儿童幽门螺杆菌感染相关危险因素研究进展

幽门螺杆菌感染可引起多种消化道及消化道外疾病,甚至诱发胃癌。多数幽门螺杆菌感染在儿童时期获得,可造成患儿恶心、呕吐、纳差、特发性血小板减少性紫癜、难治性缺铁性贫血、生长发育迟缓等多种表现。近年来,儿童幽门螺杆菌感染的研究取得诸多进展,该文从幽门螺杆菌菌株、宿主及环境等角度综述儿童幽门螺杆菌感染的危险因素,并展望进一步的研究方向。     

无症状幽门螺杆菌感染对郊区儿童生长发育影响的研究

为探讨幽门螺杆菌感染对儿童生长发育有否影响,对上海郊区一所公立小学的576名儿童,作幽门螺杆菌（Hp)的血清流行病学检测,同时,测量学生的血色素,身高,体重和腹壁皮下脂肪,并作相关因素的问卷调查,提示郊区儿童Hp平均感染率为49．83％,随着年龄的增长,儿童Hp感染率逐年递增,与家庭的生活条件和习惯密切相关,对Hp阳性儿童与Hp阴性康儿童作上述4项指标的对比研究,经统计处理,P＞0．05,无显著性差异,说明无症状幽门螺杆菌感染不影响儿童正常的生长育,但Hp感染是一慢性感染,长期滞留体内是否会影响儿童的生长发育或营养,还需作进一步的随访研究。     

幽门螺杆菌感染对儿童生长发育影响的探讨

为了解幽门螺杆菌(Helicobacter wlori，Hp)感染是否影响儿童生长发育，我院于2003年1～12月对儿童保健门诊和托幼机构体检时发现生长发育异常的儿童进行了Hp—IgG血清抗体检查，结果报告如下。     

幽门螺杆菌感染对儿童铁营养及生长发育的影响

幽门螺杆菌（ＨＰ）感染是世界范围广泛存在且最常见的细菌感染，近年来国外研究认为，ＨＰ感染是造成或加重机体铁营养不良的因素，特别是对于铁缺乏、缺铁性贫血的危险人群，当机体处于铁营养相对不足的状态下，如果再并存ＨＰ感染，通过铁的摄入量及吸收减少、机体对铁需求增加、铁流失等机制，就会出现明显的铁缺乏及缺铁性贫血。同时，ＨＰ感染还会引起儿童生长发育迟缓。本文就ＨＰ感染对儿童铁营养状况和生长发育影响及其发病机制的研究进展作一综述。     

幽门螺杆菌感染对儿童铁营养及生长发育的影响

幽门螺杆菌（HP）感染是世界范围广泛存在且最常见的细菌感染，近年来国外研究认为，HP感染是造成或加重机体铁营养不良的因素，特别是对于铁缺乏、缺铁性贫血的危险人群。当机体处于铁营养相对不足的状态下，如果再并存HP感染，通过铁的摄入量及吸收减少、机体对铁需求增加、铁流失等机制，就会出现明显的铁缺乏及缺铁性贫血。同时，HP感染还会引起儿童生长发育迟缓。本文就HP感染对儿童铁营养状况和生长发育影响及其发病机制的研究进展作一综述。     

儿童幽门螺杆菌感染与支气管哮喘

支气管哮喘(哮喘)是儿童时期最常见的呼吸道慢件疾病之一,其本质和特征是慢性非特异性炎症和气道高反应性,但引起哮喘发生的原因和机制还不完伞清楚.幽门螺杆菌(HP)也是一种全球流行的病原菌,在儿童中有很高的感染率.近年来通过流行病学调查研究表明,儿童HP感染和哮喘之间存在一定的负相关,即在儿童早期(15岁以前)感染HP可预防或者减少哮喘的发生.其可能的机制为减少胃食管反流,影响T细胞分化的卫生假说等.     

