根除幽门螺杆菌对胃黏膜病变的影响

幽门螺杆菌（H.pylori）被认为是导致胃黏膜病变的重要因子，根除H.pylori能使胃黏膜病变改善。目的：观察根除H.pylori对胃黏膜病变的影响。方法：予100例经胃镜和组织病理学检查确诊为萎缩性胃炎伴H．pylori感染患者抗H.pylori治疗，1年后复查胃镜和组织病理学，评定组织学变化。结果：所有患者均有不同程度的活动性炎症和慢性炎症。抗H.pylori治疗后，86例被根除。与根除前相比，根除后慢性炎症、活动性炎症、腺体萎缩程度评分均明显下降（P〈0．01），肠化生评分无显著改善。结论：根除H.pylori对胃黏膜病变具有临床治疗意义。     

萎缩性胃炎患者幽门螺杆菌根除后表皮生长因子及其受体的变化

目的　研究幽门螺杆菌 (Helicobacterpylori,H .pylori)感染对胃黏膜表皮生长因子受体 (epidermalgrowthfactorreceptor ,EGFR)、血清表皮生长因子 (epidermalgrowthfactor,EGF)水平的影响。方法　对 60例H pylori检测阳性的慢性萎缩性胃炎患者进行根除治疗 ,在治疗前及疗程结束 3个月后分别进行胃镜检查 ,并采用免疫组化及放射免疫法测定H pylori根除前后胃黏膜EGFR和血清EGF含量。 3 0例H pylori检测阴性且胃镜检查无明显异常者作为正常对照组。结果　 60例H pylori检测阳性的CAG患者的胃黏膜EGFR阳性率及血清EGF水平均高于正常对照 ,其差异有显著性 (P <0 0 5 ,P <0 0 1)。有 3 1例在根除治疗 3个月后进行了复查 ,其中 2 4例H pylori得到成功根除。 2 4例H pylori得到根除的CAG患者 ,根除后血清EGF水平明显下降 (P <0 0 1) ,而EGFR阳性率无改变 (P >0 0 5 )。结论　H pylori感染引起胃黏膜EGFR阳性率及血清EGF水平增加 ,根除H pylori后血清EGF可恢复至正常水平 ,而胃黏膜EGFR阳性率在短期内没有明显改变     

四联疗法根除幽门螺杆菌对慢性胃炎的治疗作用

目的:研究慢性胃炎患者行四联疗法根除幽门螺杆菌的疗效作用.方法:选取时间2019年10月至2020年10月期间就诊的慢性胃炎患者68例,将其随机分组,四联疗法为A组,三联疗法为B组.结果:经四联疗法治疗,A组幽门螺杆菌清除率97.06％及IL-6(47.64±4.26)pg/mL、IL-8(119.78±7.78)pg...     

低剂量三联加补脾煎剂根除幽门螺杆菌

低剂量三联加补脾煎剂根除幽门螺杆菌李可上全权余玉珠吴炳坤ＳｕｂｊｅｃｔｈｅａｄｉｎｇｓＨｅｌｉｃｏｂａｃｔｅｒｐｙｌｏｒｉ；Ｈｅｌｉｃｏｂａｃｔｅｒｉｎｆｅｃｔｉｏｎｓ／ｔｈｅｒａｐｙ；ｄｕｏｄｅｎａｌｕｌｃｅｒ／ｔｈｅｒａｐｙ主题词螺杆菌，幽门；...     

根除幽门螺杆菌对胃黏膜及肠化、不典型增生的影响

目的探讨根除幽门螺杆菌（Hp）后慢性胃炎的胃黏膜炎症及肠上皮化生、不典型增生的变化。方法选择172例伴有Hp感豢的慢性活动性胃炎病人分为两组：阴性组（68例）和阳性组（104例），观察阴性组治疗后的变化并与阳性组进行比较，并观察阴性组肠上皮化生和不典型增生在治疗前后的变化。结果阴性组的胃黏膜炎症有28例（41．2％）好转，2例（2．9％）治愈，明显高于阳性组（P〈0.01），其伴有的肠上皮化生有2例（25％）治愈，4例（50％）好转，不典型增生有7例（38．9％）好转，6例（33．3%）治愈。结论Hp感染阴转后慢性胃炎的治疗效果明显优于阳性者，其伴有的肠化和不典型增生亦能好转或治愈。因此，根除Hp是治疗Hp相关性胃炎和防止发生胃癌的重要措施。     

