儿童幽门螺杆菌毒力基因与抗生素耐药相关性研究

目的探讨儿童幽门螺杆菌(H.pylori)临床分离株毒力基因与抗生素耐药之间的关系。方法从具有上消化道症状的90例患儿胃窦黏膜中分离培养H.pylori阳性菌株,采用E-test法和K-B法检测H.pylori对抗生素耐药性,聚合酶链反应(PCR)检测H.pylori cag A、vac A及ice A基因。结果在胃窦黏膜分离培养的90株H.pylori菌株中,8株(8.9%)对克拉霉素耐药,31株(34.4%)对甲硝唑耐药,12株(13.3%)对克拉霉素和甲硝唑二重耐药,39株(43.3%)对抗生素均不耐药,未发现对阿莫西林和呋喃唑酮耐药的H.pylori菌株;cag A基因阳性检出率为93.3%(84/90),vac As1a、vac As1c、vac Am1和vac Am2基因阳性检出率分别为77.8%(70/90)、22.2%(20/90)、32.2%(29/90)和67.8%(61/90),vac As1a/m1、vac As1a/m2、vac As1c/m1和vac As1c/m2基因阳性检出率分别为30.0%(27/90)、51.1%(46/90)、3.3%(3/90)和16.7%(15/90),ice A1和ice A2基因阳性检出率分别为87.7%(79/90)和7.8%(7/90)。H.pylori毒力基因型在克拉霉素耐药组、甲硝唑耐药组、克拉霉素+甲硝唑二重耐药组和对抗生素敏感组四组间的阳性检出率比较,差异均无统计学意义(P0.05)。结论儿童H.pylori临床分离菌株毒力基因型与抗生素耐药无相关性。     

��ͯ�����ݸ˾����ݶ��ػ�����о�

目的探讨儿童幽门螺杆菌vacA基因型并分析各基因亚型与胃十二指肠疾病的关系。方法对80例H·pylori感染的儿童,采用PCR法扩增胃黏膜vacA基因亚型。结果南宁儿童H·pylorivacA基因型有s1a/m1和s1a/m2两种组合,基因频率分别为3·75%、66·25%。vacA基因各亚型在慢性浅表性胃炎及消化性溃疡中的检出率差异无显著性(P>0·05)。结论s1a/m2为南宁地区儿童幽门螺杆菌的vacA优势基因型。部分患儿同时感染多株不同vacA基因型H·pylori。vacA基因各亚型不能作为南宁地区儿童H·pylori菌株毒力强弱的指标。     

儿童上消化道疾病幽门螺杆菌感染状况与病理分析

目的　探讨广州地区小儿上消化道疾病中幽门螺杆菌 (H .pylori)感染的临床状况与组织学特点。方法　对 1994～ 2 0 0 1年广州市儿童医院 374 2例患上消化道疾病患儿采用日产奥林巴斯GIF PQ2 0纤维胃镜和富士能EG 4 5 0PE电子胃镜检查 ,并取胃窦部黏膜进行病理学检查及快速尿素酶试验 ,13 C 呼气试验检测。结果　胃镜检查病变检出率 94 4 4 % (35 34/ 374 2 ) ,其中H .pylori感染检出率占 18 14 % (6 4 1/ 35 34)。各年龄组胃十二指肠疾病H .pylori感染率具有显著差别 (P =0 0 0 0 1) ,H .pylori感染与年龄呈显著正相关 (r =0 914 ,P =0 0 0 0 1)。H .pylori感染前三位疾病是慢性浅表性胃炎、十二指肠球炎、十二指肠球部溃疡 ,其中结节性改变占十二指肠球炎的 4 7 5 7% (98/ 2 0 6 )。随着年龄的增长 ,上消化道疾病的发生率逐渐升高 (r =0 994 ,P =0 0 0 3)。消化性溃疡的发生率亦随年龄增长而增加 (十二指肠溃疡 :r =0 976 ,P =0 0 12 ;胃溃疡 :r =0 917,P =0 0 4 3)。H .pylori感染病例中组织学显示中 重度慢性胃炎占 82 97% (190 / 2 2 9)。结论　小儿H .pylori感染率随年龄增长而递增 ,胃、十二指肠黏膜结节性改变是小儿H .pylori感染的胃镜下特征。广州地区H .pylori感染有异于国内外其     

