幽门螺旋杆菌感染的胃外表现

目的研究幽门螺旋杆菌感染的胃外表现。方法７４例患者均行胃镜检查和Ｈｐ诊断实验,Ｈｐ感染由胃粘膜组织病理（Ｇｉｅｍｓａ染色）和组织ＰＣＲ共同确定,ＣａｇＡ表达由ＰＣＲ法测定。观察数据包括全血细胞计数、肝功能、肾功能等生化指标检测。结果７４例病人中,５２例（７０．３％）确定有Ｈｐ感染,其中３１例（４１．８％）表现为ＣａｇＡ阳性。相对于Ｈｐ阴性组,Ｈｐ阳性组患者外周血中白细胞总数和中性粒细胞计数明显升高,有显著性差异（６．４９±０．３ＶＳ５．０８±０．３,Ｐ＜０．０１;３．９２±０．２ＶＳ２．８７±０．１,Ｐ＜０．０１）。ＣａｇＡ阳性组血清ＡＳＴ水平明显高于ＣａｇＡ阴性组,差别有显著性（２８．２６±１．４ＶＳ１９．７５±０．９,Ｐ＜０．０１）。结论本研究证实Ｈｐ感染与外周血白细胞总数和中性粒细胞数的异常有关,ＣａｇＡ阳性则与血清ＡＳＴ水平的升高有关。     

~(14)C一尿素呼吸试验半定量诊断幽门螺杆菌感染

评价简化、微量的１４Ｃ一尿素呼吸试验（１４Ｃ－ＵＢＴ）对幽门螺杆菌（Ｈｐ）感染的半定量诊断价值。方法进入本实验者共１４０人次。患者空腹钦下３７ｋＢｑ１４Ｃ一尿素,于饮用前及３０ｍｉｎ后各采集１次呼吸标本（ｌｍｍｏｌＣＯ２）,测定１４Ｃ一活性。以３０ｍｉｎ计数／本底计数≥３为Ｈｐ阳性。每个病人另作组织学检查及快速尿素酶试验（ＲＵＴ）作为Ｈｐ诊断金标准：两项同时阳性为Ｈｐ阳性,同时阴性为Ｈｐ阴性。结果ＵＢＴ敏感性９２．６％,特异性９０．４％,ＵＢＴ与组织学一致性为８７．９％（ｋ值：０．７５）,与ＲＵＴ一致性为９１．４％（ｋ值：０．８１）。另外,１４Ｃ—ＵＢＴ值与组织学Ｈｐ密度分级是正相关（ｒ＝０．７４３３,Ｐ＜０．００１）。结论简化、微量的１４Ｃ—ＵＢＴ对Ｈｐ具有很高的诊断价值,并有可能对其进行半定量诊断。     

不同年龄、Hp感染状态的胃病患者胃镜检查的适应证

进一步探讨慢性胃病患者胃镜检查的适应证。方法：经胃镜病理证实的４５００例一胃病患者分为〈４５岁和≥４５岁两组，在此基础上进一步分为Ｈｐ阳性及Ｈｐ阴性组，比较同一年龄组不同Ｈｐ感染状态及不同年龄组间检查的结果，并对〈４５岁、Ｈｐ阴性的消化性溃疡（ＰＵ）易患因素作进一步分析。结果：〈４５岁ＰＵ的Ｈｐ阳性率高：十二３指肠球部溃疡（ＤＵ）９４．２％，国溃疡（ＧＵ）８６．４％，而≥４５岁Ｈｐ阴性的ＰＵ发生率升高（ＤＵ２２．７％，ＧＵ３３．３％）。〈４５岁组胃癌发生率显著低于≥４５岁组（Ｐ〈０．０１），且在≥４５岁级胃癌患者Ｈｐ多为阴性（６８．４％）。病理检查结果表明，〉４５岁组慢性萎缩性胃炎、肠上皮化生及异型增生的发生率及病程度显著低于≥４５岁组（Ｐ〈０．０５，Ｐ〈０．０１），且在≥４５岁组上述病变在Ｈｐ阴性组多见。另外     

