幽门螺杆菌根除后胃黏膜的病理变迁

目的探讨根除幽门螺杆菌(Hp)对胃黏膜萎缩、肠上皮化生等癌前病变的转归,以及胃黏膜上皮细胞增殖指标ki-67表达的影响。方法67例Hp感染且有胃黏膜萎缩和(或)肠上皮化生的慢性胃炎患者,随机分为实验组(37例)和对照组(30例),分别给予Hp根除和对症治疗,1年后复查,比较Hp根除与否对胃黏膜萎缩、肠上皮化生等癌前病变的影响;用免疫组化方法检测治疗前后胃黏膜上皮细胞增殖指标ki-67的表达,比较Hp根除与否对它的影响。结果实验组炎症程度减轻(34/37,91.9%,P<0.01),活动性炎症者减少(P<0.01),萎缩、肠上皮化生等癌前病变减轻或逆转(21/32,65.6%vs15/26,57.7%,均P<0.05);ki-67表达降低(46.5±27.7vs15.4±18.7,P<0.01)。结论根除Hp可使胃黏膜炎症程度减轻,活动性炎症消失,萎缩、肠化等癌前病变减轻或逆转,胃黏膜上皮细胞增殖指标ki-67表达减少,从而有利于预防胃癌的发生。     

Analysis of long-term serological and histological changes after eradication of Helicobacter pylori

Stratification of gastric cancer risk by measuring serological biomarkers is useful for screening of gastric cancer. However, this method has problem such as overlooking past infected patients. We aimed to evaluate the association between Helicobacter pylori infection status and serological biomarkers. We divided 5,268 patients according to Helicobacter pylori infection status and past infected patients were divided into 12 groups according to time elapsed since eradication. We analyzed mean serum H. pylori immunoglobulin G antibody, pepsinogen titers, histological and endoscopic atrophy score of each group. Mean H. pylori immunoglobulin G antibody showed a decreasing tendency, there was no significant difference from the uninfected group at 11 years after eradication (p = 0.19). PGI, PGII decreased in short term after eradication. However, both PGI and PGII gradually increased as long-term changes after eradication, became comparable to those in the uninfected group (p = 0.41, p = 0.37, respectively). Histological atrophy improved gradually, became equivalent to uninfected group. Endoscopic atrophy score did not improve for long term after eradication. In conclusion, patients with long term after eradication reach the uninfected condition serologically, histologically. Endoscopic assessment of gastric mucosal atrophy may be useful for accurate assessment of gastric cancer risk.     

根除幽门螺杆菌对慢性胃炎胃黏膜萎缩、肠化生的影响

目的用回顾性对照研究观察根除幽门螺杆菌(HP)能否逆转慢性胃炎胃黏膜萎缩和肠化生的改变。方法选择因慢性胃炎行胃镜检查的病人为研究对象,病理证实有慢性萎缩性胃炎,肠化,HP阳性(美兰染色)的患者符合入选条件,分为HP根除组(76例);HP未根除组(65例),每年做胃镜1次,连续2年以上者。结果在根除HP后1年时胃黏膜萎缩和肠化生的程度较HP未根除病人明显改善,部分病人逆转到正常,在2年时肠化生和萎缩未再进一步改善。结论对于合并胃黏膜萎缩和肠化生的慢性胃炎病人,根除HP治疗对病人可能是有益的。     

幽门螺杆菌感染根治方案的对比研究

目的比较不同方案对幽门螺杆菌感染根除治疗的疗效。方法共180例幽门螺杆菌感染患者进行治疗,随机分为A、B、C组。A组(雷尼替丁+胶体果胶铋+阿莫西林+甲硝唑)、B组(泮托拉唑+胶体果胶铋+克拉霉素+甲硝唑)、C组(雷贝拉唑+胶体果胶铋+阿莫西林+呋喃唑酮)分别采用不同方案治疗,疗程7d,停药4周后检测幽门螺杆菌。结果 A、B、C组幽门螺杆菌根除率分别为65.00%、81.66%和91.66%(P0.01),药物不良反应发生率分别为21.66%、25.00%、26.66%(P0.05)。结论雷贝拉唑、胶体果胶铋、阿莫西林和呋喃唑酮四联短程疗法对幽门螺杆菌感染具有较好的根除疗效。     

