2012年第二届亚太地区幽门螺杆菌会议

会议主题:科学向临床医学的转化:亚太地区新千年幽门螺杆菌感染特别工作组:早期胃癌的内镜诊断和治疗;H.pylori的微生物学、免疫学和分子遗传学会议热点:H.pylori与胃癌;H.pylori的分子流行病学;H.pylori的最佳治疗方法;H.pylori感染中具有争议的问题:胃食管反流病,消化不良,NSAID肠病以及胃外疾病。时间:2012年1月13～15日     

根除幽门螺杆菌在预防胃癌中的作用

胃癌在全球恶性肿瘤致死亡的原因中位居第二位,幽门螺杆菌（H．pylori）感染是胃癌发生的重要病因。动物研究显示根除H.pylori,特别是在早期阶段,能有效预防胃癌的发生。部分病例通过根除npylori可阻止胃癌前病变的发展并可能使其逆转。最新研究表明根除H．pylori可降低胃癌发生的风险,对无萎缩或肠化生者可能尤其有效。本文就根除H．p）tori在预防胃癌中作用的研究进展作一综述。     

幽门螺杆菌若干问题的共识意见

1999年4月29—30日,全国幽门螺杆菌(H．pylori)科研协作组邀请国内H．pylori研究专家56人在海南省三亚市举行我国第一次H．pylori专家共识会议。会议主要对H．pylori的诊断、与胃癌和功能性消化不良(FD)的关系及抗H．pylori治疗等进行了较充分的研讨,并对H．pylori的流行病学、致病机理进     

胃蛋白酶原联合幽门螺旋杆菌IgG抗体对胃癌早期诊断的价值

目的探讨胃蛋白酶原(Pepsinogens,PG)联合幽门螺旋杆菌(H.pylori)Ig G抗体对胃癌早期诊断价值。方法选取2015年1月-2015年12月于石河子大学医学院第一附属医院住院部及门诊就诊并行胃镜检查的患者资料,其中浅表性胃炎组40例、轻度萎缩性胃炎组40例、胃癌前病变组40例、胃癌组40例,经免疫印迹法测血清H.pylori Ig G抗体,免疫放射法测定各组PG浓度。结果与浅表性胃炎组及轻度萎缩性胃炎组比较,胃癌前病变组及胃癌组中PGⅠ、PGⅠ/PGⅡ值明显降低,差异有统计学意义(P0.05)。与浅表性胃炎组比较,胃癌前病变组及胃癌组中H.pylori Ig G抗体阳性率升高,差异有统计学意义(P0.05);H.pylori Ig G抗体阳性组PGⅠ、PGⅠ/PGⅡ值明显低于阴性组,差异有统计学意义(P0.05)。H.pylori Ig G抗体阳性组PGⅡ值明显高于阴性组,差异有统计学意义(P0.05)。PG与H.pylori Ig G抗体联合检测提高了胃癌诊断的灵敏度。结论 PG和H.pylori Ig G抗体与胃癌关系密切,两者联合检测对胃癌早期诊具有重要的临床意义。     

幽门螺杆菌感染与胃癌发病关系的文献计量学分析

目的：了解H pylori感染与胃癌关系研究现状,总结研究热点,提供参考信息．方法：采用引文分析方法对国外2001-2006有关该主题的重要文献进行调查分析,并用SPSS对高频被引文献进行聚类分析,根据各个类中的文献内容分析当前研究的热点．结果：H pylori感染与胃癌关系研究的重要文献多数发表于世界著名的综合性刊物上,肿瘤学与胃肠病学核心期刊次之．检得SCI数据库中相关文献1547篇,其参考文献出现频次高于60次论文42篇．高被引论文聚类分析树图分5类．结论：H pylori感染与胃癌流行病学、胃癌动物模型,H pylori感染的根除与胃癌的关系．H pylori感染、宿主细胞因子多态性与胃癌易感性,以及H pylori致病相关基因的为研究热点．     