儿童幽门螺杆菌感染的菌株类型及治疗

目的评估幽门螺杆菌(H.pylori)不同菌株对儿童胃粘膜炎症程度和治疗效果。方法对94例经胃镜和活检确诊H.pylori相关性胃炎的5～14岁儿童,用免疫印迹试验测血清细胞毒相关蛋白(CagA)、细胞空胞毒素(VacA)、尿素酶(urase)亚型抗体;抗H.pylori三联疗法10d,67例分A组(LAC组,用奥美拉唑 克拉霉素 阿莫仙治疗)和B组(BCF组,用果胶铋 克拉霉素 呋喃唑酮治疗),停药4周后用13C-UBT测定H.pylori根除率。结果①94例中检出CagA和/或VacA阳性86.2%,CagA和/或VacA阴性13.8%;慢性胃炎(CSG)27%,CSG 十二指肠球炎(DG)48%,CSG DG 十二指肠溃疡(DU)21%,胃溃疡(CU) DU4%,滤泡样改变56%,各种疾病检出菌株差异无显著性(χ2=2.551,P>0.05)。②94例H.pylori根除率76%,其中A组90.32%(28/31例),消化性溃疡(PU)根除率100%(12/12例)、CSG根除率84.21%(16/19例);B组H.pylori根除率为88.89%(32/36例),PU76.00%(6/8例),CSG92.86%(26/28例),两组差异无显著性(P>0.05)。各菌株根除率差异无显著性(P>0.05)。症状消退慢、难治及未能根除者大多为阳性菌。结论H.pylori蛋白印迹法简单、可靠,是流行病学筛选H.pylori细胞毒素的指标;阳性患儿必须予以根治。以下各组患儿推荐根治:①慢性活动性胃炎H.pylori阳性者;②胃十二指肠溃疡病患者;③产细胞毒素CagA阳性者。LAC三联根治H.pylori相关性胃炎疗程短、副作用小和根除率高,值得推广。     

小儿消化系统疾病诊治进展

1　消化道疾病1.1　食管疾病　我国儿科界关于食管炎的报道历来不多。龚四堂等[1] 介绍在该院所作的4 0 32例次胃镜检查中,诊断食管炎12 5例次,占3 1% ;其中92 8%为I级病变,且均局限于食管下段,未见食管裂孔疝。对比食管炎患儿与非食管炎患儿中,幽门螺杆菌(H .pylori)的检出率相似(19 2 %和18 5 % ) ,未见食管炎的发生与H .pylori感染有关。我国各地已作过了很多胃镜检查,希望能有更多的有关小儿食管炎报道。1.2　胃十二指肠疾病与H .pylori感染　陈肖肖等[2 ] 检测到4 1例H .pylori感染患儿及其82位H .pylori感染父母,I型菌相符率为89%…     

幽门螺杆菌感染儿童胃十二指肠粘膜IL-8含量的研究

检测幽门螺杆菌 (H.pylori)感染儿童的胃、十二指肠粘膜中IL_8含量的变化 ,以探讨其在H.pylori相关性胃十二指肠疾病中的机理。在胃镜下取胃窦及十二指肠球部粘膜活检标本 ,用ELISA法测定粘膜中IL_8的含量。结果 :H.pylori阳性者胃粘膜IL_8为 (24.66～177.77)pg/mg,H.pylori阴性者为(2.94～12.98)pg/mg,两者相比t=12.34,P<0.01 ;H.pylori阳性者十二指肠粘膜IL_8为(12.98～177.77)pg/mg,H.pylori阴性者为(2.04～10.43)pg/mg,两者相比t=7.18,P<0.01。活动性胃炎胃粘膜IL_8为(12.98～177.77)pg/mg,非活动性胃炎为(2.04～10.43)pg/mg,两者相比t=10.66,P<0.01;活动性胃炎十二指肠粘膜IL_8为(5.28～47.76)pg/mg ,非活动性胃炎为(3.19～8.14)pg/mg ,两者相比t=6.52,P<0.01。说明H.pylori阳性和活动性胃炎胃粘膜及十二指肠粘膜IL_8含量均较高。提示H.pylori感染时 ,IL_8在胃十二指肠粘膜局部大量中性粒细胞浸润中可能有重要作用。     

