幽门螺杆菌相关性消化性溃疡的治疗

目的评价目前推荐用于幽门螺杆菌（Hp）相关性消化性溃疡（PU）的治疗，Hp根除率（治愈率）达85％以上，且副反应少，依从性较好的三个治疗方案，以便临床选择应用．方法Hp阳性的PU，不论初发或复发，一经确诊即行抗Hp根除治疗．治疗方案①：以奥美拉唑（Ome）为主的三联疗法，①A：Ome20mg、克拉霉素250mg、甲硝唑400mg，各2次／dpo，疗程1wk；①B：Ome20mg、克拉霉素500mg、羟氨苄青霉素1000mg，各2次／dpo，疗程1wk．方案②：以铋剂为主的低剂量三联疗法，胶体次枸橼酸铋（CBS）120mg、四环素250mg、甲硝唑200mg，各4次／dpo，疗程2wk．方案③：四联疗法，Ome20mg，2次／dpo，CBS120mg、4次／d，四环素500mg、4次／d，甲硝唑400mg，3次／dpo，疗程1wk．结果经全球近年来的临床验证，方案①、②、③Hp根除率分别为85％～90％、90％和95％以上，溃疡愈合率均达90％以上．结论方案①依从性好，副反应少而轻，缓解症状快，是较理想的治疗方案，目前普遍推荐作为第一线治疗方案．方案②保持了原标准三联疗法的根除率，副反应显著降低、价廉、适用于经费有困难且甲硝唑耐药性低的患者．方案③Hp根除率最高，花费也最高，可作为第二线治疗方案，用于其他抗Hp治疗方案失败的患者．     

中西医结合治疗幽门螺杆菌阳性消化性溃疡的临床研究

将幽门螺杆菌（ＨＰ）阳性消化性溃疡６２例随机分为３组，分别用灭幽丸、抗生素三联和中西药联合进行治疗。结果显示，中药组溃疡愈合率为８０．９５％，ＨＰ根除率７６．１９％；西药组溃疡愈合率７５．００％，ＨＰ根除率９０．００％；联合组愈合率９０．４８％，ＨＰ根除率９５．２４％。活动性胃炎消失率中药组和联合组优于西药组。中药组和联合组副作用亦明显少于西药组。     

中西医结合治疗幽门螺杆菌阳性消化性溃疡的临床研究

将幽门螺杆菌（HP）阳性消化性溃疡62例随机分为3组，分别用灭幽丸、抗生素三联和中西药联合进行治疗。结果显示，中药组（灭幽丸）溃疡愈合率为80．95％，HP根除率76.19％；西药组（丽珠得乐＋甲硝唑＋四环素）溃疡愈合率75．00％，HP根除率90．00％；联合组（灭幽丸＋西药组用药）愈合率90．48％，HP根除率95．24％。活动性胃炎消失率中药组（23．80％）和联合组（28．57％）优于西药组（15.00％）。中药组和联合组副作用亦明显少于西药组。     

思密达治疗幽门螺杆菌阳性消化性溃疡68例

幽门螺杆菌(Hp)现已公认与消化性溃疡(PU)有密切关系,为了探索PU愈合率高、又能清除Hp的理想药物,我们采用法国的思密达治疗PU伴Hp阳性患者68例,并以H_2受体阻滞剂西咪替丁治疗36例作对照,进行了近期和6个月的随访观察,现将结果报告如下。     

三联疗法治疗幽门螺杆菌阳性消化性溃疡临床观察

评价以潘托拉唑、阿莫西林、甲硝唑为核心的三联疗法治疗幽门螺杆菌(H．pylorip Hp)阳性的消化性溃疡的疗效。     

消化性溃疡的幽门螺杆菌根除

确立幽门螺杆菌感染是消化性溃疡的主要致病因素,这为消化性溃疡的治疗带来革命性的改变。根除幽门螺杆菌使绝大多数消化性溃疡得以根治,提高了病人的生活质量,显著降低消化性溃疡并发症的发生率。对幽门螺杆菌阴性的消化性溃疡,抗酸疗示仍是主要的治疗方法。     

老年人消化性溃疡幽门螺杆菌感染的探讨

一、对象与方法１．对象：选择本院胃镜室从１９９６年６月至１９９８年１月经胃镜诊断的老年人十二指肠溃疡３２例、胃溃疡１９例、单纯性胃炎２３例,共７４例。其中男性４２例,女性３２例,年龄６０～７８岁,平均（６８．９±７．４）岁;非老年人十二指肠溃疡４４例...     