幽门螺杆菌感染对胃黏膜病理变化的影响

背景：幽门螺杆菌(H．pylori)感染已被公认为慢性胃炎和消化性溃疡的重要危险因素，根除H．pylori能加速消化性溃疡的愈合，但其对胃黏膜病理变化的影响尚有待进一步探索。目的：了解根除H．pylori对慢性胃炎胃黏膜病理变化和癌前状态的影响。方法：采用多中心随机对照临床试验和回顾性队列研究，样本选自胃癌高发区：上海郊区的金山区和奉贤区。共纳入360例经内镜检查证实有H．pylori感染的慢性胃炎伴或不伴十二指肠溃疡患者，随机分为两组。治疗组用三联疗法(质子泵抑制剂或Hz受体阻滞剂加两种抗生素)治疗，对照组单纯慢性胃炎患者予西沙必利、十二指肠溃疡患者予西米替丁治疗。在第1年和第4年末随访胃镜，根据H．pylori是否根除将患者分为两组：H．pylori阳性组和H．pylori阴性组。所有胃黏膜活检标本由两位病理科医师统一复读。结果：至第4年末，有120例患者完成全部随访，其中H．pylori持续根除组54例，阳转组5例；H．pylori持续未根除组45例，阴转组16例。持续根除组第1年随访时，活动性炎症比例减少(P＜O．05)；第4年随访时，慢性炎症和肠化程度以及活动性炎症比例减少(P＜O．05)。持续未根除组第1年随访时，慢性炎症程度增加(P＜O．05)；第4年随访时，慢性炎症和肠化程度以及活动性炎症比例增加(P＜O．05)，萎缩程度较第1年随访时增加(P＜O．05)。结论：根除H．pylori可以减轻慢性胃炎的炎症程度，防止肠化的发生和发展。     

幽门螺杆菌根除性治疗对慢性胃炎患者胃泌素及细胞因子的影响

目的探讨幽门螺杆菌(H.pylori)根除性治疗对慢性胃炎的治疗价值及对胃泌素和细胞因子的影响。方法选择80例慢性胃炎H.pylori阳性的患者为研究对象,随机分为观察组和对照组,对照组采用常规三联抗H.pylori治疗,观察组在对照组的基础上采用益生菌四联抗H.pylori治疗,比较两组患者的治疗效果、H.pylori根除率、胃泌素及细胞因子的变化、不良反应等。结果观察组治疗后疗效均高于对照组,H.pylori根除率高于对照组,差异具有统计学意义(P0.05)。观察组治疗后的临床症状评分、胃镜评分均低于对照组,胃泌素、炎性因子TNF-α、CRP、IL-6均低于对照组(P0.05)。观察组的不良反应少于对照组(P0.05)。结论采用益生菌四联抗H.pylori治疗能够提高慢性胃炎的治疗效果,缓解患者的临床症状,可能与减轻炎症反应和胃泌素分泌有关,且联用益生菌能够降低不良反应。     

慢性胃炎和胃癌的幽门螺杆菌基因分型

目前认为 ,幽门螺杆菌 (Hp)是慢性活动性胃炎、消化性溃疡的主要致病因素 ,而且与胃癌关系密切[1] 。本研究应用PCR RFLP基因分型方法分析Hp感染者Hp基因分型 ,鉴定Hp菌株 ,为抗Hp治疗及探讨Hp感染与慢性胃炎、胃癌的关系提供理论基础。一、材料与方法1.材料 :所有标本取自青岛大学医学院附属医院胃镜室 ,其中中、重度慢性浅表性胃炎 36例 ,胃癌 4 5例 ,均经病理证实。以无菌方法采取标本后立即提取组织DNA。2 .引物设计及PCR反应 :引物 :Hp1 S :5′ GAACTA GACTACACCAT 3′ ,Hp2 AS :5′ TGGTTTGAGGGCGAATC 3′ ,…     

