益生菌联合三联疗法根治儿童幽门螺杆菌感染的系统评价

目的对益生菌制剂联合三联疗法清除儿童幽门螺杆菌(H.pylori)感染的临床疗效及其对治疗中抗生素相关的不良反应进行系统评价。方法通过检索PubMed、EMBASE、Cochrane Central Register of ControlledTrials等数据库,1982年1月至2010年4月,全面收集应用益生菌制剂联合三联疗法治疗小儿H.pylori感染的随机对照试验,并对其进行meta分析。结果纳入5个试验包括364例儿童,益生菌制剂联合三联疗法组184例患儿H.pylori根治率为72.28%,单用三联疗法组180例患儿H.pylori根治率为61.67%,合并OR值为0.58(95%CI:0.36～0.93,P=0.02);不良反应发生率分别为益生菌组23.77%,对照组28.10%,合并OR值为1.39(95%CI:0.41～4.71,P=0.60)。结论目前证据显示联合应用益生菌制剂可提高抗H.pylori感染治疗中的根治率,但并不能有效降低三联疗法治疗中不良反应的发生。     

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??Objective??To understand the clinical eradication therapy for Helicobacter pylori infection in children and analyze the causes. Methods??H.pylori eradication therapy for 10 or 14 days was accepted by 301 cases of children??who were diagnosed with H.pyori infection??in the Children’s Hospital of Zhejiang University School of Medicine from January??2012 to October??2015. Finally??the eradication rate of H.pylori was judged. Results??In initial treatment??the eradication rate of OAC program??omeprazole??amoxicillin and clarithromycin?? was 42.3%??the eradication rate of non-OAC program was 56.7%??and there were statistically significant differences between the two groups??P??0.05??. The eradication rate of bismuth-based regimens was 50.0%??the eradication rate of standard triple therapy was 41.2%??and there were no statistically significant differences between the two groups??P??0.05??. In the rescue treatment??the eradication rate of bismuth-based quadruple therapy was 58.3%??the eradication rate of triple therapy with furaxone was 55.0%??and there were no statistically significant differences between the two groups??P??0.05??. Totally 119 strains of H.pylori were not resistant to amoxicillin??while the resistance rate to clarithromycin and metronidazole was 27.7% and 69.3%??respectively. Conclusion??In this study??the clinical eradication rate in children with Hp infection fails to achieve the goal eradication rate of 80%. Drug sensitivity test is still the first choice for treatment of Helicobacter pylori infection in children.     

序贯疗法和标准三联疗法根除儿童幽门螺杆菌的疗效观察

目的评估序贯疗法在儿童幽门螺杆菌感染根治治疗中的疗效及可行性。方法将有上消化道症状,经13C-尿素呼气试验(13C-UBT)检测H.pylori为阳性的患儿100例随机分为3组:序贯治疗组、PAC组和PAM组。序贯治疗组:前5 d二联疗法即奥美拉唑+阿莫西林,后5 d三联疗法即奥美拉唑+克拉霉素+甲硝唑;PAC组予以奥美拉唑+阿莫西林+克拉霉素,共10 d;PAM组予以奥美拉唑+阿莫西林+甲硝唑,共10 d。均为每日2次,早晚口服。所有患儿停药至少4周后复查13C-UBT,判断H.pylori根除率。结果三组患儿H.pylori根除率的符合方案数据分析(PP)分别为:序贯治疗组91.18%,PAC组68.97%,PAM组76.67%;序贯治疗组和PAC组比较,差异有统计学意义(χ2=5.01,P<0.05);序贯治疗组和PAM组比较,PAC组和PAM组比较,差异均无统计学意义(χ2=2.55、0.44,P均>0.05)。结论 10日序贯疗法根除H.pylori疗效明显优于10日标准三联疗法,10日序贯疗法可能为一有效的根除儿童H.pylori感染的新方案。     

10天序贯疗法与传统三联疗法根除儿童幽门螺杆菌感染疗效比较

幽门螺杆菌(Helicobacter pylori,Hp)是慢性胃炎和消化性溃疡的主要病因,与胃癌和胃黏膜相关淋巴组织淋巴瘤关系密切.儿童是Hp的易感人群,绝大多数感染者的第一次感染在10岁以内[1],而且胃黏膜上的Hp持续存在增加了胃癌和胃淋巴瘤发生的风险,因此根除儿童时期Hp感染具有十分重要的意义.     