德诺治疗幽门螺杆菌阳性消化性溃疡40例疗效观察

消化性溃疡(PU)与幽门螺杆菌(Hp)有密切关系。德诺片对导致PU复发的Hp具有杀菌活性，因此，我们用德诺片治疗Hp感染阳性的PU患并与雷尼替丁进行对照研究，以观察其疗效及对Hp消长、复发的影响。     

幽门螺杆菌阳性消化性溃疡的治疗及护理效果

目的:探讨幽门螺杆菌(Helicobacter pylori,H.pylori)阳性消化性溃疡采用四联疗法治疗及给予综合系统护理的临床疗效.方法:收集余姚市第二人民医院2012-03/2013-10收治的198例H.pylori阳性消化性溃疡患者,随机分为两组,观察组99例,对照组99例,观察组采用对枸橼酸铋钾+阿莫西林+克拉霉素+埃索美拉唑四联治疗及给予综合系统护理,疗程为2 wk,对照组采取阿莫西林+克拉霉素+埃索美拉唑三联治疗及一般常规护理,治疗结束复查胃镜,观察两组患者治疗及护理效果.结果:观察组治疗痊愈28例(28.3%),显效60例(60.1%),有效5例(5.1%),无效6例(6.1%),总有效率93.9%,对照组治疗后痊愈16例(16.2%),显效42例(42.4%),有效15例(15.1%),无效26例(26.3%),总有效率73.4%,治疗效果有显著差异(P<0.05);治疗结束后4 wk观察组H.pylori阴性89例,H.pylori根除率为89.9%,对照组H.pylori阴性62例,H.pylori根除率为(62.6%),有显著差异,具有统计学意义(P<0.05).结论:应用四联疗法治疗配合综合系统的护理H.pylori患者,能有效根除H.pylori,对治疗H.pylori阳性消化性溃疡患者有良好的治疗效果,值得临床推广应用.     

幽门螺杆菌与消化性溃疡治疗

目的幽门螺杆菌是多数消化性溃疡发生的主要原因，根除幽门螺杆菌可明显降低溃疡的发生和复发，促进溃疡的愈合，所以对Hp感染患者应行根除治疗．方法98例行内镜证实为消化性溃疡患者，Hp阳性，随机分为两组予以洛赛克＋羟氨苄毒霉素＋甲硝唑及德诺＋羟氨苄青霉素＋甲硝唑治疗14d．结果停药1mo后行内镜复查Hp测定两组溃疡愈合率及Hp根除率相近，统计学检验无显著差异．结论两组方法具有症状消除快，疗程短，副作用小的优点是相对理想的Hp根除方法，特别是后者造价低更适合基层医院使用．     

毫米波加药物治疗Hp+消化性溃疡50例

目的探讨幽门螺杆菌阳性（Ｈｐ＋）的消化性溃疡（ＰＵ）愈合和复发的物理治疗（毫米波ｍｍＷ）及其联合药物治疗的前景．方法本组ＰＵ９３例采用ｍｍＷ辐射探头对ＰＵ患者体表胃投影区照射３０ｍｉｎ，（ｎ＝５０）每日１～２次，联合药物（甲哨唑＋西咪替丁）在Ｈｐ＋的ＰＵ愈合和复发的疗效进行研究，并与对照组４３例进行比较．结果ｍｍＷ治疗及联合药物治疗组与对照组单用药物Ｈ２受体阻滞剂西咪替丁相比较，结果治疗组溃疡愈合率及Ｈｐ根除率１００％（５０／５０）及９８％（４９／５０）．１年后复发率为４％（２／５０）；而对照组溃疡愈合率９０５％（３８／４３），Ｈｐ根除率５０８％（２５／４３），１年后复发率２０９％（９／４３）．说明Ｈｐ根除与溃疡复发有一定关系，２组相比有显著差异（Ｐ＜００５～００１）．结论ｍｍＶ联合药物治疗Ｈｐ＋ＰＵ愈合和复发优于单用Ｈ２受体阻滞剂．     

