慢性胃炎结节状改变与幽门螺杆菌感染的关系研究

目的　探讨慢性胃炎结节状改变与幽门螺杆菌 (Hp)感染的关系。方法　对 2 0 0 1～2 0 0 2年中胃镜检查发现的慢性胃炎结节状改变患者进行Hp检测 ,对Hp阳性患者 ,进行Hp根除治疗 ,随访 6个月 ,观察其胃镜下的改变。结果　 4 939例胃镜检查患者中共发现 1 3例慢性胃炎结节状改变 ,占检查总人数的 0 2 6 %。平均年龄 2 9岁 ,均为女性患者。主要症状均为上腹部疼痛。所有患者均有Hp感染。Hp根除成功后 ,症状和胃镜下结节状表现消失 ,病理证实胃黏膜下淋巴滤泡也随之消失。结论　慢性胃炎结节状改变可作为Hp阳性胃炎的内镜下的表现之一。     

幽门螺杆菌感染致动脉粥样硬化机制的研究

动脉粥样硬化是引起心脑血管疾病的主要病理基础.大量实验和临床研究证明幽门螺杆菌（H.pylori）感染在动脉粥样硬化的发展中起重要作用.本文就近年来有关H.pylori感染致动脉粥样硬化机制的文献作一概述.     

彝汉族聚居地区胃Hp感染的血清流行病学研究

目的了解我国少数民族地区Ｈｐ感染是否存在民族差异．方法１９９４年４月－７月用整群抽样收集和调查云南云县彝族（ｎ＝４６６）、汉族（ｎ＝６１８）聚居地区１０８４名自然人群．作血清抗Ｈｐ－ＩｇＧ检测，其中３２５人同时作血清抗ＨＡＶ－ＩｇＧ检测．同时进行问卷调查有关流行因素．结果彝族Ｈｐ感染单因素分析与饮水等１０个流行因素相关，多因素Ｌｏｇｉｓｔｉｃ分析筛选出饮水、养猪、家族胃癌史、大蒜和吸毒等６个重要因素．汉族Ｈｐ感染单因素分析与饮水等１４个流行因素有关，多因素Ｌｏｇｉｓｔｉｃ分析筛选出饮水、上消化道症状、吸毒和大蒜等５个重要因素．彝、汉族感染率无差异，作４８个变量彝、汉族的相关分析除家族胃癌史和服用中药有显著性差异外均无显著性差异．结论彝汉族Ｈｐ感染无差异性     

高清晰放大胃镜对幽门螺杆菌相关性胃炎胃粘膜表现的临床研究

目的：研究高清晰放大胃镜下幽门螺杆菌（Hp）相关性胃炎胃粘膜的特点，观察Hp感染根除治疗后胃粘膜的变化。方法：使用Fujinon EG485ZH85万像素高清晰放大电子胃镜，对50例门诊病例经常规胃镜检查后转换高清晰放大功能，详细观察胃体和胃窦粘膜的微细结构，判断Hp感染情况。结果：50例中Hp阳性26例，普通胃镜判断Hp感染的敏感性为34.62％，准确性为58.00％，阳性拟然比为2.08，阴性拟然比为0.78；高清晰放大胃镜判断Hp感染的敏感性为69.23％，准确性为78.00％，阳性拟然比为5.54，阴性拟然比为0.35。两种胃镜检查的Kappa值分别为0.176和0.563。结论：Hp相关性胃炎的胃镜下表现主要是胃小凹不均匀发红，小凹变粗、变宽，集合静脉的模糊、混乱或消失。高清晰放大胃镜判断Hp感染的准确性明显高于普通胃镜。     

唾液IgG抗体测定诊断幽门螺杆菌感染

目的　探讨唾液抗HpIgG测定对Hp感染的诊断价值。方法　用ELISA法测定 5 4例Hp阳性及 15例Hp阴性患者唾液内抗HpIgG ,并与血清抗体测定结果相比较。结果　唾液抗HpIgG对Hp感染诊断的敏感性为 90 7% ,特异性为 80 % ,准确性为 88 4% ,阳性预测值 94 2 % ,阴性预测值 70 6 % ,与血清测定结果接近 (分别为 92 6 % ,86 7% ,91 3 % ,96 1%和 76 5 % ) ,唾液抗HpIgG与血清内抗HpIgG滴度显著正相关 (r=0 6 73 7,P <0 .0 0 1)。结论　唾液抗HpIgG测定诊断Hp感染有较好应用价值。     