幽门螺杆菌家庭聚集现象与家庭成员共治的关系研究

目的调查幽门螺杆菌（Hpylori,Hp）感染患者家庭成员内的感染情况,探讨Hp家庭聚集因素对根除Hp感染的影响。方法通过对内镜检查确诊的195例Hp感染患者的家庭成员采用C^13或C^14呼气试验（UBT）进行HP感染调查,排除3个其他家庭成员Hp均阴性的患者,将192例患者随机分成家庭成员同治组和非同治组,并根据生活习惯分为核心家庭组141个及非核心家庭组51个,观察不同治疗方案及家庭因素在Hp根除的差异。结果所有195个家庭568例家庭成员中Hp总感染率为91．2％,192个Hp阳性家庭中,核心家庭成员总Hp阳性率达98．6％,非核心家庭成员阳性率为81．7％,通过质子泵抑制剂（PPI）三联治疗两周后,所有192例患者Hp总根除率达91．2％。同治组与非同治组Hp根除率分别为92．2％、88．2％,但两者差异无统计学意义（P〉0．05）。结论Hp感染患者家庭成员内存在较高感染率,并可增加患者Hp根除后复发机会。在存在密切接触的家庭,感染家庭成员共同根除治疗,对于有效根除患者Hp具有重要临床意义。     

幽门螺杆菌根除对不同胃黏膜病变环氧合酶-2表达的影响

目的探讨Hpylori根除对慢性浅表性胃炎和萎缩肠化胃黏膜上皮细胞COX-2表达的影响。方法采用快速尿素酶试验和组织学碱性品红染色法检测胃黏膜Hpylori感染状况;应用免疫组织化学法检测胃黏膜上皮细胞COX-2的表达。结果17例Hpylori阳性慢性浅表性胃炎中11例见不同程度胃黏膜上皮细胞COX-2阳性表达,Hpylori根除后6例COX-2表达消失,2例减弱,2例无改变,1例增强,前后对照差异有显著性(P<0.05)。同时Hpylori根除后12例胃黏膜慢性炎症见不同程度减轻,与COX-2表达变化有较好相关性(P<0.05)。10例Hpylori感染萎缩性胃炎伴肠化生者9例COX-2表达阳性,Hpylori根除后1、2a复查COX-2表达减弱5例,消失2例,1例无变化,1例增强,前后对照差异有显著性(P<0.05),但胃黏膜组织学对照无明显改善。结论根除Hpylori可消除慢性浅表性胃炎胃黏膜上皮细胞COX-2表达,且与慢性炎症程度消退相关。而根除Hpylori虽可减弱萎缩肠化胃黏膜上皮细胞COX-2表达,但不能改善胃黏膜萎缩和肠化状态。     

Helicobacter pylori eradication and associated changes in the gastric mucosa

Persistent Helicobacter pylori infection contributes towards the development of chronic gastritis. To clarify the changes in chronic gastritis as a precursor of gastric cancer secondary to H. pylori eradication is an important issue, as it has significant implications for reducing the risk of gastric cancer. Studies published to date, however, are far from consistent with regard to the morphologic changes reported following H. pylori eradication. Of these, some papers reported improvement in gastric atrophy or intestinal metaplasia, versus others reporting no improvement, with the majority of papers published after 2000 reporting improvement in these end points. The inconsistent results concerning the impact of H. pylori eradication on gastric atrophy could be due to the inconsistency of the diagnostic criteria employed for evaluation of the morphology, confounded by the difficulties involved in evaluating atrophic changes in the gastric mucosa. While adherence to the Updated Sydney System available for evaluation of gastritis is primarily required worldwide to ensure consistency in evaluating gastritis, long-term research into the morphologic changes associated with H. pylori eradication is also required to explore strategies for the prevention of gastric cancer with H. pylori eradication.     

胃低级别上皮内瘤变根除幽门螺杆菌后病理升级的危险因素列线图建立与验证

目的 建立并验证胃低级别上皮内瘤变（LGIN）根除幽门螺杆菌（HP）感染后病理升级的危险因素列线图。方法 选取该院消化内科初诊胃镜活检病理提示为胃LGIN的患者,予以根除HP,并对其进行2年的随访,统计分析病理升级组和未升级组之间临床和内镜特征的差异,通过单因素和多因素分析筛选出有明显差异的独立危险因素,建立胃LGIN病理升级的危险因素列线图模型,并利用C指数、受试者操作特征曲线（ROC）和校正图,予以验证列线图的稳定性及可靠性。结果 共纳入309例患者。其中,有153例发生了病理升级。单因素分析表明,性别、病灶直径、有无边界、病灶数量、形状及是否伴有糜烂溃疡差异有统计学意义;而多因素分析表明,患者为男性、病灶直径≥1 cm、有边界和凹陷型且无糜烂溃疡是发生病理升级的独立危险因素。建立列线图后,验证该模型C指数为0.775 (0.724～0.826),ROC曲线的曲线下面积（AUC）为0.740,且校正图显示该模型有较好的稳定性。结论 该模型具有较好的稳定性和一致性,可用于评估胃LGIN患者中根除HP后发生病理升级的风险大小,指导临床选择合适的治疗方式。     

