幽门螺杆菌与胃癌

胃癌是世界上最常见的恶性肿瘤之一，已知幽门螺杆菌（HP）为胃癌的Ⅰ类致癌原，幽门螺杆菌感染可增加胃癌的发病率，根除幽门螺杆菌有利于减少胃癌的发生。本文就二者的关系作一综述。     

中国幽门螺杆菌感染研究进展

19世纪末 ,人们发现在胃粘膜中存在一种螺旋形的微生物 ,以后虽有不少类似的报道 ,但均未受到应有的重视。直到 1983年澳大利亚学者Ｗａｒｒｅｎ和Ｍａｒｓｈａｌｌ报告了从人胃粘膜中分离到幽门螺杆菌〔(Ｈｅｌｉｃｏｂａｃｔｅｒｐｙｌｏｒｉ,Ｈｐ ;当时称之谓幽门弯曲菌 (Ｃａｍｐｙｌｏｂａｃｔｅｒｐｙｌｏｒｉ,Ｃｐ)〕 ,认为该菌与慢性胃炎和消化性溃疡有关。我国于 1984年开展Ｈｐ的研究工作 ,近 15年来 ,通过我国医学工作者的努力 ,在Ｈｐ的基础与临床研究方面 ,均取得了重要的进展 ,现扼要综述如下。一、幽门螺杆菌的病原学与遗传…     

中国幽门螺杆菌感染流行病学Meta分析

目的：综合分析中国幽门螺杆菌(Hp)流行状况。方法：采用Meta分析对中国1990—2002年发表的有关Hp流行病学文献进行汇总、归纳和统计学分析。结果：共检索3564篇文献，Hp感染在我国分布广泛，平均感染率为58．07％，10—20岁组已达50％以上，Hp感染呈现明显的家庭聚集性。Hp是胃肠疾病发生的危险因素。结论：中国为Hp高感染率地区，家庭内传播可能是Hp感染的主要途径。Hp感染与胃部疾病有关联性，开展Hp感染和相关疾病的防治意义重大。     

幽门螺杆菌与冠心病研究进展

尽管人类在冠心病的预防和治疗方面取得了显著成就 ,但其发病率仍居高不下 ,尤其是许多缺乏明显危险因素的人仍出现严重的动脉粥样硬化(Atherosclerosis,AS) ,显然尚有一些未被认识的危险因素对 AS起作用。早在2 0世纪初就有学者提出感染性因素可诱发 AS的发生 ,但直至 70年代末尚有进一步报道。对感染性因素的研究主要集中在幽门螺杆菌 (H elicobacter,Hp) ,肺炎衣原体 (Chlamydia pneumoniae,Cpn)及单纯疱疹病毒 (H erpes simplexvirus,H SV)和巨细胞病毒 (cy-tomegalovirus,CMV)上。其中尤以 Hp与冠心病是否有关争议最多。本文就…     

γ干扰素与幽门螺杆菌感染

幽门螺杆菌是慢性胃炎、消化性溃疡的主要致病因子，与胃癌的发生密切相关，被列为Ⅰ类致癌因子。研究表明，幽门螺杆菌感染机体后，胃粘膜的γ干扰素水平升高，并与胃粘膜炎症程度呈正相关，因此认为γ干扰素参与了幽门螺杆菌的致病机制。本文就近年有关幽门螺杆菌感染时胃粘膜γ干扰素增加的机制及其在感染中的作用进行了综述。     

幽门螺杆菌感染与胃肠病关系的调查

<正> 介休市人民医院内镜检治中心对近3年来经胃镜检查的患者随机抽查异常和非异常并经HP检测的报告单对照分析,结果显示明显异常。     

有关幽门螺杆菌的两个问题

确定胃幽门螺杆菌感染：查血准还是做胃镜准。     

胃幽门螺杆菌感染与牙周炎相关性分析

[目的]探讨胃幽门螺杆菌感染与牙周炎的关系。[方法]选择2010年1～6月间在华西体检中心行微量14碳-尿素呼气试验检查胃幽门螺杆菌并行口腔检查,无系统性疾病的人群共2730例,使用SPSS17.0对数据进行统计学分析。[结果]胃幽门螺旋杆菌检查阳性为1344例,中重度牙周炎患者为785例,中重度牙周炎患者胃幽门螺旋杆菌检查阳性为412例,占52.48%;中重度牙周炎患者胃幽门螺旋杆菌检查阴性为373例,占47.52%,两组差异有统计学意义(P﹤0.05)。[结论]胃幽门螺旋杆菌与中重度牙周炎相关。     