清幽片对幽门螺杆菌阳性胃病根除作用的临床研究

自1996年1月～1998年6月,我们以清热解毒、活血化瘀为主法自拟中药清幽片对幽门螺杆菌(Hp)阳性胃病根除作用进行了临床研究,现将资料完整的48例总结如下。     

Effect of Hewei-Decoction on chronic atrophic gastritis and eradication of Helicobacter pylori

AIM: To demonstrate the effect of Hewei-Decoction (Decoction for regulating the stomach) on chronic atrophic gastritis (CAG) and eradication of Helicobacter pylori. METHODS: Ninety patients with CAG entering the investigation were divided into six differentiation syndromes, based on their major symptoms and signs. Hewei-Decoction was taken by all the patients orally for 4 or 8 wk. The efficacy was assessed by both the composite accumulation of reduced scores of major symptoms and the eradication of H pylori.X2 test was used to compare the efficacy between H pylori-positive and negative cases, and to disclose the relationship between efficacy and eradication of H pylori. RESULTS: In patients with six different syndrome types, the efficacy of Hewei-Decoction was 91.67% (11/12), 92.86% (13/14), 97.22% (35/36), 87.50% (14/16), 75.00% (6/8), 75.00% (3/4) respectively. The rate of highly efficacious was 58.33% (7/12), 50.00% (7/14), 77.78% (28/36), 62.50% (10/16), 12.50% (1/8) and 25.00% (1/4), respectively. The total efficacy was 91.11% (82/90), and the rate of highly efficacious was 60.00% (54/90). The eradication rate of H pylori was 67.86% (38/56). The therapeutic effect of Hewei-Decoction was better in H pylori positive cases than that in H pylori-negative cases with the total effect of 96.43% vs 82.35% (P<0.05). In 56 H pylori positive cases, the therapeutic effect was better in H pylori eradicated cases than that in H pylori-existent cases with the total effect of 97.37% vs 72.22% (P<0.01). CONCLUSION: Hewei-Decoction is effective in most cases of all the syndrome types. The results indicate that eradication of H pylori is one of the important mechanisms for alleviation of symptoms and signs. Also, the decoction is efficacious in H pylori-negative cases.     

中西医结合根除幽门螺杆菌对萎缩性胃炎核因子-κB表达的影响

[目的]观察以胃舒散为主的三联疗法（胃舒散、呋喃唑酮和克拉霉素）治疗幽门螺杆菌（Hp）阳性慢性萎缩性胃炎（CAG）的临床效果及其对核因子-κB（NF-κB）表达的影响。[方法]41例Hp阳性CAG患者服用胃舒散2．0g，呋喃唑酮0．1g，各3次／d，克拉霉素0．25g，2次／d，1周后再继服胃舒散4周。治疗前及治疗结束1年后行内镜及病理组织学检查，取活检观察病理组织学改变及NF-κB表达变化，采用银染色法、^14C-尿素呼气试验或快速尿素酶试验检测Hp。[结果]三联疗法结束1年后，Hp根除率为85．4％；根除Hp能显著减轻患者胃窦部慢性炎症（P〈0．05）和活动程度（P〈0．01），下调NF-κB表达（P〈0．01），但胃炎的萎缩和肠化生等病理无明显改变。[结论]以胃舒散为主的三联疗法对Hp有较高根除率。根除Hp可抑制NF-κB的表达，减轻活动性炎症，但近期观察对萎缩、肠化生等病理改变无明显作用。     