胃粘膜病变患者幽门螺杆菌感染与癌基因表达的关系 (附121例资料分析)

目的：探讨幽门螺杆菌（Ｈｐ）感染与ｒａｓ原癌基因产物ｐ２１（ｒａｓｐ２１）蛋白和ｐ５３癌基因产物突变型ｐ５３蛋白表达的关系。方法：应用免疫组织化学方法，检测慢性浅表性胃炎（ＣＳＧ）３０例、胃粘膜不全结肠型肠化生（ＩＣＭ）２５例、异型增生２９例、胃癌３７例的活检标本。结果：ＩＣＭ组、异型增生组和胃癌组的Ｈｐ感染率均明显高于ＣＳＧ组（Ｐ＜０．０５）。ｒａｓｐ２１及突变型ｐ５３蛋白的阳性表达率在ＣＳＧ组均为０，而在异型增生组和ＩＣＭ组的表达均明显低于胃癌组（４５％和３８％、３２％和３２％对６０％和７０％），Ｐ＜０．０５，Ｐ＜０．０１；其中胃癌、异型增生及ＩＣＭ组中的Ｈｐ阳性组的ｒａｓｐ２１及突变型ｐ５３蛋白表达阳性率均明显高于Ｈｐ阴性组（Ｐ＜０．０５或Ｐ＜０．０１）。经根除Ｈｐ治疗后，Ｈｐ根除者的ｒａｓｐ２１及突变型ｐ５３蛋白表达由阳性转为阴性的例数比Ｈｐ未根除者多（Ｐ＜０．０５，Ｐ＜０．０１）。结论：Ｈｐ感染可能参与了ｒａｓ癌基因的激活和ｐ５３抑癌基因的突变，这可能是其致癌机制之一。     

斑点－酶联免疫吸附法检测幽门螺杆菌抗体IgG及其临床意义

以幽门螺杆菌（Ｈｅｌｉｃｏｂａｃｔｅｒｐｙｌｏｒｉ，ＨＰ）超声粉碎物作包被抗原，以硝酸纤维素膜为载体，借助于酶标ＳＰＡ建立了检测ＨＰＩｇＧ抗体的斑点－酶联免疫吸附试验（Ｄｏｔ－ＥＬＩＳＡ）。并用此法对１８例慢性胃炎、消化性溃疡患者（患者组），１９例儿童（儿童组）和２２例正常成人（成人组）进行了血清中ＨＰＩｇＧ抗体的测定。结果显示，患者组抗体检出率为７２．２％，与快速尿素酶法相比，符合率为８３．３％，诊断敏感性为９１．７％，特异性为６６．７％。不同人群抗体阳性率以患者组最高，成人组次之，儿童组最低。本法可用于临床ＨＰ感染的初筛检查及人群的流行病学调查。     

幽门螺杆菌空泡毒作用及空泡毒中和试验

目的探讨幽门螺杆菌（ｈｅｌｉｃｏｂａｃｔｅｒｐｙｌｏｒｉ，Ｈｐ）的空泡毒作用及其与疾病的关系。方法用细胞培养观察Ｈｐ的空泡毒作用。结果６９．３５％（４３／６２株）的Ｈｐ空泡毒作用阳性，其空泡毒作用能被相应患者血清中和。７８．２６％（３６／４６例）的消化性溃疡患者，感染的是空泡毒作用阳性的Ｈｐ＋（Ｔｏｘｉｎ＋），而只有４２．８６％（６／１４例）胃炎患者感染的是Ｈｐ＋，两者Ｈｐ＋感染率差异有显著性（χ２＝４．８３，Ｐ＜０．０５）。结论Ｈｐ＋感染与消化性溃疡密切相关，其在体内也有空泡毒作用并产生相应抗体。     