幽门螺杆菌感染与老年胃病分析相关性

目的探讨幽门螺杆菌(HP)感染与老年胃病的关系。方法回顾性分析我科2002年10月～2005年10月老年胃病的临床资料,169例均做电子胃镜,活检标本快速尿素酶试验检测HP,病变组织送病检。结果169例均为慢性胃炎,其中浅表性胃炎102例,萎缩性胃炎67例,HP感染率分别为70.6%、83.6%。合并上消化道病变者胃癌发生率最高,其次为胃溃疡、十二指肠球部溃疡,其HP感染率分别为88.1%、88.6%、79.3%。结论HP感染与老年胃病密切相关,早期胃镜检查、积极抗HP治疗是防治胃癌关键。     

胃息肉与幽门螺杆菌感染的关系

目的 探讨胃息肉与幽门螺杆菌(HP)之间的关系为临床提供资料和依据.方法 对2005年在医院消化内镜中心经检查发现胃息肉,并接受胃窦部取材进行HP检测的患者的一般情况、息肉的镜下表现、病理特点及其HP感染情况进行收集、整理.结果 在95例符合研究标准的胃息肉患者中,炎性息肉76例(80.0%),增生性息肉19例(20.O%);共有32例(33.7%)存在HP感染,其中炎性息肉患者和增生性息肉患者的感染率分别为38.2%(29例)和15.8%(3例).结论 HP感染与胃炎性息肉的形成有关,对胃息肉患者进行HP的检查和治疗是必不可少的.     

纤维胃镜检查与幽门螺杆菌交叉感染检测报告

对胃镜检查导致幽门螺杆菌（Ｈｐ）交叉感染的可能性进行调查。结果从清洗消毒后胃镜活检吸引管道及活检钳采样培养出Ｈｐ。老年慢性胃炎患者随胃镜检查次数增多，Ｈｐ阳性率增高；Ｈｐ阴性胃炎患者随胃镜随访次数增加，Ｈｐ阳性率增高；Ｈｐ转为阳性随访者的平均年龄大于随机抽查、年龄匹配的正常和慢性胃炎对照中Ｈｐ阳性者。提示，胃镜及附件灭菌不严可成为Ｈｐ交叉感染的一个潜在途径，老年人接受多次胃镜检查可增加感染的危险性     

幽门螺杆菌全菌抗原与尿素酶纯化抗原ELISA检测在人群血清学诊断中的应用

用纯化的Ｈｐ抗原对６７６例各型胃病患者进行了血清抗幽门螺杆菌尿素酶抗体的检测。实验证明其特异性为９６％，敏感性为９８％。血清学ＥＬＩＳＡ检测法，尤其适宜于流行病学调查，还可用于药物治疗效果的观察和筛选非溃疡性消化不良。     

Helicobacter pylori and endoscopy

Helicobacter pylori is possibly the most common bacterial infection of humans and is now recognized as the most important acquired cause of peptic ulceration. Epidemiological evidence also recently implicated this bacterium in the pathogenesis of gastric cancer. The mechanism of spread of the organism, by either the faecal-oral or oral-oral route, raises the possibility of transmission of this organism from infected patients to hospital staff particularly those involved in endoscopy. The evidence for an increased risk to endoscopists is contradictory, varying from none to a five-fold increase. This review summarizes the evidence for mode of transmission and risk to hospital staff from this important bacterium.     