风湿病及结缔组织病

052797小儿风湿性疾病诊治进展/李永柏∥中国实用儿科杂志.2005,20(5).270～272052798儿童紫癜/臧晏∥中国临床医生.2005,33(5).4～5052799儿童过敏性紫癜脑电图分析/杨新军…∥实用神经疾病杂志.2005,8(3).103～104052800以皮肤外症状为首发的过敏性紫癜2例/张丽芬…∥中国临床医生.2005,33(5).37052801幽门螺杆菌感染与过敏性紫癜相关性的研究/陈凤琴…∥中国小儿血液.2005,10(2).52～53方法:对102例过敏性紫癜患儿全部进行幽门螺杆菌的检测,阳性者在常规治疗的基础上进行幽门螺杆菌治疗。结果:过敏性紫癜患儿中43.14%感染幽门螺杆菌,给与…     

幽门螺杆菌感染与儿童再发性腹痛关系的中文文献meta分析

目的探讨幽门螺杆菌感染与儿童再发性腹痛的关系。方法采用meta分析方法对国内有关幽门螺杆菌与儿童再发性腹痛关系的病例对照研究结果进行定量综合分析,估计合并OR值及其95%可信区间(95%CI)。结果纳入的8个研究具有一致性,选择固定效应模型进行Meta分析,OR值为2.80(95%CI:2.26～3.47)。结论 H.pylori感染与儿童再发性腹痛相关,是儿童再发性腹痛的致病因素之一。     

幽门螺杆菌菌株类型与儿童胃粘膜炎症程度的关系探讨

目的探讨幽门螺杆菌菌株类型与儿童胃粘膜炎症程度之间的关系。方法采用免疫印迹法测定134例幽门螺杆菌感染患儿血清细胞毒素相关蛋白(CagA)、空泡毒素(VacA)抗体,对幽门螺杆菌进行分型,并观察胃粘膜病理变化。结果CagA、VacA抗体总检出率分别为85.07%(114/134例)、91.04%(122/134例),检出幽门螺杆菌I型菌株113例,Ⅱ型菌株11例,中间型菌株10例,各型菌株感染引起胃粘膜中重度炎症分别为100例(88.50%)、5例(45.45%)、5例(50.00%),I型菌株与II型菌株、中间型菌株比较,差异有显著性(Hc=20.05,P<0.01)。结论幽门螺杆菌菌株类型与儿童胃粘膜炎症程度有关,I型菌株能引起较重的胃粘膜炎症。     

消化系统疾病

003477应用血清学及13G一尿素呼吸试验对幽门螺杆菌家庭感染状况的研究在页立…//中国当代儿科杂志一2000,2(1)一27一29 对166例反复慢性腹痛患儿研究结果显示一级亲属有幽门螺杆菌(HP)带菌的家庭中儿童HP症状性感染率高,HP感染有明显的家庭聚集性。血清Hl〕一IgG检测敏感性好,特异性差,‘”C一尿素呼吸试验比血清学检测更能反应HP家庭实时感染状况。表3参4(张家栋) 003478 1 442例儿童幽门螺杆菌感染状况及相关性疾病分析月余晓华一//中华流行病学杂志一2000,21(2)一100一102 1 442例中血清抗幽门螺杆菌(抗HP-馆G)( )615例,随年龄增…     

Helicobacter pylori infection and growth delay in older children

It is thought that Helicobacter pylori infection may influence growth rate in children. The aim of this study was to evaluate the prevalence of H pylori infection in healthy Italian children, and to look for differences in height between infected and non-infected subjects. Two hundred and sixteen children, aged 3 to 14 years, were tested for H pylori infection by 13C-urea breath test. Centile values for height were calculated. Composite indices for socioeconomic class and household crowding were also determined. Forty nine of 216 children (22.7%) were H pylori positive. The prevalence of infection increased with age. Eight of 49 H pylori positive children (16.3%) were below the 25th centile for height, compared with 13 of 167 H pylori negative children (7.8%). This difference became significant in children aged 8.5 to 14 years; in this group (n = 127), eight of 31 infected children (25.8%) were below the 25th centile for height, compared with eight of 96 non-infected children (8.3%). A significant correlation was found between socioeconomic conditions, household crowding, and H pylori status. By using stepwise logistic regression, only the centile value for height was significantly related to H pylori status in older children. Thus H pylori infection was associated with growth delay in older children, poor socioeconomic conditions, and household overcrowding. This finding is consistent with the hypothesis that H pylori infection is one of the environmental factors capable of affecting growth.     

