胃溃灵对消化性溃疡患者免疫功能调节作用的探讨

从临床及动物实验角度，探讨胃地消化性溃疡患者免疫功能的调节作用。结果表明：溃疡患者胃液ＩｇＧ水平明显低于正常人，而ＳＩｇＡ明显高于正常人，经胃溃灵治疗后，消化性溃疡患者胃液中ＩｇＧ水平显著提高，ＳＩｇＡ水平明显降低，两者与正常人比较无显著性差异。实验结果，胃溃有明显提高小白鼠血清抗体效价，增加其血清溶菌酶含量，增强其单核巨噬细胞的吞噬功能。提示胃溃灵对机体免疫功能有良好的调节作用。     

消化性溃疡患者微量元素测定结果分析

分别对消化性溃疡患者治疗前、经中药胃溃灵冲剂或西药雷尼替丁治疗后进行胃液、血清中微量元素测定，结果表明，消化性溃疡患者胃液铜、锌、钠、镁、含量低于正常人，两者比较Ｐ＜０．０５～０．０１；血清铜、锌含量明显低于正常人（Ｐ＜０．０１）；胃溃灵能提高胃液锌含量，而雷尼替丁对其无明显影响；胃溃灵能提高血清锌含量，但对铜、铁无明显影响，雷尼替丁则对血清铜、锌、铁均无影响。     

消费灵治疗消化性溃疡的临床研究

目的：探讨中药复方消溃灵治疗消化性溃疡的作用机制,方法：以放射免疫法检测血浆及胃粘膜匀浆前列腺素E2（PGE2）含量,血清热休克蛋白（HSPS）测量采用Western斑点印迹法,SABC免疫组织化学方法用于观察胃粘膜HSPs并进行图像分析,结果：治愈率与总有效率,中西药组明显高于西药组和中药组（均P＜0．05）,溃疡指数,中西药组显著低于西药组和中药组（均P＜0．0）,血浆及胃粘膜匀浆PGE2含量,血清及胃粘膜HSPS水平,中药组及中西药组显著高于西药组（ P＜0．01）,结论：消溃灵可提高消化性溃疡患者血清,血浆及溃疡周边胃粘膜PGE2及HSPs水平。     

消溃灵治疗消化性溃疡的临床研究

目的 :探讨中药复方消溃灵治疗消化性溃疡的作用机制。方法 :以放射免疫法检测血浆及胃粘膜匀浆前列腺素 E2 (PGE2 )含量 ,血清热休克蛋白 (HSPs)测定采用 Western斑点印迹法 ,SABC免疫组织化学方法用于观察胃粘膜 HSPs并进行图像分析。结果 :治愈率与总有效率 ,中西药组明显高于西药组和中药组 (均 P<0 .0 5 ) ;溃疡指数 ,中西药组显著低于西药组和中药组 (均 P<0 .0 1) ;血浆及胃粘膜匀浆 PGE2 含量、血清及胃粘膜 HSPs水平 ,中药组及中西药组显著高于西药组 (均 P<0 .0 1)。结论 :消溃灵可提高消化性溃疡患者血清、血浆及溃疡周边胃粘膜 PGE2 及 HSPs水平。     

胃溃灵治疗消化性溃疡的临床研究

经胃镜确诊９０例消化性溃疡（Ｐｕ）活动期，按２：１设胃溃灵组６０例，雷尼替丁组３０例。经治疗６周后．两组的胃镜疗效及胃痛疗效相似，胃溃灵的１年复发率为２０％，而雷尼替丁的１年复发率为５０％，胃溃灵的远期疗效明显优于雷尼替丁（Ｐ＜０．０１），并随机对胃溃灵组２１例患者进行临床实验研究，发现胃溃灵具有抑制十二指肠溃疡（Ｄｕ）的基础胃酸（ＢＡＯ），降低Ｄｕ的胃蛋白酶（ＰＡ）活性，促进Ｐｕ胃粘膜合成分泌前列腺素Ｅ２（ＰＧＥ２），补充锌元素，有保护胃粘膜屏障的作用。     

