含左氧氟沙星的序贯疗法与标准三联疗法根除幽门螺杆菌的疗效比较

目的 比较含左氧氟沙星的10d序贯疗法与7d标准三联疗法根除幽门螺杆菌(helicobacter pylori,H.pylori)的疗效.方法 78例胃、十二指肠溃疡及慢性胃炎伴H.pylori感染患者,随机分为2组,每组39例,治疗组前5d给予兰索拉唑30mg+阿莫西林1 000mg,2次/d,后5d给予兰索拉唑30mg+左氧氟沙星200mg+呋喃唑酮100mg,2次/d; 对照组给予兰索拉唑30mg+阿莫西林1000mg+克拉霉素500mg,2次/d,疗程7d.疗程结束后至少4周复查14C-UBT,评估治疗结果及不良反应.结果 治疗组H.pylori根除率为92.3%,高于对照组的74.3%.差异有统计学意义( P<0.05);2组不良反应发生率差异无统计学意义(P>0.05).结论 含左氧氟沙星的10d序贯疗法H.pylori根除率高,疗效优于7d标准三联疗法.     

兰索拉唑联合莫沙必利对胆汁反流性胃炎作用的研究

目的:观察兰索拉唑、莫沙必利两药联合对胆汁反流性胃炎的疗效。方法:胆汁反流性胃炎患者随机分为4组:空白对照组(n=50)、兰索拉唑(n=50,兰索拉唑20mg,1次/d),莫沙必利组(n=50莫沙必利1.0g,3次/d)及联合用药组(n=50,兰索拉唑+莫沙必利,用法同上),疗程8周。观察各组患者腹痛、腹胀、烧心、口苦等症状改善情况。结果:治疗后三组治疗组患者症状均有所改善。结论:兰索拉唑和莫沙必利联用可有效治疗胆汁反流性胃炎。     

根除幽门螺杆菌对胃炎性息肉的治疗作用

目的探讨根除幽门螺杆菌(Hp)对胃炎性息肉的治疗作用.方法将胃炎性息肉〔息肉直径3-l0mm)合并Hp感染的112例患者随机分为治疗组(56例)及对照组(56例).治疗组患者接受四联治疗,包括质子泵抑制剂(奥美拉唑或兰索拉唑)、克拉霉素、拘椽酸铋及替硝唑,疗程2周.对照组仅接受质子泵抑制剂(奥美拉唑或兰索拉唑)治疗.受试者在纳入试验前及治疗结束后4-12个月接受定期胃镜检查和Hp测定.结果治疗组和对照组各有52例及44例患者完成整个研究.治疗组有46例(88.5%)用药后4-12个月随访中 Hp得到根除,在Hp根除者中28例(60.9%)胃息肉消失.而在试验开始后12个月,对照组中完成整个研究的患者胃息肉和Hp情况未发生变化(P<0.05).结论大多数胃炎性息肉在根除Hp后消失,患者如同时患有胃炎性息肉和Hp感染,在行息肉摘除术前可先尝试Hp根除治疗.     

兰索拉唑三联治疗Hp阳性消化性溃疡疗效观察

目的 观察兰索拉唑三联疗法对幽门螺旋杆菌(HP)阳性的消化性溃疡的疗效.方法 将符合条件的患者随机分为2组,治疗组应用兰索拉唑,克拉霉素,阿莫西林三联治疗1周,之后兰索拉唑3周疗法.对照组应用奥美拉唑,甲硝唑,阿莫西林三联1周,之后奥美拉唑3周疗法.疗程结束1个月后进行胃镜和HP检查.结果 治疗组与对照组溃疡愈合率分别...     