Helicobacter pylori, helminth infections and growth: a cross-sectional study in a high prevalence population

Aim: Helicobacter pylori (H. pylori) infection is usually acquired in childhood and may adversely affect growth, although data are inconsistent. This study investigated growth parameters in a paediatric cohort with a high prevalence of H. pylori and helminth infection.
Methods: A cross-sectional study of African refugee children (<16 years) recruited at their initial health assessment following resettlement in Australia. Detailed demographic, infection and anthropometric data were obtained. H. pylori infection was diagnosed by monoclonal faecal antigen enzyme immunoassay testing (MFAT). Growth restriction was defined as children with any anthropometric measures below the fifth centile for age and gender.
Results: H. pylori infection was detected in 149/182 (81.9%). Children with H. pylori infection were older (mean 8.5 years, standard deviation (SD) 4.2 years vs. 5.8 years, SD 4.5 years, p < 0.001). No gender differences were observed. After adjustment for age, H. pylori did not adversely affect body mass index or other anthropometric measurements. Helminth infections were common (41.8%) but not associated with reduced growth or with H. pylori infection.
Conclusion: H. pylori and helminth infections are prevalent in African refugee children but neither is associated with growth restriction. Longitudinal growth velocity studies are necessary to identify any long-term consequences of H. pylori on childhood growth.     

Helicobacter pylori infection with iron deficiency anaemia and subnormal growth at puberty

The purpose of this study was to determine whether Helicobacter pylori infection can contribute to growth deficit, especially in pubescent children who need large amounts of iron for growth. A structured questionnaire was sent to the parents of 532 healthy children aged 10 to 15 years (mean 12.9) to obtain demographic information on the parents and the environment. Of the 532 questionnaires sent out, 375 (70.5%; 170 girls and 205 boys) were returned. After collecting blood samples from participants, haemoglobin, serum iron, total iron binding capacity, serum ferritin, and serum IgG antibodies to H pylori were measured. The effects of risk factors such as H pylori infection, iron deficiency anaemia, sex, socioeconomic status, type of house, and crowding index on growth were analysed using multiple regression analysis. Of 63 H pylori positive children, 18 (28.6%) were below the 25th centile values for height, compared with 63 of 312 (20.2%) H pylori negative children. The prevalence rate of H pylori infection was 15.5% (53 of 343) in children without iron deficiency anaemia and 31.3% (10 of 32) in those affected. The relative risk of short stature was 2.2 (95% confidence interval (CI), 1.0 to 4.8) for iron deficiency anaemia, and 1.4 (95% CI, 0.8 to 2.4) for H pylori infection. The mean height was significantly lower in the group having both H pylori infection and iron deficiency anaemia. Therefore, H pylori infection accompanied by iron deficiency anaemia, rather than H pylori infection per se, might delay pubertal growth.     

Helicobacter pylori infection with iron deficiency anaemia and subnormal growth at puberty.