Graves'病突眼患者血清抗眼肌抗体的观察

目的探讨抗眼肌抗体对Ｇｒａｖｅｓ＇病突眼的诊断价值。方法用牛眼肌细胞膜蛋白为抗原，建立酶联免疫吸附试验（ＥＬＩＳＡ）检测４８例健康对照和７４例Ｇｒａｖｅｓ＇病突眼患者血清中抗眼肌抗体。结果Ｇｒａｖｅｓ＇病突眼患者血清中抗眼肌抗体的阳性率为６８．９％（５１／７４），对照组抗眼肌抗体阳性率为２．１％（１／４８），两组之间有显著性差异（Ｐ＜０．０１）。本法批内误差变异系数（ＣＶ）为５．８％～９．６％，批间误差ＣＶ为７．３％～１０．８％。结论抗眼肌抗体的检测有助于Ｇｒａｖｅｓ＇病突眼的诊断。     

抗DNA酶B在风湿热诊断中的应用

目的评估Ａ组溶血性链球菌感染的血清学测定方法对诊断风湿热的临床价值。方法采用抗ＤＮＡ酶Ｂ微量法和自制试剂测定急性风湿热８７例、活动期风湿性心脏病２０２例病人血清的抗ＤＮＡ酶Ｂ抗体,与抗溶血素Ｏ抗体（ＡＳＯ）对照研究。结果在急性风湿热组,抗ＤＮＡ酶Ｂ阳性占７２４％,和ＡＳＯ测定阳性６７８％比较,差异无显著意义（Ｐ＞００５）;在活动期风湿性心脏病组,抗ＤＮＡ酶Ｂ阳性占８３７％,明显超过ＡＳＯ的４７０％阳性,其差异有非常显著意义（Ｐ＜０００１）。抗ＤＮＡ酶Ｂ试验结合ＡＳＯ测定,在急性风湿热组和活动期风湿性心脏病组的阳性例数分别占９０８％和８８６％。结论抗ＤＮＡ酶Ｂ试验对急性风湿热和风湿性心脏病活动期的诊断有重要临床价值,与ＡＳＯ结合检测可提高诊断率。     

幽门螺杆菌与非甾体消炎药相关消化性溃疡的临床研究——附69例报告

目的： 研究幽门螺杆菌（Ｈｐ） 根除对长期服用非甾体消炎药（ＮＳＡＩＤ） 的消化性溃疡愈合和复发的影响。方法：将６９ 例长期服用ＮＳＡＩＤ的消化性溃疡患者分为Ｈｐ 阳性雷尼替丁组２５ 例,Ｈｐ 阳性雷尼替丁加阿莫西林组２３ 例, Ｈｐ 阴性雷尼替丁组２１例, 三组的用药时间均为６周。结果： 三组溃疡愈合率依次为６４％ 、７４％ 、７１％（Ｐ＞ ０．０５）。追踪溃疡愈合者４３ 例, 并分为Ｈｐ 根除组１３ 例, Ｈｐ 持续阳性组１６ 例, Ｈｐ 持续阴性组１４ 例。均停用抗溃疡药物, 继续服用ＮＳＡＩＤ６ 个月后复查。累计溃疡复发率三组分别为３１％ 、４４％ 、２９％ （Ｐ＞ ０．０５）。结论： 根除Ｈｐ 不能提高ＮＳＡＩＤ相关消化性溃疡的愈合率, 亦不能降低其复发率, 且Ｈｐ 持续阳性者其溃疡复发率有升高趋势     

末梢血抗HP IgG检测方法的建立

末梢血抗ＨＰＩｇＧ检测方法的建立王琳，路又可，王年吉（南京军区南京总医院消化科２１０００２）目的：现已公认，血清抗ＨＰＩｇＧ的测定，有助于胃、十二指肠疾病的病因学诊断和ＨＰ感染的流行病学调查。为了更加方便于流行病学研究，方便于随访观察门诊患者抗ＨＰＩ...     

