煤矿工人幽门螺杆菌感染的传播途径

煤矿工人是一个较特殊的职业人群,特殊的工作环境和生活方式形成了特有的疾病谱,胃十二指肠疾病,尤其是胃癌,是严重危害广大煤矿工人的一类疾病。Hp感染与胃十二指肠疾病的关系非常密切,但Hp的传播机制尚不完全清楚,目前,有关Hp感染的传播途径的研究多是针对一般人群的研究,特别缺少对煤矿工人Hp感染的传播途径的进一步的研究。为此,我们进行了煤矿工人Hp感染的传播途径的Westernblots研究,为煤矿工人Hp感染导致的胃十二指肠疾病的防制提供一些依据。现将分析结果报告如下。     

幽门螺杆菌感染的传播

幽门螺杆菌在环境中至少可生存一定的有限时间，而人类则是该菌感染的唯一来源。幽门螺杆菌通过粪－口或口途径，可在人与人之间进行直接或间接的传播。     

幽门螺杆菌的传播途径

自1983年Warren和Marshall从人胃粘膜中分离出幽门螺杆菌(Helicobacter pylori,Hp)以来,国内外大量的研究证明,该菌是导致非自身免疫性(B型)慢性胃炎的一个重要原因。它与消化性溃疡,特别是十二指肠溃疡的关系也很密切。Hp感染和胃癌亦有一定的关系。Hp感染呈全球性分布,人群中的Hp感染率很高。研究Hp传播途径,以便有效控制其感染,对防治慢性胃病具有重要的意义,但Hp的感染途径,迄今未得到完全确认,本文就目前国内外的有关Hp传播途径作一概括。     

幽门螺杆菌的传播途径

全世界大约有50％的人群感染有幽门螺杆菌（Hp）（Belleck,2006）。阻断Hp传播途径将可能是预防Hp相关性疾病的最有效策略之一。有关Hp的传播途径目前仍不明确。本文将就Hp可能的传播途径作一简要综述。     

三种幽门螺杆菌感染诊断方法的比较

目的：对三种常用幽门螺杆菌诊断方法（细菌分离培养、快速脲酶试验、病理组织切片）进行比较。方法：对312例因胃部不适患的胃窦部活检组织，分别进行以上三种方法检测幽门螺杆菌，得到阳性检出率，然后进行比较。结果：细菌分离培养、快速脲酶试验、病理切片Hp检出率分别为60．26％，69．26％，69．235及46．15％。其中64例十二指肠球部溃疡的二块活检Hp细菌分离培养阳性率为93．75％，比一块活检组织的Hp细菌分离培养阳性率高6．25％；快速脲酶试验、病理切片与细菌分离培养的不符合率分别为14．1％和25．6％。结论：同其他两种方法相比，细菌分离培养是一种特异性高，敏感性强，技术设备要求不高，价廉的好方法。     

幽门螺杆菌粪便抗原检测在幽门螺杆菌感染诊断及随访中的价值

目的 对幽门螺杆菌粪便抗原（HpSA）检测诊断hp感染、hp根除治疗后的随访及在儿童中的应用价值,进行临床评价。方法 以快速尿素酶试验=、组织学和细菌培养中的二项阳性或细菌培养一项阳性作为诊断HP的金标准,采用ELISA法检测128例因上消化道症状接受胃镜检查患者HPSA,评价HPSA诊断HP感染的敏感性、特异性;其中79例同时进行^13C-UBT作为对照,评价HPSA诊断HP感染的准确性。结果 在128例中,HPSA检测的敏感性、特异性和准确性分别为95.16%,98.41%和96.80%。根除治疗前HPSA检测和^13C-UBT诊断HP的敏感性为97.96%和95.92%,特异性为96.67%和100.00%,准确性均为97.46%;根除治疗后4周随访HPSA检测和^13C-UBT的敏感性均为100.00%,特异性为91.43%和94.29%,准确性 93.18%和95.45%。以^13C-UBT作标准,HPSA检测29例患儿HP感染敏感性、特异性和准确性分别为91.67%,88.23%和89.66%。结论 HPSA检测是一种简便、准确、非侵入性的诊断HP感染的方法,适用于HP感染的诊断、根除治疗后随访及儿童患者。     