儿童幽门螺杆菌感染血清学研究

应用ＥＬＩＳＡ法对１８１份反复中上腹及脐周痛患儿血清及１９２份对照血清进行了抗幽门螺杆菌ＩｇＧ、ＩｇＭ测定。结果表明：有上述症状患儿血清抗－Ｈｐ ＩｇＧ检出率（５３％）明显高于其他对照组（３４．６％￣３５％），可作为Ｈｐ感染的辅助诊断指标，但其滴度与病程长短及病情严重程度无明显关系，不能反映现症感染。儿童抗－Ｈｐ ＩｇＧ检出率随年龄增加而上升，大年龄组儿童抗－Ｈｐ ＩｇＧ检出率与成人者相近。儿童血     

Prevalence of Helicobacter pylori in asymptomatic subjects—A nested PCR based study

The aim of the study was to see the prevalence of Helicobacter pylori in asymptomatic children and adults by using nested PCR which is considered to be more specific than serological methods. Saliva and stool samples of 137 healthy children (aged 8 months to 16 y) and 108 asymptomatic adults (aged 17–60 y) were collected. PCR with primers targeting Hsp60 gene sequence of H. pylori was used. H. pylori positivity with nested PCR was observed in 45.7% (112/245) of the saliva and 42.8% (105/245) of the stool specimens. Prevalence of H. pylori in saliva was found to be 2.1%, 22.7%, 55.9%, 56.0%, 68.9% and 62.9% in the age groups of <5 y, 6–10 y, 11–16 y, 17–30 y, 31–45 y and 45–60 y, respectively. The detection rates in stool were 4.25% in <5 y, 13.64% in 6–10 y, 50% in 11–16 y, 64% in 17–30 y, 58.62% in 31–45 y and 61.1% in 45–60 y of age groups. The most favourable age group for acquiring the infection was 11–16 y. H. pylori positivity increased with lowering of socioeconomic status. There was no gender bias in prevalence of the bacterium.     

幽门螺旋杆菌药敏试验指导的治疗方案和新一线四联方案:网状Meta分析

目的 比较细菌培养药敏试验指导的幽门螺旋杆菌治疗方案和新一线4种方案（伴同疗法、混合治疗、序贯治疗、铋剂四联治疗）的疗效和不良反应,并进行概率排序为临床治疗提供科学依据。方法 系统检索电子数据库,筛选截至2015年6月比较细菌培养药敏试验指导治疗和新一线4种方案,包括基于细菌培养药敏试验指导治疗、伴同疗法、混合治疗、序贯治疗、铋剂四联治疗方案的随机对照试验。通过网状Meta分析和单组率的Meta分析,定量综合这些方案的相对和绝对疗效及不良反应。采用Jadad评分量表评价随机对照试验的方法学质量,构建漏斗图定性测量发表偏倚,其中不对称性检验使用Egger线性回归法或者Begg秩相关法。结果 共纳入20个初治幽门螺旋杆菌感染的随机对照试验,涉及6 753例患者。网状Meta分析表明,细菌培养药敏试验指导治疗的方案显著优于其他方案,根除率最高,不良反应发生率最低;伴同疗法虽然高效但最有可能出现不良反应事件;混合治疗和铋剂四联治疗方案具有较高的疗效、较低的不良反应发生率。结论 对于成年人幽门螺旋杆菌感染,细菌培养药敏试验指导的治疗方案显著优于伴同疗法、混合治疗、铋剂四联治疗和序贯治疗方案;医疗条件匮乏地区可选择混合治疗和铋剂四联治疗方案。     

Reasons for non-compliance with screening for infection with Helicobacter pylori, in a multi-ethnic community in Leicester, UK

In this study, we aimed to identify reasons for non-compliance with a screening programme for Helicobacter pylori (H pylori), in a multi-ethnic community and to assess the effectiveness of Asian language materials towards increasing compliance. A serological screening test for infection with H pylori was offered to 200 Asians and 200 non-Asians (mainly Europeans), aged 21–55 y, registered at a single general practice. Reasons for non-attendance for screening were identified by reply slip or interview. A second group of 200 Asians who were offered screening were sent information in Gujarati as well as English. When information was mailed in English only, 30% Asians and 22% non-Asians attended (P = 0.09, ns). Stated reasons for non-attendance in the Asian group were not generally language related; reasons were similar in the Asian and non-Asian groups and were most frequently related to other commitments. The use of materials in Gujarati did not improve compliance.Language problems should not be assumed to dominate reasons for non-compliance with screening in ethnic minority groups. In common with those of UK origin, subjects from ethnic minority groups may more generally have insufficient interest in preventive medicine for them to prioritise health screening above other commitments.     

