疡诊疗水平,检测H.pylori感染等。全面了解上海消化性溃疡的发病规律,为如何降低本市人群中消化性溃疡疾病的发病率提供依据。     

维吾尔族消化性溃疡383例临床分析

目的了解本地区维吾尔族(简称维族)消化性溃疡的临床特点,并发症及幽门螺杆菌(Hp)感染情况。方法对2002年1月～2009年12月在我院住院检查确诊为消化性溃疡维族患者的病历资料结果进行回顾性分析。结果 (1)本组资料消化性溃疡患者中十二指肠球部溃疡332例(占86.68%),胃溃疡36例(占9.4%),男女之比为3.16:1,男性明显多于女性。(2)消化性溃疡的高发年龄段为中年,共215例(占56.14%),十二指肠球部溃疡多见于中青年,共302例(占90.96%),胃溃疡见于中老年,共32例(占88.89%)。(3)消化性溃疡的主要并发症是出血69例(95.83%),其中十二指肠球部溃疡出血49例(占71.01%)。(4)消化性溃疡Hp检出356例(占93.47%),其中十二指肠球部溃疡中Hp检出318例(95.78%),胃溃疡中的Hp检出30例(占83.33%)。结论本组消化性溃疡患者男性明显多于女性,十二指肠球部溃疡多见于中青年,胃溃疡多见于中老年,消化性溃疡的常见并发症主要是出血,消化性溃疡Hp感染检出率高,患者无种族差异。     

幽门螺杆菌相关性消化性溃疡与小肠细菌过度生长的关系

目的观察幽门螺杆菌(Helicobacter pylori,H.pylori)相关性消化性溃疡有无小肠细菌过度生长,以指导临床实践。方法对78例幽门螺杆菌相关性消化性溃疡组患者和健康对照组患者进行葡萄糖呼气试验。结果胃溃疡、十二指肠溃疡组小肠细菌过度生长(SIBO)阳性率分别为4.3%(2/46)、6.3%(2/32),胃溃疡组、十二指肠溃疡组、健康对照组在基础值及试餐后氢呼气浓度差异均无统计学意义(P>0.05)。结论幽门螺杆菌相关性消化性溃疡患者并未出现小肠细菌过度生长,只需进行根除H.pylori治疗。     

小儿消化性溃疡102例

目的探讨小儿消化性溃疡的特征及其与幽门螺杆菌(Hp)的关系.方法102例消化性溃疡的患儿经内镜检查胃粘膜进行快速尿素酶试验检测Hp.结果本组小儿消化性溃疡Hp检出率77.5%(79/102),其中十二指肠溃疡(DU)占74.7%(59/79),胃溃疡(GU)占18.9%(15/79),复合性溃疡占6.4%(5/79).年龄5岁～14岁,男女2.921,>6岁占92.2%,以十二指肠溃疡多见,GUDU=13.87;<6岁GUDU=11.71.十二指肠溃疡发生于球部92.3%(60/65),单发溃疡占44.6%(29/65),多发溃疡占15.4%(10/65),霜斑样溃疡占40%(26/65);胃溃疡中单发占70.4%(19/27),多发性溃疡占29.6%(8/27).溃疡复发者均伴Hp感染.结论小儿消化性溃疡好发于学龄期以上,以十二指肠溃疡为多见,十二指肠溃疡与Hp感染密切相关,复发亦与其有关.     

兰州地区人群血清幽门螺杆菌致病因子抗体与上消化道疾病的关系

目的研究兰州地区患者中幽门螺杆菌(Hp)致病因子VacA、CagA、UreA和UreB与上消化道疾病的关系。方法病理学HE染色诊断患者,免疫印迹技术检测80例慢性萎缩性胃炎(16例)、消化性溃疡(24例)及胃癌患者(40例)血清中VacA、CagA、UreA和UreB抗体,分析与疾病的相关性。结果兰州地区人群上消化道疾病患者中HpCagA、VacA、UreA和UreB抗体阳性率依次为87.50%、95.00%、82.50%和80.00%;消化性溃疡组UreB抗体阳性率显著低于胃癌组(P0.05);在消化性溃疡、胃癌组中CagA抗体阳性率显著高于萎缩性胃炎组(P0.05)。结论兰州地区上消化道疾病患者中Hp感染率高,以Ⅰ型菌株为主;UreB与胃癌的发病关系密切;CagA在消化性溃疡和胃癌发生中的作用更为明显。     