消溃灵对乙酸性胃溃疡大鼠一氧化氮 和内皮素的影响

探讨消溃灵对消化性溃疡愈合的影响及其胃粘膜保护作用的机制。方法采用大鼠乙酸性胃溃疡模型,分别以消溃灵灌胃和左旋精氨酸(L-Arg)、亚硝基左旋精氨酸(L-NNA)腹腔内注射治疗7d和14d后,测定溃疡指数、溃疡抑制率,检测血清一氧化氮(NO)及血浆内皮素(ET-1)含量。结果消溃灵组溃疡指数、血浆ET-1含量明显降低,而溃疡抑制率、血清NO含量显著升高,与模型组和L-NNA组比较差异有显著性意义(P＜0.01),与L-Arg组比较无统计学意义(P＞0.05)。L-NNA组溃疡指数、血浆ET-1水平显著高于模型组(P＜0.01),而血清NO含量则明显低于模型组(P＜0.01)。结论消溃灵促进溃疡愈合,保护胃粘膜的作用可能与其诱导、促进NO合成,反馈性地抑制ET-1释放,维持NO和ET的动态平衡密切相关。     

消化性溃疡患者唾液,胃液和血清中表皮生长因子含量的研究

用放免法测定消化性溃疡患者唾液、胃液和血清中的表皮生长因子（ＥＧＦ）的含量，旨在探索消化性溃疡患者与对照者相比，是否有ＥＧＦ分泌异常。结果表明，胃溃疡和十二指肠溃疡患者的唾液、胃液和血清中的ＥＧＦ水平均明显低于对照组；胃溃疡组和十二指肠溃疡组间无显著的差别；当五肽胃泌素刺激后，胃液中的ＥＧＦ含量无明显变化。提示ＥＧＦ分泌低下可能与消化性溃疡的发病有一定关系。     

十二指肠球部溃疡患者血清胃液中胃泌素水平与幽门螺杆菌相关性研究

十二指肠球部溃疡患者血清胃液中胃泌素水平与幽门螺杆菌相关性研究闫国亭，普长生，宁振生黄富珍郑州铁路局中心医院郑州４５００５２我院消化科和同位素室自１９９３年６月到１９９５年５月对经胃镜确诊的６６例球溃患者进行了ＨＰ检测和血清、胃液中胃泌素测定，并以２...     

胃溃灵对胃粘膜损伤大鼠胃粘膜分泌的影响

目的 :研究胃溃灵对乙酸引起胃粘膜损伤大鼠胃粘膜分泌的影响。方法 :将 5 0只 SD大鼠制成乙酸胃粘膜损伤模型 ,并随机将大鼠等分为 5组 ,次日起给每组大鼠分别灌服等量生理盐水、大、中、小剂量 ( 12 g/ kg、6g/kg、3 g/ kg)胃溃灵、雷尼替丁 ,10 d后处死大鼠 ,观察大鼠胃粘膜损伤程度。采用阿尔新蓝与胃液中糖蛋白结合的方法 ,分别测定大鼠胃内游离粘液量、胃壁粘液量。结果 :胃溃灵能明显提高大鼠胃内游离粘液、胃壁粘液的分泌量 ,能明显抑制乙酸对大鼠胃粘膜的损伤。结论 :胃粘液分泌量增加可加强对粘膜的屏障作用 ,这是胃溃灵保护胃粘膜损伤的机制之一。     

慢性胃病中几种胃肠激素水平的改变和意义

本文用RIA法测定352例胃镜病理诊断的胃十二指肠病患者之胃液,血清表皮生长因子（EGF），生长抑素（SS）和胃泌素（GAS）水平。结果表明，胃液EGF水平在胃癌明显升高，在消化性溃疡降低；血清SS及GAS水平在各种胃十二指肠病中均显著高于正常对照，溃疡病的血清SS和GAS水平呈负相关趋势。各种胃病血清SS水平相近，胃液SS水平胃癌显著高于良性胃病，且胃癌胃液SS显著高于其血清SS水平。幽门螺杆菌（HP）感染不影响溃疡病的血清GAS和SS水平及慢性浅表性胃炎的血清SS水平，HP感染严重时慢性萎缩性胃炎的血清SS水平显著升高。     

