幽门螺杆菌球形菌与溃疡复发关系的临床研究

目的：探讨幽门螺杆菌（Ｈｐ）球形菌与溃疡复发的关系。方法：１１例Ｈｐ阳性活动期十二指肠溃疡（ＤＵ）患者，经标准三联疗法（铋剂１０ｍｇ、四环素５００ｍｇ、甲硝唑４０ｍｇ，每日３次共１４天）治疗后４周，复查胃镜，胃粘膜涂片Ｇｒａｍ及免疫组织化学染色检查Ｈｐ球形菌，以及尿素酶试验和ＰＣＲ检测。结果：ＤＵ愈合率９６％，Ｈｐ根除率８５％。１２人检出Ｈｐ球形菌且ＤＵ均愈合占１０４％，其中９人完成一年随访，溃疡均复发占１０％，涂片均检出典型Ｈｐ。而Ｈｐ根除组８６人随访一年４人溃疡复发占４７％，均为Ｈｐ阳性。比较两组溃疡复发率差异显著（Ｐ＜００５）。结论：Ｈｐ球形菌可致溃疡复发     

幽门螺杆菌感染与肝硬化患者胃粘膜病变

目的　探讨 Ｈｐ 感染在肝硬化胃粘膜病变中的意义。方法　接受内镜检查的肝硬化患者 ５０ 例,非肝硬化患者 ２７ 例;采用快速尿素酶试验、 Ｗ ａｒｔｈｉｎｓｔａｒｒｙ 银染色、血清学方法诊断 Ｈｐ 感染。结果　肝硬化患者胃粘膜 Ｈｐ 感染率、血清抗 Ｈｐ 基因重组抗原 Ｉｇ Ｇ、 Ｈｐ 菌体抗原 Ｉｇ Ｇ 及 Ｉｇ Ａ 阳性率分别为３０％ 、７８％ 、８７．２％ 、２９．４％ ,与非肝硬化患者比较差异无显著性。肝硬化患者合并与不合并胃粘膜病变者 Ｈｐ 感染率也无明显差异（ Ｐ ＞ ０．０５）。结论　肝硬化患者 Ｈｐ 感染率与普通人群相似, Ｈｐ 感染不是肝硬化患者胃粘膜病变主要致病因素。     

尿^15N排出试验在监测抗Hp疗效上的应用

尿~（１５）Ｎ排出试验在监测抗Ｈｐ疗效上的应用刘岱青，张振华，吴继琮，唐振铎，马菊珍幽门螺旋菌（Ｈｅｌｉｃｏｂａｃｔｅｒｐｙｌｏｒｉ，Ｈｐ）已被公认为慢性胃炎，消化性溃疡，胃癌等的重要病原菌。目前，治疗和预防这些疾病的主要手段靠抗Ｈｐ治疗，而抗Ｈｐ疗?..     

胃癌癌旁组织中幽门螺杆菌感染及基因改变

应用ＰＣＲ、ＰＣＲ／ＲＦＬＰ对胃癌及癌旁组织中Ｈｐ感染进行了检测，并应用ＰＣＲ／ＲＦＬＰ、ＰＣＲ／ＳＳＣＰ、ＰＣＲ－ＤＮＡ测序探讨了Ｈｐ感染与ｒａｓ基因、ｐ５３基因变化的关系。研究结果发现：２４例胃癌组织Ｈｐ阳性１２例（１２／２４，５０％），２４例癌旁组织Ｈｐ阳性１１例（１１／２４，４８．５％），两者无显著差异，胃癌组基因改变者１７例（１７／２４，７０．８３％），其中Ｈｐ阳性１２例（１２／１７，７０．５９％），７例无基因改变者未发现Ｈｐ感染。癌旁组基因改变者１例，其中Ｈｐ为阴性。２４对胃癌ｐ５３Ｅｘｏｎ４的杂合缺失率为４７．３７％（９／１９）。ｐ５３Ｅｘｏｎ５、６、７、８突变在癌组织中有１１例（１１／２４；４５．８％），癌旁组仅一例，发生Ｈ－ｒａｓ１２位点突变者７例（７／２４，２９．１７％），癌旁组则无突变。胃癌基因改变与Ｈｐ＋相关性比较发现，Ｈｐ感染与基因改变关系密切（Ｐ＜０．０１）。各种基因改变中以ｐ５３改变似与Ｈｐ感染关系更紧密（ｒ＝０．５Ｐ＜０．０５）。结果表明，ｒａｓ基因及ｐ５３基因的协同作用在胃癌的致病机理中显示出重要作用。在癌变过程中，可能Ｈｐ的感染是基因改变进而促进组织恶变的促动因素之一。     