儿童幽门螺杆菌感染与胆汁反流的关系探讨

目的探讨儿童幽门螺杆菌(H.pylori)感染与胆汁反流(BR)之间的关系。方法将近十年来因反复出现上消化道症状的1418例儿童根据胃镜检查结果分为慢性浅表性胃炎组(A组)、十二指肠球炎组(B组)、十二指肠球炎合并滤泡样改变组(C组)和十二指肠溃疡组(D组)4组,每组根据是否伴有胆汁反流再分为A1A2、B1B2、C1C2和D1D2组(伴BR者列后)。所有患儿均行电子胃镜检查并在距胃窦部2～3cm的胃大小弯侧取胃粘膜活检组织各1块,分别作细菌培养和组织病理学检查。结果1418例患儿中A组450例,伴BR35例(7.78%);B组282例,伴BR32例(11.35%);C组600例,伴BR44例(7.33%);D组86例,伴BR12例(13.95%),各组BR率差异无显著性。1418例中H.pylori阳性578例(占40.76%);H.pylori阳性率随病情加重而升高;A组中非BR组(A1)H.pylori阳性率为29.64%,而BR组(A2)仅为11.43%,两者比较差异有显著性;其他各组BR与非BR组的H.pylori阳性率差异均无显著性。1418例中共有123例发生BR,其中H.pylori阳性44例,阳性率为35.77%,与总阳性率(40.76%)比较差异无显著性。结论BR可由多种原因引起,且与H.pylori之间关系复杂。BR早期可能会影响H.pylori的定植,但随着病情的进展,H.pylori可能会对BR逐渐适应。     

儿童幽门螺杆菌及CagA阳性幽门螺杆菌感染的流行病学调查

幽门螺杆菌(H.pylori)是小儿慢性胃炎、十二指肠炎及消化性溃疡的重要病因之一,小儿H.pylori的感染直接影响到成年期的身体健康。成人H.pylori相关性胃疾病的发生与儿童期H.pylori感染密切相关。许多学者认为,成人H.pylori感染率及消化道疾病较高是与儿童期即     

广州地区患儿感染幽门螺杆菌vacA、cagA及iceA基因研究

目的探讨广州地区患儿感染幽门螺杆菌（Hp）的vacA、cagA、iceA的基因亚型和优势基因亚型。方法105例胃、十二指肠疾病患儿的胃窦处取3块胃黏膜,分别进行快速尿素酶反应、病理检查和聚合酶链反应（PCR）。抽提胃黏膜基因组DNA,用11对引物,检测HpureA、vacA、cagA和ieeA基因,分析HpvacA、cagA、iceA基因亚型。结果快速尿素酶反应、病理检查和PCR三者均阳性的标本52例,其中感染Hp vacA s1as1c／m2、s1as1c／m1T亚型菌株的阳性率分别是82．7％（43／52）、9．6％（5／52）,m区不能分型占7．7％（4／52）,Hp vacA s1as1c／m2与其他基因亚型相比较,差异有统计学意义。Hp vacA s1a和s1c亚型总是同时检出,未发现Hp vacA s1b、s2、m1亚型。HpcagA^＋菌株检出率是90．4％（47／52）,cagA^-菌株检出率9、6％（5／52）,二者比较,差异有统计学意义。Hp iceA1亚型菌株单独检出率78．8％（41／52）,Hp iceA2亚型菌株单独检出率是1．9％（1／52）,Hpi ceA1和ieeA2亚型均阳性是3．8％（2／52）,iceA1和iceA2亚型均阴性的比率是15．4％（8／52）,Hp iceA1亚型阳性率与其他基因亚型相比较,差异有统计学意义。结论Hp的Hp vacA s1as1c／m^2、cagA^＋、iceA1亚型是广州地区患儿感染的Hp的优势基因亚型,Hp vacA s1as1c／m^2、cagA。和iceA1基因组合是广州地区患儿感染的Hp的优势基因亚型组合。     