洛赛克与兰索拉唑分别与甲硝唑联合应用治疗HP相关胃炎临床疗效比较

目的 比较洛赛克、兰索拉唑分别与甲硝唑联合应用治疗HP相关胃炎的疗效。方法 76例符合条件的病人随机分成2组，其中46例口服洛赛克20mg，甲硝唑400mg；另一组46例口服米索拉唑30mg，甲硝唑40mg；每日2次，共2周。疗程结束后1个月复查胃镜。结果 洛赛克组HP根除率及浅表性胃炎消除率分别为86％及89％，显高于兰索拉唑组的67％及67％（P＜0.05)。两组均未发现明显副反应，病人依从性良好。结论 洛赛克与甲硝唑联合应用治疗HP相关胃炎较兰索拉唑与甲硝唑组疗效好。     

长期抑酸维持治疗预防十二指肠溃疡复发的疗效及对血胃泌素的影响

目的 研究兰索拉唑治疗十二指肠溃疡和维持治疗预防溃疡复发的疗效，并探讨各疗程血清胃泌素水平的变化。方法经胃镜证实的活动期十二指肠溃疡患者90例，给予兰索拉唑30mg，qdx4周，将溃疡愈合达瘢痕期的67例患者随机分为两个治疗组。A组：兰索拉唑15mg，qd，维持3个月；B组：兰索拉唑15mg，qd，维持6个月。在治疗前，治疗4周，维持治疗3、6、9个月末分别复查胃镜，并检测血清胃泌素水平的变化。结果治疗4周后，溃疡愈合率94．4％(85／90)。A组和B组患者的溃疡半年累积复发率分别为17．6％(6／34)和18．1％(6／33)，2组间差异无显著性。在治疗4周时，血清胃泌素水平基本达到一稳定水平，在维持治疗阶段无进一步升高，停药后3个月基本恢复到基础水平。结论3个月或6个月低剂量兰索拉唑维持治疗可有效预防十二指肠溃疡复发，而不会引起血清胃泌素水平的无限升高。     

幽门螺杆菌与胃炎活动性关系的病理观察

目的:探讨胃癌高危人群幽门螺杆菌(Helicobacterpylori,Hp)与胃炎活动性的关系。方法:对胃癌高发区成年人群(533人)做内镜、快速尿素酶试验及胃粘膜活检组织学检查,Hp以组织学WS染色检查为标准,数据结果均做χ2检验。结果:(1)人群Hp的检出率为64.54%,活动性胃炎的检出率为69.42%。(2)活动性胃炎中Hp的检出率为92.43%。(3)Hp阳性组活动性胃炎的检出率为99.42%,明显高于Hp阴性组。(4)胃窦部及体小弯活动性胃炎的检出率高于胃底部;胃窦部高于体小弯。(5)Hp阳性者各活检部位的活动性胃炎组织中Hp的检出率均高。(6)Hp根除后活动性胃炎的检出率明显下降(5.77%),前后比较差异有极显著性。结论:(1)Hp与胃炎活动性密切相关。(2)Hp的检出提示胃内有活动性炎症的存在。     

兰索拉唑与莫沙必利联合治疗反流性食管炎疗效观察

目的观察兰索拉唑与莫沙必利联合治疗反流性食管炎临床效果。方法将101例反流性食管炎患者随机分为两组,治疗组53例用兰索拉唑和莫沙必利,对照组48例用兰索拉唑,观察治疗前及治疗后4、8周的临床疗效和内镜下症状改善的程度。结果治疗4、8周后治疗组总有效率显著高于对照组(P均<0.05)。内镜下反流性食管炎症状改善程度显著大于对照组(P均<0.05)。两组均未见严重不良反应。结论兰索拉唑、莫沙必利联合用药是治疗反流性食管炎安全、有效的方法。     

