中国幽门螺杆菌感染治疗的集成分析

目的：对中国５年根除ＨＰ治疗方案进行集成分析。方法：检索,逐刊查阅５年中文核心期刊及胃肠病学专业杂志。合并相同方案,对超过所有ＨＰ根除方案平均根除率以上的独立方案进行根除率,副作用,疗程,费用效果的比较。     

老年患者根除幽门螺杆菌治疗失败的影响因素

<正>幽门螺杆菌(Hp)自发现至今已有30余年,全球人口感染率高达50%〔1〕,且有随年龄增长而升高的趋势,老年人组织器官衰老、血管硬化以及全身免疫功能衰退,致使胃黏膜上皮腺体萎缩、血供减少、对细菌清除率下降,导致Hp感染率高。Hp与消化性溃疡、慢性胃炎伴消化不良、胃黏膜相关淋巴样组织淋巴瘤、胃癌的发生及进展密切相关。由于诸多原因尤其是细菌菌株对抗菌药物的耐药性,Hp根除成功率逐年下降,现就老     

根除幽门螺杆菌感染56例临床疗效观察

幽门螺杆菌（Helieobacter pylori，Hp）感染是慢性胃炎的主要病因，是消化性溃疡和胃黏膜相关淋巴组织（MALT）淋巴瘤的重要病因，与胃癌、慢性活动性胃炎、 消化性溃疡密切相关。所以，根除Hp可以降低消化性溃疡、慢性胃炎、胃癌的危险性。现将胃溃疡、十二指肠溃疡、慢性胃炎合并Hp感染56例行药物根除治疗介绍如下。     

青霉素过敏患者的幽门螺杆菌根除治疗

正幽门螺杆菌(Helicobacter pylori,Hp)感染及其相关疾病是我国重要的卫生健康问题。由于耐药率逐年升高,Hp根除治疗面临着困难,对于青霉素过敏的患者,由于临床惟一常用且敏感的抗生素——阿莫西林无法使用,其治疗更是难上加难。《MaastrichtⅣ共识意见》和《第4次全国幽门螺杆菌感染处理共识报告》都对这类患者的治疗给出了     

老年幽门螺杆菌感染根除治疗进展

幽门螺杆菌(Helicobacter pylori, Hp)是Ⅰ类致癌因子。抗生素耐药率高、感染率高、耐受性低的特点限制着常规一线抗Hp治疗在老年人群中的应用。老年患者根除Hp可显著降低消化道肿瘤与消化道出血发生的风险,治疗获益确切。目前老年Hp根除的主要方案仍为铋剂四联疗法,加载益生菌或中药可提高根除率、减少不良反应。高剂量二联疗法以其不良反应风险小、疗效肯定的优势或可成为老年Hp根除治疗的另一理想方案。     

几种幽门螺杆菌感染根除治疗方案的疗效及其费用-效果分析

目的观察几种幽门螺旋杆菌（Hp）根除治疗方案的疗效及经济学意义。方法185例胃镜证实诊断的患者，经胃窦黏膜活检病理组织学及^14C-尿素呼气试验（^14C—UBT）均呈阳性者定为Hp感染，治疗停药4周后复查^14C—UBT，阴性则定为Hp根除；回顾性的把这些患者分为A、B、C、D、E、F六个治疗方案组，A组（n=49，奥美拉唑20mg＋阿莫西林1000mg＋甲硝唑400mg，bid，疗程7天），B组（n=31，奥美拉唑20mg＋阿莫西林1000mg＋克拉霉素500mg，bid，疗程7天），C组（n=61，奥美拉唑20mg＋阿莫西林1000mg＋甲硝唑400mg＋果胶铋300mg，hid，疗程7天），D组（n=14，奥美拉唑20mg＋阿莫西林1000mg＋呋喃唑酮100mg＋果胶铋300mg，bid，疗程7天），E组（n=20，阿莫西林1000mg＋甲硝唑400mg＋果胶铋300mg，bid，疗程14天）和F组（n=10，前5天奥美拉唑20mg＋阿莫西林1000mg，后5天奥美拉唑20mg＋克拉霉素500mg＋甲硝唑400mg，bid，疗程共10天）；并对各组的疗效以及费用-效果进行分析。结果各组间Hp根除率不全相同（P〈0．05），其中D、E二组根除率为100％，依次为C组91．8％、F组80．0％、A组79．6％和B组77．4％；费用一效果分析提示，A组费用虽少，但疗效较差，D、C和E组费用适中，根除率高，F组和B组费用最高，根除率最低。结论含果胶铋的Hp根除方案根除率高，D组为Hp根除治疗的最佳方案，E组、C组与D组疗效相仿，依次为A组，F组和B组。     

