幽门螺杆菌感染与血液系统疾病的关系

幽门螺杆菌(Helicobacter pylori,H.pylori)在全球的感染率超过50%,是人类最常见的感染。除慢性胃炎、胃溃疡、十二指肠溃疡、胃癌等消化系统疾病外,血液系统疾病也被证实与H.pylori相关,包括缺铁性贫血、特发性血小板减少性紫癜、维生素B12缺乏症和黏膜相关组织淋巴瘤。以上血液疾病患者的H.pylori感染率均比正常人高,且进行H.pylori根除治疗后症状都得到不同程度的缓解。H.pylori直接或间接地通过不同机制影响或决定着4种血液系统疾病的发生。     

幽门螺杆菌感染与糖化血红蛋白表达相关性的研究进展

幽门螺杆菌(Helicobacter pylori,H.pylori)是一种与胃黏膜疾病关系密切的革兰阴性菌,研究发现其与糖尿病、冠心病、缺铁性贫血、特发性血小板减少性紫癜等胃肠外疾病亦紧密相关,然而个中机制却仍不明确.糖化血红蛋白(hemoglobin A1c,HbA1c)是糖尿病(diabetesmellitus,DM)患者血糖水平长期监控的重要指标,研究发现,H.pylori感染阳性的DM患者外周血HbA1c水平较H.pylori阴性DM患者显著升高,这很有可能是H.pylori通过下调胃黏膜瘦素和脑肠肽的表达,造成宿主代谢紊乱和胰岛素抵抗而导致的.关于H.pylori和HbA1c关系的早期研究具有一定的局限性,更为全面、深入的研究势必为H.pylori感染相关性糖尿病的早期防治提供新的方向.     

幽门螺杆菌相关过敏性紫癜

自 198 2年Warren和Marshall成功地从胃粘膜分离出幽门螺杆菌 (helicobacterpylori,以下简作Hp)以来 ,随着研究的不断深入 ,目前已确定该菌与慢性胃炎、消化性溃疡、胃癌、粘膜相关淋巴样组织淋巴瘤密切相关 ,1994年WHO将其列为第一类生物致癌因子。近年来 ,研究已涉及Hp与胃肠外疾病的关系 ,包括 :冠状动脉粥样硬化性心脏病、高血压、脑血管病、偏头痛、原发雷诺现象、干燥综合征、自身免疫性血小板减少性紫癜、过敏性紫癜、自身免疫性甲状腺炎、糖尿病、慢性荨麻疹、酒糟鼻等[1] 。本文将专题报告幽门螺杆菌相关过敏性紫癜。幽门螺杆菌…     

幽门螺杆菌感染在肝癌发生中的潜在作用

0引言在众多螺杆菌的研究中,幽门螺杆菌(H pylori)一直是研究的热点.过去十几年中,对于H pylori的致病性研究主要集中在胃肠相关疾病的领域,如慢性胃炎、消化性溃疡、胃癌以及胃淋巴瘤等.随着对H pylori的深入研究,发现H pylori与胃肠外疾病也有关.在与H pylori相关的胃肠外疾病中, 研究者们陆续在慢性肝、胆疾病及肝癌患者的肝组织中检测到H pylori的存在,认为H pylori可能作为独立的或辅助的致病因素导致肝脏病变.     

幽门螺杆菌与肝硬化的关系

幽门螺杆菌（H．pylori,HP）为1983年由澳大利亚学者巴里．马歇尔（Barry J．Marshall）和罗宾．沃伦（J．Robin Warren）发现的一种革兰氏阴性螺旋形致病菌,定植于胃黏膜,人群感染率为20％～90％,不同国家和地区的 HP感染率亦各不相同。HP感染最初仅被认为是慢性胃炎和消化性溃疡发生并导致胃癌的重要病因,可是随着对 HP 研究的不断深入,越来越多的临床及实验资料表明,HP 感染与许多胃肠外疾病亦有关联,如慢性心血管疾病、肝脏及胆道疾病、自身免疫系统疾病、胰岛素抵抗、高脂血症和慢性中性粒细胞减少等。其中HP与肝癌、肝硬化的关系就是最近的一大研究热点。肝硬化发病原因目前认为主要与乙型和丙型肝炎病毒感染、自身免疫性疾病、寄生虫、酒精、药物等因素有关,但仍有很大比例肝硬化患者发病原因不明。近年来有研究表明 HP 感染可能与肝硬化的发生有一定的相关性。现将 HP 感染与肝硬化关系的研究进展作一综述。     

