幽门螺杆菌感染的临床与病理

目的了解有消化遗症状小儿的幽门螺杆菌（Hp）感染率,小儿感染Hp后的临床与病理变化,为防治小儿Hp感染提供科学依据。方法采用富士能电子胃镜检查,胃窦部取活检送病理组织学检查及Hp检测。结果上消化道疾病检出率97％,Hp检出率为48％,Hp感染随年龄平均每年递增3．99％,上消化道出血Hp检出率达73％,十二指肠溃疡、活动性胃炎Hp检出率分别为79％、87％。小儿Hp感染后胃粘膜病理变化相对比成人轻,Hp含量与胃粘膜病理变化、炎症程度呈正比。结论有消化遗症状小儿Hp感染率较高,并随年龄而递增,胃炎的病理炎症程度与胃内存在Hp量呈正相关,Hp感染是小儿慢性活动性胃炎的重要病因。     

儿童上消化道出血的临床、胃镜、病理与幽门螺杆菌检出分析

目的 通过对上消化道出血患儿的胃镜、病理活检、Hp检测,观察其病理变化以及与Hp感染的关系。方法 取103例儿童上消化道出血样本进行胃镜检查、病理诊断和Hp检测。结果 儿童上消化道出血以胃窦炎并十二指肠球溃疡最多见,其次为单纯性胃窦炎;病理检查以胃窦慢性浅表性胃明显高于胃粘膜慢性炎症;Hp检出率10a以上明显高于10a以下;病理炎症重组Hp检出率明显高于中、轻组。结论 儿童上消化道出血以胃窦炎并十二指肠溃疡为多见,病理改变以胃窦慢性胃炎为主要表现,Hp感染随年龄的增长而增加;胃窦炎症状越严重,Hp检出率越高。     

儿童幽门螺杆菌及CagA阳性幽门螺杆菌感染的流行病学调查

幽门螺杆菌(H.pylori)是小儿慢性胃炎、十二指肠炎及消化性溃疡的重要病因之一,小儿H.pylori的感染直接影响到成年期的身体健康。成人H.pylori相关性胃疾病的发生与儿童期H.pylori感染密切相关。许多学者认为,成人H.pylori感染率及消化道疾病较高是与儿童期即     

小儿幽门螺杆菌感染研究进展

幽门螺杆菌(HP)感染引起成人相关性胃炎及十二指肠炎或溃疡已为许多学者所承认,在小儿中的感染及其致病作用,也引起了广泛关注,并进行了大量病原学和临床研究。现就HP在小儿感染的研究进展综述如下。     

儿童幽门螺杆菌感染的流行病学研究

幽门螺杆菌（Ｈｅｌｉｃｏｂａｃｔｅｒｐｙｌｏｒｉ,Ｈｐ）是世界各地最常见的感染性疾病病原之一,许多研究表明,Ｈｐ感染后能导致胃炎和消化性溃疡病的发生。此外,人类胃粘膜上的Ｈｐ持续存在也增加了胃癌和胃淋巴瘤发生的风险。最近从成人中获得的流行病学资料显示...     

儿童消化性溃疡与幽门螺杆菌感染临床治疗探讨

为探讨儿童消化性溃疡(PU)与幽门螺杆菌(H.pylori)感染的关系,观察274例(4～14岁)有上消化道症状的儿童,男174例,女100例,电子胃镜证实PU。病理及H.pylori检测后,随机分为7组根除H.pylori。A、B组应用枸橼酸铋钾(CBS)和克拉霉素(CLA),A组加甲硝唑(MET)、B组加呋喃唑酮(FUR),疗程7d。D组标准三联疗程14d。A、D两组再加泰胃美6周。质子泵抑制剂(PPI)组洛赛克和CLA,加另一抗生素AMO(C组)、MET(E组)、FUR(F组)疗程7d。G组Smecta、AMO和MET疗程14d。停药4周以上复查胃镜和/或~(13)C-尿素呼气试验(~(13)C-UBT)。结果:①274例患儿H.pylori检出率79.93％,胃镜见十二指肠溃疡95.26％,慢性浅表性胃炎(CSG)89.42％,胃粘膜炎症和溃疡活动度与H.pylori感染有显著相关(P<0.01)。②治疗后1周内PPI组和铋剂A、B两组腹痛缓解均≥90％,各组腹痛消退时问比较差异有显著性(P<0.01);停药4周以上复胃镜53例,溃疡愈合和消失88.68％。③随访210例,H.pylori转阴81.43％、耐药14.29％,复燃2.86％,再感染1.43％,各组转归之间差异无显著性(P>0.05)。用胃镜复查H.pylori转阴75.76％;用~(13)C-UBT检测H.pylori转阴82.17％;胃镜联合~(13)C-UBT检查20例,H.pylori转阴90％,随访方式与转归之间有显著相关(P<0.01)。表明H.pylori是小儿PU的     

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.     

