儿童幽门螺杆菌感染的流行病学及诊治现状

儿童幽门螺杆菌感染不仅与消化性溃疡、慢性胃炎等胃肠道疾病密切相关,还可能与多种胃肠道外疾病有关,如生长发育迟缓、营养不良、营养性缺铁性贫血、特发性血小板减少性紫癜等。本文从多种诊断方法的利弊、各种治疗药物在不同地区显示出不同程度的耐药性,提醒临床医生对儿童Hp感染诊治时要注意本地的耐药情况和儿童个体差异。     

儿童幽门螺杆菌感染治疗进展

幽门螺杆菌（Hp）与消化性溃疡、胃癌、慢性胃炎及胃黏膜相关性淋巴组织（MALT） 淋巴瘤等多种胃肠道疾病密切相关,并可导致多种胃肠外疾患。Hp感染最重要的年龄段是儿童时期,大部分成人Hp感染是在此阶段获得,控制儿童Hp感染不仅能保障儿童健康发育,亦可有效降低成人时期消化性溃疡和胃癌的发病率。Hp感染率在发展中国家较高,我国儿童感染率为25%～59%,平均40%,并以平均每年0.5%～1.0%的速度递增[1]。因此,了解并推广儿童Hp感染的规范治疗,有效控制儿童期Hp的感染,是当前儿科医师的一项重要工作。      

感染幽门螺杆菌要不要治

在门诊,常有胃病患者或体检者查出感染了幽门螺杆菌,这时他们往往会问：幽门螺杆菌是什么？如果没什么不舒服,是不是可以不管呢？     

三联药物疗法联合L-GMI漱口液治疗儿童幽门螺杆菌感染疗效观察

目的观察三联药物疗法联合多聚赖氨酸复合体漱口液根除儿童胃部幽门螺杆菌(H.pylori)感染的疗效。方法 2010年1月至2014年12月江苏大学附属医院儿科门诊收治由13 C-呼气试验证实为H.pylori阳性患儿120例,随机分为观察组和对照组各60例。对照组采用奥美拉唑+克拉霉素+阿莫西林三种药物联合治疗,观察组在对照组治疗的基础上加用多聚赖氨酸复合体漱口液漱口,疗程均为2周。观察患儿治疗7d、14d的疗效,停药4周后H.pylori根除率及随访1年后复发率。结果治疗7、14d后观察组总有效率分别为90.0%(54/60)、96.7%(58/60),均高于对照组73.3%(44/60)、83.3%(50/60),差异有统计学意义(P0.05)。观察组H.pylori根除率为80.0%(48/60),高于对照组53.3%(32/60),差异有统计学意义(P0.01)。观察组H.pylori根治患儿复发率为14.6%(7/48),低于对照组37.5%(12/32),差异有统计学意义(P0.05)。结论常规药物治疗的同时增加L-GMI漱口液根除儿童H.pylori感染,可显著提高儿童H.pylori的根治率,降低复发率。     

抗幽门螺杆菌感染治疗后患儿肠道菌群的变化

【摘要】目的探讨儿童幽门螺杆菌(H·pylori)感染及抗H·pylori治疗对儿童肠道菌群状 态的影响。方法将浙江大学医学院附属儿童医院2004年4~10月门诊收治的68例慢性胃炎、十二指肠球炎患儿分为H·pylori阳性组36例、H· pylori阴性组32例二组。称取68例患儿新鲜粪便1.0g，分别进行需氧和厌氧培养，分离肠道菌群中最有代表性的三种需氧菌(肠杆菌、肠球菌、 酵母菌)和四种厌氧菌(双歧杆菌、乳杆菌、类杆菌、产气荚膜梭菌),菌落记数，同时计算B/E比值来代表定植抗力。对36例H·pylori阳性组中 的26例患儿进行“三联”抗H·pylori治疗1周后留取新鲜粪便进行肠道菌群分析，5例患儿在停药1个月后再次进行肠道菌群分析。结果H· pylori阳性组和H·pylori阴性组上述三种需氧菌和四种厌氧菌的菌落检出率比较，差异无统计学意义(P>0.05)。抗H·pylori治疗1周后双歧杆 菌、乳杆菌、类杆菌菌落数量较治疗前明显降低(P<0.05),B/E值明显下降(P<0.01)，酵母菌的检出率明显增加(P<0.05)，产气荚膜梭菌检出率 下降(P<0.05)。5例患儿在停药1个月后，乳酸杆菌数量仍继续下降，肠杆菌数量继续增加，双歧杆菌、类杆菌数量有所恢复，但仍低于治疗前 。结论儿童H·pylori感染后对肠道菌群影响不大；三联疗法抗H·pylori治疗对儿童肠道菌群产生明显的影响，因此在治疗H·pylori感染时须 考虑到大量抗生素治疗后可能对患儿的副作用及潜在的危险。     