儿童幽门螺杆菌感染研究进展

幽门螺杆菌(H.pylori)是引起儿童慢性胃炎、消化性溃疡、胃黏膜相关性淋巴样组织(MALT)淋巴瘤等相关疾病的重要病原微生物。H.pylori感染可能发生在儿童早期,如不给予根除治疗,可持续终身,甚至直接影响到成年期的健康。文章综述近年来关于儿童H.pylori感染情况、感染途径、感染的免疫特点及其与胃十二指肠外疾病的关系。     

上海地区部分儿童幽门螺杆菌cagA、vacA、iceA基因型别分析

目的：了解上海部分地区儿童感染幽门螺杆菌（Hp）的cagA、vacA、iceA的基因亚型,探讨其与儿童上消化道疾病的关系。方法：收集2007年5月至2008年1月在我院行胃镜检查确诊Hp感染59例患者的胃黏膜组织,分别进行聚合酶链反应（PCR）检测cagA、vacA和iceA基因;病理检查胃窦黏膜炎症程度;酶联免疫吸附试验（ELISA）检测胃窦黏膜IFN-γ 和IL-4的含量。结果：cagA基因单独检出率为65%（37/57）,vacAs1/m1单独检出率为19%（11/57）,vacAs1/m2单独检出率为40%（23/57）,iceA1单独检出率为63%（36/57）,iceA2单独检出率为19%（11/57）,9%（5/57）的菌株iceA1 和iceA2均阳性。不同基因型菌株在慢性胃炎和消化性溃疡中的检出率差异无统计学意义（P>0.05）。不同基因型菌株与胃窦黏膜炎症的严重程度无关（P>0.05）。不同基因型菌株感染的胃窦黏膜IFN-γ、IL-4的含量差异亦无统计学意义（P>0.05）。结论：cagA/vacAs1/m2/iceA1为上海部分地区儿童中Hp的优势基因型。除了菌株因素外,宿主基因多态性、环境因素对于疾病的发生、发展也发挥了重要作用。［中国当代儿科杂志,2010,12（4）：267-271］     

cagA,vacA, and iceA genotypes of Helicobacter pylori in Korean children

Background: Several putative virulence factors for Helicobacter pylori have been identified including cagA, vacA, and iceA. The aims of the present study were to study the distribution of cagA, vacA, and iceA genotypes in children with H. pylori gastritis and to examine the association of genotypes with severity of gastritis. Methods: H. pylori DNA was extracted from antral biopsy specimens from 33 children with H. pylori gastritis. Specific polymerase chain reaction assays were used for three genes: cagA, vacA, and iceA. The features of gastritis were graded in accordance with the updated Sydney System. Results: Of the 33 children, 31 (94%) were cagA positive. Twenty‐four (72%) had s1c genotype and nine (27%) had s1a. The m1 genotype was seen in 27 (82%) and m2 was found in five (15%). The iceA1 genotype was detected in 25 (76%). Scores of neutrophil activity, chronic inflammation, and H. pylori density were independent of cagA, vacA and iceA status. Conclusion: The cagA‐positive vacA s1c/m1 iceA1 genotype was predominant in Korean children with recurrent abdominal pain and H. pylori gastritis. The cagA, vacA and iceA genotype were not associated with the severity of gastritis.     

Helicobacter pylori genotypes in Israeli children: the significance of geography

BACKGROUND: There is substantial genetic variation among different isolates of Helicobacter pylori, which may affect the clinical outcome. The aims of this study were to find the common H. pylori genotypes in Israeli children and to look for a possible genotype-phenotype correlation. METHODS: Ninety-eight H. pylori cultures were isolated from antral biopsy specimens of symptomatic Israeli children and were analyzed for vacA and iceA genotype and cagA and cagE status by polymerase chain reaction. RESULTS: cagA and cagE genes were present in only 25.5% and 24.5%, respectively. The common vacA genotype was s2m2, which was found in 65%. Eleven specimens (11%) contained multiple vacA genotypes. iceA1 was found in 37% and iceA2 in 52% of cases. Both iceA alleles were found in 11%. Increased prevalence of iceA1 and cagE were observed in children with duodenal disease, although it did not reach significance. CONCLUSIONS: The low prevalence of cagA and the high prevalence of vacA genotype s2m2 in Israeli pediatric patients are different from the genotype prevalence reported globally. However, similar findings have been reported in Egypt, indicating a possible geographic influence. There is a possible correlation between duodenal ulcer and cag E and ice A1 genotype, but the power of the study was too low to prove it.     