放大内镜在幽门螺杆菌相关性胃炎诊断中的价值

目的：研究正常胃黏膜及幽门螺杆菌(Hp)相关性胃炎的放大内镜表现，探讨放大内镜对幽门螺杆菌相关性胃炎的诊断价值。方法：66例患者接受电子放大胃镜检查，观察胃体黏膜毛细血管网、胃小凹及集合小静脉，并取活组织行病理检查及进行Hp检测。结果：66例患者中Hp阳性者为36例，阴性者为30例。Hp阳性者中正常胃黏膜者2例，炎症者34例；Hp阴性者中，正常胃黏膜者28例，炎症者2例。Hp阳性者中，Z0型(见集合小静脉、网状真性毛细血管及针眼样的胃小凹)3例，Z1型(集合小静脉消失，毛细血管网正常或失去正常形态，胃小凹可见)8例，Z2型(集合小静脉及真性毛细血管网皆消失，扩张的胃小凹及沟回发白)15例，Z3型(扩张的胃小凹周围发红)10例；Hp阴性者中，Z0为27例，Z1为1例，Z2为2例，Z3为0例。结论：电子放大胃镜下观察到的胃体黏膜集合小静脉、毛细血管网、胃小凹是正常胃黏膜的特征，而它们的消失与变化是Hp相关性胃炎的特征。     

幽门螺杆菌感染内镜下的诊疗方法

目的探讨活检部位与Ｈｐ的检出率，观察内镜下喷洒美蓝治疗Ｈｐ的效果．方法选择内镜下诊断的慢性萎缩性胃炎或其它胃病伴有萎缩改变及肠上皮化生改变者２６８例．对其萎缩面的形态、肠上皮化生的特点进行分型．结果闭合型萎缩性胃炎以窦部Ｈｐ检出率高，而开放型以体部检出率高（Ｐ＜００１），肠上皮化生广泛的部位，Ｈｐ检出率低（Ｐ＜００１）．美蓝喷洒法与口服法比较具有相同治疗效果．结论内镜下取活检的部位及肠上皮化生的程度可影响Ｈｐ检出率．喷洒美蓝治疗Ｈｐ法，经济、效果好、副作用少．     

幽门螺杆菌感染可视化诊断的临床研究

目的改革国外对幽门螺杆菌（Ｈｅｌｉｃｏｂａｃｔｅｒｐｙｌｏｒｉ，Ｈｐ）感染可视化诊断中的繁杂方法。方法对３００例经胃镜检查病例，在胃镜直视下采用喷洒ｐＨ５．５的调节水来调整胃黏膜表面的ｐＨ值，再对胃黏膜表面直接喷洒０．５ｍｏｌ／Ｌ尿素０．１％酚红溶液。通过酚红的变红反应，使Ｈｐ的感染及其分布可视化。并对尿素酚红液变色呈阳性反应的病例，在变色部位取活检，对呈阴性反应的不变色病例，在胃窦近幽门２ｃｍ左右的前、后壁、胃窦前庭或胃体大弯分别取活检２～３块，进行病理组织切片的Ｇｉｅｍｓａ染色检查并将两者相对照。结果３００例中１９０例胃镜喷洒尿素酚红溶液后胃黏膜表面变红呈阳性反应，病理检查Ｈｐ呈阳性者１８２例，诊断符合率为９５．８％（１８２／１９０）。１１０例呈阴性反应病例，病理检查Ｈｐ呈阴性者９５例，两者符合率为８６．４％（９５／１１０）。镜下诊断与病理诊断总符合率为９２．３％（２７７／３００）。结论对Ｈｐ感染的可视化诊断，改良的尿素酚红液喷洒为一种简单可行的内镜下诊断方法。     