丽珠胃三联联合兰索拉唑治疗幽门螺杆菌相关性消化性溃疡的临床观察

目的 评价丽珠胃三联(Livzon WeiSanlian)联合兰索拉唑(lansoprazole)根除幽门螺杆菌(Helicobacter pylori.Hp)和治疗相关性消化性溃疡(peptic ulcer,PU)的效果。资料与方法:将61例Hp相关性PU病人随机分为丽珠胃三联+兰索拉唑组(A组)和兰索拉唑组(B组)。A组:枸橼酸镁铋钾110mg,4/d,替硝唑0.5.2/d,克拉霉素025,3/d,兰索拉唑30mg,1/d,连续1周,B组 兰索拉唑30mg,1/d,阿莫西林0 5,3/d,甲硝唑200mg 3/d,连续2周,疗程结束后继续服用兰索拉唑到4周。停药4周后复查电子胃镜及~(14)C呼吸试验。结果:A组Hp根除率(96.7％)明显高于B组(83.9％)(P<0.05),A组的溃疡愈合率(900％)、总有效率(967％)高于B组(83.9％、903％),A组的疼痛消失时间、症状消失率亦较B组快,但均无显著差异(P>0 05),两组均无明显副作用。结论:丽珠胃三联联合兰索拉唑能有效根除Hp,对PU有较高的治愈率和症状缓解率,且副作用小。     

幽门螺杆菌感染儿童胃十二指肠黏膜IL-8含量的研究

目的　探讨胃、十二指肠黏膜中IL 8含量在幽门螺杆菌 (H .pylori)相关性胃十二指肠疾病中的机理。 方法　对92例H .pylori或非H .pylori感染的胃炎患儿 ,在胃镜下取胃窦及十二指肠球部黏膜活检标本 ,用ELISA法测定黏膜中IL 8的含量。结果　H .pylori阳性者胃黏膜IL 8为 (1 88± 0 0 6 ) pg/mg ,H .pylori阴性者为 (0 82± 0 0 5 )pg/mg,两者相比 P <0 0 0 1;H .pylori阳性者十二指肠黏膜IL 8为 (1 18± 0 0 6 ) pg/mg ,H .pylori阴性者为 (0 6 2± 0 0 4 )pg/mg ,两者相比 P <0 0 0 1。活动性胃炎胃黏膜IL 8为 (1 84± 0 0 7) pg/mg ,非活动性胃炎为 (0 78± 0 0 6 ) pg/mg ,两者相比 P <0 0 0 1;活动性胃炎十二指肠黏膜IL 8为 (1 19± 0 6 ) pg/mg。非活动性胃炎为 (0 6 6± 0 0 5 ) pg/mg ,两者相比 P <0 0 0 1。说明H .pylori阳性和活动性胃炎的胃黏膜及十二指肠黏膜IL 8含量均较高。结论　提示H .pylori感染时 ,IL 8在胃十二指肠黏膜局部大量中性粒细胞浸润中可能有重要作用。     

Helicobacter pylori infection, glandular atrophy, intestinal metaplasia and topography of chronic active gastritis in the Nepalese and Japanese population: The age, gender and endoscopic diagnosis matched study

Background: The incidence and mortality from gastric cancer is high in Japanese but extremely low in Thailand. It is different among Asian countries. The aim of this study is to investigate the difference of peptic ulcer disease, glandular atrophy, intestinal metaplasia and topography of chronic active gastritis between the Nepalese and Japanese population. Materials and methods: Nepalese patients were paired with Japanese patients by age, gender and endoscopic diagnosis in order to compare the prevalence of H. pylori infection (N=309) and the difference of H. pylori related peptic ulcer disease (N=48). Glandular atrophy and intestinal metaplasia scores were also compared between the Nepalese and Japanese population in H. pylori positive cases (N=152) and negative cases (N=145) using paired cases by age, gender and endoscopic diagnosis. Paired H. pylori-positive Nepalese and Japanese population were also used to compare the ratio of corpus gastritis to antrum gastritis (C/A ratio) (N=152). Results: Among peptic ulcer diseases, gastric ulcer was frequent in Japanese and duodenal ulcer was frequent in Nepalese. The prevalence of H. pylori infection in the Nepalese and Japanese population were similar. Glandular atrophy and intestinal metaplasia scores in the H. pylori positive Japanese were significantly higher than those of Nepalese in all positions according to triple site biopsy. Furthermore, there were significant differences in glandular atrophy and intestinal metaplasia scores between in the H. pylori-negative Nepalese and Japanese population except intestinal metaplasia score in the greater curvature of the upper corpus. Japanese C/A ratio was significantly higher than that of Nepalese. Corpus predominant gastritis (C/A ratio>1.00) was characteristic in the elderly Japanese. Nepalese was antrum predominant (C/A ratio<1.00) in every age group. Conclusions. Gastric ulcer was a common disease in Japanese, in contrast duodenal ulcer was common in Nepalese. H. pylori infected Japanese patients showed severe atrophic and metaplastic gastritis in comparison with Nepalese. These results may be associated with the high incidence of gastric cancer in Japanese. Corpus predominant gastritis was found in the elderly Japanese and antrum predominant gastritis was found in every age Nepalese. Key words: H. pylori, atrophy, metaplasia, corpus-predominant gastritis, Nepal.     