术前与术后根除幽门螺杆菌胃癌患者生存率差异的研究

目的研究术前与术后根除幽门螺杆菌(Hp)治疗胃癌患者的生存率差异。方法回顾性选取2014年6月至2016年6月应急总医院收治的胃癌患者60例,所有患者依据根除幽门螺杆菌时间节点不同分为治疗组和对照组,各30例。对照组患者在胃癌切除术前接受根除Hp治疗,治疗组患者胃癌切除术后接受根除Hp治疗。统计分析两组患者的6个月、1年、2年、3年生存情况以及Hp复发情况。结果两组患者术后6个月、1年生存率[100.0%(30/30)、96.7%(29/30)vs.100.0%(30/30)、93.3%(28/30)]比较,差异均无统计学意义(P>0.05)。对照组患者2年、3年生存率[93.3%(28/30)、83.3%(25/30)]均显著高于治疗组[80.0%(24/30)、66.7%(20/30)],差异具有统计学意义(P<0.05)。对照组患者中Hp复发1例,Hp复发率为3.3%(1/30);治疗组患者中复发3例,Hp复发率为10.0%(3/30)。两组患者的Hp复发率比较,差异无统计学意义(P>0.05)。结论胃癌患者术前与术后根除Hp近期疗效相似,但前者更能有效提升胃癌患者2年、3年生存率。     

Helicobacter pylori eradication: role of individual therapy constituents and therapy duration

Treatment of Helicobacter pylori ( H. pylori ) infection has become a key factor in the management of dyspepsia and is the treatment of choice for peptic ulcer disease. First-line eradication regimens combining a proton pump inhibitor (PPI) with clarithromycin and amoxicillin or metronidazole are considered most effective when given for a minimum period of 1 week. Eradication regimens of shorter duration have shown promising results but clinical experience remains limited. Pharmacological properties such as bioavailability and plasma concentrations of individual PPIs differ between individuals but it remains unclear whether these differences impact on the efficacy of eradication therapy and are influenced by renal or hepatic impairment. Bioavailability of PPIs also differs and is impacted on by factors including intragastric pH, metabolic pathways, potency on an mg-for-mg basis and intrinsic antibacterial activity. Several significant pharmacokinetic differences between the PPIs do not seem to influence overall H. pylori eradication rates for first-line triple therapy. However, comparison of factors including pharmacokinetics and treatment duration may prove important in achieving successful eradication with second- and third-line treatments. Based on the factors which influence therapy outcome, we suggest an algorithm for the use of H. pylori eradication therapies.     

应激状态下幽门螺杆菌感染与胃黏膜损伤的关系探讨

目的研究应激时胃黏膜的损伤程度与幽门螺杆菌(Hp)感染的变化情况及其相关性。方法选取新兵60名,在其军训前后进行血清皮质醇(COR)、儿茶酚胺(CA)、14 C-尿素呼气试验、Hp抗体检测,以及《症状自评量表》(SCL-90)评估,部分受试者行胃镜检查和胃黏膜病理分析。结果心理调查问卷分析中,军训后较军训前SCL-90总分、躯体化、抑郁、偏执分明显升高,与军训前比较,差异有统计学意义(P0.05)。军训后新兵的血清COR和CA水平分别为(276.64±156.89)μg/dL、(320.76±123.75)pg/mL,明显高于军训前的(8.28±2.43)μg/dL、(18.69±5.98)pg/mL,差异有统计学意义(P0.05)。胃黏膜病理检查显示军训后胃黏膜炎症积分和14 C-尿素呼气试验检测结果明显升高。结论应激可导致胃黏膜损伤加重,且加重了机体Hp的感染。     