The purpose of this study was to determine whether Helicobacter pylori infection can contribute to growth deficit, especially in pubescent children who need large amounts of iron for growth. A structured questionnaire was sent to the parents of 532 healthy children aged 10 to 15 years (mean 12.9) to obtain demographic information on the parents and the environment. Of the 532 questionnaires sent out, 375 (70.5%; 170 girls and 205 boys) were returned. After collecting blood samples from participants, haemoglobin, serum iron, total iron binding capacity, serum ferritin, and serum IgG antibodies to H pylori were measured. The effects of risk factors such as H pylori infection, iron deficiency anaemia, sex, socioeconomic status, type of house, and crowding index on growth were analysed using multiple regression analysis. Of 63 H pylori positive children, 18 (28.6%) were below the 25th centile values for height, compared with 63 of 312 (20.2%) H pylori negative children. The prevalence rate of H pylori infection was 15.5% (53 of 343) in children without iron deficiency anaemia and 31.3% (10 of 32) in those affected. The relative risk of short stature was 2.2 (95% confidence interval (CI), 1.0 to 4.8) for iron deficiency anaemia, and 1.4 (95% CI, 0.8 to 2.4) for H pylori infection. The mean height was significantly lower in the group having both H pylori infection and iron deficiency anaemia. Therefore, H pylori infection accompanied by iron deficiency anaemia, rather than H pylori infection per se, might delay pubertal growth.     

无锡地区散居儿童幽门螺杆菌感染及相关因素流行病学调查

目的了解无锡地区儿童人群中幽门螺杆菌(H．pylori)感染率，探讨影响H．pylori感染的因素。方法采用酶联免疫分析法检测1126例0—12岁健康儿童及其父母粪便中的幽门螺杆菌抗原(HpSA)。并对每位人选者进行问卷调查，对其平时有无消化道症状、生活环境、生活习惯及家族史等情况进行了解。结果本地区儿童平均H．pylori感染率为19．1％，其中男性为19．6％，女性为18．5％，两者差异无显著性。有症状组阳性率为26．％，无症状组为10．6％。城区儿童H．pylori感染率为12．5％，城郊结合部儿童为19．3％，郊区、农村儿童为24．9％。结论无锡地区儿童中H．pylori感染率较高．有随年龄递增的趋势。幽门螺杆菌感染为引起无锡地区儿童胃十二指肠疾病的主要原因。     

Helicobacter pylori infection in children with constitutional delay of growth and puberty

Helicobacter pylori is a gastroduodenal pathogen strongly associated with chronic gastritis and duodenal ulceration. It is thought that H. pylori infection might be one of the causes of growth retardation in children. The aim of this study was to evaluate the seroprevalence of H. pylori in children with constitutional delay of growth and puberty (CDGP). H. pylori seropositivity was studied in 24 children with CDGP (22 M, 2 F) and 32 healthy age-matched children with normal pubertal development. Mean age of the children with CDGP was 14.53 +/- 1.12 yr and all of them had been diagnosed as CDGP after physical and laboratory assessment. H. pylori IgG positivity was detected in 16 of the 24 children with CDGP (66.6%) and 12 of 32 controls (37.5%) (p <0.05). This finding is consistent with the hypothesis that H. pylori infection could be one of the environmental factors causing CDGP.     

Five- to 7-year-old children with Helicobacter pylori infection are smaller than Helicobacter-negative children: a cross-sectional population-based study of 3,315 children.

OBJECTIVE: To test whether Helicobacter pylori-positive children are smaller and weigh less than H pylori-negative children. DESIGN: Cross-sectional population-based study. PARTICIPANTS: In 3,315 5-to 7-year-old preschool and school children, the putative influence of H pylori infection on growth was investigated. Standing height and weight were analyzed in relation to H pylori infection. The diagnosis of H pylori infection was established by 13C-urea-breath test. RESULTS: The prevalence of H pylori infection in boys was 7.2% (95% confidence interval, 5.9-8.9; n = 1,550) and in girls was 6.1% (95% confidence interval, 4.9-7.3; n = 1,552) H pylori-positive children were smaller than noninfected children (117.6 +/- 5.5 cm vs. 118.9 +/- 5.7 cm; P < 0.01). Although H pylori-positive boys were 2.06 cm smaller than H pylori-negative boys (117.4 +/- 5.6 cm vs. 119.5 +/- 5.7 cm; P < 0.001), the difference in girls was not significant (117.9 +/- 5.3 cm vs. 118.4 +/- 5.7 cm). When standing height was adjusted for age, the found differences were more pronounced. Differences between the infected and noninfected children with regard to body weight were not significant (22.4 +/- 4.0 kg vs. 22.1 +/- 4.0 kg), nor was there a significant difference with regard to body-mass index. However, boys with H pylori infection had a lower weight than noninfected boys (21.6 +/- 3.3 kg vs. 22.6 +/- 4.0 kg; P < 0.01), but in girls, these differences were not observed (22.2 +/- 4.0 vs. 22.8 +/- 4.6 kg, respectively). When weight was adjusted for age, H pylori -positive children also had a lower weight than H pylori -negative children because of the lower weight of boys. CONCLUSIONS: H pylori infection is associated with growth delay, growth retardation, or both in affected children.     