儿童上消化道疾病幽门螺杆菌感染状况与病理分析

目的　探讨广州地区小儿上消化道疾病中幽门螺杆菌 (H .pylori)感染的临床状况与组织学特点。方法　对 1994～ 2 0 0 1年广州市儿童医院 374 2例患上消化道疾病患儿采用日产奥林巴斯GIF PQ2 0纤维胃镜和富士能EG 4 5 0PE电子胃镜检查 ,并取胃窦部黏膜进行病理学检查及快速尿素酶试验 ,13 C 呼气试验检测。结果　胃镜检查病变检出率 94 4 4 % (35 34/ 374 2 ) ,其中H .pylori感染检出率占 18 14 % (6 4 1/ 35 34)。各年龄组胃十二指肠疾病H .pylori感染率具有显著差别 (P =0 0 0 0 1) ,H .pylori感染与年龄呈显著正相关 (r =0 914 ,P =0 0 0 0 1)。H .pylori感染前三位疾病是慢性浅表性胃炎、十二指肠球炎、十二指肠球部溃疡 ,其中结节性改变占十二指肠球炎的 4 7 5 7% (98/ 2 0 6 )。随着年龄的增长 ,上消化道疾病的发生率逐渐升高 (r =0 994 ,P =0 0 0 3)。消化性溃疡的发生率亦随年龄增长而增加 (十二指肠溃疡 :r =0 976 ,P =0 0 12 ;胃溃疡 :r =0 917,P =0 0 4 3)。H .pylori感染病例中组织学显示中 重度慢性胃炎占 82 97% (190 / 2 2 9)。结论　小儿H .pylori感染率随年龄增长而递增 ,胃、十二指肠黏膜结节性改变是小儿H .pylori感染的胃镜下特征。广州地区H .pylori感染有异于国内外其     

小儿再发性腹痛与幽门螺杆菌感染的临床观察

目的研究小儿再发性腹痛与幽门螺杆菌（Hp）感染的关系。方法应用^14C-尿素呼气实验对56例再发性腹痛患儿进行幽门螺杆菌感染的检测，并对幽门螺杆菌感染阳性与幽门螺杆菌感染阴性患儿进行腹痛部位、腹痛与饮食的关系、伴随的症状（恶心、呕吐）以及家族中有无幽门螺杆菌的感染者进行比较。结果Hp感染阳性的再发性腹痛患儿其家族中感染率113．3％，明显高于Hp感染阴性的再发性腹痛患儿家族中的感染率12．5％，两组间差异有非常显著性（x^2=30．15，P〈0．01）。而腹痛部位、腹痛与饮食的关系、伴随的症状，两组间均无差别。结论小儿再发性腹痛与幽门螺杆菌感染有关，但不能以腹痛部位、腹痛与饮食的关系、伴随的症状（恶心、呕吐）等来确定再发性腹痛患儿是否存在Hp感染。     

儿童幽门螺杆菌感染临床检测方法评价

目的探讨适合检测儿童幽门螺杆菌(Hp)抗原的方法。方法对2000年9月-2006年2月儿科消化专科门诊及住院937例患儿行13C尿-素呼气试验(13C-UBT)。其中96例行胃黏膜活检标本检测;557例行Hp粪便抗原(HpSA)检查。2003年4月-2004年4月105例患儿同时进行13C-UBT及HpSA检测,以13C-UBT作为诊断标准。结果1.13C-UBT阳性检出率为41.7%,胃镜取胃黏膜活检的Hp抗原阳性检出率40.6%,HpSA的抗原阳性检出率为38.2%,三者间无统计学差异。2.同时行13C-UBT及HpSA患儿105例,13C-UBT阳性率为41.9%,HpSA阳性率为39.0%,以13C-UBT为诊断标准,HpSA检测Hp感染敏感性为91.8%、特异性为81.8%、一致性Kappa系数为0.743(P=0),13C-UBT与HpSA检测阳性检出率无统计学差异(P=0.388)。结论13C-UBT与HpSA 2种检测方法均可作为临床非侵入性检测Hp抗原有效方法,且HpSA更简便、非侵入、经济,是儿童及家长更易接受的诊断儿童Hp感染的有效方法。     

Clinical Practice: Helicobacter pylori infection in childhood

Helicobacter pylori infection is recognised as a cause of gastritis and peptic ulcer disease (PUD) and usually acquired during the first years of life. While there is a decline in the prevalence of H. pylori infection in northern and western European countries, the infection is still common in southern and eastern parts of Europe and Asia. Symptoms of H. pylori-related PUD are nonspecific in children and may include epigastric pain, nausea and/or vomiting, anorexia, iron deficiency anaemia and hematemesis. Besides, only a small proportion of children develop symptoms and clinically relevant gastrointestinal disease. H. pylori infection can be diagnosed either by invasive tests requiring endoscopy and biopsy or non-invasive tests including the ¹³C-urea breath test, detection of H. pylori antigen in stool and detection of antibodies in serum, urine and saliva. The aim of treatment is at least 90 % eradication rate of the bacteria, and a combination of two antibiotics plus a proton pump inhibitor has been recommended as first-line treatment. However, frequent use of antibiotics during childhood is associated with a decline in eradication rates and the search for new treatment strategies as well. This is an overview of the latest knowledge and evidence-based guidelines regarding clinical presentation, diagnosis and treatment of H. pylori infection in childhood.     