Helicobacter pylori in children with peptic ulcer and their families

Little is known about the source and spread of Helicobacter pylori, but transmission from infected family contacts has been suggested. We have therefore investigated 15 children with peptic ulcer and their first-degree relatives for H. pylori. Serum anti-H. pylori IgG, pepsinogen I, and gastrin levels were measured. Endoscopy was carried out on the children and relatives, and biopsies were taken from the gastric antrum for histology, microbiology, and urease testing. Six of 11 children with duodenal ulcer (55%) and two of four children with gastric ulcer (50%) were positive for H. pylori. Fourteen of 16 parents (87%) and eight of 13 siblings (61%) of H. pylori-positive children with peptic ulcer were also infected compared with eight of 14 parents (57%) and none of four siblings of H. pylori-negative children with peptic ulcer (P less than 0.10, greater than 0.05, and NS, respectively). The children with H. pylori-negative peptic ulcer and negative siblings combined were younger than positive children with peptic ulcer and positive siblings (P less than 0.001). The reliability of serum anti-H. pylori IgG level as a screening test for infection was confirmed. These findings call into question a pathogenetic role for H. pylori in some childhood peptic ulceration, but do suggest that person-to-person spread of infection occurs.     

Does quantitative serologic testing for Helicobacter pylori predict peptic ulcer disease in cirrhosis?

BACKGROUND: Helicobacter Pylori is strongly associated with peptic ulcer disease. A correlation between high IgG serum antibody concentrations and a clinical diagnosis has been reported. It has been recognized that peptic ulcer disease occurs with increased frequency in cirrhosis. In this study, we attempted to establish a relation between the magnitude of serum IgG antibody to H pylori and the endoscopic diagnoses in H pylori-infected cirrhotic patients. METHODS: All cirrhotic patients who had undergone esophagogastroduodenoscopy with a positive H pylori IgG serology and who did not receive anti-H pylori treatment or take medications noxious to the gastroduodenal mucosa were included in the study. H pylori IgG serology was determined by an enzyme-linked immunosorbent assay with values of greater than 50 units/mL being seropositive. The functional reserve of cirrhosis was classified by modified Pugh-Child criteria. RESULTS: One hundred four seropositive cirrhotic patients were recruited. The serum IgG titers ranged from 51 to 1200 units/mL with a peak frequency at 50 to 99 units/mL (35. 6%). Statistical analysis did not reveal any relation between the quantitative H pylori IgG values and the endoscopic diagnoses, which included gastric ulcers, duodenal ulcers, gastroduodenal erosions, and normal findings. CONCLUSIONS: In cirrhosis, the magnitude of H pylori IgG serology cannot be used to predict the presence or absence of peptic ulcer disease.     

Accuracy of Helicobacter pylori serology in two peptic ulcer populations and in healthy controls

AIM： To estimate the test characteristics of Heli- cobacter pylori （H pylori） serology and of C14-urea breath test （C14-UBT） in two different peptic ulcer populations and in community controls. Second, the aim was to explore the association between the level of Hpylori IgG antibodies and severity of inflammation as to active peptic ulceration in the same populations. METHODS： Vagotomized （n = 83）, medically treated peptic ulcer patients （n = 73） and one reference group of community controls （n = 88） were gastroscoped. H pylori status was determined by histology, bacterial growth, C14-UBT and serology. Based on the updated Sydney System, cumulative scores from biopsies from the prepyloruos, incisura angularis, corpus and fundus were calculated. RESULTS： The prevalence of Hpylori infection varied from 70% to 79%. The C14-UBT had high accuracy compared to the serology test. The sensitivity of the serology test was good, but the specificity was low （41%-71%）. The association between H pylori IgG antibodies and scores of gastric mucosal inflammation and current or previous peptic ulcer were weak. CONCLUSION： The accuracy of CI4-UBT to diagnose Hpylori infection was good, and the clinical utility of a negative H pylori serology test was substantial, while the gain in clinical information of a positive test was meagre. Positive H pylori titres could not distinguish between subjects with or those without active peptic ulceration.     

Can anti-Helicobacter pylori and anti-CagA antibodies be used to select patients with dyspepsia for gastroscopy?