幽门螺杆菌空泡毒作用

目的研究幽门螺杆菌（Ｈｅｌｉｃｏｂａｃｔｅｒｐｙｌｏｒｉ,Ｈｐ）空泡毒作用。方法用体外细胞毒试验,结合细胞化学及荧光染色、透射电镜技术研究Ｈｐ空泡毒作用及其病理机制。结果７８．２６％的Ｈｐ相关消化性溃疡患者感染的是空泡毒作用阳性Ｈｐ（Ｔｏｘｉｎ＋）,而只有４２．８６％的胃炎患者感染的是Ｈｐ（Ｔｏｘｉｎ＋）。Ｈｐ（Ｔｏｘｉｎ＋）引起的细胞空泡样变,吖啶橙及酸性磷酸酶染色阳性;透射电镜显示空泡为双层膜结构。结论Ｈｐ（Ｔｏｘｉｎ＋）感染与Ｈｐ相关消化性溃疡密切相关。Ｈｐ（Ｔｏｘｉｎ＋）引起的空泡是自噬体,是细胞在毒性物质作用下表现的病理现象。     

非幽门螺杆菌感染患者上腹部不适的可能机制

目的 探讨非幽门螺杆菌感染患者上腹部不适相关症状的可能机制.方法 收集2006年8月至11月初次行胃镜、组织学检查幽门螺杆菌呈阴性的成人患者232例,2005年9月至2009年8月门诊及住院儿童患者31例(年龄<14岁).对以上患者行胃镜取胃黏膜组织做连续切片,HE染色及WS染色观察组织学改变.结果 成人组患者组织内可观察到微、小动脉腔堵塞和(或)灶性出血病变,其中16例(8.8%)黏膜和(或)黏膜下层见微、小动脉腔部分或完全堵塞,82例(45.6%)仅有黏膜灶性出血,82例(45.6%)两种病变同时存在.微、小动脉腔堵塞病变以移行部检出率最高(65.2%,P=0.159),灶性出血病变以底体部检出率最高(65.6%,P=0.001).微、小动脉腔堵塞病变组烧心症状发生率显著低于无动脉腔堵塞/出血病变组(x2=8.564,P=0.003).儿童组中96.8%(30/31)的患者活检组织中观察到微、小动脉腔堵塞和(或)灶性出血病变.结论 胃微、小动脉堵塞引起的黏膜缺血比较常见,可发生于各个年龄段,可能是导致非幽门螺杆菌感染患者上腹部不适相关症状的重要原因.     

慢性胃炎伴良性结节状改变与幽门螺杆菌及淋巴滤泡的关系

目的研究慢性胃炎伴良性结节状改变与幽门螺杆菌（Hp）及胃黏膜淋巴滤泡的关系。方法从2004年7月1日-2005年6月30日行内镜检查患者中，筛选出胃窦黏膜有良性结节样改变者为研究对象，在患者胃窦黏膜处喷洒靛胭脂作色素内镜观察，确定有结节状形态改变，并在有明显结节处取活检组织3块，其中1块立刻作Hp快速试验，判定有无Hp感染；另外2块送病理检查，观察胃黏膜淋巴滤泡形成和淋巴细胞浸润情况，并采用亚甲蓝-硼酸染色法进一步明确诊断Hp感染情况。结果将胃黏膜良性结节状改变的慢性胃炎患者分为三组：结节性胃炎组、萎缩性胃炎组和疣状胃炎组，患者平均年龄分别为（31．OO±11．62）岁、（58．61±12．14）岁和（51．29±12．99）岁，其中结节性胃炎组患者发病年龄最小（P〈0．01）；Hp感染率分别为92．86％、82．56％和69．89％，其中结节性胃炎组的感染率明显高于其他两组（P〈0．01）；有淋巴组织增生所见依次为94．90％、27．9％、18．28％，其中结节性胃炎患者淋巴组织增生明显高于其他胃炎患者（P〈0．01）。伴有结节样改变的萎缩性胃炎患者中萎缩和肠化生百分率分别为100％和59．3％，远高于疣状胃炎组的7．53％、8．60％和结节状胃炎组的4．03％、0．00％。结论在三种常见的胃黏膜良性结节状改变的胃炎中，结节性胃炎与Hp感染及胃黏膜淋巴滤泡形成之间存在密切相关性。可以把Hp感染及淋巴组织滤泡形成和淋巴细胞浸润作为诊断结节性胃炎的病理诊断依据。     