Detection and evaluation of salivary antibodies to Helicobacter pylori in dyspeptic patients

Helicobacter pylori infection is one of the most prevalent infections in humans. The high prevalence and the association with peptic ulceration and gastric cancer require simple and non-invasive methods for the diagnosis of the infection. Detection of salivary anti-H. pylori IgG antibodies has advantages compared with those on serum. In this study, salivary immunoglobulin G response to H. pylori was evaluated in 100 consecutive dyspeptic patients by enzyme-linked immunosorbent assay (ELISA), in comparison with culture and histopathologic examination of gastric biopsy specimens obtained at endoscopic procedures and assessed the accuracy of salivary diagnosis of the infection. The overall sensitivity and specificity of the test were 87 and 73%, respectively. These results suggest that saliva testing for H. pylori antibodies could be used reliably for screening dyspeptic patients in general practice, especially in children in whom venesection is more difficult.     

乙肝相关性肝病患者幽门螺杆菌感染的研究

目的研究慢性乙型肝炎(乙肝)、乙肝肝硬化、乙肝后肝癌等肝病患者幽门螺杆菌(Hp)感染情况。方法收集慢性乙肝、乙肝肝硬化、乙肝后肝癌等肝脏疾病患者273例,日期正常体检人群60例,采用免疫层析法检测患者血清中抗Hp抗体(Hp-IgG),定量PCR检测HBV DNA。结果乙肝相关性肝病患者Hp感染率73.3%,正常体检人群为40.0%,2组比较差异有统计学意义(P<0.01);慢性乙肝、乙肝肝硬化、乙肝后肝癌3组患者Hp感染率分别为62.7%、77.0%、79.7%,后二者Hp明显高于慢性乙肝患者(P<0.05);按病毒载量分级,HBV DNA阴性组Hp感染率低于HBV DNA阳性组,而阳性组按低、中、高分组,各组间Hp感染率分别为69.4%、65.0%、66.1%(P>0.05);乙肝肝硬化患者按Child-push分级后,A、B、C各级之间的Hp感染率分别为51.9%、63.4%、65.6%(P>0.05)。结论 Hp感染可能参与乙肝肝病患者肝脏损伤,显示Hp具有肝细胞毒性作用;肝硬化、肝癌感染率高于慢性乙型肝炎,提示Hp感染与慢性肝病疾病进展和肝癌的发生有一定相关性。     

胆汁反流性胃炎、反流性食管炎与幽朗螺杆菌的关系探讨

目的：探讨幽门螺杆菌(Hp)与胆汁反流性胃炎(BRG)、反流性食管炎(RE)的关系。方法：对192例病人作胃镜检查，并对胃或食管粘膜分别作快速尿素酶试验和病理学妇科白带涂片快速染色法(CTB)，进行分级。结果：BRG患者的Hp感染率为88．88％(96／108)，RE患者的Hp感染率为35．71％(30／84)，BRG组Hp感染率明显高于RE组，差别有显著意义；BRG患者CTB分级较RE高，差别有显著意义。Hp阳性RE患者胃镜分级、病理程度与Hp阴性组比较，差别无显著意义。结论：胆汁反流性胃炎与幽门螺杆菌感染有密切关系，而反流性食管炎与幽门螺杆菌的关系不确定。     

不同疗程四联疗法根除幽门螺杆菌的疗效观察

目的 研究泮托拉唑短程四联4、5、7d疗法根除幽门螺杆菌(Hp)的疗效.方法166例经胃镜证实Hp阳性的重度胃炎患者随机分为泮托拉唑四联疗法4 d组、5 d组和7 d组,均给予泮托拉唑40mg+枸橼酸铋钾220 nag+克拉霉素250 mg+阿莫西林1 g,每日2次治疗,泮托拉唑疗程1周,枸橼酸铋钾疗程2周,克拉霉素、阿莫西林疗程在3组分别为4、5和7 d.疗程结束4周后复查Hp,观察Hp根除率、症状缓解率及不良反应等.结果泮托拉唑四联疗法4、5和7d组Hp根除率分别为73.8%(45/61)、75.9%(41/54)和80.4%(41/51);疼痛缓解率分别为82.4%(42/51)、85.1%(40/47)和88.9%(40/45),各组之间比较差异均无统计学意义(均P>0.05).结论泮托拉唑四联短程疗法(4或5 d)为安全、有效、符合药物经济学要求的根除Hp的方案.     