A short-term eradication therapy for Helicobacter pylori acute gastritis

BACKGROUND AND AIMS: Acute gastritis, caused by an initial infection of Helicobacter pylori (H. pylori), may resolve spontaneously, but the infection sometimes becomes chronic. We examined the efficacy of a short-term H. pylori eradication therapy on acute gastritis. METHODS: Among the 15 patients with hemorrhagic acute gastritis who were randomly allocated to group A (eradication therapy) or group B (Lansoprazole, LPZ), 10 of them started to receive treatment within 1 day after the disease onset. The other five patients began the eradication therapy 4-6 days after disease onset (group C). Eradication therapy consisted of a daily oral administration of each of 30 mg lansoprazole (LPZ), once a day; 400 mg clarithromycin, twice a day; 1000 mg amoxicillin, twice a day; and 300 mg rebamipide, three times a day, for one week. If the endoscopy was normal, medication was stopped for the following 4 weeks before gastric endoscopy was performed again in order to assess H. pylori eradication. RESULTS: All group A patients were cured after the 1-week treatment and therefore, they became H. pylori negative. Group B and C patients had erosions or ulcers after the 1-week treatment and so received an additional 3-week administration of LPZ. Four weeks later, their gastritis was cured and except for one group B patient, they became H. pylori-negative. CONCLUSION: In patients with acute gastritis, caused by an initial H. pylori infection, eradication therapy was efficacious in achieving early healing. This therapy should be started as soon as possible after disease onset.     

幽门螺杆菌感染对胃黏膜环氧合酶-2表达的影响

目的评估幽门螺杆菌(Hp)感染对慢性胃炎胃黏膜环氧合酶-2(COX-2)表达的影响.方法与10例正常对照者比较,用免疫组化方法半定量检测46例慢性胃炎患者Hp根除治疗前后胃窦黏膜COX-2蛋白的表达,用悉尼分类标准对胃黏膜炎症、活动性和Hp密度进行半定量测定.结果在胃黏膜表面上皮、腺上皮细胞和固有层间质细胞的胞浆中可见COX-2表达.与正常对照者比较,Hp感染胃黏膜的COX-2平均阳性细胞率明显增加[(18.0±14.1)%比(12.3±4.6)%,P＜0.05)];成功根除Hp后的胃黏膜COX-2平均阳性细胞率明显下降[(20.1±13.1)%比(13.8±5.9)%,P＜0.05)];COX-2表达与慢性炎症计分相关(r=0.78,P＜0.05).结论Hp感染导致胃黏膜COX-2表达增加,提示COX-2在Hp相关性胃炎发生中起作用.     

H pylori感染及根除对慢性糜烂性胃炎患者IL-18水平的影响

目的:探讨H pylori感染及根除对慢性糜烂性胃炎患者IL-18水平的影响,同时检测抗H pylori治疗前后抗体水平的变化.方法:60例上消化道患者分两组,慢性糜烂性胃炎组(实验组)40例,慢性浅表性胃炎组(对照组)20例.实验组H pylori阳性者予口服洛赛克20 mg和克拉霉素500 mg及阿莫西林1000 mg,1 wk后症状缓解者,开始口服洛赛克20 mg/d至4 wk实验结束,对照组仅口服洛赛克抗H pylori治疗,1 mo后复查~(13)C呼气实验和胃镜.H pylori免疫印迹法进行蛋白抗体分型,同时ELISA法检测H pylori-IgG,IL-18水平.结果:治疗前H pylori阳性者实验组血清IL-18水平高于对照组(267.18±148.23 ng/L vs 119.31±45.34 ng/L:P<0.05).抗H pylori治疗后慢性糜烂性胃炎患者的IL-18,抗体水平均有明显下降(267.18±148.23 ng/L vs 93.82±22.15 ng/L;31.36±23.26 kU/L vs 21.00±9.47 kU/L;P<0.05).H pylori感染类型及糜烂的严重程度与IL-18水平无明显的相关性.结论:抗H pylori治疗后IL-18水平的下降在慢性糜烂性胃炎糜烂的治疗过程中发挥重要作用.     