Association between mucosal surface pattern under near focus technology and Helicobacter pylori infection

BACKGROUND Many studies evaluated magnification endoscopy(ME) to correlate changes on the gastric mucosal surface with Helicobacter pylori(H. pylori) infection. However, few studies validated these concepts with high-definition endoscopy without ME.AIM To access the association between mucosal surface pattern under near focus technology and H. pylori infection status in a western population.METHODS Cross-sectional study including all patients referred to routine upper endoscopy. Endoscopic exams were performed using standard high definition(S-HD) followed by near focus(NF-HD) examination. Presence of erythema, erosion, atrophy, and nodularity were recorded during S-HD, and surface mucosal pattern was classified using NF-HD in the gastric body. Biopsies were taken for rapid urease test and histology.RESULTS One hundred and eighty-seven patients were analyzed from August to November 2019. Of those, 47(25.1%) were H. pylori+, and 42(22.5%) had a previous H. pylori treatment. In the examination with S-HD, erythema had the best sensitivity for H. pylori detection(80.9%). Exudate(99.3%), nodularity(97.1%), and atrophy(95.7%) demonstrated better specificity values, but with low sensitivity(6.4%-19.1%). On the other hand, the absence of erythema was strongly associated with H. pylori-(negative predictive value = 92%). With NF-HD, 56.2% of patients presented type 1 pattern(regular arrangement of collecting venules, RAC), and only 5.7% of RAC+ patients were H. pylori+. The loss of RAC presented 87.2% sensitivity for H. pylori detection, 70.7% specificity, 50% positive predictive value, and 94.3% negative predictive value, indicating that loss of RAC was suboptimal to confirm H. pylori infection, but when RAC was seen, H. pylori infection was unlikely.CONCLUSION The presence of RAC at the NF-HD exam and the absence of erythema at S-HD were highly predictive of H. pylori negative status. On the other hand, the loss of RAC had a suboptimal correlation with the presence of H. pylori.     

Prevalence of Intestinal Metaplasia in Helicobacter pylori Gastritis

Eidt S, Stolte M. Prevalence of intestinal metaplasia in Helicobacter pylori gastritis. Scand J Gastroenterol 1994;29:607-610

Background: The prevalence of intestinal metaplasia (IM) in underlying Helicobacter pylori gastritis was studied in 1446 patients.

Methods: Antral and body mucosa biopsy specimens (stains: hematoxylin and eosin, Warthin-Starry) were taken from five groups of patients: gastritis with no lesions, gastritis with duodenal, pyloric, or gastric ulcers or with chronic antral erosions.

Results: The prevalence of IM was higher in the antral than in the body mucosa (22.9% versus 2.8%; p < 0.001). Patients with IM had a higher mean age than those without IM in the overall group (p < 0.01). IM could be detected with the highest frequency in patients with gastric ulcers (p < 0.001).

Conclusions: The higher prevalence of IM in the antral mucosa–the preferred location of gastric carcinomas–further supports the postulated association of H. pylori and gastric carcinoma. The various prevalences of IM might contribute to explaining the different probabilities of gastric carcinoma developing in the groups investigated.     

Helicobacter pylori infection in subjects negative for high titer serum antibody

AIM To investigate the clinicopathological features of the patients testing negative for high titer serum antiHelicobacter pylori(H. pylori) antibody.METHODS The antibody titers were measured using antigens derived from Japanese individuals. ~(13)C-urea breath test-positive individuals were defined as having H. pylori infection. We investigated the demographic characteristics, laboratory data, endoscopic findings including Kyoto classification of gastritis, and histology in negative-high titer patients without H. pylori eradication therapy. Kyoto classification consisted of scores for gastric atrophy, intestinal metaplasia, enlarged folds, nodularity, and redness.RESULTS Of the 136 subjects enrolled, 23(17%) had H. pylori infection. Kyoto classification had an excellent area under the receiver operating characteristics curve(0.886, 95% confidence interval: 0.803-0.968, P = 3.7 × 10~(-20)) for predicting H. pylori infection with a cutoff value of 2. Further, Kyoto classification, H. pylori density, and neutrophil activity had high accuracies(89.7%, 96.3%, and 94.1%, respectively). Kyoto classification was independent of the demographic and laboratory parameters in multivariate analysis.CONCLUSION Endoscopic Kyoto classification of gastritis is a useful predictor of H. pylori infection in negative-high titer antibody patients.     