临床决策辅助与根除幽门螺杆菌

临床决策辅助 (ｃｌｉｎｉｃａｌｄｅｃｉｓｉｏｎａｉｄｓ)是国外新近开展的一种促进患者参与治疗的方法 ,旨在使患者更多了解治疗的益处和可能的风险 ,鼓励患者表明自己愿意采用的治疗方法[1] 。自从发现幽门螺杆菌 (Ｈｐ)以来 ,已推出较多的根除Ｈｐ方案 ,但对每个患者而言 ,各个方案的相对益处和可能风险尚难得出确定的答案 ,此时采用临床决策辅助方法可能是有益的。为此 ,我们将 149例Ｈｐ感染者随机分成两组治疗 ,以评价决策辅助在Ｈｐ根除中的作用。一、材料与方法1.对象 :149例患者 ,其中男 5 7例 ,女 92例 ,年龄 2 8～6 6岁 ,平均 …     

粪便幽门螺杆菌抗原测定的临床研究

幽门螺杆菌 (Ｈｐ)感染与多种胃病关系密切。已被世界卫生组织列为Ⅰ类致癌物。现已证明 ,治疗Ｈｐ有助于慢性活动性胃炎、消化性溃疡的治愈 ,并可降低其复发率 ,根除Ｈｐ感染已成为治疗上述疾病的重要组成部分。目前 ,临床上评价Ｈｐ感染与否的方法虽较多 ,但均存在不足之处。粪便Ｈｐ抗原测定可用于Ｈｐ诊断[1] 。我们通过免疫动物产生Ｈｐ特异性抗体 ,建立了免疫胶体金斑点渗透法粪便Ｈｐ抗原测定方法 ,并对其临床价值予以评价。一、对象和方法1 对象 :共 5 9例 ,其中男 32例 ,年龄 2 4～ 5 6岁 ,女 2 7例 ,年龄 2 8～ 5 1岁。Ｈｐ诊断标…     

^14C—UBT和RUT诊断慢性胃炎Hp感染110例分析

幽门螺杆菌 (ＨｅｌｉｃｏｂａｃｔｅｒＰｙｌｏｒｉ简称Ｈｐ)是一微需氧的革兰氏阴性杆菌。自 1993年Ｗａｒｒｅｎ和Ｍａｓｈａｌｌ从慢性胃炎病人的胃粘膜中分离及培养出Ｈｐ以来的十多年间 ,在Ｈｐ的诊断治疗方面取得了巨大的进展。Ｈｐ显著的生物学特征之一是具有分泌尿素酶的功能 ,尿素酶可迅速降解尿素成为二氧化碳和氨。医学界在Ｈｐ的诊断方面相继出现了胃粘膜尿素酶试验 (ＲＵＴ)和同位素13Ｃ和14 Ｃ尿素酶呼气试验 (即13Ｃ和14 ＣＵＢＴ)。现就我院消化科从 1988年以来开展ＲＵＴ检测Ｈｐ感染十年多的基础上自 1998年 2月 2日开展…     

幽门螺杆菌的培养上清液诱发鼠胃粘膜组织学损伤的研究

目的：本研究目的在于通过动物实验观察幽门螺杆菌（Ｈｐ）的细胞毒素是否对小鼠胃粘膜具有损害作用。方法：用不同剂量的产毒Ｈｐ菌株（ＮＣＴＣ１６３７）的培养上清液灌服ＢＡＬＢ／Ｃ小鼠，观察胃粘膜普通病理及超微结构的改变，并与用非产毒Ｈｐ菌株（来自于临床分离株）的培养上清液及生理盐水灌服过的鼠胃粘膜进行比较。结果：Ｈｐ的细胞毒素可以对小鼠胃粘膜产生明显的损害，但并不能引起明显的炎症反应，特别是多形核细胞的浸润。而对照组（用生理盐水）以及无毒素组对小鼠胃粘膜则无明显损害。结论：提示细胞毒素在导致胃部疾病方面起重要作用     

幽门螺杆菌疫苗的研究进展

现今的幽门螺杆菌 (Ｈｅｌｉｃｏｂａｃｔｅｒｐｙｌｏｒｉ,Ｈｐ)治疗方案是以抗生素联合应用质子泵抑制剂 (ＰＰＩ)或 (和 )铋剂的“三联”或“四联”疗法 ,但由于患者依从性、药物副作用、停药后复发和再感染 ,特别是耐药菌株迅速增加等问题的存在使其应用前景受限。免疫防治为解决这一棘手问题提供了新手段。现已普遍认为Ｈｐ疫苗是在全球范围内控制Ｈｐ感染的最有效方法[1] 。在 1990年Ｈｐ疫苗的构想提出时 ,还有许多人对发展Ｈｐ疫苗持怀疑态度 ,而如今Ｈｐ疫苗的研制已成为世界Ｈｐ研究领域的热点 ,并取得了令人瞩目的进展。一、Ｈｐ…     