Hp感染与不同类型上消化道疾病中Cyclin D1表达相关性研究

目的研究不同类型上消化道疾病中幽门螺杆菌(Hp)感染率、东亚型Cag A阳性Hp感染率及与Cyclin D1表达的相关性,探索Hp致胃癌及其癌前病变的机制。方法采用免疫组化链霉菌抗生素蛋白-过氧化物酶连接法(SP)法分别检测慢性浅表性胃炎(CSG)、慢性萎缩性胃炎(CAG)、十二指肠球部溃疡(DU)、胃溃疡(GU)和胃癌(GCA)患者胃体、胃窦组织中Cyclin D1的表达变化,及Hp、东亚型Cag A阳性Hp感染率。结果 CSG、CAG、GCA患者胃体、胃窦组织中Cyclin D1蛋白表达阳性率逐渐升高(P0.05)。Hp阳性者胃体、胃窦组织中Cyclin D1表达明显高于Hp阴性者(P0.05)。东亚型Cag A阳性者Cyclin D1表达明显高于东亚型Cag A阴性者(P0.05)。结论胃黏膜癌变过程中的Cyclin D1阳性表达呈递增趋势,Hp感染特别是东亚型Cag A阳性Hp感染导致Cyclin D1过量表达,使细胞周期调节紊乱,有助于肿瘤的发生。     

胆汁返流对慢性胃炎胃黏膜病变的影响

目的探讨胆汁返流对慢性胃炎胃黏膜病变特征的影响。方法采用 2 4h胃腔内胆红素吸光度和pH值联合监测方法 ,检测 4 9例慢性胃炎患者 ,并将其分为胆汁返流阳性组和阴性组。观察胃体、胃角和胃窦黏膜活动性感染等各项病理改变 ,并分析胃内胆汁返流时间与胃黏膜病变特征和胃内pH >4时间之间的相关性。结果 4 9例慢性胃炎患者中 ,38例胃内存在胆汁返流 ,11例不存在胃内胆汁返流。胆汁返流组全胃黏膜病变均较无胆汁返流组严重 ;胆汁返流时间与近端胃黏膜病变呈正相关 ,与pH >4时间无明显相关。结论胆汁返流是慢性胃炎患者全胃黏膜病变的重要病因之一 ,可能会促进H .pylori定植范围向胃体蔓延 ,从而加重近端胃黏膜损伤 ,对胃黏膜酸暴露情况没有显著影响     

糜烂性胃炎756例内镜分析

目的：探讨内镜下糜烂性胃炎（EG）的特点。方法：回顾性分析756例EG的内镜资料。结果：胃窦炎的病变程度与胃体炎差异无显著性（P＞0.05），合并十二指肠溃疡30.0％，胃溃疡12.6％，有较高的肠化检出率（36.4％），幽门螺杆菌（Hp）与糜烂类型、糜烂程度、有无肠化生及不典型增生，差异均无显著性（P＞0.05），与有无炎症活动及炎症程度差异均有显著性（P＜0.005）。结论：EG内镜下分型及病变程度的划分，对病情判断和治疗随访有指导意义；要积极治疗肠化生和不典型增生；Hp可以促使该病的发展。     