幽门螺杆菌细胞毒素相关基因、空泡毒素基因及其表达产物与儿童胃十二指肠疾病的关系

目的　研究幽门螺杆菌 (Hp)的细胞毒素相关基因 (cagA基因 )、空泡毒素基因 (vacA基因 )及其表达产物cagA蛋白、vacA抗体与儿童消化性溃疡 (PU)、慢性胃炎 (CG)之间的关系。 方法　对 15 2例Hp感染患儿 (PU 31例 ,CG 12 1例 )的胃黏膜应用 4对不同引物 ,通过聚合酶链反应 (PCR)技术检测cagA、vacA基因 ;用免疫印迹法测定 139例血清cagA、vacA抗体。结果　 15 2例胃黏膜 10 0 %具有vacA基因 ( 15 2 /15 2 ) ,cagA基因经用 3对不同引物检测 ,其总阳性率为 78% ( 118/15 2 ) ,其中PU 71% ( 2 2 /31) ,CG 79% ( 96 /12 1) ,两组间差异无显著性 ( χ2 =0 .996　P >0 .0 5 )。 139例血清vacA抗体阳性率 92 .1% ( 12 8/139) ,PU 86 .7% ( 2 6 /30 ) ,CG 94 .5% ( 10 3/10 9) ( χ2 =1.14 6　P >0 .5 ) ;cagA抗体阳性率 91.4 % ( 12 7/139) ,PU 83.3% ( 2 5 /30 ) ,CG93.6 % ( 10 2 /10 9) ( χ2 =3.130　P >0 .5 ) ,以上两组间差异均无显著性。结论　 1.浙江地区儿童感染的Hp绝大多数为具有cagA基因的毒力菌株。 2 .亚洲地区与西方人群中感染的Hp菌株可能存在等位基因的多态性、变异性     

High prevalence of cagA and vacA seropositivity in asymptomatic Bangladeshi children with Helicobacter pylori infection

Aim: To evaluate the prevalence of antibodies against two major markers of virulence of Helicobacter pylori--cytotoxin-associated gene A (cagA) and the vacuolating cytotoxin gene (vacA)--among children in a peri-urban community of Bangladesh, and to evaluate Western blot (WB) assay for detection of H. pylori infection diagnosed by [Formula: See Text]C urea breath test (UBT) in such children. Methods: One hundred and eighty-two children aged 18-60 mo, of the peri-urban community of Dhaka, were screened for H. pylori infection using UBT, and the serum samples were analysed for antibody against cagA and vacA by Western blot. Results: The overall prevalence of H. pylori infection by [Formula: See Text]C-urea breath test was 80%. The seroprevalence of cagA with or without vacA, vacA with and without cagA, and both cagA and vacA were 82%, 82% and 81%, respectively. Among children with a positive UBT, 95% were seropositive for both cagA and vacA, indicating that the products of these genes are frequently co-expressed in H. pylori infection in this community. The sensitivity, specificity, positive and negative predictive value of the Western blot test for H. pylori infections, compared to UBT, were 94%, 68%, 92% and 76%, respectively.

Conclusion: Compared to UBT, Western blot test is reliable for the detection of H. pylori infection. The high seroprevalence of cagA- and vacA-positive virulent H. pylori strains in an asymptomatic paediatric population indicate that such strains are common in this population and may cause characteristic H. pylori infection in Bangladesh.     