短程联合用药根除幽门螺杆菌的疗效观察

目的：为了寻求效佳、安全、短程根除幽门螺杆菌（Ｈｐ）的方法，对兰索拉唑（Ｌａｎ）、法莫替丁（Ｆａｍ）合用阿莫西林（Ａｍｏ）的二联疗法进行了临床观察。方法：４４例经胃镜检查证实为十二指肠溃疡患者、Ｈｐ阳性，随机分为二组分别接受Ｌａｎ和Ｆａｍ治疗。Ｌａｎ组：Ｌａｎ３０ｍｇＢｉｄ×１４天；Ｆａｍ组：Ｆａｍ２０ｍｇＢｉｄ×１４天，两组均同时服用Ａｍｏ０．５ｇｔｉｄ×１４天。结果：停药４周，行胃镜检查及Ｈｐ测定，结果表明二组的溃疡愈合率及Ｈｐ根除率相近，分别为８７５％及８５％；７５％及７０％。结论：本研究显示Ｌａｎ和Ｆａｍ加Ａｍｏ的二联疗法具有缓解症状快、疗程短，副反应小等优点，是较理想的根除Ｈｐ方案     

口腔牙菌斑中的幽门螺杆菌

报道用快速尿素酶法、免疫荧光染色和细菌培养法及电镜观察检测４０例消化性溃疡、慢性胃炎和胃癌患者牙菌斑中的幽门螺杆菌（Ｈｐ），同时从胃粘膜活检做嗜银染色（ＷＳ）和尿素酶试验检测Ｈｐ。结果发现，多数患者的牙菌斑中可能有大量Ｈｐ存在，牙菌斑中的Ｈｐ形态、生化特性和免疫学特性、培养条件均与胃粘膜Ｈｐ相似，说明牙菌斑中很可能有Ｈｐ寄生，它与胃粘膜Ｈｐ可能相同。     

北京地区反流性食管炎患者幽门螺杆菌感染率调查

目的调查近3年来北京地区反流性食管炎患者幽门螺杆菌(Hp)感染率,分析目前反流性食管炎与Hp感染的相关性。方法选择反流性食管炎患者119例和正常对照组121例,以快速尿素酶试验及13C-尿素呼气试验检测Hp感染。结果反流性食管炎患者Hp感染率(26.89%),显著低于对照组(42.15%),P<0.05。结论Hp可能在反流性食管炎的发病中起到保护作用。     

Comparative analysis between breath test, serological immunoassay and rapid-urease test for detection of Helicobacter pylori infection in Mexican patients with non-investigated dyspepsia

Introduction: There are multiple Helicobacter pylori (Hp) detection tests, some are invasive and other noninvasive. The diagnostic accuracy of these methods varies according to the prevalence of the disease. Objective: To determine the diagnostic accuracy of the breath test, serology and rapid urease test, considering gastric biopsy with Giemsa stain as the gold standard in Hp-infected subjects with uninvestigated dyspepsia. Methods: Eighty four subjects (64 women, mean age 45 years) who were referred for dyspeptic symptoms were evaluated. Also, 20 healthy volunteers (12 men, average age 38 years) were evaluated. All the subjects underwent hystological analysis with Giemsa stain, breath test (Heliprobe?), rapid urease test (CLOtest?) and serological immunoassay (Hexagon?). Results: Overall, Hp infection was diagnosed by histological analysis in 59 subjects (49 patients and 10 healthy subjects). Positivity to breath test, rapid urease test and serology were 56%, 46% and 44% respectively. Agreement with the histological análisis was 0.902 for the breath test, 0.620 for rapad urease test and 0.45 for serology. The area under the curve for the breath test was 0.95, for the rapid urease test was 0.82 and for serological test was 0.74. Conclusions: In our population, the breath test shown to have a diagnostic accuracy equivalent to histological analysis by Giemsa in subjects with uninvestigated dyspepsia.     