Impact of Helicobacter pylori infection on growth of children: a prospective cohort study

OBJECTIVE: The aim of this study was to prospectively follow a cohort of children without Helicobacter pylori infection and to compare growth velocity in the children who become infected during follow-up with that of children who remained infection-free. METHODS: Three hundred forty-seven children in general good health, aged 12 to 60 months, who tested negative for H. pylori by the 13C-urea breath test, from three daycare centers in a lower-middle class borough of Cali, Colombia, were monitored for 2.5 years. Anthropometric measurements were performed every 2 months and breath tests every 4 months. Linear mixed models were used to analyze growth velocity in relation to onset of H. pylori infection. RESULTS: One hundred five (30.3%) children who were uninfected at the start of the study became infected during follow-up. Growth velocity in infected children was reduced by 0.042 +/- 0.014 cm/mo (P = 0.003) (approximately 0.5 cm/yr) after adjusting for age. The rate of deceleration in growth velocity was relatively constant over time. CONCLUSIONS: Among these lower-middle class children aged 12 to 60 months from a population with high prevalence of H. pylori infection, a new and sustained infection was followed by significant growth retardation.     

Early Helicobacter pylori colonisation: the association with growth faltering in The Gambia.

BACKGROUND: Helicobacter pylori is one of the commonest causes of chronic infection of mankind, yet the natural history of acute infection is poorly understood. Some studies suggest that gastric colonisation with H pylori is associated with suboptimal nutrition and growth in childhood. AIMS: To describe the clinical features of early H pylori colonisation and assess its role in the development of infant malnutrition and growth faltering. METHODS: Two consecutive prospective longitudinal cohort studies were conducted at the Medical Research Council Laboratories in a rural community in The Gambia, West Africa. The first birth cohort of 125 infants was followed by a second of 65 children from the same community. H pylori colonisation was detected by sequential 13C urea breath tests, and infant growth was monitored by serial measurements. RESULTS: Children with early H pylori colonisation became significantly lighter, shorter, and thinner than their peers in late infancy. The association was found in both cohorts. No socioeconomic or demographic confounding variables were identified to explain this, and the weight deficit was no longer detectable when the children were aged 5-8 years. CONCLUSIONS: Results suggest that H pylori colonisation in early infancy predisposes to the development of malnutrition and growth faltering, although the effect did not persist into later childhood.     

幽门螺杆菌感染与儿童胃炎关系探讨

为进一步研究幽门螺杆菌（Helicobacter pylori,H.pylori)感染与儿童胃炎的关系，对我科1998年至2000年间500例3岁－15岁儿童胃镜活检组织进行组织学和H.pylori观察，按Sydney胃炎标准对病变分级，分析和探讨H.pylori感染与儿童胃炎发展变化的关系。结果表明：40.4%的儿童胃炎与H.pylori感染有关；而且炎症的程度、淋巴滤泡的形成、嗜酸细胞增多及幽门腺萎缩明显高于无H.pylori感染的儿童胃炎。提示上海地区儿童胃炎有很高的H.pylori感染率，H.pylori感染与儿童胃炎关系密切，儿童H.pylori胃炎的胃粘膜病理变化比非H.pylori感染者严重。