幽门螺杆菌感染儿童厌食机制研究

目的探讨Ghrelin表达以及不同幽门螺杆菌(H.pylori)毒力基因型在H.pylori感染患儿厌食发病机制中的作用。方法 H.pylori感染患儿60例,根据临床表现分为厌食(n=30例)和非厌食(n=30例)组。应用RT-PCR方法检测胃黏膜Ghrelin mRNA表达水平,比较两组患儿以及厌食患儿在H.pylori根治前后的差异。同时采用PCR方法检测所有患儿的H.pylori毒力cagA/vacA基因并分型。结果 H.pylori感染厌食患儿胃黏膜GhrelinmRNA表达低于非厌食患儿,两组差异有统计学意义(P<0.01);厌食患儿H.pylori根治后Ghrelin mRNA表达明显升高,与根治前比较差异有统计学意义(P<0.05);同时患儿食欲改善,体质量增长显著。厌食与非厌食患儿感染的H.pylori均为Ⅰ型毒力株,厌食患儿的cagA m1阳性率高于非厌食患儿,厌食患儿的H.pylori基因型以s1/m1多见。结论 Ghrelin在H.pylori感染厌食患儿中表达降低,而H.pylori根治后表达升高,H.pylori可能通过影响Ghrelin分泌而导致厌食;毒力较强的H.pylori ...     

Helicobacter pylori infection, histopathological gastritis and gastric epithelial cell apoptosis in children

AIM: Features of gastritis and gastric epithelial cell apoptosis in children infected with Helicobacter pylori genotypes are seldom studied. Therefore, we investigated the relationship between vacA genotypes and the severity of gastritis, and gastric epithelial cell apoptosis in H. pylori-infected children. METHODS: Antral biopsies from 52 children infected with H. pylorivacA genotypes (s1a/m1 = 17, s1a/m2 = 21 and s2/m2 = 14) were analysed for severity of gastritis on histopathology. Fifteen biopsies infected with different vacA genotypes were studied for gastric epithelial cell apoptosis by terminal uridine deoxynucleotidyl nick-end labelling. RESULTS: Children infected with the s1a/m1 and s1a/m2 vacA genotypes had higher severity of chronic inflammation than the s2/m2 genotype (s1a/m1 vs s2/m2, p=0.05; s1a/m2 vs s2/m2, p=0.01). The vacA s1a allele was more independently associated with severe chronic inflammation than the s2 allele (p=0.02). Children infected with the s1a/m1 and s1a/m2 strains had higher gastric epithelial cell apoptosis than the s2/m2 strain (s1a/m1 or s1a/m2 vs s2/m2, p<0.0001). CONCLUSION: The s1a/m1 and s1a/m2 H. pylorivacA genotypes have significantly higher association with severe chronic gastritis and gastric epithelial cell apoptosis than the s2/m2 genotype in children. The role of H. pylorivacA genotypes and their allelic subtypes in relation to pathogenicity and disease potential in children needs further studies.     

Helicobacter pylori infection and cytotoxic antigen associated gene "A" status in short children.

BACKGROUND: Helicobacter pylori is now an accepted gastroduodenal pathogen and is being investigated for possible implications in nongastroenterological conditions such as growth impairment. Subjects infected by cytotoxic Cag-A positive strains seem more likely to develop serious gastroduodenal diseases but the possible role of Cag-A positive strains in non gastroenterological diseases has not been fully investigated. OBJECTIVE: 1) To evaluate the prevalence of Helicobacter pylori infection and Cag-A positivity in short children compared to auxologically normal children. All the subjects were without gastro-intestinal symptoms and were not obese or significantly underweight. 2) To verify the reliability of the ELISA assay for H. pylori. SUBJECTS: H. pylori infection was assessed in 338 children, 182 auxologically normal and 156 short children, with and without deficiency in growth hormone, by the determination of specific IgG antibody. In 79 subjects (all seropositive and a random sample of seronegative children), 13C-urea breath test and cytotoxic Cag-A positive strains were examined. RESULTS: The overall seroprevalence of H. pylori infection by IgG antibody was 18/156 (11.5%) and 13/182 (7.1%) in short and auxologically normal children respectively. The 13C-urea breath test was positive in 29 children: 17 (10.9%) short and 12 (6.6%) auxologically normal. Western blotting documented infection by cytotoxic Cag-A positive strains in 12/17 (70.6%) and 8/12 (66.6%) of short and auxologically normal children respectively. None of the differences between the two groups were significant. CONCLUSIONS: 1) We found a similar prevalence of H. pylori infection and Cag-A positivity in two large pediatric populations of short or auxologically normal children. Therefore: 1) Our data did not confirm a role of H. pylori infection in short stature in children. 2) We found a high reliability of ELISA assay for the detection of IgG antibodies compared to breath test.