胃癌预防亚太地区共识指南

背景与目的：胃癌是亚太地区的主要健康负担之一，但对其预防策略尚缺乏共识。本共识会议旨在评价预防胃癌的策略。方法：多学科专家组应用德尔菲（Delphi）法制订共识条文，提呈相关数据，对证据等级、推荐强度以及共识水平予以分级。结果：幽门螺杆菌（H.pylori）感染是非贲门胃腺癌必要但非充分的致病因子。盐的高摄人与胃癌强烈相关。新鲜果蔬对胃癌具有预防作用，但维生素和其他饮食补充并不能预防胃癌。Hprtori感染中的宿主-细菌相互作用导致不同类型的胃炎和胃酸分泌，从而决定疾病结局。胃癌阳性家族史是一个重要的危险因素。低血清胃蛋白酶原反映胃萎缩程度，可作为检出胃癌高危人群的标志物。H．prlori筛查和治疗被推荐作为减少高危人群胃癌危险性的一种策略．该策略在萎缩性胃炎发生前实施最为有效，但并不排除对胃癌高危人群的内镜监测。对胃癌低危人群不推荐行H．pylori筛查。H．pylori感染的一线治疗应遵循国家治疗指南。结论：高危人群中H．pylori筛查和根除策略可能会减少胃癌的发生率，本共识根据现有证据予以推荐。     

幽门螺杆菌-尿素呼气试验临床应用专家共识(2020年)

H.pylori感染与众多消化系统疾病的发生密切相关, 是预防胃癌最重要且最可控的危险因素, 诊断和根除H.pylori可作为预防胃癌的一级措施。尿素呼气试验(UBT)是目前临床检测H.pylori的最常用方法, 具有非侵入性、准确、特异、快捷的特点。目前国内医疗机构应用UBT诊断H.pylori感染较多, 亟需建立UBT检测H.pylori的临床应用专家共识, 提高UBT的规范性, 推广UBT在H.pylori检测中的应用, 推动早期胃癌筛查和H.pylori感染的防控。     

H pylori相关性胃溃疡、胃癌组织中VEGF和NF-κB的表达及意义

目的：探讨H pylori相关性胃溃疡、胃癌组织中VEGF,NF-κB的表达及三者的相互关系,进一步了解H pylori致胃溃疡、胃癌的发病机制．方法：选择胃镜室及外科手术切除的36例胃溃疡和52例胃癌病理标本,应用免疫组化SABC法,检测H pylori,VEGF及NF-κB的表达．结果：H pylori( )组胃溃疡发病率与H pylori(-)组比较差别有显著性(78％vs 22％,P＜0．05),36例胃溃疡组织中H pyloH( )组VEGF,NF-κB表达明显高于H pylori(-)组(53．6％vs 12．5％,P＜0．05；39．3％vs 0,P＜0．05)；52例胃癌组织中H pylori( )组VEGF,NF-κB表达明显高于H Pylori(-)组(84％vs 40．7％,P＜0．05；80％vs 48．1％,P＜0．05)；NF-κB与VEGF在胃渍疡、胃癌组织中的表达具有相关性(r=0．997,P＜0．05)．结论：胃溃疡、胃癌组织中NF-κB,VEGF的表达与H pyiori感染相关,其中H pylori感染为初始因素,而H pylori对NF-κB的激活,则可能是胃溃疡、胃癌发病的关键步骤,三者的协同作用导致胃溃疡、胃癌的发病．     

儿童幽门螺杆菌感染的诊断和治疗

幽门螺杆菌（H．pylori）感染主要发生在儿童期，儿童期许多消化系统疾病，如慢性胃炎、消化性溃疡等与H．pylori感染密切相关，并可能与成年后胃癌的发生相关。H．pylori感染还可导致儿童缺铁性贫血。H．pylori感染主要经“口-口”或“粪-口”以及“胃-口”途径从人到人传播，社会经济因素对H．pylori感染的影响是主要的。胃镜活检胃黏膜细菌学检查是诊断H．pylori现症感染的“金标准”，粪抗原的测定和^13C-尿素呼气试验可用于诊断和评价疗效。质子泵抑制剂（PPI）加两种抗生素的三联疗法是目前最佳治疗方案，抗生素耐药的不断增加给治疗带来了困难．儿童H．pylori感染对大环内酯类药物的耐药高于成人。     