BACKGROUND: agA IgG antibody in sera may indicate presence of peptic ulcer disease among dyspeptic patients and therefore may be used as a serological marker to identify high risk patients for peptic ulcer who can be subjected to endoscopy. Present study was performed to identify association of CagA IgG antibody in patients with peptic ulcer. METHODS: Consecutive patients with dyspepsia were subjected to endoscopy and sera was collected from each. Rapid urease test in antral tissue collected from each patient by endoscopic biopsy was performed. Antral tissue was also examined histologically. IgG Antibody against H. Pylori and CagA IgG antibody was tested in each patients sera. RESULTS: Out of 82 patients with dyspepsia included in the study 28 had peptic ulcer. Of whom 26 were positive for anti IgG H. Pylori antibody. More than 80% patients with peptic ulcer patients had detectable anti Cag A antibody in contrast to 33% patients with non ulcer dyspepsia (P < 0.001). CONCLUSION: Anti-Cag A antibody may be used as a screening test in patients with dyspepsia to select high risk patients for peptic ulcer for upper gastrointestinal endoscopy.     

消溃灵对乙酸性胃溃疡大鼠一氧化氮和内皮素的影响

目的 :探讨消溃灵对消化性溃疡愈合的影响及其胃粘膜保护作用的机制。方法 :采用大鼠乙酸性胃溃疡模型 ,分别以消溃灵灌胃和左旋精氨酸 (L- Arg)、亚硝基左旋精氨酸 (L- NNA)腹腔内注射治疗 7d和 14d后 ,测定溃疡指数、溃疡抑制率 ,检测血清一氧化氮 (NO)及血浆内皮素 (ET- 1)含量。结果 :消溃灵组溃疡指数、血浆 ET- 1含量明显降低 ,而溃疡抑制率、血清 NO含量显著升高 ,与模型组和 L- NNA组比较差异有显著性意义 (P<0 .0 1) ,与L- Arg组比较无统计学意义 (P>0 .0 5 )。L- NNA组溃疡指数、血浆 ET- 1水平显著高于模型组 (P<0 .0 1) ,而血清NO含量则明显低于模型组 (P<0 .0 1)。结论 :消溃灵促进溃疡愈合 ,保护胃粘膜的作用可能与其诱导、促进 NO合成 ,反馈性地抑制 ET- 1释放 ,维持 NO和 ET的动态平衡密切相关。     

Size of the peptic ulcer in Helicobacter pylori-positive patients: association with the clinical and histological characteristics

OBJECTIVE: Based on a large trial of Helicobacter pylori-positive peptic ulcer patients, we studied whether the size of the ulcer, along with other clinical and histological characteristics, has any effect on healing. We also studied the clinical and endoscopic characteristics associated with size of the peptic ulcer. MATERIAL AND METHODS: A total of 333 consecutive patients with H. pylori infection and peptic ulcer were enrolled (mean age 54.8+/-12.7 years). Location of the ulcer was recorded by gastroscopy and the presence of H. pylori was assured by rapid urease test, histology and by serum H. pylori IgG and IgA antibody measurement. The diameter of the ulcer was measured by placing the opened biopsy forceps (7 mm) beside it. Biopsy specimens were examined in accordance with the Sydney system. RESULTS: Mean size of the peptic ulcer was 13.2+/-8.3 in corpus, 11.3+/-5.3 in antrum, 13.8+/-7.8 in angulus, 9.5+/-5.3 in prepylorus and 9.2+/-4.7 mm in duodenum (duodenal versus gastric type; p<0.05). Average size of the ulcers was 9.4+/-5.3 mm in patients with Forrest III type and 11.5+/-6.8 in other types (p<0.05). Patients who were >or=50 years of age, currently smoking, or who had corpus-predominant chronic gastritis or atrophic gastritis, had larger ulcers than others. Size of index ulcers, successful eradication of H. pylori and the presence of atrophic gastritis were independent factors for healing. The odds ratio was 11.5 (95% CI 3.3-40.5; p<0.01) for eradication of H. pylori, 3.5 (95% CI 1.1-11.2; p<0.05) for size of the index ulcer (10 mm) and 3.4 (95% CI 1.2-9.8; p<0.05) for atrophic gastritis versus no atrophy. CONCLUSIONS: Size of the peptic ulcer, successful H. pylori eradication and atrophic gastritis were independent factors for the healing of peptic ulcers. A number of clinical and endoscopic variables (age, current smoking, corpus-predominant gastritis, Forrest classification) were associated with size of the peptic ulcer in H. pylori-positive patients.     