胆汁反流、胃酸、幽门螺杆菌感染对胃黏膜损伤的影响

目的　探讨胆汁反流、胃酸、幽门螺杆菌 (Hp)感染对胃黏膜损伤的影响。方法　 30例具有胆汁反流症状并经胃镜检查证实有胆汁反流的患者 ,同步行动态 2 4小时胃内胆汁及 pH值监测 ,胃镜下取胃窦胃小弯处黏膜 4块 ,1块做快速尿素酶试验 ,3块做病理检查 ;常规固定、包埋、切片和苏木精和伊红 (HE)、Giemsa染色 ,后者用于Hp检测 ;根据胃窦黏膜有无活动性炎症、萎缩、肠化和不典型增生分别记 2分或 1分 ;根据上腹痛、腹胀、吐苦水、恶心、嗳气和食欲不振的程度给予症状评分 ;得出胆红素吸收值 (Abs)≥ 0 .14的时间百分比、pH值 <4的时间百分比 ,以及胃内Abs与pH值对应表。结果　 30例患者中Hp的感染率是 2 3.3% ,胃内Abs≥ 0 .14的时间百分比是 (30 .6 4±14 .6 7) % ;胃内Abs≥ 0 .14的时间百分比Hp阳性组 (2 0 .6 4± 7.13) % ,Hp阴性组 (4 0 .38± 13.35 ) % ,两者相比差异有统计学意义 (P <0 .0 5 ) ;胃窦部黏膜糜烂、肠化的程度积分与胆汁反流程度呈正相关 (r =0 .74 9,P =0 .0 0 5 )。结论　胆汁反流可以抑制Hp在胃内的定植 ,胆汁反流是胃黏膜损伤的危险因素     

Helicobacter pylori treatment: Still a work in progress

Helicobacter pylori is a common worldwide bacterium, possessing adaptability that has created difficulty achieving eradication. While the standard treatment was thought to be triple therapy with a proton pump inhibitor, amoxicillin, and clarithromycin, growing rates of treatment failure and antibiotic resistance have stimulated research into novel regimens. Quadruple therapy with bismuth has been compared for both first- and second-line treatments, but eradication still has not reached expected goals. Innovative regimens including sequential and concomitant therapy, as well as the introduction of new antibiotics into previous treatment schedules, have shown promising improvements in eradication rates. We discuss and compare these unique regimens, reviewing the current literature to deduce those which are most likely to provide the highest success in curing H. pylori infection.     

双歧杆菌四联活菌片辅助含呋喃唑酮及四环素四联疗法补救根除幽门螺杆菌的疗程研究

目的探讨含呋喃唑酮、四环素的四联疗法在补救根除幽门螺杆菌(Helicobacter pylori,Hp)治疗中辅助应用不同疗程双歧杆菌四联活菌片对根除率及不良反应的影响。方法选取2016年12月至2019年5月于华北理工大学附属开滦总医院消化内科门诊就诊患者348例进行前瞻性研究,均为初次根除Hp失败的慢性胃炎患者,利用Excel随机分组方法分为A、B、C组,A组(116例)给予14 d艾普拉唑、果胶铋、呋喃唑酮、四环素方案治疗;B组(116例)在A组方案基础上同时服用14d双歧杆菌四联活菌片;C组(116例)在A组方案治疗第二周开始同时服用7 d双歧杆菌四联活菌片。根除治疗结束4周后复查14C-尿素呼气试验,比较3组的Hp根除率及不良反应发生率。结果3组按意向性治疗分析根除率分别为80.2%、84.5%和82.3%,按符合方案分析根除率分别为88.6%、90.7%和89.7%,3组两种分析方法比较,差异均无统计学意义(按意向性治疗分析:χ^2=0.755P=0.685,按符合方案分析:χ^2=0.271P=0.873);3组不良反应发生率分别为16.4%、6.3%和7.3%,差异有统计学意义(χ^2=7.561,P=0.023),且B组显著低于A组(χ^2=5.570,P=0.017),差异有统计学意义,但C组与A组比较差异无统计学意义(χ^2=4.362,P=0.037)。结论14 d双歧杆菌四联活菌片辅助含呋喃唑酮、四环素的四联疗法补救根除Hp可以显著降低不良反应,但双歧杆菌四联活菌片不能显著提高Hp根除率。     

Helicobacter pylori and non-Helicobacter pylori bacterial flora in gastric mucosal and tumour specimens of patients with primary gastric lymphoma