幽门螺杆菌感染与胃癌及胃部病变的多组病例对照研究

目的：探讨幽门螺杆菌（Helicobacter pylori,Hp）感染与胃癌及胃部病变之间是否存在因果关系。方法：将1994～1996年经病理确诊的胃癌及胃部病变病例分为多个病例组及对照组,利用1987年山东胃癌高发区组织库,作为Hp暴露史测量的资料。结果：调整年龄、性别及文化程度3个外部变量后,胃窦慢性浅表性胃炎、消化性溃疡及炎症活动程度与Hp感染间OR分别为2.072、2.980、2.086,有统计学关联,且差异有显著性。相关分析表明胃病严重程度与Hp感染之间存在负相关关系(r=－0.217)。结论：Hp感染与胃窦慢性浅表性胃炎、消化性溃疡及炎症活动程度存在部分因果关系。     

幽门螺杆菌长期感染鼠腺胃模型的研究

目的 建立适合不同研究需要的Ｈｐ动物模型,方法 二级Ｗｉｓｔａｒ大鼠,二级Ｃ３７ＨＬ／６小鼠及三级ＢＡＬＢ／ｃ小鼠４０只,每种动物随机分为实验组（２０只）及对照组（２０只）。实验组动物拉种Ｈｐ（ｓｙｄｎｅｙｓｔｒａｉｎ１ＳＳ１）小鼠０．４ｍｌ／只,大鼠１．５ｍｌ／只（约１０＾９／ｍｌ）连续５次,１周完成,而对照组则不作相应处理,距最后一次接种Ｈｐ的４,８,１２及２４周（ＢＡＬＢ／ｃ１６周）分别处死     

Dominant cagA/vacA genotypes and coinfection frequency of H. pylori in peptic ulcer or chronic gastritis patients in Zhejiang Province and correlations among different genotypes, coinfection and severity of the diseases

Background Almost half of the world’s population suffer from the Helicobacter pylori (H. pylori) infection, but only some individuals develop gastric diseases with clinical symptoms. One reason for the phenomenon may be the different pathogenicity of infected H. pylori strains. The presence of cytotoxin-associated gene A (cagA) and expression of vacuolating cytotoxin activity encoded by vacuolating cytotoxin gene A (vacA) are considered the two major virulent markers of H. pylori. The aim of this study was to detect dominant cagA/vacA genotypes and coinfection frequency of H. pylori in patients with peptic ulceration (PU) or chronic gastritis (CG), and to determine correlations among different cagA/vacA genotypes, coinfection and severity of the diseases. Methods For each of 139 patients in Zhejiang Province who had been diagnosed as PU or CG based on clinical symptoms and gastroscopy, two gastric biopsy specimens (one from antrum and the other from corpus) for H. pylori isolation were taken by two different disinfected biopsy forceps. One hundred and fifty-six H. pylori strains were isolated from both the antrum and corpus biopsy specimens of 78 patients (36 PU and 42 CG). PCRs were performed to detect cagA genes, and signal (s) and middle (m) regions of vacA genes in the H. pylori isolates. The amplified fragments of dominant vacA gene s and m subtypes from representative H. pylori isolates were sequenced after TA cloning. Dominant cagA/vacA genotypes of the H. pylori isolates, coinfection frequency and correlations among the different genotypes, coinfection and severity of the diseases were determined.Results Of the H. pylori strains isolated from the antrum specimens, 96.2% were cagA gene positive, as were 97.4% of the H. pylori strains isolated from the corpus specimens. Only one s region subtype (s1a) and four m region subtypes m1, m2, m1b and m1b-m2 of vacA gene were found. The proportions of vacA gene subtypes s1a/m1, s1a/m2, s1a/m1b and s1a/m1b-m2 in the 83 strains isolated from the antrum specimens were 7.2%, 61.5%, 30.1% and 1.2%, respectively, while those in the other 84 strains isolated from the corpus specimens were 9.5%, 58.3%, 28.6% and 3.6%, respectively. s1a/m2 (58.3% vs 30.1%, χ2=13.47, P&lt;0.01) and then s1a/m1b (28.6% vs 9.5 %, χ2=9.88, P&lt;0.01) were the dominant vacA gene subtypes in the H. pylori isolates. The dominant H. pylori genotype was cagA+s1a/m2 (59.0% from antrum specimens and 57.1% from corpus specimens), and followed by cagA+s1a/m1b (28.9% from antrum specimens and 27.4% from corpus specimens). Sixteen of 78 patients (20.5%) were infected with two or three H. pylori strains with different genotypes. However, no statistically significant differences among cagA occurrence, the different vacA subtypes and PU or CG could be found (each P&gt;0.05). Similarities of the nucleotide sequences from vacA gene s region PCR products of six isolates and from vacA gene m region PCR products of four isolates were 93.2% to 98.3% and 93.8% to 97.6%, respectively, compared to the reported corresponding sequences.Conclusions The dominant genotypes of H. pylori in PU or CG patients in Zhejiang area may be cagA+ s1a/m2 and cagA+ s1a/m1b. Numerous coinfections with different H. pylori strains in PU or CG patients indicate diversity of the infected H. pylori origins. s and m regions of vacA gene from different H. pylori isolates show high nucleotide sequence similarities. cagA gene positive rate, different vacA gene subtypes and coinfection with different H. pylori strains are not closely associated with severity of the diseases.     

