HP阴性消化性溃疡相关病因及胃粘膜组织学变化的研究

近十多年来,随着HP检测方法的不断完善,越来越多的研究报告证实90％以上的消化性溃疡(PU)患者胃粘膜组织中伴随HP感染。大量的研究将注意力集中在HP感染与慢性胃炎,PU发生、进展和转归等方面,而有关HP阴性PU患者的临床资料却少有报道。本文在观察一系列HP阴性和阳性PU患者的基础上,对其相关的病因及胃粘膜组织形态学变化进行了对照、分析和探讨。     

消化性溃疡中胃粘膜病变的特点分析

分析４９１例消化性溃疡伴随胃溃膜病变的特点。结果：性别年龄因素对病变发生率无影响。粘膜炎症较之萎缩和溃疡关系更密切。十二指溃肥广泛粘膜炎症及体部慢性轻度炎症为特点；胃溃疡以广泛萎缩，窦部重度萎缩及重度慢性活动性炎症为特点。两者粘膜病变特点和现有关于两者发病机理的认识相吻合。     

消化性溃疡和出血性胃粘膜病的治疗

20年来,有关胃酸分泌的研究卓有成效,因此消化性溃疡的治疗也有了很大进展。过去只知胃酸分泌出现尿硷潮,壁细胞能将血液H~+浓缩百万倍以上。近来已清楚壁细胞在某些物质刺激下的泌酸过程:ATP转化成cAMP,激活蛋白质激酶使CO_2快速变为H_2CO_3,并电离出H~+,     

类固醇激素致消化性溃疡28例

1 对象和方法 1.1 对象 本院1988-1993年78例长程大剂量激素治疗肾脏病,其中并发消化性溃疡28例。其中原发性肾病综合征60例,狼疮性肾炎14例,紫癜性肾炎4例。男52例,女26例。年龄17-52岁,平均31.5岁。78例经上消化道钡餐造影或内镜检查,证实消化性溃疡28例,浅表性胃炎29例,十二指肠炎10例,未见病变11例。28例消化性溃疡患者,其中原发性肾病综合征18例,狼疮性肾炎8例,紫癜性肾炎2例。临床表现,规律上腹部疼痛12例,反酸、嗳气14例,剑下或脐上压痛15例,腹胀10例。无明显症状4例。症状多于激素治疗第8-12周时出现。其中2例出现上消化道出血,主要表现为黑便。BUN<7.14mmol/L 4例,BUN 7.14-14.3mmol/L 19例,BUN>14.3mmol/L 5例。     

消化性溃疡与幽门螺杆菌L型感染相关性研究

目的　探讨消化性溃疡 (PU)与幽门螺杆菌 L型 (HP- L )感染的关系。方法　取 386例 PU患者胃窦、胃体及十二指肠粘膜组织 ,常规切片后以革兰氏染色和免疫组化染色镜检 HP- L 型细菌 ,并计算检出率。结果　 HP- L 型检出率为 5 3.37% ,其中革兰氏染色和免疫组化染色检出率分别为 5 6 .73%、5 4 .2 9% ,差异无显著性(P>0 .0 5 ) ;胃溃疡、十二指肠溃疡 HP- L 型检出率分别为 5 8.33%、5 5 .5 0 % ,差异无显著性 (P>0 .0 5 ) ;男女患者HP- L 检出率前者 (6 1.18% )明显高于后者 (38.17% ) (P<0 .0 1) ;30岁以下、30岁～、4 0岁～、5 0岁～患者 HP- L检出率依次为 32 .0 5 %、4 1.94 %、5 9.18%、71.79% ,差异显著 (P<0 .0 1)。结论　 PU患者 Hp- L型感染率较高 ,且男性高于女性 ,HP- L型检出率随年龄增长而增高。 PU患者 HP- L型变异可能是导致溃疡迁延不愈、反复发作的重要原因之一     