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．     

慢性胃炎及消化性溃疡诱生型一氧化氮合酶表达和Hp感染的意义

目的探讨一氧化氮在慢性胃炎及消化性溃疡发病机制中的作用，以及ＮＯ和Ｈｐ感染的关系．方法用免疫组化法对正常对照者６例，慢性胃炎５６例及消化性溃疡患者１６例的胃粘膜标本进行检测，观察ｉＮＯＳ表达强度．并用改良Ｇｉｅｍｓａ法同步检测Ｈｐ感染状况．结果ｉＮＯＳ染色定位于胞质，在正常人胃及十二指肠粘膜细胞和腺体均有表达．慢性浅表性胃炎组呈过度表达，其平均表达强度明显高于对照组及慢性萎缩性胃炎组（Ｐ＜００１）．慢性萎缩性胃炎组平均表达水平和对照组比较差异无显著性（Ｐ＞００５）．慢性胃炎组ｉＮＯＳ表达强度与其Ｈｐ分级间呈明显正相关（Ｐ＜００５）．消化性溃疡组平均表达水平较对照组增强（Ｐ＜００５），其ｉＮＯＳ表达强度和Ｈｐ分级间相关性不明显（Ｐ＞００５）．结论ｉＮＯＳ活性增强和过度表达可能在慢性胃炎和消化性溃疡的发病机制中发挥一定作用，并可能是Ｈｐ感染导致慢性胃炎的相关发病机制之一．     

灭Hp胶囊多联治疗Hp阳性消化性溃疡

目的寻求中西医结合治疗Hp相关性消化性溃疡(PU)的理想方案方法采用前瞻性、随机双盲、安慰剂对照研究Hp阳性的PU患者93例被随机分为4组A组(新三联)达克普隆30mg,1次/d+阿莫西林500mg,2次/d+克拉霉素250mg,2次/d,连服10 d;B组(灭Hp胶囊四联)新三联10d+灭Hp胶囊6粒,2次/d,连服28 d;C组(灭Hp胶囊三联)达克普隆30 mg,1次/d+克拉霉素250 mg,2次/d,连服10 d,+灭Hp胶囊6粒,2次/d,连服28 d,D组(安慰剂)胃舒平3片,2次/d,连服28 d.双盲双模拟用药.结果 Hp根治率在B,C组与A组分别为96%,92%和92%;溃疡愈合率分别为100%,92%和88%,三组间差异无显著性,明显高于D组的HP根治率(0%)和溃疡愈合率(20%)(均P＜0.01).B,C组溃疡愈合质量明显优于D组,也优于A组B,C组治疗后胃粘膜磷脂(mg/g,93±26.92±27)、氨基己糖(mg/g,55±20,53±15)和血清表皮因子(EGF)(μg/L,0.7±0.3,0.6±0.4)含量明显高于治疗前磷脂(mg/g,79±23,81±23,均P＜0.01)、氮基己糖(mg/g,40± 14;42±16,均P＜0.01)和EGF(μg/L,0.5±0.2,P＜0.01;0.5±0.3,P＜0.05)含量.A组治疗后仅氨基己糖含量(49 ± 18)高于治疗前(42±16,P＜0.05),磷脂和EGF无明显变化.D组磷脂、氨基已糖和EGF治疗前后无明显变化(P＞0.05)各项检测指标B组优于C组,但无统计学意义治疗期间患者依从性好,无不良反应发生.结论中西医结合灭Hp胶囊三联、四联疗法除了有Hp根除与溃疡愈合率高,而乏副作用外,还具有保护胃粘膜,溃疡愈合质量高的特点,是治疗Hp相关性PU的较为理想方案.     