儿童幽门螺杆菌根除治疗过程中肠道菌群的变化

目的探讨儿童幽门螺杆菌根除治疗对肠道菌群的影响,并寻找影响根除治疗效果的差异菌群。方法确诊幽门螺杆菌感染儿童进行三联标准化方案治疗14天,留取治疗前、治疗7天及14天时的粪便进行16SrDNA测序。根据取样时间分为治疗前组、治疗7天组、治疗14天组,根据治疗效果分为治疗成功组、治疗失败组,根据既往根治病史分为复治成功组、初治成功组,分析不同组别之间的菌群差异。结果幽门螺杆菌感染儿童肠道菌群优势菌门依次为厚壁菌门、拟杆菌门、变形菌门、放线菌门、疣微菌门,主要优势菌属有拟杆菌、栖粪杆菌、大肠杆菌/志贺菌、双歧杆菌、Gemmiger、克雷伯菌。与治疗成功组相比,普氏菌属在治疗失败组相对丰度升高,差异有统计学意义(P0.001)。幽门螺杆菌根除治疗前、治疗7天和14天比较,各肠道菌群相对丰度均发生改变,差异有统计学意义(P0.05)。LEfSe分析及组间秩和检验发现,治疗失败组弓形杆菌属、肠道巴恩斯菌属、Coprobacter、粪球菌属、霍尔德曼菌属、假单胞菌属高于治疗成功组,差异有统计学意义(LDA2)。与初治成功组相比,复治成功组不动杆菌属、魏斯菌属、萨特菌属、普罗维登斯菌属显著升高(LDA2),另枝菌属、丹毒丝菌属、梭状芽胞杆菌属、粪杆菌属、Gemmiger显著降低(LDA2)。结论幽门螺杆菌根除治疗影响肠道菌群结构,表现为菌群多样性下降及优势菌群改变。肠道致病性细菌的生长可能影响幽门螺杆菌根除效果,导致根除治疗失败。     

幽门螺杆菌感染家庭内聚集和根除治疗相关性探讨

目的研究幽门螺杆菌(H.pylori)感染儿童家庭内聚集现象,探讨根除H pylori感染的相关性治疗.方法经胃镜检查、病理切片、快速尿素酶试验(RUT)、PCR-UreA-DNA确诊H pylori感染患儿226例,对其383位父母及部分家庭成员进行流行病学调查.应用洛赛克+克拉霉素+羟氨苄青霉素三联1周疗法,治疗92例患儿,分成与感染的父母同治组和未同治组,观察对照2组H pylori根除率差异性.结果 226个家庭383位父母及部分家庭成员中H pylori总阳性检出率为83.8%.41例患儿菌株血清基因型与73位父母基因型符合率为89%(65/73).与父母同治组H pylori根除率为95.2%(40/42);未同治组H pylori根除率为80%(40/50),χ2=4.67,P<0.05,二组间差异有显著性意义.结论 H.pylori感染有突出的家庭内聚集现象,父母及有密切接触的其他家庭成员是儿童感染的重要传染源;与感染父母或家庭成员的同步治疗,对提高患儿H pylori根除率与预防再感染有重要意义.     

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??TheinfectionrateofHelicobacterpyloriisincreasingyearby year??whiletheeradication rateisdeclining. The paper explains the difficult problems in the treatment of Helicobacter pylori infection from strain??host and environment. Through combination of recent research advances and clinical experiences??the authors provide some solutions to the above problems in order to increase the eradication rate and reduce recurrence.     

儿童中根除幽门螺杆菌新的治疗对策

幽门螺杆菌与许多消化系统疾病如慢性胃炎、消化性溃疡、胃黏膜相关淋巴样组织淋巴瘤和胃癌密切相关,还可导致儿童缺铁性贫血、生长障碍、哮喘、过敏性疾病等,而根除幽门螺杆菌是防治这些疾病的重要措施。近年来,随着克拉霉素及甲硝唑耐药率逐渐上升,标准三联疗法根除率已小于80％,远远达不到临床要求。特别是克拉霉素高耐药地区,标准三联疗法已不能被推荐作为一线治疗,需探讨新的治疗对策以提高幽门螺杆菌的根除率。儿童中根除幽门螺杆菌新的治疗方案主要有序贯疗法、含铋剂疗法、伴同疗法及联合益生菌等。该文就近年国内外对上述新方案的研究进展作一综述。     

A randomized, open trial evaluating the effect of Saccharomyces boulardii on the eradication rate of Helicobacter pylori infection in children