There is an association between Helicobacter pylori (H. pylori) and gastric mucosa-associated lymphoid tissue (MALT) and MALT lymphoma. Histologically, mainly non-specific stains are used to detect H. pylori, such as haematoxylin–eosin (HE) or modified Giemsa (MG). In this study, both a MG and a specific immunohistochemical stain (IMM) for H. pylori (Dako B471) were performed on sequential slides of resected material containing tumour and non-tumorous gastric mucosa from patients with primary gastric lymphoma (n = 52). Special attention was paid to the presence of non-H. pylori bacterial flora diagnosed by a positive MG (according to form and localization) and a subsequently negative IMM. On all slides, bacterial density was scored semiquantitatively (grades 0, 1, 2, 3). In total, 32 (61.5%) patients were H. pylori positive using IMM and 34 (65.4%) were non-H. pylori positive using MG. In 24 out of the 34 patients, the non-H. pylori flora consisted mainly of cocci in combination with rods in 15 patients, mostly in minor quantities; in another 10 patients, high numbers of both cocci and different types of rods were present. Most non-H. pylori bacteria were localized superficially, although in 22 patients minor quantities of non-H. pylori were also seen in the glandular lumina. After all of the patients had been analysed, no differences in the density of H. pylori and of non-H. pylori flora were found. Only when comparing patients who had a small-cell lymphoma with those who had a large-cell lymphoma was a significantly higher density of H. pylori found in the corpus mucosa of large-cell lymphomas and a higher prevalence of non-H. pylori was found in tumours, in antrum or corpus, of patients with large-cell lymphomas. In conclusion, with joint evaluation using MG and a H. pylori-specific immunohistochemical stains, the proportion of H. pylori-positive gastric lymphoma patients was lower than in most previous studies but other bacteria were found in a relatively high proportion. The role of the non-H. pylori intragastric bacterial flora identified in this study has to be further elucidated in the aetiopathogenesis of primary gastric lymphoma.     

Faecal antigen tests in the confirmation of the effect of Helicobacter eradication therapy

Background. The frequent occurrence of Helicobacter pylori infection requires significant health care resources after eradication therapy. Therefore the non‐invasive testing methods are required to alleviate the increased work‐load of health care personnel and to allow an easy control of eradication therapy. Conventionally, the effect of eradication therapy has been confirmed with ¹³C‐urea breath test 4–6 weeks after a completed eradication.

Aim. To assess the applicability of Helicobacter pylori stool antigen tests as alternatives to the breath test in the control of the effect of eradication therapy.

Methods. Fifty patients were diagnosed Helicobacter‐positive by endoscopy and histology as well as by rapid urease test from mucosal specimen. Four weeks after an eradication therapy the patients were subjected to ¹³C‐urea breath test as well as to faecal Helicobacter pylori antigen tests with mono‐ and polyclonal primary antibodies.

Results. The monoclonal and polyclonal stool tests had 94% and 88% sensitivity, and 100% and 97% specificity, respectively, in the detection of Helicobacter pylori infection as compared to the ¹³C‐urea breath test. The non‐invasive test results were completely parallel in patients with various grades of mucosal atrophy or intestinal metaplasia.

Conclusions. Monoclonal faecal Helicobacter pylori antigen test is slightly superior to the polyclonal test regarding the sensitivity in the detection of stool Helicobacter antigens. Due to their sufficient sensitivity and specificity, and to their practicability and cost‐effectiveness, they can be recommended for non‐invasive testing of Helicobacter pylori infection as alternatives to the ¹³C‐urea breath test.     

幽门螺杆菌L 型感染对胃癌侵袭和转移能力的影响

目的：探讨幽门螺杆菌L型（H p‐L型）感染对胃癌侵袭和转移能力的影响。方法选取胃癌患者80例,每例患者采集癌组织及癌旁正常组织各1份,制作切片标本,采用革兰染色、免疫组化染色、透射电镜对组织标本进行 Hp‐L型、基质金属蛋白酶‐9（MMP‐9）、血管内皮生长因子（VEGF）检测。结果癌组织标本 Hp‐L 型阳性率为67．50％,高于癌旁正常组织的23．75％（P＜0．05）。癌组织标本MMP‐9、VEGF阳性率均高于癌旁正常组织（P＜0．05）。 Hp‐L型阳性癌组织VEGF、MMP‐9阳性率均高于 Hp‐L型阴性癌组织（P＜0．05）。胃癌组织Hp‐L型阳性率与癌细胞局部和远处淋巴结转移及侵袭深度相关,与肿瘤大小无关。结论 Hp‐L型感染与胃癌的发生密切相关,也有可能对胃癌转移和侵袭产生影响。