幽门螺杆菌粪便抗原检测的临床意义

目的评价幽门螺杆菌粪便抗原(HpSA)检测诊断幽门螺杆菌(H.pylori)感染的可靠性.方法收集183例接受内镜检查患者粪便标本,用ELISA法定性检测HpSA.以尿素酶试验和涂片染色联合检测H.pylori作为"金标准”,两者均阳性者为H.pylori感染,均阴性者为无H.pylori感染.结果"金标准”诊断H.pylori阳性120例,阴性63例.120例"金标准”阳性中HpSA检测阳性者为110例,阴性10例.63例"金标准”阴性中HpSA检测阴性者为58例,阳性为5例.HpSA检测的敏感性为91.7%(110/120),特异性为92.1%(58/63),阳性期望值为95.7%(110/115),阴性期望值为85.3%(58/68),总的诊断准确率为91.8%(168/183).结论HpSA检测试验是一种简便、可靠的非侵入性的诊断H.pylori感染的新方法.     

幽门螺杆菌感染—热点聚焦

最近研究发现，幽门螺杆菌（Helicobacter pylori；Hp）感染基本上全系完成于小儿期。Konao（2005）就44名Hp抗体阳性母亲所生小儿的粪便抗原作5年之随访检测发现有5名受染，其感染时间在1岁时有4名、4岁时有1名，提示初其感染时间多在2岁之前。传播途径以家庭成员间感染为最重要，约占80％，尤其母婴传播为多（约占70％）。家庭外感染则可能系幼儿保育机构和智障小儿养育单位内的水平传播。传播方式当为经口感染，但依时间与地区生活习俗之相异可有种种不同的方式。传播因子可有饮水，感染的粪便或呕吐物污染以及感染口嚼喂养等等，此乃预防感染之关键要点。     

胃癌高发区儿童幽门螺杆菌感染及传播途径

目的研究胃癌高发区儿童幽门螺杆菌（Ｈｐ）和ｃａｇＡ＋亚型感染状况及细菌传播方式，探讨儿童早期感染Ｈｐ与胃癌的关系．方法用１３Ｃ尿毒酶呼吸实验（１３ＣＵＢＴ）方法检测（山东省临朐县）９８名儿童Ｈｐ感染状况，用ＥＬＩＳＡ方法检测７０名儿童抗ＣａｇＡ抗体及成人抗Ｈｐ抗体．结果胃癌高发区儿童Ｈｐ感染率为６９４％，其中３岁～４岁儿童Ｈｐ感染率为５２６％．９岁～１０岁上升为８５％，１１岁～１２岁下降为６６７％，接近于成人水平．儿童ｃａｇＡ＋亚型感染率为７１４％．Ｈｐ感染有明显的家族聚集性，其中父母双方或一方Ｈｐ感染阳性的子女Ｈｐ感染率（８５％）明显高于父母Ｈｐ感染均阴性者（２２％，Ｐ＜００５）．结论胃癌高发区儿童Ｈｐ、特别是ｃａｇＡ＋亚型感染率很高，且有家族聚集性，表明儿童阶段即可感染Ｈｐ，并且与当地胃癌高发有明显关系．     

口腔幽门螺杆菌感染影响阿尔茨海默病发生发展的途径研究进展

阿尔茨海默病(AD)是一种中枢神经系统退行性疾病,其特征性病理改变为脑组织中的β淀粉样蛋白聚集形成的老年斑、Tau蛋白过度磷酸化形成的神经元纤维缠结以及神经元数量减少等.幽门螺杆菌是牙周炎、龋病、口腔黏膜病等口腔疾病的常见致病菌,口腔幽门螺杆菌感染与AD的发生发展存在一定关系.口腔幽门螺杆菌可通过影响牙周组织炎症状态和...     

Transmission of Helicobacter pylori Infection Studies in Families of Healthy Individuals

Helicobacter pylori is accepted as the commonest cause of type-B gastritis. Detailed information about the mode of transmission remains scanty. We investigated the frequency of H. pylori infection within families, defined as consisting of a husband and wife with at least one biologic child, all living in the same household. Inclusion criteria required that both the parents and the children had been born in the United States, had used no antibiotic or bismuth for the previous 2 months, had no recent major illness or surgical operation, and had no symptoms referable to the upper gastrointestinal tract. H. pylori infection was identified with a ¹³C-urea breath test and an enzyme-linked immunosorbent assay for anti-H. pylori IgG. Forty-one families (151 healthy individuals) were enrolled. Before the results of the H. pylori tests were known, one parent was selected as the index subject. H. pylori infection clustered; that is, 68% of spouses of H. pylori-infected index subjects were also H. pylori-infected, compared with 9% of spouses of H. pylori-negative index subjects (p < 0.0001). The children of infected index parents were also more likely to be infected than children of uninfected index parents—40% versus 3%, respectively (p < 0.0001)—and the results in the children were independent of whether the father or the mother was the index subject. Clustering of H. pylori infection within families suggests person-to-person transmission or common source exposure. The high frequency of H. pylori infection in spouses suggests that genetic factors are less important than living conditions for transmission of H. pylori infection.     