健脾清热中药治疗Ⅰ型幽门螺杆菌相关性胃炎的研究

目的　研究健脾清热中药对Ⅰ型幽门螺杆菌相关性胃炎的疗效。方法　 10 0例Ⅰ型幽门螺杆菌感染的慢性胃炎患者随机分成 2组。研究组 (A组 ) 5 0例 ,服用健脾清热中药 (汤剂 ) 5 0ml 3 日 ,雷尼替丁 15 0mg 2 日 ;对照组(B组 ) 5 0例 ,口服甲硝唑 40 0mg 2 日 ,阿莫西林 10 0 0mg 2 日 ,雷尼替丁 15 0mg2 日 ,疗程均为 2周。停药 4周后给予1 4　C -UBT试验。结果　临床症状缓解率A组高于B组 (P <0 .0 5 ) ,HP的根除率两组间不存在显著差异 (P >0 .0 5 ) ,而A组产生的治疗副作用少。结论　健脾清热中药外加雷尼替丁是一种根除Ⅰ型幽门螺杆菌和缓解慢性胃炎症状的有效组合。     

A five-year follow-up study on the pathological changes of gastric mucosa after H. pylori eradication

Objectives To investigate the relationship between H.pylori infection,gastric cancer and other gastric diseases through the changes in gastric mucosa and the status of different gastric diseases within 5 years after H.pylori eradication in H.pylori-positive subjects in a high incldence region of gastric cancer. Methods One thousand and six adults were selected from the general population in Yantai,Shandong province,a high Incidence region for gastric cancer in China.Gastroscopy and Campylobacter-like organism(CLO)testing were performed on all subjects,Biopsy samples from the gastric antrum and body were obtained for histology and assessment of H.pylori infection.All H.pylori-positive subjects were then randomly divided into two groups:treatment group receiving Omeprazole Amoxicillin Clarythromycin(OAC) triple therapy and placebo as controls.These subjects were endoscopically followed up in the second and fifth year.We compared the endosopic appearance and histology of the biopsy specimens from the same site obtained at the first and last visits.Results All 552H.pylori-positive subjects were randomly and evenly divided into treatrment group or control group.During the five-year follow-up,the numbers of patients who continued to be negative or positive for H.pylori were 161 and 198,respectively.Statistical analysis revealed that:①At the initial visit,there were no significant differences in the severity and activity of inflammation,atrophy and intestinal metaplasia between the biopsy specimens from the antrum and body resopectively in both groups. ②The severity and activity of inflammation in both the antrum and body were markedly reduced after H.pylori eradication(P=0.000).③Within five years after H.pylori eradication,intestinal metaplasia in the antrum either regressed or had no progression,while the proportion of intestinal metaplasia in the H.pylori-positive group increased significantly(P=0.032).④After H.pylori eradication,the atrophy in both the antrum and body had no significant regression.The P value was 0.223 and 0.402,respectively.Conclusions H.pylori eradication results in remarkable reduction in the severity and activity of chronic gastritis,marked resolution of intestinal metaplasia in the antrum.On the other hand.continuous H.pylori infection leads to progressive aggravation of atrophy and intestinal metaplasia.