功能性消化不良与幽门螺杆菌根除治疗

幽门螺杆菌（H．pylori）阳性功能性消化不良（FD）或非溃疡性消化不良（NUD）患者几乎均有慢性和（或）急性活动性炎症的组织学改变，使FD与慢性胃炎的鉴别更为闲难．亦影响了FD患者根除H．pyZo一治疗的研究。罗马Ⅲ诊断标准是以症状学为主的诊断标准，FD仅发生于具有心理调节障碍的特殊易感群体，患者存在中枢神经系统的高敏感性、脑-肠轴调控功能异常以及某些神经介质和神经肽类物质分泌异常．并显示有遗传特征。根除Hpylori可能对部分H．pylori阳性FD患者有益，在仔细评估患者利益和风险的情况下．可考虑对FD患者行根除H．pylori治疗。     

幽门螺杆菌感染根除后复发的问题

幽门螺杆菌 (Hp)感染被根除后复发率为 0 %～ 4 0 % ,各家报告差异很大 ,复发率高则根除的价值受限。本文就影响复发的因素、复发的预防和治疗等进行综述。     

中国人幽门螺杆菌根除后重感染率的报告

对５４例幽门螺杆菌根除后患者进行１年以上追踪，定期于停药３，６，１２，１８，２４个月进行＾１４Ｃ－尿素呼吸试验检查。呼吸试验阳性者行胃镜复查取胃粘膜活检ＨＰ检测证实。结果发现ＨＰ感染于停药３个月４例，停药６个月１例，停药６个月之后无１例。     

Helicobacter pylori Treatment Strategies in Singapore

The management of Helicobacter pylori infection in Singapore remains a clinical challenge. Similar to other regions, there has been an increase in antibiotic resistance rates through the years. Nonetheless, over the past two decades, clarithromycin-based triple therapy has continued to be used as the first line treatment option, with an eradication rate exceeding 90%, although the accepted treatment duration must now be lengthened from 1 to 2 weeks to maintain efficacy. Concomitant and sequential therapies did not demonstrate superiority over standard triple therapy. Current empiric second line treatment utilizes either bismuth-based quadruple therapy or levofloxacin-based triple therapy, but outcomes remain less than ideal. Identifying options to further improve treatment success rates is challenging. Strategies being considered include the use of potent acid suppressants, such as vonoprazan, and H. pylori culture and antibiotic susceptibility testing-guided therapy.     

小鼠模型中蔓越莓汁防治幽门螺杆菌感染的实验研究

背景:根除幽门螺杆菌(H.pylori)感染有助于消化性溃疡和胃黏膜炎症的愈合,蔓越莓汁已被证实可预防尿路感染的复发。目的:探讨蔓越莓汁是否能根除或预防H.pylori感染。方法:治疗实验中,以H.pylori感染C57BL/6小鼠。感染后2周,80只小鼠随机分为4组,每组20只。A组:经口灌胃予蔓越莓汁(0.5 ml/只,1次/d)共30天;B组:三联疗法(阿莫西林50 mg/kg、枸橼酸铋6.15 mg/kg和甲硝唑22.5 mg/kg,1次/d)共14天;C组:蔓越莓汁加三联疗法:对照组:H.pylori感染后不予任何治疗。治疗实验结束后24 h和4周,各组分别处死10只小鼠,用快速尿素酶试验、细菌培养和组织病理学方法检测H.pylori感染情况。预防实验中,40只小鼠经口灌胃予蔓越莓汁(0.5 ml/只,1次/d)共25天,第26～30天时将小鼠随机分为4组,每组10只。在第26、28和30天,A组:不给予蔓越莓汁,而予H.pylori攻击3次;B组:先将H. pylori在蔓越莓汁中孵育30 min,然后再攻击小鼠;C组:给予蔓越莓汁后6 h予H. pylori攻击;对照组:不给予蔓越莓汁而仅予H. pylori攻击。在第27和29天,各组仍给予蔓越莓汁。预防实验结束后2周处死小鼠检测H. pylori感染情况。结果:治疗实验结束后24 h,A、B、C组的H. pylori清除率分别为80％、100％和90％,均显著高于对照组(P<0.01);治疗实验结束后4周,A组     