检测胃粘膜幽门螺杆菌感染不同方法之比较

目的研究适合临床使用的检测幽门螺杆菌（Ｈｅｌｉｃｏｂａｃｔｅｒｐｙｌｏｒｉ，Ｈｐ）的方法．方法患有胃炎、消化性溃疡或恶性肿瘤的患者１５０例，其中男８４例，女６６例，年龄１８岁～８０岁，平均４５岁．经内镜取胃窦粘膜３～４块，分别行病理切片染色法、尿素酶法（ＵＴ）及快速尿素酶法（ＲＵＴ）检测和血清学ＨｐＩｇＧ检测．结果血清ＨｐＩｇＧ，ＵＴ，ＲＵＴ病理ＷＳ染色法的Ｈｐ检出率分别为７８７％（１１８／１５０），４８７％（７３／１５０），４８０％（７２／１５０），５８０％（８７／１５０）．ＲＵＴ的敏感性为８２８％，特异性为１００％．ＲＵＴ一点与二点取材的敏感性分别为８６４％和７９１％，无显著性差异．结论ＲＵＴ的敏感性（８２８％）和特异性（１００％）稳定，操作简单，价廉，适合临床使用．     

HUITAI rapid urease test: a new ultra-rapid biopsy urease test for the diagnosis of Helicobacter pylori infection

BACKGROUND: The gastric biopsy urease test is an accurate and robust diagnostic test for Helicobacter pylori infection. Large endoscopy units use their own homemade unbuffered ultra-rapid urease test for diagnosis of H. pylori infection but several commercial rapid urease tests are available. OBJECTIVE: To compare the accuracy and reaction time of a new biopsy urease test, HUITAI rapid urease test, in the diagnosis of H. pylori infection. METHODS: Consecutive patients presenting with dyspepsia to the endoscopy unit, University of Malaya Medical Center were recruited for the study. Patients who were previously treated for H. pylori infection or who had received antibiotics, proton pump inhibitors or bismuth compounds in the preceding 4 weeks were excluded. The H. pylori diagnosis was made based on the homemade rapid urease test, histology and culture of gastric biopsies. Biopsies from the antrum and corpus of the stomach were taken for this purpose. In addition, two antral and corpus biopsies were taken for the HUITAI rapid urease test. A positive diagnosis of H. pylori infection was made when the culture was positive or if both histology and the rapid urease test were positive. A negative diagnosis was made when all tests were negative. The positive reaction time of the HUITAI rapid urease test was carefully timed up to 60 min. RESULTS: Two hundred and six patients were recruited in the study. One hundred and twelve were diagnosed as having an H. pylori infection while the other 94 patients were regarded as negative. There were no spoiled tests and no indeterminate results. The sensitivity of the HUITAI rapid urease test was 98.2% (95% confidence interval (CI): 93.7%, 99.8%), specificity, 99.0% (95% CI: 94.2%, 100%), positive predictive value, 99.0% (95% CI: 95.1%, 100%), negative predictive value, 97.9% (95% CI: 92.6%, 99.7%). The overall diagnostic accuracy for the HUITAI rapid urease test was 98.5% (95% CI: 96.6, 99.9). The median positive reaction time was 1.0 min (25-75% inter-quartile range [IQR]: 1.0-3.0 min). CONCLUSIONS: The HUITAI rapid urease test is highly accurate for the diagnosis of an H. pylori infection and showed a very rapid positive reaction time.     

Comparison of two invasive diagnostic tests for Helicobacter pylori after antimicrobial therapy

Objective. To compare the accuracy of two invasive tests, the rapid urease test and histology, one month after antimicrobial treatment of Helicobacter pylori. Material and methods. In the present study the rapid urease test was compared with histology in a group of 232 patients who fulfilled the Maastricht criteria for eradication of H. pylori infection. All patients had one week of triple therapy which included omeprazole b.i.d. and two of three antibiotics (metronidazole, chlarythromycin and amoxicillin) b.i.d. One month after antimicrobial therapy, all the patients underwent upper gastrointestinal endoscopy. Two biopsy samples were taken from the antrum and corpus for each test. We used the office rapid urease test, which was previously evaluated, and histology with Giemsa stain. Results. Concordance between both methods was 94% for antrum biopsies, 97% for corpus biopsies and 96% for pooled data. Kappa values were 0.81 for antrum (95% CI: 0.77–0.85%), 0.87 for corpus (95% CI: 0.83–0.91%) and 0.84 for pooled data (95% CI: 0.80–0.88%). Specificity of the rapid urease test is very high (over 98%), sensitivity is lower, but can be improved, if biopsy specimens are taken from both the corpus and the antrum (to 83.6%). Conclusions. The rapid urease test with two biopsies from the antrum and corpus of the stomach is a reliable diagnostic method for evaluation of the success of H. pylori eradication one month after antimicrobial therapy.     