The association of drinking water quality and sewage disposal with Helicobacter pylori incidence in infants: the potential role of water-borne transmission

The mode of transmission of Helicobacter pylori, a bacterium causing gastric cancer and peptic ulcer disease, is unknown although waterborne transmission is a likely pathway. This study investigated the hypothesis that access to treated water and a sanitary sewerage system reduces the H. pylori incidence rate, using data from 472 participants in a cohort study that followed children in Juarez, Mexico, and El Paso, Texas, from April 1998, with caretaker interviews and the urea breath test for detecting H. pylori infection at target intervals of six months from birth through 24 months of age. The unadjusted hazard ratio comparing bottled/vending machine water to a municipal water supply was 0.71 (95% confidence interval (CI): 0.50, 1.01) and comparing a municipal sewer connection to a septic tank or cesspool, 0.85 (95% CI: 0.60, 1.20). After adjustment for maternal education and country, the hazard ratios decreased slightly to 0.70 (95% confidence interval: 0.49, 1.00) and 0.77 (95% confidence interval: 0.50, 1.21), respectively. These results provide moderate support for potential waterborne transmission of H. pylori.     

Helicobacter pylori prevalence in Leipzig’s 1998 school entries: methodology and first results

The non-invasive, stable-isotope-aided Helicobacter pylori (H. pylori) tests- breath and equivalent urine tests- were offered on a voluntary basis as part of the mandatory school entry medical examination to the 1998 school entry cohort of the City of Leipzig (480000 residents). Parents of participating subjects were asked to fill out a detailed epidemiologic questionnaire.The response rate was 94% (n 2228 of 2369 school starters born in 1991/92). Parent-completed questionnaires were returned by 1890 (80%) children. The overall H. pylori positive prevalence was 7.2%. The prevalence among children with a test and a parent-completed questionnaire was 6.5%. Prevalences among subsequently tested family members of the positive tested children was 65,60 and 39% for mothers, fathers and siblings respectively. Though studies have shown that the direct transmission of the bacterium (oral- oral and fecal- oral) is a dominant pathway of infection, the questionnaire analyses indicate associations between H. pylori colonisation and living as well as environmental conditions.     

Sterilizing immunity against experimental Helicobacter pylori infection is challenge-strain dependent

The development of a murine model of Helicobacter pylori infection through serial in vivo passage of candidate strains has enabled a quantitative assessment of vaccine efficacy. In this study we compare infection with and protection against challenge from both CagA⁺ type I, and CagA⁻ type II in vivo adapted isolates. In vivo passage of a type II H. pylori isolate resulted in a highly infectious strain (X47-2AL), capable of reproducibly infecting mice to high density (10⁷ CFU/g of gastric tissue). Similarly adapted type I strains were found to colonize mice at a significantly lower level (10⁴–10⁵ CFU/g tissue). Mucosal immunization with recombinant urease (rUre) significantly protected animals against both types. Protection against X47-2AL was characterized by a ≥100-fold (or 2 log) reduction in bacterial density. However, the presence of a residual infection highlighted the inability to achieve sterilizing immunity against this strain. The level of protection appeared independent of challenge dose, and was stable for up to 6 months, all animals exhibiting a low-level residual infection that did not recrudesce with time. Similarly immunized mice challenged with isolates representing the residual infection were also protected, confirming that they did not represent a sub-population of H. pylori that could escape immunity. Immunization and challenge studies with type I adapted-isolates, demonstrated a similar 2–3 log reduction in the bacterial burden, but that in this instance resulted in sterilizing immunity. These results suggest varied specificity for the murine host by different Helicobacter strains that can influence the outcome of both infection and immunity.