Aim: The failure rate of Helicobacter pylori ( H. pylori ) eradication imposes the assessment of new options.
Subjects and methods: A prospective open study was performed in 90 symptomatic children (range 3–18 years) with H. pylori infection, randomized in two groups: control (42 patients) and intervention group (48 patients). Both groups were treated with the standard triple eradication therapy (omeprazole/esomeprazole, amoxicillin and clarithromycin) for 7–10 days. The intervention group was also treated with Saccharomyces boulardii ( S. boulardii ), 250 mg b.i.d., for 4 weeks. The eradication rate of H. pylori was assessed by the same methods (urease test and histology) 4–6 weeks after treatment. Adverse events and compliance were evaluated after 7 and 28 days of treatment. The Chi-square test was used for statistical evaluation (p < 0.05).
Results: H. pylori infection was identified in 90 of 145 children (62%) and it correlated positively with age (p < 0.002) and inversely with socioeconomic status (p < 0.005). All infected children had chronic gastritis, with antral nodularity in 76.7%. Overall, H. pylori eradication rate was 87.7% (control 80.9%, S. boulardii group 93.3%) (p = 0.750). The incidence of side effects was reduced in the S. boulardii group: 30.9% in the control versus 8.3% in the probiotic group (p = 0.047).
Conclusion: The addition of S. boulardii to the standard eradication treatment confers a 12% nonsignificant enhanced therapeutic benefit on H. pylori eradication and reduces significantly the incidence of side effects.     

Urinary 8-hydroxydeoxyguanosine excretion in children before and after therapy for eradication of Helicobacter pylori infection

Aim: A number of reports have implicated oxygen free radicals in the pathogenesis of Helicobacter pylori (H. pylori)-associated disease. 8-hydroxydeoxyguanosine (8-OHdG) has recently been accepted as a sensitive marker for reflecting the oxidative DNA damage. However, there have been no previous studies comparing the changes in urinary 8-OHdG excretions before and after therapy for eradication of H. pylori infection, or to examine 8-OHdG excretions in children with H. pylori infection. The aim of this study was therefore to examine the DNA damage in gastric mucosal cells in children with H. pylori infection. Methods: Urinary 8-OHdG excretions were measured before and after therapy for eradication of H. pylori infection in 15 children diagnosed with the H. pylori infection and 13 parents who were also suffering from the same infection. Results: In both the children and their parents, no significant differences were found in urinary 8-OHdG excretions either before or after the eradication therapy. Furthermore, there was no significant difference in urinary 8-OHdG excretions between 8 children with peptic ulcers and 7 children without ulcers, either before or after the therapy.

Conclusion: These results suggest that measurement of urinary 8-OHdG levels is not useful for evaluation of the DNA damage in H. pylori-infected gastric mucosa in children.     

Esomeprazole-based 1-week triple therapy directed by susceptibility testing for eradication of Helicobacter pylori infection in children

BACKGROUND: Poor compliance to therapy and antibiotic resistance are the main causes for failure of anti-Helicobacter pylori therapy. OBJECTIVE: To evaluate the effectiveness of esomeprazole-based triple therapy directed by susceptibility testing. METHODS: Symptomatic children with H. pylori infection, who underwent successful susceptibility testing and were colonized by no double-resistant strain, received 1-week triple therapy with esomeprazole, amoxicillin and either clarithromycin or metronidazole. Success of eradication was investigated by C-urea breath test. RESULTS: Fifty-eight children (median age, 11.4 years; range, 2.2-17.7 years; 81% immigrants) were included. Helicobacter pylori was resistant to clarithromycin in 5 (9%) and to metronidazole in 9 children (16%). Eradication was successful in 49 (92%) of 53 children receiving esomeprazole, amoxicillin and clarithromycin and in all 5 children treated with metronidazole instead of clarithromycin, resulting in an eradication rate of 93% (95% confidence interval, 83%-98%, intention-to-treat analysis). All 4 treatment failures occurred in immigrants with language problems; 2 of them were obviously noncompliant. CONCLUSION: Esomeprazole-based 1-week triple therapy directed by susceptibility testing is highly effective for eradication of H. pylori infection in children.     

Meta-analysis of randomized, controlled treatment trials for pediatric obsessive-compulsive disorder

Objective:  To conduct a meta-analysis on randomized, controlled treatment trials of pediatric obsessive-compulsive disorder (OCD).
Method:  Studies were included if they employed randomized, controlled methodology and treated young people (19 years or under) with OCD. A comprehensive literature search identified 13 RCTs containing 10 pharmacotherapy to control comparisons ( N  = 1016) and five cognitive-behavioral therapy (CBT) to control comparisons ( N  = 161).
Results:  Random effects modeling yielded statistically significant pooled effect size (ES) estimates for pharmacotherapy (ES = .48, 95% CI = .36 to .61, p  < .00001) and CBT (ES = 1.45, 95% CI = .68 to 2.22, p  = .002). The results were robust to publication bias.
Conclusions:  This is the first meta-analysis of treatment RCTs for pediatric OCD. CBT and pharmacotherapy were the only treatments effective beyond control in alleviating OCD symptoms. CBT showed a greater ES than pharmacotherapy. Previous meta-analyses that included uncontrolled trials exaggerated the efficacy of both treatments.