儿童幽门螺杆菌感染时T淋巴细胞亚群的变化

目的研究儿童幽门螺杆菌(H.pylori)感染时的T淋巴细胞亚群变化。方法流式细胞仪直接免疫荧光法测定38例［H.pylori+慢性浅表性胃炎(CSG)12例；H.pylori+十二指肠溃疡(DU)5例；H.pylori-CSG 21例］儿童胃窦黏膜及外周血T淋巴细胞亚群。各组患儿均在内镜检查下取胃窦黏膜作快速尿素酶试验、组织学检查及淋巴细胞提取，同时抽取外周肝素抗凝静脉血2mL。提取的淋巴细胞经CD3 FITC、CD4 PE、CD8 PerCP染色后行流式测定。其中，胃黏膜T淋巴细胞亚群的检测以CD3设门。结果(1)胃黏膜CD+3(%)细胞的检出率分别为：H.pylori-CSG组3.14±2.03,H.pylori+CSG组4.58±2.30,H.pylori+DU组为6.49±4.49；(2)胃黏膜CD+3细胞中CD+4(%),CD+8(%)的相对比例及CD+4/CD+8值分别为：H.pylori-CSG组为19.81±9.25,47.30±12.83,0.43±0.19，H.pylori+CSG组为40.66±12.52,29.25±8.58,1.42±0.31,H.pylori+DU组为31.98±14.02,49.52±19.00，0.72±0.43。H.pylori+CSG组局部胃窦黏膜CD+4细胞、CD+4/CD+8比值明显高于H.pylori-CSG组，CD+8细胞则低于H.pylori-CSG组(P<0.01)。H.pylori+DU组CD+4、CD+4/CD+8比值也高于H.pylori-CSG组(P<0.05)，但CD+8细胞无统计学差异。H.pylori+DU组CD+8细胞高于H.pylori+CSG组而CD+4细胞无统计学差异，CD+4/CD+8比值则低于H.pylori+CSG组(P<0.01)。(3)外周血T淋巴细胞亚群的变化在三组之间并无明显的差异。结论H.pylori+DU与H.pylori+CSG的宿主的T淋巴细胞反应并不相同，而局部胃窦黏膜的T淋巴细胞亚群的异常可能在儿童H.pylori感染的免疫致病机制中起一定的作用。     

广州地区2~12岁儿童胃幽门螺杆菌感染状况分析

目的探讨广州地区2~12岁儿童胃幽门螺杆菌(H·pylori)感染的临床及病理学特点。 方法对广州地区2~12岁具有消化道症状的儿童1186例进行胃镜检查，取胃窦部黏膜进行快速尿素酶试验，用ELISA检测血清H·pylori抗体，并对其中528例同时取胃黏膜进行病理组织学检查。 结果胃镜检查为胃十二指肠疾病者1010例，阳性率为85.2%(1010/1186)；发现幽门螺杆菌感染301例，阳性率25.38%，各年龄组幽门螺杆菌的检出率为2~3岁14.38%(21/146),4~5岁为19.31%(39/202)，6~7岁为24.01%(67/279)，8~9岁为28.87%(82/284)，10~12岁为33.45%(92/275)；组织学改变为胃黏膜上皮变性，腺体上皮脱落坏死，发生坏死的腺体有淋巴细胞的广泛浸润及聚集灶，感染严重的病例可找到生发中心的淋巴小结。在变性的黏膜表面与坏死的腺体内可找到幽门螺杆菌。 结论H·pylori感染在广州地区2~12岁有消化道症状的儿童中并不少见，并随年龄的增加有上升趋势。H·pylori感染的病理改变全部为慢性炎症表现，炎症程度重，表现为胃黏膜上皮细胞和腺体的变性坏死，固有层淋巴细胞浸润，多形白细胞浸润较少。     

儿童幽门螺杆菌空泡毒素基因的研究

目的探讨儿童幽门螺杆菌vacA基因型并分析各基因亚型与胃十二指肠疾病的关系。 方法对80例H·pylori感染的儿童，采用PCR法扩增胃黏膜vacA基因亚型。 结果南宁儿童H·pylorivacA基因型有s1a/m1和s1a/m2两种组合，基因频率分别为3.75%、66.25%。vacA基因各亚型在慢性浅表性胃炎及消化性溃疡中的检出率差异无显著性(P>0.05)。 结论s1a/m2为南宁地区儿童幽门螺杆菌的vacA优势基因型。部分患儿同时感染多株不同vacA基因型H·pylori。vacA基因各亚型不能作为南宁地区儿童H·pylori菌株毒力强弱的指标。     