幽门螺杆菌感染与胰腺疾病

近年来，不断有证据表明幽门螺杆菌(H．pylori)感染不仅是慢性胃炎、消化性溃疡和胃癌的主要致病因素，而且也与许多胃肠外疾病有关。由于H．pylori感染可引起上消化道正常生理状况发生变化，而胰腺的外分泌功能与上消化道正常生理功能的关系又极为密切，故人们推测H．pylori感染与胰腺疾病之间可能存在着某种联系，并就此进行了一定的探讨，此文就该方面研究作简要综述。     

高海拔地区军人胃肠疾病与幽门螺杆菌感染的相关性研究

目的探讨高海拔地区军人胃、十二指肠等胃肠疾病的高发病率与幽门螺杆菌(H.pylori)感染的相关性。方法对2011年长期驻扎在西藏那曲地区申扎县军人,经申扎县人民医院门诊并确定有胃肠疾病的412例患者,行胃镜及胃黏膜病理组织学检查,采用美蓝染色检测H.pylori感染情况,观察胃黏膜组织炎症活动程度。结果 412例患者H.pylori总感染率为71.6%。胃溃疡、十二指肠溃疡、糜烂性胃炎患者H.pylori感染率分别为81.5%、93.9%、89.1%,萎缩性胃炎、肠化、异型增生患者H.pylori感染率分别为63.8%、67.4%、73.3%,明显高于浅表性胃炎患者的49.1%(P<0.05)。士兵入伍后的前3年,随军龄的增加,H.pylori感染率逐渐增加(P<0.05),3年以上军龄者H.pylori感染率无明显差异。所有慢性胃炎患者胃黏膜组织炎症活动从轻度(+)→中度(++)→重度(+++),其H.pylori感染率逐级增加,分别为42.7%、56.2%、76.2%,差异有统计学意义(P<0.05)。结论高海拔地区的军人胃、十二指肠等胃肠疾病患者H.pylori感染率高,军人的军营生活特点可能促使H.pylori感染。     

地塞米松、环孢素A对慢性特发性血小板减少性紫癜患者淋巴细胞凋亡的影响

目的研究在体外条件下,地塞米松和环孢素A对慢性特发性血小板减少性紫癜患者外周血淋巴细胞凋亡的影响。方法用流式细胞仪测经地塞米松和环孢素A处理过的慢性特发性血小板减少性紫癜患者淋巴细胞凋亡率。结果用地塞米松、环孢素A处理过的慢性特发性血小板减少性紫癜患者淋巴细胞凋亡率明显高于对照组（P〈0．01）。结论地塞米松和环孢素A能增加慢性特发性血小板减少性紫癜患者淋巴细胞凋亡,是有效的免疫抑制药物,能针对慢性特发性血小板减少性紫癜患者细胞免疫异常的发病机制进行治疗。     

肝硬化并发消化性溃疡与Helicobacter pylori感染的临床相关性研究

目的探讨Helicobacter phylori(H.pylori)与肝硬化并发消化性溃疡的临床相关性。方法 H.pylori阳性患者1 887例和H.pylori阴性患者685例,采用Logistic回归分析计算其比值比(OR)和95%CI,以此确定H.pylori感染是否是肝硬化并发消化性溃疡的独立因素。结果 100例失代偿期肝硬化合并消化性溃疡患者,H.pylori阳性38例,H.pylori阴性62例。364例代偿期肝硬化并发消化性溃疡患者,H.pylori阳性195例,H.pylori阴性169例。非肝硬化患者消化性溃疡H.pylori阳性1 654例、H.pylori阴性454例。Logistic回归分析显示,失代偿期肝硬化患者(OR=0.25,P0.001)和代偿期肝硬化患者(OR=0.52,P0.001)H.pylori感染率较低。结论 H.pylori感染可能不是肝硬化合并消化性溃疡的主要病因。     

对我国幽门螺杆菌研究的思考

自1982年澳大利亚学者J．R．Warren和B．J．Marshall首次从人胃黏膜组织中分离出幽门螺杆菌（H．pylori）以来，H．pylori作为一个新发现的传染病致病菌从根本上改变了人们对胃肠疾病的认识．使胃肠疾病的病因学和治疗学发生了一场革命。H．pylori作为人类消化性溃疡和慢性活动性胃炎的主要病因．以及与胃癌的密切联系已为国际医学界所确认。与心脑血管病等消化系统外疾病的关系也受到广泛关注，已成为国际医学界研究的热点。H．pylori和H．pylori感染问题已经成为一个严重的公共卫生问题。根据1990-2002年66项H．pylori流行病学调查资料。我国农村地区人群平均感染率为64．4％．城市人群为48．7％．H．pylori感染危害十分严重。1985年张振华教授首次在国内成功分离出H．pylori，在Hpylori感染的防治中作出了贡献．推动了我国H．pylori相关疾病的防治工作。     

