332例幽门螺杆菌感染老年患者多次根除治疗的疗效研究

目的总结分析幽门螺杆菌（Hp）感染老年患者多次根除Hp治疗后的根除率,探讨反复多次根除Hp治疗疗效及与相关因素的关系。方法回顾性分析Hp检测阳性的老年病例332例,符合Hp根除治疗的标准,曾多次行抗Hp根除治疗,每次治疗停药1个月后均行13C-尿素呼气试验,有明确随访结果。将收集的病例进行统计学率的计算,多个率的比较采用卡方检验。结果332例老年患者经第一次抗Hp根除治疗,211例患者13C-尿素呼气试验检测证实Hp为阴性;首次治疗后检测仍为阳性的121例患者,有117例行第二次抗Hp根除治疗,89例患者治疗后行13C-尿素呼气试验证实Hp检测为阴性;检测仍为阳性的28例患者中有16例进行第三次根除治疗,13例患者治疗1个月后行13C-尿素呼气试验检测证实为阴性。结论对有根除指征的Hp反复阳性老年患者进行及时有效的根除治疗很有必要。反复多次根除治疗时,个体化调整治疗方案,以四联治疗为主,将治疗时间由1周延长为2周,对于提高Hp感染根除率可能有益。     

根除幽门螺杆菌后自身免疫性血小板减少性紫癜的消退

意大利Franceschi等基于Hp感染可能参于一些自身免疫性疾病发病的假设,评估了根除Hp治疗对原发性自身免疫性血小板减少性紫癜(primary autoimmunethrombocvtopenic purpura,PATP)的影响。PATP的诊断标准为:血小板减少、抗血小板自身抗体阳性,排除血小板减少的继发原因。用~13C-尿素呼气试验检测Hp:用三联疗法根除Hp;治疗结束后6周重新评估Hp状态及进行血小板计数和抗血小板自身抗体测定。     

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。     

~(13)C-尿素呼气试验、血清胃蛋白酶原在慢性萎缩性胃炎筛查中价值的初探

背景:慢性萎缩性胃炎为胃癌的癌前病变。幽门螺杆菌(Hp)能引起胃黏膜细胞的慢性炎症,促使血液中胃蛋白酶原(PG)含量发生变化,从而反映胃黏膜萎缩状态,为诊断萎缩性胃炎提供依据。~(13)C-尿素呼气试验是一种应用广泛的Hp感染检测方法。目的:探讨~(13)C-尿素呼气试验、血清PG在慢性萎缩性胃炎筛查中的应用价值。方法:选取2016年10月—2017年10月在上海电力医院行胃镜病理检查诊断为慢性胃炎的164例患者,分为慢性萎缩性胃炎组和慢性非萎缩性胃炎组,以病理学结果评估Hp感染情况。比较慢性胃炎Hp阳性和阴性亚组中血清PGⅠ、PGⅡ和PGⅠ/PGⅡ比值(PGR)以及肠化生情况,并评估~(13)C-尿素呼气试验判断Hp感染的准确性。结果:慢性萎缩性胃炎Hp阳性和阴性亚组血清PGⅠ水平和PGR均显著低于慢性非萎缩性胃炎Hp阳性和Hp阴性亚组(P0.05);而PGⅡ水平无明显差异(P0.05)。慢性萎缩性胃炎Hp阳性亚组血清PGⅠ、PGⅡ显著高于Hp阴性亚组(P0.05),PGR显著降低(P0.05),肠化生率显著升高(P0.05)。~(13)C-尿素呼气试验诊断Hp阳性的总体准确率为96.3%,敏感性为96.6%,特异性为96.1%。结论:Hp感染与血清PG含量变化有一定相关性,Hp感染可提高慢性萎缩性胃炎的肠化生率。~(13)C-尿素呼气试验是一种无创、有效的Hp感染检测方法。~(13)C-尿素呼气试验、血清PG检测可为胃癌及其癌前病变的早期诊断和治疗提供有价值的依据。     

特发性血小板减少性紫癜与幽门螺杆菌的关系

目的:探讨特发性血小板减少性紫癜(ITP)与幽门螺杆菌(Hp)的关系。方法:对33例ITP患者进行Hp的检测,并进行抗Hp的治疗,观察血小板的恢复情况。结果:Hp阳性的ITP患者,经抗Hp治疗后Hp阴转者的疗效好于未阴转及Hp阴性的患者。结论:Hp感染可能是ITP的发病原因之一。     

幽门螺杆菌感染与2型糖尿病患者大动脉弹性的关系

目的 探讨幽门螺杆菌（Hp）感染与2型糖尿病（T2DM）大动脉弹性的关系.方法 对65例T2DM患者行13C-尿素呼气试验、血清学Hp及其抗体、糖化血红蛋白、血脂、尿酸（UA）检测,并测量其脉搏波传导速度（PWV）.结果 Hp阳性43例,Hp阴性22例;Hp阳性者的PWV明显高于Hp阴性者（P＜0.05）.相关分析显示,Hp阳性T2DM患者的PWV与UA、年龄、平均动脉压、Hp感染有关（P＜0.05或＜0.01）.结论 Hp感染与T2DM患者的动脉粥样硬化（AS）相关,其可能是加速T2DM患者AS进程的重要因素.     