中西医结合根治慢性胃炎儿童幽门螺杆菌感染60例疗效观察

目的 观察根治慢性胃炎儿童幽门螺杆菌（HP）感染的有效方法。方法 对120例HP阳性的慢性胃炎及消化性溃疡患儿随机分为对照组和观察组各60例。对照组采用四联疗法（阿莫西林＋克拉霉素＋胶体次枸橼酸铋＋奥美拉唑）1周,观察组在对照组治疗基础上,服用半夏泻心汤加减2周。两组均服用培菲康,4周后进行检测。结果 观察组根治率为95.0％（57/60）,高于对照组83.3％（50/60）,差异有统计学意义（P＜0.05）;观察组发生副反应7例,对照组6例,两组比较差异无统计学意义（P＞0.05）。结论 中西医结合治疗HP感染具有根除率高,无显著副反应的优点,值得推广应用。     

妊娠剧吐与幽门螺杆菌感染的相关性研究

妊娠剧吐至今病因不明 ,一般认为与孕期血中绒毛膜促性腺激素 (ｈＣＧ)及雌激素水平升高有关。妊娠剧吐多见于年轻的初孕妇[1] 。本研究通过血清学试验检测患者的幽门螺杆菌 (Ｈｐ)感染状况 ,初步探讨Ｈｐ感染与妊娠剧吐的相关性。一、资料与方法1.资料来源与分组 :研究组 :1998年 7月～ 1999年 10月在武汉大学人民医院、武汉军工总医院以及铁道部大桥局中心医院门诊诊断为妊娠剧吐的孕妇共 72例 (年龄 2 3～ 35岁 ) ,诊断标准参考文献 [1]。对照组 :为同期常规产前检查 ,年龄及孕周相近的正常孕妇 10 0例。2 .方法 :第 1次就诊时 ,抽取肘静…     

Efficient and non-invasive method for investigating Helicobacter pylori in gravida with hyperemesis gravidarum: Helicobacter pylori stool antigen test

AIM: To investigate the relationship between Helicobacter pylori infection and severe hyperemesis gravidarum (H.Gravidarum) by using Helicobacter pylori Stool Antigen (HpSA) and other serologic test results. METHODS: Twenty-seven pregnant women with H.Gravidarum and 97 asymptomatic pregnant women of matching gestational age without gastric problems were enrolled in a prospective study. Serum samples collected from cases were investigated in terms of specific antibodies for H. pylori (immunoglobulin-IgG, IgA) and feces samples were investigated for HpSA. Statistical analysis of the data obtained from the groups was made by appropriate chi2 tests. RESULTS: Rate of HpSA positivity in patients with H.Gravidarum was 40.7%, while the same rate was 12.4% in the control group. The difference between the two groups was significant (P = 0.001). Rates of positivity for specific IgG formed against H. pylori in gravida with H.Gravidarum and in the asymptomatic gravida were 85.2% and 73.2%, respectively, and the rates for IgA were 48.1% and 41.2%, respectively. There was no difference between groups in terms of specific Igs formed against H. pylori (P > 0.05). CONCLUSION: The HpSA scan showed a statistically significant relation between H. pylori infection and H.Gravidarum. HpSA test gives more efficient, reliable and realistic results than specific Igs formed against H. pylori in the identification of H. pylori positivity in gravida with H.Gravidarum.     

Helicobacter pylori and thrombocytopenia in the pregnant hispanic population

Objective: An association between Helicobacter pylori (H. pylori) and thrombocytopenia has been demonstrated in the literature in a non-pregnant population. The purpose of this study was to determine whether or not there is a similar association in the third trimester of pregnancy in a Hispanic population. Methods: This is a secondary analysis of 82 pregnant Hispanic women with and without hyperemesis gravidarum who underwent serologic evaluation for H. pylori IgG. Results of complete blood counts obtained in the third trimester were analysed for thrombocytopenia. Results: Of the 82 subjects who had H. pylori testing, 54 subjects had both serum H. pylori IgG results and third trimester platelet levels. The prevalence of thrombocytopenia was 11.1% (6/54). Thirty-six subjects were seropositive for H. pylori IgG and 18 subjects were seronegative. Of the 36 subjects who were H. pylori seropositive, four (11.1%) developed thrombocytopenia compared to three of 18 (16.7%) H. pylori seronegative subjects (P = 0.67). There was no difference between the groups in their mean platelet values (205 K/cu mm vs. 212 K/cu mm, P = 0.69). Conclusions: In this limited study, we found no association between H. pylori and thrombocytopenia in the pregnant Hispanic population.     