幽门螺杆菌感染对胃黏膜基质金属蛋白酶表达的影响及其与胃癌的关系

基质金属蛋白酶（MMPs）是一组锌依赖性内肽酶，可降解细胞外基质蛋白，有助于肿瘤细胞浸润和转移。已证实幽门螺杆菌（H．pylori）胃癌的发生有关，但其对胃癌浸润和转移的作用尚未明确。近年有研究显示H．pylori感染可使胃黏膜上皮MMPs表达增高，推测H．pylori感染可能通过MMPs而促进胃癌浸润和转移。本文就H．pylori感染对胃黏膜MMPs表达的影响及其与胃癌的关系作一综述，并对金属蛋白酶组织抑制剂（TIMPs）治疗胃癌的前景作一展望．     

胃癌患者中反流性食管炎与幽门螺杆菌感染的相关性分析

目的探讨胃癌患者中反流性食管炎与幽门螺杆菌感染的相关性。 方法选取2015年8月至2017年1月,在新疆维吾尔自治区人民医院就诊的胃癌合并反流性食管炎患者45例与同期在本院就诊的胃癌患者45例,比较两组患者幽门螺杆菌的感染率,并对幽门螺杆菌感染与反流性食管炎进行相关性分析。 结果胃癌合并反流性食管炎组和胃癌患者幽门螺杆菌感染率的发生率分别是22.22%和88.89%,差异有统计学意义（χ²=15.568,P＜0.05）。胃癌合并反流性食管炎组的幽门螺杆菌感染率低于胃癌患者。 结论胃癌患者中幽门螺杆菌感染可能对反流性食管炎发病有一定的保护作用。     

Role of Helicobacter pylori in stomach cancer after partial gastrectomy for benign ulcer disease.

OBJECTIVE: To determine the prevalence of Helicobacter pylori infection in patients having undergone gastrectomy for non-neoplastic disease who later developed gastric stump cancer. MATERIAL AND METHODS: Retrospective study of all patients with partial gastrectomy for non-malignant peptic disease who were submitted to an endoscopic exploration between 1995 and 2001. A comparison was made of major clinical and histological characteristics, and the presence of Helicobacter pylori among patients with and without gastric cancer in the stomach remnant. RESULTS: A total of 73 patients were studied in this period. Fifteen patients (20.5%) had remnant-stump gastric cancer. All but one were adenocarcinomas (71% intestinal and 29% diffuse, respectively). The average time between diagnosis of gastric cancer and previous gastrectomy was 32 (14-48) years. There was a higher detection rate of Helicobacter pylori in patients with cancer in the gastric remnant (100 vs. 81.5%, respectively, p < 0.07). No relationship was seen between type of gastric reconstruction (Billroth I or II) and rate of Helicobacter pylori detection. CONCLUSIONS: Helicobacter pylori infection is frequent in patients with previous gastrectomy for non-neoplastic disease. The results of the study suggest that Helicobacter pylori infection may play a role in gastric stump cancer.     

Changes in prevalence of helicobacter pylori infection after subtotal gastrectomy

Background/Aims: There have been few reports comparing pre and postoperative prevalence of Helicobacter pylori infection and gastritis in patients with gastric cancer surgery. Methodology: Seventy patients with primary gastric cancer were identified to be infected with Helicobacter pylori preoperatively and tested for Helicobacter pylori infection after subtotal gastrectomy. We analyzed changes in Helicobacter pylori infectivity and histological features of gastric mucosa. Results: The overall spontaneous regression rate of Helicobacter pylori infection was 38.6% (27/70). The mean time between surgery and follow-up tests was 1.02±0.5 years. The activity and chronic inflammation scores were significantly decreased in regression group. In non-regression group, there was no significant difference in activity scores, but the chronic inflammation score was significantly increased. There were no significant changes in atrophic gastritis and intestinal metaplasia scores in either group. The grade of Helicobacter pylori infection was significantly decreased in non-regression group. Conclusions: The spontaneous regression rate of Helicobacter pylori infection after subtotal gastrectomy was 38.6% (27/70), it occurred in larger scale of patients and it occurred earlier (1.02±0.5 years) than in previous studies. We suggest that further prospective study on spontaneous regression rate of Helicobacter pylori infection after subtotal gastrectomy and its mechanism is needed in the future.     

幽门螺旋杆菌与残胃癌发生的研究进展

残胃癌发病率呈上升趋势,其发生机制与多种因素有关,其中幽门螺旋杆菌感染被认为是重要因素,但尚无肯定的结论.本文就残胃幽门螺旋杆菌感染与残胃癌发生及相关机制作一综述.     