^13C—尿素呼气试验诊断幽门螺杆菌感染的研究

目的评估13C-尿素呼气试验（13C-UBT）幽门螺杆菌（Hp）感染的可靠性。方法对82例因胃病而行胃镜检查的患者，于胃窦和胃体取多个活检标本作组织学、粘膜涂片和快速尿素酶试验，以决定是否感染Hp，并作13C-UBT。结果13C-UBT的敏感性、特异性、阳性预测值、阴性预测值是与组织学和尿素酶方法检测Hp的检测结果比较而计算得到。13C-尿素呼气试验的敏感性97．92％、特异性100％、阳性预测值100％、阴性预测值97．14％、准确性98．78％。结论13C-尿素呼气试验有高度敏感性和特异性，对确定患者的Hp感染状态是一非常可靠而又无创伤的诊断方法。     

幽门螺杆菌相关性胃癌患者局部Th1/Th2细胞免疫应答变化

背景:幽门螺杆菌(Hp)感染与胃癌发生相关,免疫应答可能是其主要致病机制之一。目的:探讨Hp相关性胃癌患者黏膜局部Th1/Th2细胞免疫应答变化。方法:选取2011年1～6月27例胃癌患者和28例对照者,采用14C-尿素呼气试验、Hp抗体检测Hp感染,免疫组化法检测胃黏膜局部干扰素(IFN)-γ和白细胞介素(IL)-4表达情况。结果:Hp总体感染率为61.8%。Hp阳性患者中,胃癌组IFN-γ表达明显低于对照组(P<0.05),IL-4表达明显高于对照组(P<0.05);Hp阴性患者中,胃癌组IFN-γ、IL-4表达与对照组均无明显差异(P>0.05)。Hp阳性胃癌患者IL-4表达明显高于Hp阴性胃癌患者(P<0.05),Hp阳性对照组IFN-γ表达明显高于Hp阴性对照组(P<0.05)。结论:Hp阳性对照者以Th1细胞介导的免疫应答为主,Hp阳性胃癌患者以Th2细胞为主。黏膜局部Th1/Th2细胞免疫应答变化可能与Hp感染相关疾病的进展,特别是胃癌的发生密切相关。     

大剂量地塞米松联合长春新碱治疗慢性难治性特发性血小板减少性紫癜的临床观察

特发性血小板减少性紫癜(ITP)是一种自身免疫性疾病。一线治疗以口服泼尼松为主。对此疗法无效或须长时间大剂量糖皮质激素才能维持血小板计数在安全水平,称为慢性难治性ITP。2003年4月以来,我们采用短期间断大剂量地塞米松联合长春新碱的方法治疗难治性慢性ITP8例,疗效较好,现报道如下:资料与方法一般资料患者8例,符合张之南主编《血液病诊断和疗效判断标准》ITP诊断标准。男3例,女5例,年龄21～52岁,平均34.2岁;病程1.5～23年,平均5.1年。8例均口服(泼尼松)常规剂量无效、无糖皮质激素依赖者,均未行脾脏切除术。治疗前血小板计数维持…     

根除幽门螺杆菌治疗后值得注意的问题——本文综合报道日本第55次(1998年4月15日)全国消化内镜学会专题讨论会上的部有关内容

一、根除Hp后的再阳性率 北海道大学石塜淳报告了Hp根除后再阳性的随访结果。他们用~13C-尿素呼气试验(UBT)、快速尿素酶试验、培养和组织学检查检测Hp,治疗后1个月全部试验阴性作为Hp根除,340例患者治疗后265例Hp转阴,根除率为78％。对这些患者进行随访,平均观察时间为14个月,其中随访1年以上72例,2年以上21例。在3个月、6个月和1年时分别有4例、1例和3例再阳性,累积再阳性率4％/年。随访1年后,未再出现新的再阳性病例。作者认为Hp根除治疗后1月转阴的患     

