幽门螺杆菌感染的治疗

幽门螺杆菌感染的治疗陈洁平徐采朴解放军第三军医大学第一附属医院消化科四川省重庆市６３００３８ＳｕｂｊｅｃｔｈｅａｄｉｎｇｓＨｅｌｉｃｏｂａｃｔｅｒｉｎｆｅｃｔｉｏｎｓ／ｔｈｅｒａｐｙＨｅｌｉｃｏｂａｃｔｅｒｐｙｌｏｒｉ主题词螺杆菌感染／治疗螺杆...     

幽门螺杆菌感染治疗的现状与展望

临床医生必须明确幽门螺杆菌(Hp)感染根除治疗的适应证，并且合理、规范地应用抗生素。l周或2周的含铋剂、质子泵抑制剂或雷尼替丁胶体铋(RBC)三联疗法是公认的较好方案，Hp根除率为80％～90％，1周和2周治疗根除率无明显差异。对上述3种治疗案无效者可采用四联疗法。Hp治疗的耐药问题突出，应强调规范的治疗方案，最好采取按地区性Hp菌株耐药性选择治疗方案的原则。在Hp根除后6个月以上Hp检测阳性者应考虑再感染，但细菌DNA图谱分析法证实多数病人再感染时为同一菌株感染。     

“除草、杀虫、养土”三步法治疗幽门螺杆菌感染的研究

[目的]应用"三步法"治疗幽门螺杆菌(Hp)感染感染临床疗效观察。[方法]按随机数字表法将300例Hp感染患者随机分为治疗组(三步法+四联方案)150例和对照组(四联方案)150例,治疗后分别观察2组患者临床疗效、主要不良反应、1年后Hp复感率。[结果]治疗组Hp根除率高于对照组(96.67%:85.33%,P<0.05)。治疗组根治Hp过程中主要不良反应明显少于对照组(P<0.05)。治疗1年后随访,治疗组Hp复感率(14.28%)低于对照组(24.26%)(P<0.05)。[结论]"三步法"治疗Hp感染疗效确切,依从性高,不良反应较少,Hp难治性及易复发可能与"湿"邪有关。     

幽门 螺杆菌感染的药物治疗

自从1982年Marshall和Warren从胃粘膜中成功分离出幽门螺杆菌(Helicobacterpylori,Hp)以来,大量的基础研究及临床实践证明Hp是慢性胃窦炎、消化性溃疡、胃粘膜相关性淋巴组织样淋巴瘤(MALTL)的主要致病因素,与胃癌亦有密切关系,被WHO定为第一类致癌因子.     

幽门螺杆菌补救治疗的研究进展

近年来,幽门螺杆菌(Hp)感染率持续升高,耐药性的问题日益严峻,其初次治疗成功率逐渐下降,有部分患者需要补救治疗.选择合适的补救治疗药物、适当的补救治疗时间及提高患者的依从性,对于提高补救治疗的成功率至关重要.该文对近年来有关Hp补救治疗的研究进展作一综述.     

幽门螺杆菌感染根除治疗现状与进展

幽门螺杆菌(helicobacter pylori,Hp)根除治疗有效地改变了胃十二指肠疾病的预后,迄今开展根除治疗已经有20余年的历史,目前的现状是Hp对常用的抗生素如克拉霉素、甲硝唑等的耐药率明显增加,由此而导致使用最广泛的传统三联疗法的根除率已经下降至不可接受的水平,国内外探索了一系列的根除治疗方案,试图改变这种现状,提高根除率,本文对相关进展综述如下。     

幽门螺杆菌根除治疗失败后的补救治疗

幽门螺杆菌（H.pylori)对抗生素的耐药率上升是导致根除治疗失败率上升的主要原因，对经标准方案根除H.pylori失败的患者有必要进行补救治疗。目的：评估铋剂、质子泵抑制剂（PPI）联用呋喃唑酮和四环素组成的7天四联方案用于根除H.pylori治疗失败后补救治疗的疗效，以及H.pylori耐药对疗效的影响。方法：予35例经含克拉霉素根除H.pylori方案治疗、H.pylori仍为阳性的患者以为期7天的四联治疗：枸橼酸铋钾220mg bid 奥美拉唑20mg bid 呋喃唑酮100mg bid 四环素750mg bid。治疗前取胃窦黏膜活检标本进行快速尿素酶试验、组织学检查和培养检测H.pylori。用琼脂扩散法测定克拉霉素、呋喃唑酮和四环素的最低抑菌浓度（MIC）。治疗结束后至少4周，采用^13C-尿素呼气试验进行H.pylori感染状态评估。结果：33例患者完成治疗和随访，2例失访。根据意图治疗（ITT）和试验方案（PP）分析，该补救方案的H.pylori根除率分别为68．6％（24／35）和72．7％（24／33）。10例（28．6％）患者发生轻度副反应（9例发生恶心、中上腹不适，1例发生皮疹）。35例中有27例H.pylori培养成功，克拉霉素的耐药率为51．8％（14／27），呋喃唑酮为3．7％（1／27），四环素为7．4％（2／27）。各药物耐药菌株和敏感菌株的H.pylori根除率无显著差异。结论：铋剂、PPI联用呋喃唑酮和四环素组成的7天联方案作为根除H.pylori治疗失败后的补救治疗可获得较高的H.pylori根除率。     

幽门螺杆菌感染的药物治疗新进展

0引言幽门螺杆菌(Helicobacter pyiori,H pylori)的发现已有20 a的历史.近20 a来,在胃肠病工作者全面而深入的研究下,H pylori已被确认是慢性胃炎和大部分消化性溃疡的重要病因,与胃黏膜相关性淋巴样组织(MALT)恶性淋巴瘤密切相关,与胃痛的关系也越来越受到人们的重视,世界卫生组织已经将H pylori列为第一类致癌因子,并明确为胃癌的危险因素.正是由于H pylori与胃十二指肠疾病的关系如此密切,H pylori感染的治疗一直是胃肠病工作者所关注的热门课题,根除H pylori能有效治愈溃疡,甚至可作为预防胃癌的工具之一.本文就H pylori感染的治疗现状及药物治疗过程中应注意的几个问题作一综述.     