Long-term endoscopic follow-up for peptic ulcer patients after eradication of H. pylori; comparison with the maintainance therapy by H2-blocker

This study was aimed to clarify the endoscopic findings and the decline of serum IgG titer after successful eradication of H. pylori in long-term (from 2 to 7 years). Forty-six H. pylori-positive peptic ulcer (22 GU and 26 DU) cases were eradicated with antimicrobial therapy. Sixty-nine non-eradicated DU cases who received maintainance therapy with H2-blocker were control group. Biopsy urease test (BUT) and culturing was performed to diagnose the H. pylori infection. Anti-H. pylori IgG titer (EIA) were also measured in some cases, pre and 6, 12, 24 months after the eradication. In 3 cases, H. pylori were recrudescent and only in a case, DU recurred during 5 years after eradication. Meanwhile, in 55% of control cases, DU were recurred during same periods. In 62% of eradicated cases, serum IgG-antibody to H. pylori declined below the cut-off level during 2 years after eradication. It was certified that eradication therapy against H. pylori prevents ulcer recurrence for long time, and re-rise of serum IgG titer to H. pylori might predict a recrudescence of infection.     

血清抗幽门螺杆菌IgG抗体、胃蛋白酶原水平与胃癌发病的相关性分析

目的研究长春地区人群血清抗幽门螺杆菌(Helicobacter pylori,Hp)IgG抗体、胃蛋白酶原水平和胃癌发病的相关性,为胃癌的防治研究提供依据和流行病学资料。方法选择2008年10月至2011年2月吉林大学第一医院明确诊断的450例原发性胃癌患者作为病例组,选择同时期体检中心1072例健康体检者作为对照组。采用酶联免疫吸附(ELISA)法检测血清中Hp IgG抗体、胃蛋白酶原Ⅰ(PGI)和Ⅱ(PGII)的水平,确定Hp菌感染和萎缩性胃炎的发生状况。以PGI≤82.3μg/L,同时PGI/PGII≤6.05作为萎缩性胃炎的诊断标准。结果胃癌组与对照组相比,Hp感染阳性率明显增高(69.1%vs.52.4%,χ2=36.1,P<0.001)。胃癌组中血清PGI水平与对照组比较无显著差异(93.2vs.88.9μg/L,P<0.001),而PGII浓度显著升高(15.9vs.11.3μg/L,P<0.001),同时PGI/PGII比值明显降低(5.4vs.7.8,P<0.001)。胃癌组中患萎缩性胃炎的比例明显高于对照组(31.4%vs.10.4%,P<0.001)。多因素回归分析显示:在调整年龄和性别因素后,Hp感染和萎缩性胃炎均为胃癌发病的独立危险因素。结论本研究对象人群中Hp感染率,尤其是青年胃癌患者中Hp感染率仍然较高,Hp感染和萎缩性胃炎是胃癌发病的危险因素。与PGI相比,血清PGII浓度和PGI/PGII比值可能成为胃癌筛选的潜在血清学标志物。     

Association of CagA-positive infection with Helicobacter pylori antibodies of IgA class

cagA gene, the best known virulence factor of Helicobacter pylori, codes for an immunodominant CagA protein. In this study, CagA antibodies of the IgG class were measured by immunoblot or enzyme immunoassay in subjects with positive H. pylori serology, and the presence of CagA antibodies was compared with that of H. pylori antibodies of IgA and IgG classes. Serum samples were available for a total of 1,481 subjects, including gastroscopied patients with biopsy-verified H. pylori infection, smoking men with a normal or low serum pepsinogen I level indicating atrophic corpus gastritis, and subjects who later developed gastric cancer and their matched controls. CagA antibodies were significantly more prevalent among individuals with elevated H. pylori antibody titres of the IgA class than in those with IgG antibodies only, with the exception of a small subgroup of individuals who later developed gastric cancer. CagA-positive H. pylori strains seem to induce an immune response with a markedly higher frequency of IgA than what is found in inflammation caused by CagA-negative strains. The presence of serum IgA antibodies to H. pylori seems to indicate a higher risk for CagA-positive H. pylori infection and possibly more severe late sequelae of the disease.     