口服疫苗预防幽门螺杆菌感染的实验研究

目的：利用感染人类幽门螺杆菌（Ｈ．ｐｙｌｏｒｉ）的小鼠模型,研究Ｈ．ｐｙｌｏｒｉ粗制抗原与霍乱毒素（ＣＴ）或重组霍乱毒素Ｂ亚单位（ｒＣＴＢ）组成的口服疫苗预防ｈ．ｐｙｌｏｒｉ感染的作用。方法：无特殊病原菌级Ｃ５７ＢＬ／６小鼠分为４组,通过灌胃方法分别予各组小鼠以Ｈ．ｐｙｌｏｒｉ超声粉碎抗原１ｍｇ加ＣＴ１０μｇ、Ｈ．ｐｙｌｏｒｉ超声粉碎抗原１ｍｇ加ｒＣＴＢ１０μｇ、单纯Ｈ．ｐｙｌｏｒｉ超声粉碎抗原１     

幽门螺杆菌根除效果的影响因素分析

幽门螺杆菌(Helicobacter pylori,H.pylori)感染是最常见的细菌感染之一,影响着世界约50%的人口,被世界卫生组织定义为胃癌致病因子。H.pylori根除治疗可以降低消化性溃疡、胃癌等疾病的发病风险。目前H.pylori根除率呈逐渐下降的趋势。加深对其根除率影响因素的了解,可能有助于制定更为有效的根除治疗或预防感染的方案。本文结合国内外相关研究,对影响H.pylori根除率的因素作一概述。     

不同病变胃组织端粒酶活性及其与让螺杆菌感染的关系

分析不同病变胃粘膜端粒酶活性的差异及其与幽门螺杆菌（Ｈ．ｐｙｌｏｒｉ）感染的关系,探讨端粒酶活性、Ｈ．ｐｙｌｏｒｉ感染与胃粘膜癌变的关系。方法：应用端粒重复扩增法测定正常胃粘膜、癌前病变和胃癌组织中的端粒酶活性,用酶免疫法检测Ｈ．ｐｙｌｏｒｉ感染患者的血清Ｈ．ｐｙｌｏｒｉ－ＣａｇＡ－ＩｇＧ水平,并分析端粒酶活性与Ｈ．ｐｙｌｏｒｉ－ｃａｇＡ－ＩｇＧ水平的关系。结果：１７２例胃镜活检标本中,下沉胃粘膜     

Successful isolation of Helicobacter pylori after prolonged incubation from a patient with failed eradication therapy

Helicobacter pylori （H pylori）, a gastric pathogen, is a major cause of chronic gastritis and peptic ulcer disease, and is an important risk factor for the development of gastric malignancies. Culture of the bacterium from gastric biopsy is essential for the determination of drug resistance of Hpylori. However, the isolation rates of H pylorifrom infected individuals vary from 23.5% to 97% due to a number of factors such as biopsy preparation, cultural environment, medium and the method adopted. In the present case, we found that a prolonged incubation period of up to 19 d allowed successful isolation of H pylori from a patient who received triple therapy that failed to eradicate the bacterium.     

功能性消化不良是否需要根除幽门螺杆菌——支持的观点

幽门螺杆菌（H.pylori）阳性的功能性消化不良（FD）或非溃疡性消化不良（NUD）相当于有消化不良症状的慢性活动性胃炎，前者强调消化不良症状,后者则强调胃黏膜组织学改变。根除H.pylori可使部分患者的症状得到长期改善,胃黏膜活动性炎症消退，逆转或防止萎缩／肠化生的发展,预防胃癌和消化性溃疡，与其他治疗措施相比具有费用,疗效比优势。     

Evidence-Based Guidelines for the Treatment of Helicobacter pylori Infection in Korea 2020

Helicobacter pylori infection is one of the most common infectious diseases worldwide. Although the prevalence of H. pylori is gradually decreasing, approximately half of the world''s population still becomes infected with this disease. H. pylori is responsible for substantial gastrointestinal morbidity worldwide, with a high disease burden. It is the most common cause of gastric and duodenal ulcers and gastric cancer. Since the revision of the H. pylori clinical practice guidelines in 2013 in Korea, the eradication rate of H. pylori has gradually decreased with the use of a clarithromycin-based triple therapy for 7 days. According to a nationwide randomized controlled study conducted by the Korean College of Helicobacter and Upper Gastrointestinal Research released in 2018, the intention-to-treat eradication rate was only 63.9%, which was mostly due to increased antimicrobial resistance, especially from clarithromycin. The clinical practice guidelines for the treatment of H. pylori were updated according to evidence-based medicine from a meta-analysis conducted on a target group receiving the latest level of eradication therapy. The draft recommendations developed based on the meta-analysis were finalized after an expert consensus on three recommendations regarding the indication for treatment and eight recommendations for the treatment itself. These guidelines were designed to provide clinical evidence for the treatment (including primary care treatment) of H. pylori infection to patients, nurses, medical school students, policymakers, and clinicians. These may differ from current medical insurance standards and will be revised if more evidence emerges in the future.