幽门螺杆菌Cag A抗体的临床意义

对慢性胃炎、消化性溃疡患者进行细胞毒素相关基因蛋白 (ＣａｇＡ)抗体检测 ,并测定血清幽门螺杆菌 (Ｈｐ)抗体ＩｇＧ浓度 ,以探索血清ＣａｇＡ ＨｐＩｇＧ与十二指肠球部溃疡 (ＤＵ)、胃溃疡、慢性胃炎的关系 ,为临床诊治Ｈｐ感染提供参考。一、对象与方法1 病例资料 :我院门诊或住院病人 110例 ,男 48例、女6 2例 ,年龄 2 3～ 83岁 ,经胃镜证实为ＤＵ 30例、胃溃疡 15例、慢性胃炎 6 5例且同时抽取静脉血进行抗ＣａｇＡ ＨｐＩｇＧ和ＨｐＩｇＧ的检测。此外 ,选择男 15例、女 2 5例 ,共 40例健康、仅轻微或无消化道症状者作为对照组也进行…     

幽门螺杆菌与消化性溃疡发病关系30例临床分析

目的探究消化性溃疡与幽门螺杆菌(HP)的关系。方法选择2013年3月至2014年3月我院收治的30例由幽门螺杆菌引起的消化性溃疡患者为研究对象,将患者实行胃镜检查,将发现的可疑病灶送检,探讨分析幽门螺杆菌与消化性溃疡的关系。结果所有消化性溃疡患者中,溃疡患者11例,十二指肠溃疡患者13例,复合性溃疡患者6例。幽门螺杆菌显示阳性患者13例,溃疡患者6例,十二指肠溃疡患者5例,复合性溃疡患者2例。幽门螺杆菌显示阴性患者17例,溃疡患者7例,十二指肠溃疡患者6例,复合性溃疡患者4例。结论幽门螺杆菌与消化性溃疡存在密切联系,早期进行检查,促进尽早患者康复。     

CagA基因型Hp与上消化道疾病的关系

目的为探讨ＣａｇＡ基因型Ｈｐ在上消化道疾病中的作用。方法采用尿素酶快速试验,Ｇｉｅｍｓａ染色和ＰＣＲ扩增ＨｐＵｒｅＡ基因三种方法检测１１８份胃镜活检组织中的Ｈｐ,并对６７份Ｈｐ阳性标本进行ＨｐＣａｇＡ基因ＰＣＲ扩增。结果６７例Ｈｐ感染患者中５０例检出ＣａｇＡ基因,阳性率为７４．６％。其中１５例十二指肠溃疡患者全部检出ＣａｇＡ基因,阳性率为１００％,１０例胃溃疡患者中８例检出ＣａｇＡ基因,阳性率为８０％,４２例慢性胃炎患者中２７例检出ＣａｇＡ基因,阳性率为６４．３％。结论ＣａｇＡ基因型Ｈｐ与消化性溃疡有密切的关系。     

胃十二指肠疾病幽门螺杆菌检出的意义

目的:研究幽门螺杆菌(Hp)与消化性溃疡及慢性胃炎致病的关系。方法:因胃十二指肠疾病而做胃镜的患者,采取胃粘膜进行组织快速检菌,一分钟尿素酶(1min UT)试验和血清间接免疫荧光法进行检菌分析。结果:对5000例胃及十二指肠疾病Hp的组织检出率为88.1％。1min UT阳性率为62.9％,两种检菌法有显著差异(P<0.01)。十二指肠溃疡Hp检出为96.0％,胃癌和萎缩性胃炎Hp感染率为50.0％和59.2％,而1min UT只有41.5％阳性率。结论:胃癌和萎缩性胃炎均有粘膜层萎缩,腺体减少、粘液分泌功能降低,Hp茵不能适应强酸环境下生存。十二指肠溃疡和慢性胃炎多伴引起幽门口水肿和幽门变型,胃排空减缓。是导致Hp茵高检出率的重要因素。     

胃粘膜淋巴滤泡的发生与幽门螺杆菌感染

目的：了解胃粘膜淋巴滤泡的发生与ＨＰ感染的关系、胃炎活动程度对其发生的影响以及它在ＨＰ相关性胃十二指肠疾病中的存在状况。方法：本文对６５５例慢性胃、消化性溃疡的患者进行胃镜检查，取粘膜组织作幽门螺杆菌（ＨＰ）检测和组织病理观察。结果 在ＨＰ天津的患者中胃粘膜淋巴滤泡的检出率为６０．１％，而无ＨＰ感染者仅为１７．１％；ＨＰ感染者中，胃窦部粘膜淋巴滤泡的发生率（５１．１％）明显高于胃体部粘膜（１９．３     