左氧氟沙星、雷贝拉唑和呋喃唑酮三联方案治疗幽门螺杆菌

目的：观察雷贝拉唑联合左氧氟沙星、呋喃唑酮根除幽门螺杆菌（Hp）的临床疗效。方法：选择胃镜检查Hp阳性的慢性胃炎及消化性溃疡患者86例,随机分成治疗组和对照组。治疗组给予雷贝拉唑肠溶片10mg,均为2次.d-1;左氧氟沙星0.2g,每天2次;呋喃唑酮0.1g,每天2次,疗程1周;对照组给雷贝拉唑10mg,阿莫西林1.0g,甲硝唑0.4g,均为2次.d-1,疗程1周。疗程结束4周后复查Hp,根除率治疗组为84.8%,对照组为75.0%,两者有显著差异。结论：雷贝拉唑联合左氧氟沙星及呋喃唑酮三联根治幽门螺杆菌具有疗效好、不良反应小、价格便宜的特点,可作为根除幽门螺杆菌的治疗方案之一,值得推广。     

Association between Helicobacter pylori cytotoxic type I CagA-positive strains and migraine with aura

Recent studies have suggested an association between Helicobacter pylori infection and migraine. However, various strains of the bacterium are present, some endowed with greater pathogenicity. In particular, H. pylori type I CagA-positive strains induce a higher release of proinflammatory substances by the gastric mucosa that could trigger systemic vasospasms. The aim of the present study was to assess the prevalence of H. pylori CagA-positive strains in subjects with migraine. One hundred and seventy-five patients affected by migraine (49 with aura, 126 without aura) were consecutively enrolled and matched for sex, age, social background and geographical origin with 152 controls. Helicobacter pylori infection was assessed through 13C-urea breath test. Specific serological IgG against CagA were detected through ELISA. The prevalence of H. pylori infection was similar in migraine patients and in controls (40% vs. 39%, respectively). Among migraine patients, prevalence of infection was not related to presence or absence of aura (45% vs. 37%, respectively). However, among infected subjects, a significantly higher prevalence of CagA-positive strains was observed in patients affected by migraine with aura when compared with those affected by migraine without aura (41% vs. 19%, P < 0.01) and with controls (41% vs. 17%, P < 0.01). CagA-positive H. pylori strains were found to be strongly associated with migraine with aura. A higher inflammatory response of the gastric mucosa to more virulent strains could release substances that may act as triggers of vasospasm in peculiar cerebral arterial districts, probably implicated in the 'aura' phenomenon.     

兰索拉唑与雷尼替丁联用抗生素治疗幽门螺杆菌阳性十二指肠溃疡的疗效对比

目的：比较兰索拉唑与雷尼替丁联用抗生素治疗幽门螺杆菌（Helicobacter pylori,Hp)阳性十二指肠溃疡的疗效。方法：将经内窥镜证实的105例Hp阳性十二指肠溃疡患者随机分为两组，分别给予口服兰索拉唑和雷尼替丁（均联用抗生素）治疗。于停药后1个月。于停药后1个月、1年复查内窥镜及Hp检测，并作随访观察1年。结果：治疗组与对照组对十二指肠溃疡的愈合率分别为94．44％和74．51％，好转率分别为5．56％和25．49％。Hp根除率分别为90．74％和56．86％（P＜0．01）。随访1年后，治疗组的十二指肠溃疡复发率为3．70％，对照组复发率为21．57％，根除Hp者中溃疡复发率为2．56％，未根除Hp者中溃疡复发率为30．30％（P＜0.01)。结论：兰索拉唑对Hp阳性十二指肠溃疡的Hp根除和溃疡愈合有较高的成功率。