年龄相关性消化性溃疡与幽门螺杆菌感染及胃肠激素关系的研究

目的 :探讨各年龄段消化性溃疡 (PU)发病机制的特点。方法 :对不同年龄的 PU患者通过尿素酶和放射免疫学方法检测幽门螺杆菌 (Hp)及血清与胃液中胃泌素 (GAS)、表皮生长因子 (EGF)、内皮素 - 1(ET- 1)的水平。结果 :溃疡组与胃炎组相比 ,餐后血清 GAS水平增高 ,血清及胃液 EGF水平下降 (P<0 .0 5 ) ;Hp阳性组与 Hp阴性组相比 ,餐后血清 GAS水平增高 ,而血清及胃液 EGF水平下降 (P<0 .0 5 ) ;不同年龄组 PU(从低到高 )相比 ,空腹血清 GAS水平随年龄的增大而逐渐升高 (P<0 .0 5 ) ,餐后血清 GAS水平均增高 ,但差异无显著性意义 (P>0 .0 5 ) ,血清及胃液 EGF水平均降低 (P<0 .0 5 ) ,血清 ET- 1水平随年龄的增大逐渐升高 (P<0 .0 5 )。结论 :在不同年龄阶段 ,与 PU的发病机制有关的血清 GAS、EGF、ET- 1及 Hp感染等因素存在相似作用 ,但有程度上的差别 ,这对临床确定治疗方案具有一定指导意义。     

消化性溃疡,胃癌患者胃窦粘膜中胃肠激素含量变化及其意义

研究了胃十二指肠疾病患者胃窦粘膜胃泌素（Ｇａｓ）、生长抑素（ＳＳ）、Ｐ－物质（ＳＰ）的含量变化及其意义。结果表明：胃窦粘膜ＳＳ含量在胃溃疡组低于其余各组（Ｐ均〈０．０５），而在胃癌时则显著增高（Ｐ〈０．００１）；ＳＰ浓度在十二指肠溃疡组显著低于其余各组（Ｐ均〈０．０５）；胃癌患者Ｇａｓ水平显著高于对照组（Ｐ〈０．０５）；ＳＳ与ＳＰ在十二指肠溃时呈明显负相关。提示：胃粘膜中Ｇａｓ、ＳＳ、ＳＰ的含量变     

慢性胃炎、消化性溃疡和胃癌的健康效用值的测定

质量调整生命年 (ＱＡＬＹ)是慢性病研究中的常用效果指标 ,它具有同时考虑病人生存期的长短和生命质量的优点。计算ＱＡＬＹ所用的生命质量调整权数称为健康效用值(ｈｅａｌｔｈｕｔｉｌｉｔｙ) ,通常为 0～ 1的数值[1] 。慢性胃炎、消化性溃疡和胃癌都是常见的消化系统慢性疾病 ,在对病人的生理健康产生影响的同时 ,还给病人带来一定的精神负担 ,目前尚未见健康效用值测定的报道。本文用评分法和量表评定法测定这些疾病及其特定阶段的健康效用值 ,在综合评价疾病对健康影响的同时也可为其他有关的研究提供参数。材料与方法健康效用值是评…     

胃癌及消化性溃疡患者胃窦粘膜胃肠激素的变化

目的探讨胃癌及消化性溃疡（ＰＵ）患者胃窦粘膜胃肠激素变化的意义．方法内镜及活检确诊的浅表性胃炎（ＣＳＧ）１０例，胃溃疡（ＧＵ）１５例，十二指肠溃疡（ＤＵ）１２例，胃癌（ＧＣ）６例．胃镜下取胃窦粘膜，用ＲＩＡ法测定胃泌素（Ｇａｓ）、生长抑素（ＳＳ）、Ｐ物质（ＳＰ）的含量，各组间进行比较．结果胃窦粘膜ＳＳ含量在ＧＵ，ＤＵ，ＣＳＧ，ＧＣ组分别为２５１ｐｇ／ｍｇ±１９４ｐｇ／ｍｇ（以下同），４７０±１７９，５３２±２１１及１２９３±５２３。其中ＧＵ组低于其余各组（Ｐ＜００５），而ＧＣ时则显著升高（Ｐ＜００１）．ＳＰ含量在ＤＵ组显著降低，与ＧＵ，ＣＳＧ，ＧＣ比较分别为４７９±１５７ｖｓ７６５±４１５，７８９±３９０及８０１±３４６，Ｐ＜００５；ＧＣ患者Ｇａｓ水平显著高于ＣＳＧ组，为４６４５±２９４４，ｖｓ２７６８±１５７２，Ｐ＜００１．结论胃粘膜中Ｇａｓ，ＳＳ，ＳＰ含量的变化可能在ＰＵ及胃癌的发病机理中起重要作用．     

Decreased expression of gastrokine 1 in gastric mucosa of gastric cancer patients