Helicobacter pylori and gastric cancer

Infection with Helicobacter pylori is now recognized as the primary cause of peptic ulcers and their recurrence. Compelling evidence has also been found linking H. pylori infection to gastric cancer, the second most common cancer in the world. Given the high rate of patient morbidity and mortality associated with gastric cancer, any method by which one can reduce the occurrence of the disease or increase its early detection is desirable. The strong correlation with H. pylori infection and the current availability of easily administered tests for the detection of the pathogen argue for screening at least those individuals with a family history of gastric cancer or other risk factors. This article reviews the association between H. pylori and gastric cancer and the pathologic changes that the infection produces in the gastric mucosa, as well as the cost-effectiveness of universal testing and eradication of the infection in H. pylori-positive individuals to reduce gastric cancer.     

幽门螺杆菌感染与胃癌局部浸润的相关性

胃癌是一种常见的恶性肿瘤,严重威胁着人类的健康,幽门螺杆菌被国际上确认为胃癌的主要病因之一,且其与胃癌的不良预后相关.本文主要通过探讨幽门螺杆菌与胃癌局部浸润的关系,阐明幽门螺杆菌与胃癌转移的可能机制,为胃癌患者根除幽门螺杆菌治疗提供理论依据.     

Helicobacter pylori infection and histological types of gastric cancer]

The relationship between Helicobacter pylori (H. pylori) infection and gastric cancer was evaluated clinicopathologically by histological types of gastric cancer (intestinal or diffuse type). Histological findings of resected stomach tissues and serum anti-H. pylori IgG antibody titers obtained in patients with early gastric cancer revealed H. pylori infection and associated inflammatory changes in all cases, irrespective of histological types of cancer, and suggested that diffuse type cancer occurs in the mucosa with marked inflammation at a relatively early stage of H. pylori infection, while intestinal type cancer occurs at a relatively late stage of infection in parallel with the progression of mucosal atrophy and intestinal metaplasia. Results of immunohistochemical staining showed high incidence of secretory components in and around cancer foci, suggesting that immunological mechanisms for H. pylori infection play a role in the development of gastric cancer regardless of its histological type.     

Helicobacter pylori infection and risk of gastric cancer in Changle County,Fujian Province,China

AIM:To evaluate the effects of Helicobacter pylor infection and other environmental factors on the development of gastric cancer.METHODS:A population-based case control study was conducted in Changle County, Fujian Province. The primary gastric cancer cases were histologically confirmed or diagnosed by surgery between January 1996 and March 1998. Healthy controls were randomly selected and matched by age, sex, and neighborhood of residence.A total of 101 pairs were included in the study. Specially trained interviewers conducted face-to-face interviews with the subjects according to a standardized questionnaire. Helicobacter pylori infections were measured by serum IgG antibody to Helicobacter pylori. Conditional Logistic Regression analysis was used.RESULTS:The presence of IgG antibody to Helicobacter pylori was 63.7% in study subjects, 56.0% in patients with cardiac cancer, and 60.5% in patients with non-cardiac gastric cancer. The risk factors of gastric cancer in Changle County were identified such as low educational level (OR = 3.864; 95% confidence interval (95%CI) 1.604-9.311), low consumption of fresh vegetables (OR = 4.925; 95%CI 1.356-17.885), high intake of fish sauce (OR = 10.587; 95%CI 2.821-39.738), unscheduled meals (OR = 4.254; 95%CI 1.445-12.552), and Helicobacter pylori infection (OR = 3.453; 95%CI 0.901-13.224).CONCLUSION:Helicobacter pylori infection may be important in the etiology of gastric cancer, but major risk factors other than Helicobacter pylori are responsible for the high gastric morbidity in Changle County.     

Mechanism for gastric cancer development by Helicobacter pylori infection

Helicobacter pylori (H. pylori) infection plays a crucial role in the development of gastric cancer. There are two major pathways for the development of gastric cancer by H. pylori infection: the indirect action of H. pylori on gastric epithelial cells through inflammation, and the direct action of the bacteria on epithelial cells through the induction of protein modulation and gene mutation. Both pathways work together to promote gastric carcinogenesis.