血清幽门螺杆菌CagA蛋白抗体滴度与消化性溃疡的关系

目的　通过比较消化性溃疡和慢性胃炎病人血清中CagA抗体阳性的流行情况 ,探讨消化性溃疡和血清幽门螺杆菌CagA蛋白抗体滴度之间的关系。方法　采用病例对照研究设计方案。研究对象来源于中山医院门诊因中上腹痛或腹胀进行胃镜检查的人群。自 1998年 10月 -1998年 12月共收集胃溃疡病例 2 6例 ,十二指肠球部溃疡 2 7例 ,对照组为同期胃镜和病理证实慢性浅表性胃炎的病例 6 5例。Hp感染的判断采用快速尿素酶和病理Giemsa相结合的方法 ,二者均阳性定为阳性。采用ELISA方法检测HpCagA抗体。结果　总的HpCagA抗体的阳性率为 6 2 5 % ,在胃溃疡组为 76 9% ( 2 0 / 2 6 ) ,在十二指肠球部溃疡组为 88 9% ( 2 4/ 2 7) ,在慢性胃炎组为 49 3 % ( 3 2 / 6 5 ) ,胃溃疡组和十二指肠球部溃疡组均明显高于慢性胃炎组 ,差异有显著性。结论　本研究提示CagA蛋白阳性的幽门螺杆菌菌株在消化性溃疡的发病中起一定作用。     

浙江汉族人群Toll样受体4基因多态性与幽门螺杆菌相关消化性溃疡的关系

背景：幽门螺杆菌（H.pylori）感染是消化性溃疡的主要病因,然而其致病性存在个体差异,可能与宿主遗传易感性和先天性免疫机制有关。Toll样受体（TLR）在机体的先天性抗感染免疫中起重要作用。目的：探讨浙江汉族人群TLR4基因Asp299Gly多态性与H.pylori相关消化性溃疡的关系。方法：以聚合酶链反应-限制性片段长度多态性（PCR-RFLP）方法检测118例浙江汉族消化性溃疡患者和210名健康对照者的TLR4基因Asp299Gly等位基因和基因型;行快速尿素酶试验和血清H.pyloriIgG检测判断H.pylori感染情况。结果：本组浙江汉族人群TLR4基因Asp299Gly均为AA纯合子基因型,未见突变基因型AG和GG。消化性溃疡组H.pylori感染率为94.9%,显著高于正常对照组的62.4%（P=0.000）;两组Asp299Gly基因型频率差异无统计学意义。结论：浙江汉族人群TLR4基因Asp299Gly多态性与H.pylori相关消化性溃疡无相关性。     

Non-Helicobacter pylori and non-NSAID peptic ulcer disease in the Japanese population

BACKGROUND: Helicobacter pylori and non-steroidal anti-inflammatory drugs (NSAIDs) are recognized as the major causes of peptic ulcer disease. The status of H. pylori infection in the background population may influence the incidence of H. pylori-negative peptic ulcer disease. OBJECTIVE: To examine the incidence of H. pylori-negative peptic ulcer disease without intake of NSAIDs in Japan. PATIENTS: A total of 398 patients who had no eradication therapy for H. pylori prior to this study, including 246 patients with gastric ulcer (GU) and 152 patients with duodenal ulcer (DU), were enrolled. METHODS: H. pylori status was assessed by rapid urease tests, histological examinations (haematoxylin & eosin stain, Giemsa stain and/or immunostaining) and serum IgG antibody. Two biopsy specimens were taken from the antrum within 3 cm of the pyloric and two from the middle corpus of the stomach, along the greater curvature. Patients were asked a series of questions regarding risk factors, including the use of NSAIDs. The presence of gastritis, gastric atrophy and intestinal metaplasia was examined according to the updated Sydney system. RESULTS: Of the 246 patients with GU, 12 patients (4.9%) were considered to be H. pylori-negative. Of the 152 patients with DU, two patients (1.3%) were considered to be H. pylori-negative. Hence, a total of 14 patients were found to be H. pylori-negative. Nine of them were taking NSAIDs. Consequently, the frequency of H. pylori-negative ulcer without intake of NSAIDs was 1.3%. There was no significant difference in the frequencies of H. pylori-negative patients between the GU and DU groups. CONCLUSION: The incidence of H. pylori-negative peptic ulcer disease without intake of NSAIDs was very low in the Japanese population.