Correlation between CD4, CD8 cell infiltration in gastric mucosa, Helicobacter pylori infection and symptoms in patients with chronic gastritis

AIM: To evaluate the correlation between CD4, CD8 cell infiltration in gastric mucosa, Helicobacter pylori(H pylori) infection and symptoms or the assemblage of symptoms in cases with chronic gastritis. METHODS: Biopsy samples at the gastric antrum were obtained from 62 patients with chronic gastritis. CD4 and CD8 cell infiltration was evaluated by immunohistochemical assays on frozen sections of the biopsy samples. Fifteen symptoms referring to digestion-related activity and non-digestion related activity were observed. The correlation between lymphocyte infiltration and each symptom or symptom assemblage was analyzed by logistic regression and K-mean cluster methods. RESULTS: CD4 cell infiltrations in gastric mucosa were much more in patients with H pylori infection, while CD8 cell infiltrations were similar in patients with or without H pylori infection. Logistic regression analysis showed that the symptoms including heavy feeling in head or body (t = 2.563), and thirst (t = 2.478) were significantly related with CD4 cell infiltration in gastric mucosa (P<0.05), and cool limbs with aversion to cold were related with CD8 cell infiltration (t = 2.872, P<0.05). Further analysis showed that non-digestive related symptom assemblage could increase the predicted percentage of CD4 and CD8 cell infiltration in gastric mucosa, including lower CD4 infiltration by 12.5%, higher CD8 infiltration by 33.3%, and also non-H pylori infection by 23.6%. K-means cluster analysis of all symptoms and CD4 and CD8 cell infiltration in gastric mucosa showed a similar tendency to increase the predicted percentage of CD4, CD8 cell infiltration and H pylori infection. CONCLUSION: Based on correlation between the gastric mucosa lymphocyte infiltration, H pylori infection and clinical symptoms, symptoms or symptomatic assemblages play an important role in making further classification of chronic gastritis, which might help find a more specific therapy for chronic gastritis.     

胃窦部幽门螺杆菌清除对萎缩性胃炎病理改变的影响

目的通过对幽门螺杆菌（Hp）相关的萎缩性胃炎病人Hp清除治疗前后胃窦部黏膜病理改变的分析，来确定Hp对其炎症程度、活动性（中性粒细胞浸润）、腺体萎缩和肠上皮化生的影响。方法106例Hp相关的萎缩性胃炎患者接受Hp清除治疗，对其治疗前后胃窦部黏膜的病理变化进行分析，分析标准按96悉尼系统评定。结果在62例治疗成功组中，治疗后胃黏膜的炎症程度及活动性较治疗前明显减轻，但腺体萎缩及肠上皮化生未减轻。在44例治疗失败组中，治疗前后胃黏膜的炎症程度、活动性、腺体萎缩及肠化均没有变化。且随着Hp感染时间的延长，腺体萎缩和肠化还可加重。结论Hp的清除治疗可使萎缩性胃炎患者胃黏膜的炎症程度及活动度减轻，对此类病人应行Hp清除治疗。     

“疗胃煎剂”胃粘膜保护作用的实验研究

目的研究“疗胃煎剂”对胃粘膜慢性损伤的防护作用。方法应用2级Wistar大鼠灌胃接种SSlHp菌株,灌胃3％水杨酸钠溶液,交替自由饮用5％乙醇与5mmol/L去氧胆酸钠溶液及饥饱失常的综合方法制备Hp相关CAG动物模型。模型制备成功后均先行根除Hp,进行“疗胃煎剂”治疗,并以三九胃泰作对照,12周疗程结束后,进行Hp感染,组织病理学检查及血清EGF及粘膜氨基己糖含量检测。结果“疗胃煎剂”中、高剂量组大鼠胃粘膜固有层、粘膜表面上皮层、PAS(＋)层厚度较模型自然恢复组明显增加(P＜0.01),其中粘膜固有层与表面上皮层厚度增加明显优于三九胃泰(分别(P＜0.05),已接近正常组水平(P＞0.05)。“疗胃煎剂”与三九胃泰组均有增加PAS(＋)层厚度的作用(P＜0.05)。“疗胃煎剂”中剂量组粘膜氨基己糖含量较模型自然恢复组明显增加(P＜0.05)。各治疗组血清EGF浓度均较模型自然恢复组明显下降。结论“疗胃煎剂可以增加氨基己糖含量及粘膜表面上皮层厚度,具有增强粘膜屏障功能的作用。