慢性特发性血小板减少性紫癜患者PAIgG、ACAIgG的测定及意义

应用ELISA法对 41例慢性特发性血小板减少性紫癜 (ITP)患者和 2 5例健康对照者进行血浆和 (或 )血清血小板相关抗体 (PAIgG)、抗心磷脂抗体 (ACAIgG)测定 ,并常规血小板计数。发现ITP患者治疗有效组治疗后血小板计数明显升高、PAIgG含量显著降低 ,治疗前较治疗后及对照组均有显著性差异 (P <0 .0 1 ) ,且血小板计数与PAIgG之间呈显著性负相关 (r =- 0 .738,P <0 .0 0 1 )。而治疗无效组血小板计数、PAIgG均无明显变化。ACAIgG治疗前后无明显变化 ,且未发现与血小板及PAIgG相关。PAIgG、ACAIgG含量增高提示ITP患者针对血小板磷脂及其他糖类蛋白等不同抗原产生了自身免疫反应 ,为免疫抑制剂的应用提供了理论依据     

血小板自身抗体的流式细胞仪检测与意义

目的：应用流式细胞术（ＦＣＭ）测定血小板自身抗体ＰＡＩｇＧ,研究其对待发性血小板减少性紫癜（ＩＴＰ）诊断的意义。方法：应用ＦＣＭ检测２０例ＩＴＰ患者血小板膜表面及血浆中的抗血小板抗体,并与ＥＬＩＳＡ所测结果进行比较。结果：ＦＣＭ测得１４例（７０％ＩＴＰ患者血小板膜自身抗体ＰＡＩｇＧ阳性,９例（４５％）血浆抗血小板抗体阳性。ＥＬＩＳＡ显示１２例（６０％）患者ＰＡＩｇＧ阳性,７例（３５％）血浆抗血小板     

Helicobacter pylori eradication in the management of patients with idiopathic thrombocytopenic purpura

PURPOSE: To investigate the relation between Helicobacter pylori infection and the clinical features of idiopathic thrombocytopenic purpura (ITP), and to examine the effects of H. pylori eradication on platelet counts. METHODS: A(13)C urea breath test for H. pylori infection was performed in a cohort of 137 consecutive patients with ITP. Patients who tested positive received standard eradication therapy if their platelet count was <50 x 10(9)/L or if they had symptoms of dyspepsia. RESULTS: H. pylori infection was detected in 64 patients (47%), and was not associated with dyspepsia or other clinical or laboratory features. Eradication therapy was successfully administered to 52 patients. Platelet responses were observed in 17 (33%) of these patients, which lasted for more than 1 year in 11 patients. Duration of ITP was shorter among responders than nonresponders. Only one response was observed among patients with severe thrombocytopenia (platelet count <30 x 10(9)/L). CONCLUSION: The prevalence of H. pylori infection in patients with ITP is similar to that found in the general population. Infection is not associated with distinctive features of the disease. H. pylori eradication may improve the platelet counts in adults in whom the ITP is of recent onset and in those with less severe degrees of thrombocytopenia, but was not effective in patients with chronic severe ITP.     

Helicobacter pylori eradication in patients with idiopathic thrombocytopenic purpura--the associateion between the activity of Helicobacter pylori and platelet recovery

We investigated the prevalence of Helicobacter pylori infection and the effect of eradication therapy in patients with idiopathic thrombocytopenic purpura (ITP). H. pylori infection was found in 9 of 11 patients (81.8%). H. pylori eradication was obtained in all patients and significant platelet recovery was found in 5 of 9 patients (55.6%). One patient required re-eradication therapy because the urea breath test remained positive after the first therapy. After complete eradication, long time remission was obtained. The results suggested that the platelet count might be correlated closely with the amount of H. pylori in some patients with H. pylori positive ITP.     

Platelet-associated IgG in immune thrombocytopenic purpura

A method for the measurement of immunoglobulin G associated with gel- filtered platelets is described and finding in 70 control subjects and 37 patients with immune thrombocytopenic purpura (ITP) are reported. Control platelet-associated IgG (PAIgG) levels (nanograms IgG per 10(9) platelets) averaged (+/-SD) 1231+/-424; samples studied after 24 and 48 hr remained within the control range. PAIgG values of 19 adult and 12 childhood patients with chronic ITP averaged 4711+/-3025 and 4923+/- 3955, respectively, and differed significantly from controls (p less than 0.001). There was an inverse correlation between PAIgG values and the chronic ITP patient's platelet count. Six patients with childhood acute ITP had PAIgG levels ranging from 5588 to 56,250 and appeared to represent a different statistical population from those with chronic ITP. In chronic ITP patients responding to splenectomy, there was an immediate normalization of PAIgG levels; however, a certain percentage of patients studied several months after splenectomy evidenced elevated PAIgG levels in association with normal platelet counts. These data showed that the direct measurement of platelet associated antibody is a useful technique in the diagnosis and follow-up of patients with chronic ITP. Preliminary studies in patients with acute ITP have suggested that this method may be useful in differentiating acute and chronic childhood ITP.     