慢性胃炎及消化性溃疡诱生型一氧化氮合酶表达和Hp感染的意义

目的探讨一氧化氮在慢性胃炎及消化性溃疡发病机制中的作用，以及ＮＯ和Ｈｐ感染的关系．方法用免疫组化法对正常对照者６例，慢性胃炎５６例及消化性溃疡患者１６例的胃粘膜标本进行检测，观察ｉＮＯＳ表达强度．并用改良Ｇｉｅｍｓａ法同步检测Ｈｐ感染状况．结果ｉＮＯＳ染色定位于胞质，在正常人胃及十二指肠粘膜细胞和腺体均有表达．慢性浅表性胃炎组呈过度表达，其平均表达强度明显高于对照组及慢性萎缩性胃炎组（Ｐ＜００１）．慢性萎缩性胃炎组平均表达水平和对照组比较差异无显著性（Ｐ＞００５）．慢性胃炎组ｉＮＯＳ表达强度与其Ｈｐ分级间呈明显正相关（Ｐ＜００５）．消化性溃疡组平均表达水平较对照组增强（Ｐ＜００５），其ｉＮＯＳ表达强度和Ｈｐ分级间相关性不明显（Ｐ＞００５）．结论ｉＮＯＳ活性增强和过度表达可能在慢性胃炎和消化性溃疡的发病机制中发挥一定作用，并可能是Ｈｐ感染导致慢性胃炎的相关发病机制之一．     

Clinical relevance of Helicobacter pylori CagA-positive strains: gastroduodenal peptic lesions marker.

OBJECTIVES: peptic ulcer is characterized by its recurrent nature, which necessitates maintenance treatment in most patients. But this natural history can be changed in patients with peptic ulcer associated to Helicobacter pylori, as shown by the low rates of recurrence and decreased hemorrhagic recidivism associated with this infection. Whether CagA or VacA strains are associated with a greater risk of peptic ulcer is controversial. This study was designed to examine endoscopic findings and their relation with H. pylori phenotype (CagA or VacA). METHODS: 106 selected dyspeptic patients underwent upper gastrointestinal tract endoscopic examination between September 1996 and May 1997 [69 with H. pylori (Hp) and 37 without this infection]. Endoscopic findings were classified as gastric ulcer (GU), duodenal ulcer (DU), gastric erosions (GE), duodenitis (Du), chronic gastritis (CG) and normal mucosa (NM). Hp phenotype was analyzed with a western blot test. RESULTS: 75% of H. pylori strains were CagA-positive and 54.2% were VacA-positive. 82.4% of the cases of DU were associated with a CagA+ phenotype, but the association was not statistically significant. Otherwise 100% of gastric ulcers were associated with CagA+ strains (p < 0.005). VacA phenotype was not associated with any particular endoscopic finding. Peptic ulcer (DU or GU) was also associated with the CagA+ phenotype (p < 0.05). CONCLUSIONS: the CagA+ H. pylori phenotype seems to be a peptic lesion marker, but was more frequently related with GU than with DU in our sample of Spanish patients.     

Evidence for the role of gastric mucosa at the secretion of soluble triggering receptor expressed on myeloid cells （strem-1） in peptic ulcer disease

AIM: To investigate the role of gastric mucosa at the secretion of sTREM-1 in peptic ulcer. METHODS: Seventy two patients were enrolled; 35 with duodenal, 21 with gastric ulcer and 16 with chronic gastritis. Patients were endoscoped and gastric juice was aspirated. Patients with duodenal and gastric ulcer underwent a second endoscopy post-treatment. Biopsies were incubated in the absence/presence of endotoxins or gastric juice. Supernatants were collected and sTREM-1 and TNFα were measured by enzyme immunoabsorbent assays. Scoring of gastritis was performed before and after treatment according to updated Sydney score. RESULTS: Patients with duodenal and gastric ulcer and those with chronic gastritis had similar scores of gastritis. sTREM-1 was higher in supernatants of tissue samples of H pylori-positive than of H pylori-negative patients with gastric ulcer. Median (± SE) sTREM-1 was found increased in supernatants of patients with gastric ulcer before treatment (203.21 ± 88.91 pg/1000 cells) compared to supernatants either from the same patients post-treatment (8.23 ± 5.79 pg/1000 cells) or from patients with chronic gastritis (6.21 ± 0.71 pg/1000 cells) (P < 0.001 and < 0.001, respectively). Similar differences for sTREM-1 were recorded among LPS-stimulated tissue samples of patients (P = 0.001). Similar differences were not found for TNFα. Positive correlations were found between sTREM-1 of supernatants from patients withboth duodenal and gastric ulcer before treatment and the degree of infiltration of neutrophils and monocytes. CONCLUSION: sTREM-1 secreted by the gastric mucosa is an independent mechanism connected to the pathogenesis of peptic ulcer. sTREM-1 was released at the presence of H pylori from the inflamed gastric mucosa in the field of gastric ulcer.     