Helicobacter pylori infection in children

Helicobacter pylori colonizes the human stomach, especially during childhood. However, a variety of H. pylori strains exists, with major differences in virulence characteristics which probably account for different clinical symptoms, and the majority of infected subjects remains asymptomatic. Helicobacter pylori infection is correlated with socioeconomic conditions and hygienic circumstances, resulting in an extremely high prevalence in children in developing countries. Commercial screening tests are not capable of separating the more virulent strains (type I with vacuolating toxin VacA and CagA protein) from the less virulent strains (type II, VacA and CagA negative). Type I strains, but not type II, are associated with an increased risk for duodenal ulcer and gastric cancer. Therefore, future screening tests and vaccinations should focus on the type I strains.     

Flies and Helicobacter pylori infection

Houseflies have been proposed to be a reservoir and vector for Helicobacter pylori. We assessed the effect of insecticide spraying in villages in The Gambia on H. pylori infection in young children. Effective control of flies did not prevent infection with H. pylori.     

Helicobacter pylori infection in children

A number of scientific breakthroughs since H pylori first became recognized as a human pathogen have increased our understanding of the pathogenesis of gastroduodenal disease. In particular, advances in molecular bacteriology and the complete sequencing of the H pylori genome in 1999, and soon thereafter the human genome, provide tools allowing better delineation of the pathogenesis of disease. These molecular tools for both bacteria and host should now be applied to multicenter pediatric studies that evaluate disease outcome. More recent developments indicate that a better understanding of the microbial-host interaction is critical to furthering knowledge with respect to H pylori-induced diseases. Studies are needed to evaluate either DNA-based or more traditional protein-based vaccines, to evaluate more specific antimicrobials that confer minimal resistance, and to evaluate probiotics for the management of H pylori infection. Multicenter multinational studies of H pylori infection in the pediatric population, which include specific, randomized controlled eradication trials, are essential to extend current knowledge and develop better predictors of disease outcome.     

�����ݸ˾���Ⱦ���ͯ����θ��θ�Ĥ����仯��ϵ�о�

目的探讨幽门螺杆菌(HP)感染对不同年龄组儿童慢性胃炎胃黏膜病理变化的影响。方法 2007年1月至2010年12月,对上海交通大学医学院附属瑞金医院1634例反复上消化道症状儿童行电子胃镜检查,取胃窦部黏膜组织检测HP,按1996年悉尼标准进行病理评分,分析HP感染与炎症严重程度及活动性的关系。并根据年龄分为4组:<4岁组69例,4～<7岁组313例,7～<11岁组706例,11～18岁组546例,比较各组HP感染率、活动性病变发生率以及淋巴滤泡检出率的差异。结果 1634例患儿中HP阳性524例(32.1%),阳性率随年龄增长而升高。HP阳性患儿活动性炎症、中重度炎症、中性粒细胞浸润、淋巴细胞重度浸润和淋巴滤泡的检出率均高于阴性者(P<0.01)。胃黏膜病理示慢性浅表性胃炎(CSG)中、重度炎症及慢性萎缩性胃炎(CAG)中度炎症的发生率,HP阳性患儿均高于阴性者(P<0.01)。除婴幼儿组外,各年龄组HP感染患儿的活动性病变发生率和淋巴滤泡检出率均显著高于HP阴性者(P<0.05)。结论儿童HP感染率随年龄增长而升高。HP感染与胃黏膜炎症严重程度、活动性炎症发生率以及滤泡样改变均密切相关,与慢性胃炎不同病理类型的严重程度也密切相关。     

Growth in children with Helicobacter pylori infection and dyspepsia

Aims: To compare the height, weight, and body mass index (BMI) of children presenting with dyspeptic symptoms and Helicobacter pylori infection, to those with dyspepsia but without the infection. Methods: A retrospective chart review of 257 children was performed. ¹³C urea breath test was performed to detect H pylori infection; weight and height were recorded and BMI was calculated. Weight, height, and BMI SD scores were determined using the 1990 UK normative data. The Index of Multiple Deprivation 2004 (IMD 2004) scores, which measure deprivation at small area level, were calculated from the patients'' postcodes. Results: Ninety seven of the 257 children were H pylori positive. The mean age at diagnosis and presenting symptoms of H pylori positive and negative patients were similar. The mean IMD 2004 scores for children with H pylori infection were significantly higher compared to H pylori negative patients, suggesting that children with the infection came from relatively more deprived areas. The mean weight and height SD score were significantly lower for children with H pylori infection compared to those without. However, this difference was no longer significant after adjusting for socioeconomic deprivation and ethnic differences between the groups. Conclusion: Children with dyspepsia and H pylori infection were shorter and lighter than patients with similar symptoms but no infection. The differences in anthropometry may be due to socioeconomic and ethnic factors rather than H pylori infection.