特发性血小板减少性紫癜无效输注原因分析

目的:探讨特发性血小板减少性紫癜(ITP)患者血小板无效输注的原因.方法:90例确诊的ITP患者中对输注血小板的48例计算血小板计数增高指数(CCI),评价输注的效果并分析与感染、脾脏肿大、血小板抗体、骨髓巨核细胞数和免疫指标等因素的关系.结果:18例应用血小板和激素治疗的患者,44.4%有效输注,30例应用血小板、激素和丙种球蛋白患者,53.3%有效输注.24例无效输注患者中在感染组与非感染组、脾脏肿大组与正常组、血小板相关抗体升高组与正常组,有效输注率有显著性差异.骨髓巨核细胞数升高组与正常组、调节性T细胞低表达组与正常组,有效输注率差异无统计学意义.结论:ITP患者输注血小板50%存在无效输注,其原因可能与感染、脾脏肿大、血小板相关抗体有关.因此控制感染和抑制免疫应作为首选治疗,而血小板的输注应严格把握指征.     

Platelet recovery after eradication of <Emphasis Type="Italic">Helicobacter pylori</Emphasis> in patients with idiopathic thrombocytopenic purpura

The association between Helicobacter pylori ( H. pylori) infection and idiopathic thrombocytopenic purpura (ITP) has been reported by several groups. We investigated the prevalence of H. pylori infection and the effectiveness of its eradication in Japanese patients with ITP. H. pylori infection was found in 21 of 30 patients (70.0%) by (13)C urea breath test and presence of serum antibodies to H. pylori. H. pylori was eradicated in 18 of the 21 infected patients (85.7%) by administration of a proton pump inhibitor and two kinds of antibiotics. In only one patient was medication discontinued due to skin rash on the 4th day of treatment. Platelet recovery was obtained in ten patients (55.6%). In two patients with treatment failure, platelet recovery was obtained after successful re-eradication. In three patients without H. pylori infection, platelet counts did not significantly increase with the same treatment. On the other hand, eradication therapy did not affect platelet counts in patients with gastric ulcer. In conclusion, H. pylori eradication can be used for initial treatment with tolerable adverse effects in some ITP patients.     

Successful treatment of refractory idiopathic thrombocytopenic purpura by eradication of Helicobacter pylori

A 53-year-old woman was diagnosed as having idiopathic thrombocytopenic purpura (ITP) in 1990, and treated with prednisolone and splenectomy, which did not result in remission. In November 2000, gastrointestinal endoscopy showed superficial gastritis, and Helicobacter pylori infection was revealed by the rapid urease test and histologic examination. After eradication of Helicobacter pylori by amoxicillin, clarithromycin and lansoprazole, the patient's platelet count was increased from 24 x 10(9)/l to 134 x 10(9)/l and platelet-associated IgG (PAIgG) was decreased from 695 ng/10(7) cells to 33 ng/10(7) cells. This case suggests that eradication of Helicobacter pylori may be useful for treating some patients with refractory ITP.     

Purification of Placenta-Eluted Gamma Globulins and Their Strong Effect against Graft-versus-Host Reactions In Vitro and In Vivo

A retrospective study was performed to determine the prevalence of Helicobacter pylori (H pylori) infection, the effect of H pylori eradication on platelet counts, and the characteristic clinical features of chronic immune or idiopathic thrombocytopenic purpura (ITP) with H pylori infection. H pylori infection was found in 300 patients, a group that was significantly older (P < .005) and had more cases of hyperplastic megakaryocytes in the bone marrow (P = .01) than patients without H pylori infection. H pylori eradication therapy was performed in 207 H pylori-positive ITP cases, and the platelet count response was observed in 63% of the successful eradication group and in 33% of the unsuccessful eradication group (P < .005). In the successful group, the complete remission and partial remission rates were 23% and 42%, respectively, 12 months after eradication. In the majority of responders, the platelet count response occurred 1 month after eradication therapy, and the increased platelet count continued without ITP treatment for more than 12 months. H pylori eradication therapy was effective even in refractory cases, which were unresponsive to splenectomy. In conclusion, H pylori infection was involved in most ITP patients older than 40 years in Japan, and eradication therapy should be the first line of treatment in H pylori-positive ITP patients.