雷、环、痢方案根治幽门螺杆菌感染临床疗效观察(附134例报告)

目的　观察雷尼替丁、环丙沙星、痢特灵三联对幽门螺杆菌 (Hp)阳性的消化性溃疡、慢性胃炎患者的Hp根除率及对消化性溃疡的治疗效果。方法　经快速尿素酶试验及胃粘膜活检均确认有Hp感染的消化性溃疡、慢性胃炎患者共 15 5例 ,用雷尼替丁、环丙沙星、痢特灵三联与改良的经典三联 (果胶铋、四环素、痢特灵 )作随机对照治疗。治疗组进入临床试验病例 79例 ,疗效评价 6 8例。对照组进入试验病例 76例 ,疗效评价 6 6例。结果　治疗组与对照组Hp根除率分别为 88 2 % ( 6 0 /6 8)与 84 8% ( 5 6 /6 6 )。消化性溃疡临床愈合率分别为 81 7%与 6 5 6 % ,总有效率分别为 97 2 %与81 3 %。不良反应发生率分别为 4 4%与 14 9% ,上述结果经统计学比较Hp根除率两组差异无显著性 (P >0 0 5 ) ,消化性溃疡愈合率及总有效率、不良反应发生率差异有显著性 (P <0 0 5 )。结论　雷尼替丁、环丙沙星、痢特灵三联为一效好、价廉、不良反应少的治疗方案。     

Light and electron microscopy study of Helicobacter pylori-associated gastritis and gastric carcinoma

ＬｉｇｈｔａｎｄｅｌｅｃｔｒｏｎｍｉｃｒｏｓｃｏｐｙｓｔｕｄｙｏｆＨｅｌｉｃｏｂａｃｔｅｒｐｙｌｏｒｉａｓｓｏｃｉａｔｅｄｇａｓｔｒｉｔｉｓａｎｄｇａｓｔｒｉｃｃａｒｃｉｎｏｍａＬＵＯＨｏｎｇＴａｏ１，ＣＨＡＮＧＷｅｎＨｕａ２ａｎｄＪＩＸｉａｏ...     

门脉高压性胃病患者幽门螺杆菌感染率调查

目的探讨幽门螺杆菌（Hp）与肝硬化并发胃和十二指肠病变的关系。方法采用快速尿素酶试验和改良的Giemsa染色法检测Hp感染。结果在264例肝硬化患者,Hp阳性183例（69．4％）,在262例慢性胃炎（EG）患者,Hp阳性172例（66．4％,19〉0．05）;在79例肝硬化伴有PHG患者,Hp阳性60例（75．9％）,在114例肝硬化不伴PHG患者,Hp阳性75例（65．8％）,在37例肝硬化伴轻型PHG患者,Hp阳性26例（70．2％）,在42例肝硬化伴重型PHG患者,Hp阳性34例（80．9％,P〉0．05）;在56例肝硬化伴十二指肠溃疡（DU）患者,Hp阳性48例（85．7％）,在109例肝硬化不伴消化性溃疡（Pu）患者,Hp阳性67例（61．4％,P〈0．05）;在125例DU患者,Hp阳性112例（89．6％）;在28例肝硬化伴胃溃疡（GU）患者,Hp阳性20例（71．4％）,在47例GU患者,Hp阳性43例（91．5％）。结论肝硬化伴DU患者Hp感染率较高。     

Assay of gastrin and somatostatin in gastric antrum tissues of children with chronic gastritis and duodenal ulcer

AIM: To study the expressions of gastrin (GAS) and somatostatin (SS) in gastric antrum tissues of children with chronic gastritis and duodenal ulcer and their role in pathogenic mechanism. METHODS: Specimens of gastric antrum mucosa from 83 children were retrospectively analyzed. Expressions of GAS and SS in gastric antrum tissues were assayed by the immunohistochemical En Vision method. RESULTS: The expressions of GAS in chronic gastritis Hp group (group A), chronic gastritis Hp- group (group B), the duodenal ulcer Hp group (group C), duodenal ulcer Hp- group (group D), and normal control group (group E) were 28.50 4.55, 19.60 2.49, 22.69 2.71, 25.33 4.76, and 18.80 2.36, respectively. The value in groups A-D was higher than that in group E. The difference was not statistically significant. The expressions of SS in groups A-E were 15.47 1.44, 17.29 2.04, 15.30 1.38, 13.11 0.93 and 12.14 1.68, respectively. The value in groups A-D was higher than that in group E. The difference was also not statistically significant. CONCLUSION: The expressions of GAS and SS are increased in children with chronic gastritis and duodenal ulcer.