The best method of detecting prior Helicobacter pylori infection

AIM: Prior Helicobacter pylori (H pylori) infection has often been underestimated. These underestimations have misled physicians attempting to determine the significance between H pylori and certain gastrointestinal lesions such as intestinal metaplasia, atrophic gastritis, and gastric cancer. Our study endeavored to detect past H pylori infections accurately, easily,and rapidly with the newly developed immunoblot kit, Helico Blot 2.1.METHODS: Thirty-three patients, including 25 H pylori infected and 8 uninfected cases, were enrolled in our study. All patients received consecutive gastroendoscopic examinations and 13C-urea breath test (UBT) tests at 6-or 12-mo intervals for up to 4 years. Serum samples were obtained from each patient at the same time. Intragastric H pylori infection was confirmed in accordance with the gold standard. Twenty-five H pylori-infected patients received triple therapies after initial bacterial confirmation,and were successful in eradicating their infections. Serially obtained sera were tested by means of Helico Blot 2.1.RESULTS: Current infection marker detected by Helico Blot 2.1 was unreliable for representing ongoing H pylori infection. Only 35 and 37 ku antibodies of H pylori had significant seroconversion rates 1 year after having been cured. The seropositive rates of 116 ku (cytotoxin-associated antigen [CagA]) and Helico Blot 2.1 were nearly 100%during 4-year follow-up period. Both CagA antigen and Helico blot 2.1 could serve as indicators of long-term H pylori infection.CONCLUSION: Helico Blot 2.1 can detect past H pylori infections for up to 4 years, and is the best method to date for detecting previous long-term H pylori infection.     

幽门螺杆菌长期感染与胃黏膜炎症和肠上皮化生的关系

目的探讨幽门螺杆菌(Hp)长期感染及根除与胃黏膜炎症和肠上皮化生(IM)的关系。方法随访71例5年前和78例10年前Hp感染者,分析对比其前后Hp感染情况、胃黏膜炎症和IM的变化。结果5年前Hp阳性71例中,现在52例(73.2％)Hp仍呈阳性,19例(26.8％)转阴;10年前Hp阳性的78例中,现在59例(75.6％)Hp仍呈阳性,19例(24.4％)转阴。Hp长期阳性者5年前和现在及10年前和现在慢性炎症严重程度积分分别为1.635±0.376与1.808±0.301(P>0.05)和1.661±0.398与2.232±0.335(P<0.01);IM的发生率分别为17.3％(9/52)与26.9％(14/52)(P>0.05)和11.9％(7/59)与39.0％(23/59)(P<0.01);IM严重程度积分分别为1.444±0.527与1.667±0.442(P>0.05)和1.571±0.534与2.286±0.488(P<0.05)。Hp转阴者5年前和现在及10年前和现在慢性炎症严重程度积分分别为1.684±0.369与1.369±0.426(P<0.05)和1.647±0.389与1.182±0.396(P<0.01);IM的发生率为31.6％(6/19)和52.6％(10/19);IN严重程度积分分别为1.333±0.516与1.167±0.775(P>0.05)和1.600±0.516与1.100±0.316(P<0.05)。结论Hp感染持续时间越长,胃黏膜炎症越严重,IM程度亦越严重且发生率高;根除Hp不仅能减轻胃黏膜的炎症程度和IM程度,而且能防止IM的发生。     

Nucleotide-binding oligomerization domain 1 and Helicobacter pylori infection: A review

Nucleotide-binding oligomerization domain 1(NOD1) is an intracellular innate immune sensor for small molecules derived from bacterial cell components. NOD1 activation by its ligands leads to robust production of pro-inflammatory cytokines and chemokines by innate immune cells, thereby mediating mucosal host defense systems against microbes. Chronic gastric infection due to Helicobacter pylori(H. pylori) causes various upper gastrointestinal diseases, including atrophic gastritis, peptic ulcers, and gastric cancer. It is now generally accepted that detection of H. pylori by NOD1 expressed in gastric epithelial cells plays an indispensable role in mucosal host defense systems against this organism. Recent studies have revealed the molecular mechanism by which NOD1 activation caused by H. pylori infection is involved in the development of chronic gastritis and gastric cancer. In this review, we have discussed and summarized how sensing of H. pylori by NOD1 mediates the prevention of chronic gastritis and gastric cancer.     