AIM: To investigate the expression of gastrokine 1(GKN1) in normal gastric mucosa, precancerous lesions and gastric cancer tissues, and to analyse its correlations with tumour site and pathological pattern.METHODS: Thirty gastric cancer patients(12 cases of diffuse type and 18 cases of intestinal type), 13 atrophic gastritis patients and 15 healthy volunteers with almost normal gastric mucosa(superficial gastritis) were enrolled in this study. Helicobacter pylori(H. pylori) infection was examined in all subjects. All gastric mucosa biopsy specimens were obtained. Cancer-adjacent specimens were taken from corresponding gastric cancer patients. Immunohistochemistry and real-time PCR were performed to determine the expressions of the GKN1 protein and m RNA, respectively.RESULTS: H. pylori infection had no significant association with age, gender, tumour site or pathological pattern in all subjects. Compared with the superficial gastritis and atrophic gastritis groups, the expression of GKN1 protein(P = 0.011) and m RNA(P < 0.001) in gastric cancer was significantly decreased. The GKN1 m RNA level in diffuse type gastric cancer was significantly lower than in intestinal type gastric cancer(0.296 ± 0.076 vs 0.525 ± 0.164, P < 0.001).CONCLUSION: Compared with almost normal gastric mucosa, GKN1 expression in the gastric mucosa of gastric cancer patients is decreased; this is associated with progression and prognosis of gastric cancer.     

胃溃疡及十二指肠球部溃疡患者胃排空时间的初步研究

为探讨胃溃疡（ｇａｓｔｒｉｃｕｌｃｅｒ，ＧＵ）及十二指肠球部溃疡（ｄｕｏｄｅｎａｌｕｌｃｅｒ，ＤＵ）和胃排空的关系，我们对１４例ＧＵ，２０例ＤＵ患者及１１名健康人，应用９９ｍＴＣ一植酸钠的鸡肝固相食物进行显像和排空时间一放射性曲线的检测与对照，作为评价ＧＵ及ＤＵ患者胃运动功能的指标，结果表明：（１）健康人胃排空时间为５１．５±１２．８分钟（￣χ±２ｓ）；（２）ＧＵ４例＞９０分钟，１例＜３０分钟，９例在健康人范围内；（３）ＤＵ组中１４例＜３０分钟，４例＞９０分钟，２例在健康人范围内。     

Gastric emptying and plasma levels of gastrointestinal hormones in patients with peptic ulcer

ＧａｓｔｒｉｃｅｍｐｔｙｉｎｇａｎｄｐｌａｓｍａｌｅｖｅｌｓｏｆｇａｓｔｒｏｉｎｔｅｓｔｉｎａｌｈｏｒｍｏｎｅｓｉｎｐａｔｉｅｎｔｓｗｉｔｈｐｅｐｔｉｃｕｌｃｅｒＣＨＥＮＪｉａｎ,ＬＩＪｕｎＭａｎ,ＬＩＸｕｅＨｕｉ,ＨＡＯＨｏｎｇＳｈｅｎｇａｎ...     

Characteristics of gastric cancer in peptic ulcer patients with Helicobacter pylori infection

AIM:To evaluate the incidence and clinical characteristics of gastric cancer(GC) in peptic ulcer patients with Helicobacter pylori(H.pylori) infection.METHODS:Between January 2003 and December 2013, the medical records of patients diagnosed with GC were retrospectively reviewed.Those with previous gastric ulcer(GU) and H.pylori infection were assigned to the Hp GU-GC group(n = 86) and those with previous duodenal ulcer(DU) disease and H.pylori infection were assigned to the Hp DUGC group(n = 35).The incidence rates of GC in the Hp GU-GC and Hp DU-GC groups were analyzed.Data on demographics(age, gender, peptic ulcer complications and cancer treatment), GC clinical characteristics [location, pathological diagnosis, differentiation, T stage, Lauren's classification, atrophy of surrounding mucosa and intestinal metaplasia(IM)], outcome of eradication therapy for H.pylori infection, esophagogastroduodenoscopy number and the duration until GC onset were reviewed.Univariate and multivariate analyses were performed to identify factors influencing GC development.The relative risk of GC was evaluated using a Cox proportional hazards model.RESULTS:The incidence rates of GC were 3.60%(86/2387) in the Hp GU-GC group and 1.66%(35/2098) in the Hp DU-GC group.The annual incidence was 0.41% in the Hp GU-GC group and 0.11% in the Hp DUGC group.The rates of moderate-to-severe atrophy of the surrounding mucosa and IM were higher in the Hp GU-GC group than in the Hp DU-GC group(86% vs 34.3%, respectively, and 61.6% vs 14.3%, respectively, P 0.05).In the univariate analysis, atrophy of surrounding mucosa, IM and eradication therapy for H.pylori infection were significantly associated with the development of GC(P 0.05).There was no significant difference in the prognosis of GC patients between the Hp GU-GC and Hp DU-GC groups(P = 0.347).The relative risk of GC development in the Hp GUGC group compared to that of the Hp DU-GC group,after correction for age and gender,was 1.71(95%CI:1.09-2.70;P=0.02).CONCLUSION:GU patients with H.pylori infection had higher GC incidence rates and relative risks.Atrophy of surrounding mucosa,IM and eradication therapy were associated with GC.     