胃舒胶囊治疗消化性溃疡236例

目的观察胃舒胶囊治疗消化性溃疡（ＰＵ）的临床疗效．方法用胃舒胶囊（６粒，ｐｏ，３次／ｄ×２ｗｋ×２）治疗ＰＵ２３６例（男１９２例，女４４例；年龄１８岁～７４岁，平均３２岁±７岁；病程１ａ～１５ａ，平均４９ａ±３５ａ；ＤＵ１０６例，ＧＵ８３例，ＣＵ４７例），用纤维内镜观察不同证型ＰＵ患者的治疗效果．结果用胃舒胶囊两个疗程，对消化道症状改善率达９１２％～１００％，溃疡愈合率达９２８％，对肝胃气滞、寒邪犯胃、脾胃虚寒、胃热炽盛和瘀血阻络各型的治愈率分别为９２８％，９３５％，９４２％，８００％和８５７％．治疗组的疗效明显优于西咪替丁加胃必治组（Ｐ＜００１）．结论胃舒胶囊治疗ＰＵ具有显著疗效，其治疗作用可能与保护胃粘膜，中和胃酸和杀灭Ｈｐ等有关．     

Markers of slow-healing peptic ulcer in the elderly

Little is known about ulcer outcome in the elderly. The aims of the present paper were to establish whether risk factors of slow-healing peptic ulcer can be demonstrated in the elderly and whether clinical differences exist between ulcer patients whose age of onset of the disease was before or after 65 years old. The short-term, open study, involving 1052 elderly patients (over 65 years) in 37 gastroenterology centers throughout Italy aimed to compare two schedules of ranitidine treatment: 150 mg twice daily versus 300 mg at bedtime. As nonsignificant differences were found between these two schedules, the sample was considered as a whole. It included 319 gastric ulcer (GU) patients, 699 duodenal ulcer (DU) patients, and 34 concomitant GU and DU cases. Ninety-three patients dropped out of the trial; 79/294 GU, 138/635 DU, and 10/30 GU+DU were found still unhealed after four weeks and 20 GU, 15 DU, and 1 GU+DU remained so after eight weeks. Statistical analysis was performed using likelihood-ratio and Pearson's chi-squared tests and Cox's models. Univariate analysis showed that the indicators of slow-healing GU were ulcer size (P=0.002) and persisting ulcer symptoms (P=0.0001); indicators of slow-healing DU were ulcer size (P=0.0001), persisting ulcer symptoms (P=0.0001), alcohol (P=0.0003), and NSAID (P=0.0088) consumption. DU patients taking antiplatelet drugs have significantly better results after four weeks and worse results after eight weeks (P=0.0352). Cox's models revealed that the persistence of ulcer symptoms is the most important factor predicting unhealing ulcers (GU,P=0.0008; DU,P=0.0002), while ulcer size is only important for DU (P=0.0215). Patients with ulcer disease onset before 65 years of age were more frequently males; DU subjects were more frequently smokers, with a family history of ulcer and no NSAID consumption. In conclusion, persistence of ulcer symptoms and ulcer size are indicators of slow-healing ulcer in the elderly; in the case of DU, NSAID and alcohol consumption may be additional factors.This study was performed under the auspices of the R. Farini Foundation for Gastrointestinal Research.Centers participating in the study: Alba (G. Prandi, R. Bianco); Asti (C. Moro, M. Grassini); Avezzano (A. de Sanctis, A. Sedici); Belluno (F. Costan Biedo, P. Olivieri); bussolengo (S. Adamo, G. Sartori); Cagliari (P. Loriga, C. Caschili); Castelfranco V. to (S. Bertazzo, G. Pesce); Castrovillari (S. Leone, G. Mollica); Conegliano V. to (G. Lollo, P. Lunardi); Cosenza (A. Belmonte, G. Manno); Cuneo (G. Ferro, A. Manca); Fano (M. Cuzzupoli, A. Olivieri); Fiesole (P. Ciani, L. Manneschi); Gorizia (E. Benedetti, S. Fayenz); Lanciano (S. Di Matteo, F. Cifani); Malo (C.F. Azzini, A. Pilotto); Monza (S. Magni, A. Lomazzi); Melito P.S. (G. Dattola); Napoli (B. De Luca, D. Di Cesare); Negrar (A. Geccherle, C. Manfrini); Novara (M. Del Piano, F. Montino); Orbassano (G. Emanueli, C. Calcamuggi); Oristano (A. Tuveri, M. Sau); Padova (R. Naccarato, F. Di Mario); Palermo (G. Barbagallo-Sangiorgi, S. Vigneri); Polistena (G. Gerace); Popoli (A. Pomidori, R. Lattanzio); Prato (A. Candidi-Tomasi, M. Lami); Reggio Calabria (P. Califano, C. Campolo); Roma (L. Capurso, M. Koch); Rovereto (A. Bernardi, M.C. Paler); S. Vito al Tagliamento (G. Tasca, A. Pighin); Scilla (G. Naim); Terni (A. Della Spoletina, F. Bellavigna); Torino (G. Babando, L. Lombardo); Venezia (M. Pasquino, M.E. Benvenuti); Vercelli (W. Giorgelli, G. Ardizzone).     