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.     

Transmission of Helicobacter pylori infection in families of preschool-aged children from Minas Gerais, Brazil

We evaluated the role of the family in the transmission of Helicobacter pylori infection in preschool-aged children from a rural district in the State of Minas Gerais, Brazil. Sixty-six families (66 index children, 63 mothers, 60 fathers and 134 siblings), defined as at least one parent living in the same household with at least one offspring up to 8 years old, were studied. Odds ratios (OR) and 95% confidence intervals (CI) were estimated by logistic regression controlling for age, gender, number of children in household and H. pylori status of the father, mother and siblings. The prevalence of the infection was 69.7% (469 of 673) and it increased with age (P < 0.001). Positive mothers were a strong and independent risk factor for infection (OR 22.70; 95% CI 2.31-223.21). Positive siblings were also positively associated with infection (OR 1.81; 95% CI 1.01-3.30).     

Helicobacter pylori infection in children

Helicobacter pylori was sought prospectively by culture of antral biopsy, histology and serology (IgG and IgA) in 440 consecutive endoscopies on children to determine the prevalence, clinical presentation and histological features of H. pylori infection in our population. Twenty-eight patients had H. pylori (8% overall). The mean age of infected patients was significantly higher than that of non-infected patients (P less than 0.0001). No patient under 5 years of age had H. pylori isolated. Overall, there was no significant difference in clinical presentation between those with and those without H. pylori infection, but 23% of patients 5 and 26 years of age who presented with abdominal pain as the indication for their endoscopy had H. pylori isolated. Macroscopic changes ranged from no abnormality to frank ulceration, but the typical antral mamilliform changes were 100% predictive of infection. Fifty-eight per cent of patients with duodenal ulcers, but only 17% with gastric ulcers had H. pylori infection. Histological gastritis was present in 144 patients (including all H. pylori positive patients). None of the patients with another definable cause for gastritis had H. pylori isolated. In conclusion, H. pylori is an important cause of primary gastritis in our population, occurring in children over 5 years of age. Culture of an antral biopsy should be performed in children over this age undergoing endoscopy for the investigation of abdominal pain and, more particularly, in those with peptic ulceration.     

幽门螺杆菌感染与反流性食管炎的关系

目的探讨幽门螺杆菌（Hp）感染与反流性食管炎（RE）的关系。方法对在本院消化科就诊的患者行内镜下快速尿素酶测定却感染，观察比较却阴性组、却阳性组RE的发病率。对却阳性组中经胃镜及病理切片证实为消化性溃疡的患者，进行却根除治疗，3个月后复查胃镜比较抗却治疗前后RE发病率的变化。结果却阳性组RE发病率为5．28％，却阴性组RE发病率为7．59％，二者差异有统计学意义（P〈0．05）。抗却治疗前后RE发病率分别为10．7％、35．7％，二者差异有统计学意义（P〈0．05）。结论①却不是RE的病因；②抗坳治疗会导致RE发病率的升高。     

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。     

十二指肠胃化生与幽门螺杆菌感染

本文调查了155例十二指肠溃疡旁粘膜的组织病理学变化,并与对照组相比较。结果显示:溃疡旁组织炎症、胃化生和Hp检出率分别为69.7％、75.5％和24.5％,显著高于对照组的18.8％、10.4％和4.2％(P<0.01)。Hp在胃化生组织中的检出率为32.8％,81例不伴胃化生的粘膜中均未检出Hp(P<0.01)。透射电镜观察胃化生有其特征性改变。提示胃化生可能是溃疡形成的基础,Hp在化生区定植并非是产生溃疡的唯一直接因素,还可能通过其他复杂环节间接起作用。     

幽门螺杆菌感染与Toll样受体

Toll样受体(TLR)是固有免疫系统中的细胞跨膜受体及微生物相关分子模式识别受体之一,可激活固有免疫应答,同时还是连接固有免疫和获得性免疫的桥梁。因此,Toll样受体在免疫系统中有着十分重要的作用。最近研究发现TLR信号通路和幽门螺杆菌(Hp)的感染和致病关系密切。此文主要介绍TLR的结构、信号通路及其在Hp感染和致病中的作用。