Overview: Helicobacter pylori and Extragastric Disease

Isolation of the gastric spiral bacterium Helicobacter pylori totally reversed the false dogma that the stomach was sterile. In addition to its causal role in peptic ulceration, the newly identified bacterium has now been implicated in other gastric and even extragastric diseases, including chronic atrophic gastritis, gastric MALT lymphoma, gastric cancer, functional dyspepsia, idiopathic thrombocytopenic purpura (ITP), iron deficiency anemia, chronic urticaria, ischemic heart disease, and others. The majority of the reports are anecdotal, epidemiologic, or eradication studies, but there are also relevant in vitro studies. ITP represents one disease showing a strong link with H pylori infection. There are also accumulating data on the role of H pylori infection in iron deficiency anemia and ischemic heart disease. In summary, the association between H pylori infection and other extragut diseases is still controversial but worthy of further investigation.     

Helicobacter pylori-associated idiopathic thrombocytopenic purpura: a narrative review

The Gram-negative bacterium Helicobacter pylori has a well-demonstrated role in several gastroduodenal diseases, including peptic ulcer disease, chronic active gastritis, mucosa-associated lymphoid tissue lymphoma, and gastric adenocarcinoma. In addition, more recently, several studies have focused on the possible causal role of H. pylori in various extragastric disorders, such as cardiovascular, respiratory, neurological, skin, and autoimmune conditions. The current status of the research on the pathogenesis, clinical and therapeutic aspects of H. pylori-associated idiopathic thrombocytopenic purpura in adults and children will be addressed in this narrative review.     

Helicobacter pylori infection and chronic immune thrombocytopenic purpura: long-term results of bacterium eradication and association with bacterium virulence profiles

Eradication of Helicobacter pylori may lead to improvement of chronic immune thrombocytopenic purpura (ITP), although its efficacy over time is uncertain. We report the results of H pylori screening and eradication in 75 consecutive adult patients with ITP. We also used molecular methods to investigate lymphocyte clonality and H pylori genotypes in the gastric biopsies from 10 H pylori-positive patients with ITP and 19 H pylori-positive patients without ITP with chronic gastritis. Active H pylori infection was documented in 38 (51%) patients and successfully eradicated in 34 (89%) patients. After a median follow-up of 60 months, a persistent platelet response in 23 (68%) of patients with eradicated infection was observed; 1 relapse occurred. No differences in mucosal B- or T-cell clonalities were observed between patients with ITP and control participants. Of note, the frequency of the H pylori cagA gene (P = .02) and the frequency of concomitant H pylori cagA, vacAs1, and iceA genes (triple-positive strains; P = .015) resulted statistically higher in patients with ITP than in control participants. All asymptomatic H pylori-positive patients with ITP were suffering from chronic gastritis. Our data suggest a sustained platelet recovery in a proportion of patients with ITP by H pylori eradication alone. Overrepresentation of specific H pylori genotypes in ITP suggests a possible role for bacterium-related factors in the disease pathogenesis.     

Absence of platelet response after eradication of Helicobacter pylori infection in patients with chronic idiopathic thrombocytopenic purpura

Eradication of Helicobacter pylori infection has been associated with the correction of thrombocytopenia in patients with idiopathic thrombocytopenic purpura (ITP). We have analysed the response to eradication of H. pylori in a series of 56 adult patients with chronic ITP. Forty patients had H. pylori infection (71%) that was eradicated in 23 of 32 evaluable patients (72%). Platelet counts did not significantly vary according to H. pylori treatment outcome. Three of 56 patients (5%) achieved a partial response attributable to H. pylori eradication. Therefore, detection of H. pylori infection should not be routinely included in the initial work-up of ITP.     

Does H. Pylori infection play a role in idiopathic thrombocytopenic purpura and in other autoimmune diseases?

Idiopathic thrombocytopenic purpura (ITP), an autoimmune disease caused by sensitization of platelets by autoantibodies leading to platelet destruction, has been associated with some infectious agents, including Helicobacter pylori. The study by Suzuki et al., published in this issue, provides further evidence of the role of H. pylori infection in the pathogenesis of ITP, as confirmed by the increase in the platelet count in patients with ITP, following H. pylori eradication. Interestingly, H. pylori infection has also been shown to play a role in other diseases in which autoimmune mechanisms may be predominant, such as acne rosacea, idiopathic chronic urticaria, and atherosclerosis. While H. pylori eradication is usually recommended in patients with gastric diseases, there are no specific indications for extraalimentary diseases. In the light of the recent findings, a revision of the current guidelines for the management of H. pylori infection may be needed.     