老年人胃癌与谷胱甘肽转硫酶P1基因多态性关系的研究

目的 探讨幽门螺杆菌(Hp)感染及谷胱甘肽转硫酶P1(GSTP1)基因多态性与胃癌的关系.方法 选择老年胃癌患者(胃癌组)98例和胃镜检查正常者(对照组)149例,以快速尿素酶试验、13C-尿素呼气试验或活检标本吉姆萨染色(Giemsa)检测Hp感染;通过聚合酶链式反应-限制性片段长度多态性(PCR-RFLP)分析方法检测GSTP1基因型.结果 Hp感染率胃癌组(54.1%)与对照组(40.9%)比较,差异有统计学意义(x2=4.11,P＜0.05);具有GSTP1突变纯和基因型并有Hp感染阳性的人群胃癌发病风险显著增加OR值5.44(1.26～26.79)(x2=7.13,P＜0.01).结论 老年患者Hp感染和GSTP1基因型多态性与胃癌的发病风险有关.

Abstract：

Objective To study the relationships of Helicobacter pylori (Hp) infection and genetic polymorphisms of glutathione s-transferase P1 (GSTP1) with gastric cancer (GC). Methods The 98 patients with GC and 149 controls with normal finding at endoscopy were enrolled for this study. The rapid urease test (RUT), 13C- urea breath test (13C-UBT) and Giemsa staining of biopsy samples were used to check Hp infection. PCR-based restriction fragment length polymorphisms (PCR-RFLP) was used to detect GSTP1 genotype. Results The rate of Hp infection was higher in GC group than in control group (54.1% vs. 40.9%, x2 =4.11, P＜0. 05). The risk of GC would significantly increase in the GSTP1 homozygous mutant gene (MM) group with Hp infection (OR=5.44, 95%CI 1. 26-26. 79, x2=7.13, P＜0.05). Conclusions Hp infection and GSTP1 genetic polymorphisms are associated with gastric cancer risk in the elderly.     

Detection of Helicobacter pylori using nested polymerase chain reaction and rapid urease test in gastric biopsy samples.

BACKGROUND/AIMS: The purpose of this study was to compare nested polymerase chain reaction and rapid urease test findings in the diagnosis of Helicobacter pylori infection. METHODS: Two gastric biopsy specimens were obtained from each of 64 patients and polymerase chain reaction and rapid urease test were performed. DNA extraction was followed by amplification with two primer pairs from the urease A gene of Helicobacter pylori genome. RESULTS: Fourty two patients (65.6%) had a positive rapid urease test result while 22 (34.4%) had a negative result for Helicobacter pylori. Sixty of 64 patients (93.8 %) had a positive result with the nested polymerase chain reaction method. Four patients with negative nested polymerase chain reaction results also had negative rapid urease test results. All of the eighteen patients with rapid urease test-negative results were positive with nested polymerase chain reaction. The number of nested polymerase chain reaction-positive patients (93.8%) was significantly higher than rapid urease test-positive (65.6%) and first round polymerase chain reaction-positive (53.1%) patients (P<0.001). CONCLUSIONS: Our results indicate that the nested polymerase chain reaction is more specific and sensitive than the rapid urease test for detecting Helicobacter pylori in gastric biopsy samples.     

Comparison of two invasive diagnostic tests for Helicobacter pylori after antimicrobial therapy

OBJECTIVE: To compare the accuracy of two invasive tests, the rapid urease test and histology, one month after antimicrobial treatment of Helicobacter pylori. MATERIAL AND METHODS: In the present study the rapid urease test was compared with histology in a group of 232 patients who fulfilled the Maastricht criteria for eradication of H. pylori infection. All patients had one week of triple therapy which included omeprazole b.i.d. and two of three antibiotics (metronidazole, clarithromycin and amoxicillin) b.i.d. One month after antimicrobial therapy, all the patients underwent upper gastrointestinal endoscopy. Two biopsy samples were taken from the antrum and corpus for each test. We used the office rapid urease test, which was previously evaluated, and histology with Giemsa stain. RESULTS: Concordance between both methods was 94% for antrum biopsies, 97% for corpus biopsies and 96% for pooled data. Kappa values were 0.81 for antrum (95% CI: 0.77-0.85%), 0.87 for corpus (95% CI: 0.83-0.91%) and 0.84 for pooled data (95% CI: 0.80-0.88%). Specificity of the rapid urease test is very high (over 98%), sensitivity is lower, but can be improved, if biopsy specimens are taken from both the corpus and the antrum (to 83.6%). CONCLUSIONS: The rapid urease test with two biopsies from the antrum and corpus of the stomach is a reliable diagnostic method for evaluation of the success of H. pylori eradication one month after antimicrobial therapy.     

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。