幽门螺杆菌感染与心血管疾病的研究进展

幽门螺杆菌(H. pylori)感染是慢性胃炎、消化性溃疡和胃癌等消化道疾病明确的重要致病因素, 并与多种胃外疾病有关。H. pylori感染与心血管疾病的关系是近年来研究的热点, 也是争论的焦点。许多临床研究发现两者密切相关, 认为H. pylori感染是心血管疾病的致病因素, 但亦有学者认为两者关联性较弱。其原因可能与不同H. pylori菌株类型的致病性差异, 及宿主因素和环境因素等有关。本文回顾了近年来H. pylori与心血管疾病相关的研究, 归纳和分析H. pylori感染在动脉粥样硬化形成中的作用及机制。     

Helicobacter pylori infection: treatment options

After two decades of progress the best current approach to treatment of Helicobacter pylori infection is a strategy that combines two consecutive complementary treatments. Current guidelines recommend a first-line triple therapy - 7-10 days of a proton-pump inhibitor (PPI), clarithromycin and amoxicillin - followed by a quadruple therapy combining a PPI, metronidazole, tetracycline and a bismuth salt for treatment failures. Regrettably, present cure rates for first-line triple therapy are below 80%, and many patients require second-line treatment with further testing and control visits. Although most compliant patients are cured by the second-line treatment, patients often do not complete the full process and, as a result, final cure rates for the whole strategy often fall below 90%. This means that more effective first-line therapies are required. Promising recent developments include using quadruple therapy as first-line therapy, the use of adjuvant lactoferrin with triple therapy and a newly devised combination of a PPI, clarithromycin, amoxicillin and metronidazole, known as sequential treatment. Additional future developments will require the incorporation of new antibiotic weapons in the anti-H. pylori arsenal. The new quinolones and rifamycin derivates have recently demonstrated their efficacy in the treatment of H. pylori infection.     

Helicobacter pylori infection

IS THERE ANYTHING NEW? Helicobacter pylori has been for many years a forgotten bacterium, since the first report on this spiral organism dated from the 19th century[1]. As early as in 1906, an association between a spiral organism and gastric carcinoma was suggested[2].Doenges reported in 1938 that on autopsy not less than 40% of human stomachs were found to be invaded by spiral organisms[3].     

Helicobacter pylori infection

Summary The present report describes two patients with fasting hypergastrinemia, gastric acid hypersecretion, andHelicobacter pylori gastritis. Provocative testing for Zollinger-Ellison syndrome was negative and imaging studies did not demonstrate an intra-abdominal mass. Following eradication of theHelicobacter pylori infection, the fasting hypergastrinemia resolved in both patients and in one patient the gastric acid hypersecretion also resolved. The implications of this case on the differential diagnosis of Zollinger-Ellison syndrome are discussed.     

Lactobacillus reuteri in the treatment of Helicobacter pylori infection

Probiotics have proven to be useful in the treatment of a number of gastrointestinal diseases. Probiotics may compete directly with Helicobacter pylori, possibly by interference with adherence or by the production of antimicrobial molecules. Lactobacillus reuteri has been shown to inhibit H. pylori in vitro and in vivo, and theoretically may play a role in eradication therapy. The aim of this study was to examine the efficacy of L. reuteri in H. pylori eradication therapy. This was an open label single center study. H. pylori infection was defined as positive gastric histopathology and ¹³C-UBT. Intervention consisted of L. reuteri (DSM 17938) 10⁸ cfu plus pantoprazole 20 mg twice a day for 8 weeks. Eradication was defined as a negative ¹³C-UBT, 4–6 weeks post therapy. Compliance was considered good if at least 90 % of the total number of the pills were taken. 21 of 22 subjects completed the study without protocol violation (mean age 52 years; 36 % men). L. reuteri plus pantoprazole twice a day cured 13.6 % (3/22; 95 % CI 2.9–34.9 %) of patients with H. pylori infection by ITT analysis and 14.2 % (3/21; 95 % CI 3.0–36 %) by PP analysis. Overall urease activity assessed before and 4–6 weeks post therapy showed a significant reduction with a difference of mean of 38.8 vs. 25.4 by one-tailed test (P = 0.002). In conclusion, L. reuteri may have a potential role in H. pylori eradication therapy if the cure rate can be improved by changes in dose, dosing interval, or duration of therapy.     

幽门螺杆菌感染治疗方案的评价

幽门螺杆菌(Helicobacter pylori，下称Hp)从发现到现在已有超过20年的历史。20年来，胃肠病工作对Hp与上胃肠道疾病的关系进行了大量而深入的研究。Hp被认为是慢性胃炎的重要病因，并且与消化性溃疡的发病有着十分密切的关系，根除Hp之后，不仅能加速溃疡愈合，而且能显降低溃疡复发率，从而使溃疡病治愈。     

Research progress on Helicobacter pylori outer membrane protein

Helicobacter pylori (H pylori), one of the most common bacterial pathogens on human beings, colonizes the gastric mucosa. In its 95 paralogous gene families, there is a large outer membrane protein (OMP) family. It includes 32 members. These OMP are important for the diagnosis, protective immunity, pathogenicity of H pylori and so on. They are significantly associated with high H pylori density, the damage of gastric mucosa, high mucosal IL-8 levels and severe neutrophil infiltration. We introduce their research progress on pathogenicity.