Helicobacter pylori infection and risk of preeclampsia: a systematic review and meta-analysis

Objective: Helicobacter pylori is associated with many pregnancy adverse effects such as preeclampsia (PE). We performed this systematic review and meta-analysis study to assess the possible association between H. pylori infection and PE and this is the first meta-analysis to clarify this issue.

Methods: PubMed, ISI (Web of Science), SCOPUS, and Google Scholar databases were searched (up to April 2017) to identify the relevant studies. The Meta-analysis of Observational Studies in Epidemiology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines were used to do this study. Pooled odds ratio (OR) and 95% confidence intervals (CI) were estimated using a random-effects meta-analysis model. Heterogeneity was assessed with the χ²-based Q-test and I² statistic.

Results: A total of eight studies including 889 participants (460 preeclamptic women and 429 controls) met the eligibility criteria. A positive association was found between H. pylori infection and PE (OR: 3.35; 95% CI: 2.21–5.10). Heterogeneity was acceptable (χ²?=?13.39; I²?=?47.7, 95% CI: 0–77). In subgroup analysis, cytotoxin-associated antigen A seropositivity was a substantial risk factor for PE when immunoblotting methods (OR: 11.12; 95% CI: 5.34–23.16; χ²?=?6.42; I²?=?53.3, 95% CI: 0–85) were used, whereas it was not potential risk factor for PE when ELISA was used as a detecting method (OR: 1.11; 95% CI: 0.6–2.06; χ²?=?1.83; I²?=?0, 95% CI: 0–90).

Conclusions: This study indicated that women with H. pylori infection, especially those infected with Cag A positive strains are more likely to have PE compared with the uninfected women.     

Endoscopy in hyperemesis gravidarum and Helicobacter pylori infection.

OBJECTIVES: To establish a relationship between hyperemesis gravidarum (HG) and Helicobacter pylori (H. Pylori) infection by histologic testing. METHODS: Twenty patients with severe HG (Group I) and 10 volunteer pregnant women without gastric complaints (Group II) were included in the study. Endoscopic evaluations were done in both groups and biopsies were obtained from the antrum and corpus for the histopathologic diagnosis of H. pylori. The groups were compared with the chi(2)-test and Fisher's exact test where appropriate. RESULTS: H. pylori was diagnosed in 19 (95%) of 20 patients in Group I and 5 (50%) of 10 patients in group II. H. pylori densities in the antrum and corpus were higher in Group I and the differences between the two groups were statistically significant. The biopsy specimens revealed significant inflammation and H. pylori activation processes in patients with HG, and in 18 of 19 patients inflammation scores were greater than +2 on the scale. Pangastritis was demonstrated by endoscopic examination in 17 of 20 patients with HG. Enterogastric reflux was also diagnosed in 10 patients. In the control group, three patients had antral gastritis. CONCLUSIONS: We suggest that in patients with intractable nausea and vomiting during pregnancy, pangastritis and enterogastric reflux are the main endoscopic findings and that these findings are closely associated with H. pylori infection, which can be diagnosed histologically. The degree of gastric complaints may be associated with the density of H. pylori infection.     

Association of Vac A- and Cag A-specific Helicobacter pylori strain infection with spontaneous preterm birth

Purpose: To better understand the correlation between Helicobacter pylori (H. pylori) seropositivity and spontaneous preterm birth.

Materials and methods: A total of 320 pregnant women were classified into two groups: normal control singleton pregnant group (n?=?264) and singleton spontaneous preterm birth group (n?=?56). Blood samples were collected at the time of delivery, and the H. pylori IgG, various virulence factors and systemic inflammation status were compared between the two groups.

Results: Between the two groups, the serum H. pylori IgG, Cytotoxin-associated agntigen A (Cag A), Vacuolating cytotoxin A (Vac A) significantly increased in spontaneous preterm birth group than in the control group. Also, in preterm group, highly sensitive C-reactive protein (hsCRP) as a systemic inflammatory marker is statistically elevated at inflammatory status range. Whereas in the term pregnant group, hsCRP was normal range even though high incidence of H. pylori IgG seropositivity. Also, in the seropositive group, hsCRP is statistically correlated with H. pylori IgG, Cag A and Vac A.

Conclusions: There is an association between the presence of antibodies against H. pylori in maternal serum and the development of preterm birth. Furthermore, serology type of H. pylori with Vac A, Cag A relates to preterm birth even though high H. pylori prevalence rate.