维敏四联治疗Hp相关的消化性溃疡

目的应用维敏胶囊（胶态果胶铋）四联药物疗法治疗Hp相关的消化性溃疡（PU）2wk，停药4wk后经内镜、14C-UBT等方法观察溃疡的愈合及Hp根除的疗效方法经内镜确诊为PU，其中十二指肠溃疡（DU）169例；胃溃疡（GU）89例．受检前2wk内未服抗生素、铋剂及质子泵阻断剂，排除孕妇和溃疡出血者，并镜下活检病理排除恶性溃疡Hp检测：先行快速尿素酶检测（RUT），阳性者再行14C-UBT检测，其中DU的Hp阳性率为95．5％；GU的Hp阳性率为81．0％．四联治疗方法：对Hp阳性PU，给予维敏胶囊100mg，4次／d；兰索拉唑30mg，2次／d；阿莫西林0．5g，4次／d；甲硝唑0．4g，2次／d，疗程为2wk．停药后4wk，同时复查内镜及14G-UBT．结果DU愈合率91．2％，Hp根除率93．0％；GU愈合率86．0％，Hp根除率92．0％．DU和GU愈合率及Hp根除率差异不明显（P＞0．05）；四联疗法后肝肾功能无异常结论Hp与PU关系密切．采用四联治疗Hp相关的PU，有良好效果．14GUBT检测Hp感染具有很高的敏感性和特异性，无创伤性，是治疗后复查Hp的首选方法     

Clinical and experimental research on weile jiaonang for peptic ulcer

AIM To observe the therapeutic effect of weile jiaonang (WLJN) for peptic ulcer (PU) and its toxicity toanimals, and to find out the nontoxic Chinese medicines in replacing those chemical medicines with sideeffect.METHODS Five hundred and forty patients with PU were divided into three groups, therapeutic group byWLJN, control group taking famotidine and combined group with WLJN and famotidine. One hundred andeighty patients in each group were studied. The diagnosis of 540 patients with PU is in accordance with thebasis provided by the National Scientific Congress of Digestive System Disease convened in Hangzhou, 1978.The study followed the criterion provided by this Congress.RESULTS Total effective rate in therapeutic group was 93.3%, and 93.3% in control group. Combinedgroup achieved a total effective rate of 100%. For all three groups, there was no significant differencestatistically, but the control group appeared obvious side effects. The result of acute toxic experiments onwhite mice showed that there no death and toxic side effect even the highest dosage was given, which wasequivalant to 120 times to the dosage of patients. The result of chronic toxic experiment showed there was noobvious pathologic change in three dosed groups. The tails of mice in dosed groups were more smooth delicateand cleaner than those in control group.CONCLUSION Through observation in clinic and exprimental animal, it is proved that weilejiaonang isparticularly effective and safe Chinese patent drug against PU.