不同肝功能分级肝硬化患者血小板参数、胃电参数及胃肠激素水平比较

目的比较不同肝功能分级肝硬化患者血小板参数、胃电参数及胃肠激素水平。方法选取2012年2月-2013年1月于岑溪市人民医院进行诊治的48例肝硬化患者作为观察组,同时期体检的48名健康人员作为对照组,将两组人员的血小板参数、胃电参数及胃肠激素水平进行比较,并对观察组中不同Child-Pugh分级者的上述指标进行比较。结果观察组的PLT和PCT均低于对照组,PDW、MPV及P-LCR均高于对照组,餐前及餐后的胃电幅值、胃电频率和正常慢波节律比均低于对照组,餐前及餐后的血清GAS、VIP、MTL均高于对照组,并且Child-Pugh分级高者波动大于分级低者,差异有统计学意义(P均0.05)。结论肝硬化患者血小板参数、胃电参数及胃肠激素存在明显的异常波动,且Child-Pugh分级越高者波动越大。     

Lewis blood genotypes of peptic ulcer and gastric cancer patients in Taiwan

AIM: The Lewis b (Leb) antigen has been implicated as a possible binding site for attachment of Helicobacter pylori (H pylori) to gastric mucosa. However, studies both supporting and denying this association have been reported in the literature. Differences in secretor (Se) genotype have been suggested as a possible reason for previous discrepancies. Therefore, we investigated the relationship between Le and Se genotypes and H pylori infection rates in people with peptic ulcer or gastric cancer. METHODS: Peripheral blood samples were obtained from 347 patients with endoscopic evidence of peptic ulcer disease (235 cases of duodenal ulcer, 62 of gastric ulcer, and 50 of combined duodenal ulcer/ gastric ulcer) and 51 patients with gastric cancer on endoscopy. Peripheral blood specimens from 101 unrelated normal volunteers were used as controls. Lewis phenotype was determined using an antibody method, whereas Le and Se genotypes were determined by DNA amplification and restriction enzyme analysis. Gastric or duodenal biopsies taken from patients with endoscopic evidence of peptic ulcer or gastric cancer were cultured for H pylori. Isolates were identified as H pylori by morphology and production of urease and catalase. The H pylori infection status was also evaluated by rapid urease test (CLO test), and urea breath test (13C-UBT). Results of studies were analyzed by chi-square test (taken as significant). RESULTS: H pylori was isolated from 83.7% (303/347) of patients with peptic ulcer disease. Statistical analysis did not show any significant difference in Lewis phenotype or genotype between patients with and without H pylori infection. No significant association was found between Lewis genotype and peptic ulcer or gastric cancer. CONCLUSION: Lewis blood genotype or phenotype may not play a role in the pathogenesis of H pylori infection. However, bacterial strain differences and the presence of more than one attachment mechanism may limit the value of epidemiological studies in elucidating this matter.     

胃癌与相关胃肠激素的关系研究进展

胃癌细胞的增殖转移与相关胃肠激素如胃泌素等密切相关,有关激素及其改造试剂对胃癌等肿瘤做定位诊断以及生物学治疗已成为科研热点,在新的诊断和治疗思路上有较好的进展和前景。     

消化性溃疡患者Hp感染与粘膜血流量

目的研究幽门螺杆菌（Ｈｐ）感染与消化性溃疡（ＰＵ）胃肠粘膜血流量（ＧＤＭＢＦ）的关系．福建省立医院消化内科福建省福州市３５０００１方法采用多普勒激光血流仪测定内镜检查患者的非病灶区贲门、胃体、胃窦部及溃疡或胃炎病灶区的ＧＤＭＢＦ．结果非病灶区ＧＤＭＢＦ以贲门部最高，胃体部次之，胃窦部较低，分别为１．６８±０５５Ｖ，１７０±０４２Ｖ和１３５±０３７Ｖ，均明显高于ＰＵ病灶区０８９±０３３Ｖ（Ｐ＜００１）；伴有Ｈｐ感染的ＰＵ患者病灶区及其它非病灶区ＧＤＭＢＦ均显著低于不伴Ｈｐ感染者．结论Ｈｐ感染可造成胃肠粘膜血流量降低，可能是溃疡病灶难愈或复发的原因之一．