粪便抗原检测诊断幽门螺杆菌现症感染

目的 评价应用免疫酶联吸附试验(ELISA)检测粪便中幽门螺杆菌(Helicobacter pylori)抗原诊断H.pylori现症感染的敏感性和特异性。方法 应用^14C呼气试验以及幽门螺杆菌粪便抗原(HpSA)试验，对100例因上消化道不适就诊，怀疑有H.pylori感染的患者进行检测，观察两种检查的符合率。结果 ^14C呼气试验和HpSA同时阳性者38例，^14C呼气试验阳性而HpSA阴性者4例；^14C呼气试验和HpSA同时阴性者57例，^14C呼气试验阴性而HpSA阳性1例。以^14C呼气试验作为金标准计算，HpSA检测方法的敏感性为90．48％，特异性为98．28％。结论 幽门螺杆菌抗粪便原检测与^14C呼气试验有较高的符合率，而且简便易行，不需特殊设备，解决了无法进行呼气试验的婴幼儿和有肺部疾患者的非侵人性幽门螺杆菌现症感染诊断问题，是一种非侵入性幽门螺杆菌现症感染诊断的新方法。     

Helicobacter pylori infection in Icelandic children

Objective: The prevalence of Helicobacter pylori (HP) infection is decreasing in the western world. The seroprevalence among 25–50-year-old Icelandic adults was recently shown to be 30–40%. Information on the seroprevalence in Nordic children is limited. We aimed at ascertaining the infection prevalence among healthy Icelandic children.

Methods: The infection status in stored frozen blood samples from two cross-sectional studies on the health of 7–9-year-old children (n?=?125) and 16–18-year-old adolescents (n?=?80) was determined by enzyme-linked immunosorbent assay (ELISA). Information on family demographics and GI symptoms was obtained by standardized questionnaires.

Results: Overall, 3.4% (7/205) of the children were infected with H. pylori. The prevalence was 2.6% (5/190), missing data n?=?3, among children with both parents born in a low prevalence country compared to 17% (2/12) among those with at least one parent born in a high prevalence area (p?=?.026). When at least one parent was born in a high prevalence country, the odds ratio for being H. pylori seropositive was 2.2 (95% CI, 1.02–54.67), when adjusted for the educational status of the mother. There was no significant association between H. pylori infection and gastrointestinal symptoms.

Conclusion: Prevalence of H. pylori infection in Iceland has become very low, suggesting a great reduction in transmission from older generations. There was an association between H. pylori infection and origin from high prevalence areas but not with gastrointestinal symptoms. The results mirror recent studies of children of Scandinavian ancestry.     

Anti-Helicobacter pylori therapy significantly reduces Helicobacter pylori -induced gastric mucosal damage in Mongolian gerbils

AIM: To investigate the effectiveness of 4 d‘anti-Helicobacter pyloritherapy on the H pylori-infected Mongolian gerbils based on physiological and pathological changes. METHODS: We used 6-wk-old male gerbils orally inoculated with H pylori (ATCC43504, 2&#215;10^8 CFU/mL). Seven weeks alter Hpyloriinoculation, the animals of study group received 4 d‘arti-H pyloritriple therapy (Hpylorieradicated group). Seven days later, all animals of the H pylori-eradicated and control groups (H pylori-infected &amp; H pylori-uninfected groups) were sacrificed. We examined gastric mucosal lesions macroscopically, studied gastritis microscopically and determined the stomach weight ratio, myeloperoxidase (MPO) activity and prostaglandin (PG) E2 level. RESULTS: The results showed that both macroscopic and histological gastric damages were significantly less in H pylori-eradicated group than H pylori-infected group. Stomach weight ratio, MPO activity and PGE2 levels were significantly higher in H pylori-infected group than those in the other two groups. CONCLUSION: Four days‘anti-H pylori therapy was effective in the improvement of H pylori-induced gastric lesions in Mongolian gerbils.