抗幽门螺杆菌治疗对慢性特发性血小板减少性紫癜患者疗效观察

目的通过对特发性血小板减少性紫癜(ITP)患者行抗幽门螺杆菌(HP)感染的临床研究,观察ITP与HP感染之间的关系以及抗HP在ITP患者治疗中的作用。方法2003-07~2003-12对解放军301医院17例慢性ITP患者采用14C尿素呼气试验进行HP检测,女11例,男6例,病程4个月至8年,并对阳性患者行奥美拉唑、克拉霉素及阿莫西林三联根除HP治疗,观察血小板情况。结果本组17例患者中HP阳性13例,阴性4例,抗HP后转阴11例,其中8例血小板水平较前有所提高。结论抗HP治疗确实可提高部分慢性ITP患者的血小板数。     

Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report

BACKGROUND: Guidelines on the management of Helicobacter pylori, which cover indications for management and treatment strategies, were produced in 2000. AIMS: To update the guidelines at the European Helicobacter Study Group (EHSG) Third Maastricht Consensus Conference, with emphasis on the potential of H pylori eradication for the prevention of gastric cancer. RESULTS: Eradication of H pylori infection is recommended in (a) patients with gastroduodenal diseases such as peptic ulcer disease and low grade gastric, mucosa associated lymphoid tissue (MALT) lymphoma; (b) patients with atrophic gastritis; (c) first degree relatives of patients with gastric cancer; (d) patients with unexplained iron deficiency anaemia; and (e) patients with chronic idiopathic thrombocytopenic purpura. Recurrent abdominal pain in children is not an indication for a "test and treat" strategy if other causes are excluded. Eradication of H pylori infection (a) does not cause gastro-oesophageal reflux disease (GORD) or exacerbate GORD, and (b) may prevent peptic ulcer in patients who are na?ve users of non-steroidal anti-inflammatory drugs (NSAIDs). H pylori eradication is less effective than proton pump inhibitor (PPI) treatment in preventing ulcer recurrence in long term NSAID users. In primary care a test and treat strategy using a non-invasive test is recommended in adult patients with persistent dyspepsia under the age of 45. The urea breath test, stool antigen tests, and serological kits with a high accuracy are non-invasive tests which should be used for the diagnosis of H pylori infection. Triple therapy using a PPI with clarithromycin and amoxicillin or metronidazole given twice daily remains the recommended first choice treatment. Bismuth-containing quadruple therapy, if available, is also a first choice treatment option. Rescue treatment should be based on antimicrobial susceptibility. CONCLUSION: The global burden of gastric cancer is considerable but varies geographically. Eradication of H pylori infection has the potential to reduce the risk of gastric cancer development.     

10d序贯疗法对根除幽门螺杆菌疗效的随访研究

背景:幽门螺杆菌(H.pylori)与慢性胃炎、消化性溃疡、胃癌和胃黏膜相关淋巴组织(MALT)淋巴瘤密切相关,但标准三联疗法的根除率逐年下降。目的:比较10 d序贯疗法和三联疗法根除H.pylori的疗效。方法:将经快速尿素酶试验(RUT)和~(14)C-尿素呼气试验(UBT)证实为H.pylori阳性的106例消化性溃疡、慢性糜烂性胃炎和萎缩性胃炎患者随机分为以雷贝拉唑为基础的10 d序贯疗法组(n=56)和三联疗法组(n=50)。治疗结束4周后复查RUT和,~(14)C-UBT,评估H.pylori根除情况;随访1年后再复查~(14)C-UBT评估H.pylori复发情况。结果:共93例患者按方案完成治疗。10 d序贯疗法组H.pylori根除率按意向治疗(ITT)和按方案(PP)分析均显著高于三联疗法组(ITF:89.3%对62.0%,P0.01;PP:94.3%对77.5%,P0.05);10 d序贯疗法组不良反应发生率(7.1%对30.0%,P0.01)和随访1年后的H.pylori复发率(6.0%对25.8%,P0.01)均显著低于三联疗法组。结论:以雷贝拉唑为基础的10 d序贯疗法可明显提高H.pylori根除率,提高患者的依从性,减少不良反应的发生。