Resistance of Helicobacter pylori to antibiotics from 2000 to 2009 in Shanghai

AIM: To investigate the resistance of Helicobacter pylori (H. pylori ) to 6 commonly used antibiotics from 2000 to 2009 in Shanghai. METHODS: A total of 293 H. pylori strains were collected from 2000 to 2009 in Shanghai and tested for their susceptibility to metronidazole, clarithromycin, amoxicillin, furazolidone, levofloxacin and tetracycline using agar dilution. RESULTS: The resistant rates of H. pylori to clarithromycin (8.6%, 9.0% and 20.7%) and levofloxacin (10.3%, 24.0% and 32.5%) increased from 2000...     

Variation in human genetic polymorphisms, their association with Helicobacter pylori acquisition and gastric cancer in a multi-ethnic country

Background and Aim: The contribution of human genetic polymorphisms to Helicobacter pylori infection and gastric cancer (GC) development remains unclear due to geographic variation in the association between specific host genetic polymorphisms and GC. In the current study we investigated the association between polymorphisms related to immune and cancer‐related pathways and H. pylori infection among the major ethnicities, Chinese, Malay and Indian, resident in Singapore and Malaysia as well as the association between these polymorphisms and GC development in ethnic Chinese patients. Methods: Thirty‐four polymorphisms in 26 genes were typed by mass spectrometry in 422 patients undergoing endoscopy (162 Chinese, 113 Indian and 87 Malay controls and 60 Chinese GC cases). Patients were assessed for evidence of H. pylori infection. Odds ratios (OR) and confidence intervals (CI) were obtained using logistic regression models. Result: The prevalence of 16 polymorphisms varied significantly among the ethnicities. In the Chinese subgroup, nominally significant associations were shown between (i) EBBR2+1963G (rs1801200) and H. pylori infection (per‐allele OR: 0.48, 95% CI 0.23, 0.98, P = 0.04), (ii) PTGS2‐1195G (rs689466) and an increased risk of GC on adjusting for H. pylori status (OR: 1.53, 95% CI 0.99, 2.37, P = 0.05), and (iii) IL1B‐1473C (rs1143623) and a decreased risk of GC (OR: 0.64, 95% CI 0.41, 0.99, P = 0.05). Borderline significant associations were seen between IL2‐330G (rs2069762) (OR 1.45, 95% CI 0.95, 2.15, P = 0.06) and IL13‐1111T (rs1800925) (OR 0.65, 95% CI 0.42, 1.01, P = 0.06) and H. pylori infection. Conclusion: These findings contribute to the understanding of the genetic variation between ethnicities, which may influence H. pylori susceptibility and the outcome of infection.     

8d与10d序贯疗法根除幽门螺杆菌的疗效比较

目的:比较雷贝拉唑、阿莫西林、克拉霉素、奥硝唑组成的8d与10d序贯疗法根除幽门螺杆菌(H.pylori)的疗效.方法:将经胃镜检查确诊为慢性胃炎和消化性溃疡,且H.pylori阳性的217例患者随机分为2组,8d组(n=104)方案:前4d,雷贝拉唑+阿莫西林;后4d,雷贝拉唑+克拉霉素+奥硝唑.10d组(n=113)方案:前5d,雷贝拉唑+阿莫西林;后5d,雷贝拉唑+克拉霉素+奥硝唑.根除治疗后复查14C-尿素呼气试验,比较两组H.pylori根除率.结果:8d组和10d组H.pyloriITT根除率分别为89.3%和91.2%,PP根除率分别为92.0%和93.7%.两种分析方法比较两组的根除率差异均无统计学意义(P>0.05),但8d序贯疗法降低了成本-效果比,减轻了患者的经济负担.两种方案症状缓解率及不良反应发生率的差异无统计学意义(P>0.05).结论:8d序贯疗法可以获得较高的H.pylori根除率和症状缓解率,且经济、安全,是一种可供选择的一线治疗方案.     

不同幽门螺旋杆菌感染状态胃镜下黏膜特点分析

目的探讨感染幽门螺旋杆菌(Hp)及Hp阴性患者胃镜下黏膜表现的差异,旨在为临床诊疗工作提供参考依据。 方法回顾性分析2017年12月至2019年3月经天津医科大学附属第二医院消化内科门诊收治的14C呼气试验(＋)及14C呼气试验(－)并同时间段行胃镜检查的受检者共1 792例内镜下观察,对胃黏膜表现进行记录,并分析Hp阳性及Hp阴性的胃镜下黏膜差异。 结果(1)不同Hp感染状态胃镜下黏膜表现差异分析上,单因素分析显示,消化性溃疡、点状发红、斑片状发红、线状红斑、黏膜出血、结节样改变、黏膜水肿、黏膜萎缩、皱襞肿大、增生性息肉在Hp感染者及Hp阴性患者的胃镜下黏膜表现有显著的统计学差异(P<0.05),且以上表现在Hp感染者中发生率高。反流性食管炎(RE)、规则的集合静脉(RAC)、胃底腺息肉在Hp阴性者中发生率较Hp阳性者高,有明显统计学差异(P<0.05)。黏膜糜烂在Hp阳性者及Hp阴性者中无显著统计意义(P>0.05),但胃窦部隆起型糜烂在Hp感染者中发生率明显高于未感染Hp患者,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,RE、RAC、胃底腺息肉在Hp阴性者中发生率高,差异有统计学意义(P<0.05)。消化性溃疡、点状发红、结节样改变、黏膜水肿、黏膜萎缩、线状红斑、斑片状发红、胃窦部隆起型糜烂在Hp感染者中发生率高,差异有统计学意义(P<0.05)。(2)不同胃镜下黏膜表现对于预测Hp感染与否的诊断价值分析上,RAC对预测Hp阴性的AUC、敏感性、特异性、阳性预测值及阴性预测值分别为0.750、65.6%、84.5%、77.8%及74.7%;胃底腺息肉预测Hp阴性的特异性、阳性预测值分别为99.8%、96.4%。RE患者诊断Hp阴性的特异性高达94.7%;黏膜点状发红作为预测Hp阳性的敏感性为80%,特异性为74.9%,AUC为0.774,阳性预测值为79.3%;结节样改变对于预测Hp阳性其特异性可高达99.9%,阳性预测值高达92.3%。消化性溃疡、增生性息肉、黏膜萎缩及线状红斑对于预测Hp感染的特异性分别为90.8%、98.2%、86.3%及85.1%,阳性预测值分别为78.3%、71.4%、80.4%及75%。 结论(1)RE、RAC、胃底腺息肉为Hp阴性的独立的胃镜下黏膜征象;消化性溃疡、点状发红、结节样改变、黏膜水肿、黏膜萎缩、线状红斑、斑片状发红、胃窦部隆起型糜烂为Hp阳性独立的胃镜下黏膜征象;(2)RAC、黏膜点状发红预测Hp感染与C14呼气试验结果的符合率较高。结节样改变、黏膜萎缩、消化性溃疡、胃窦部隆起型糜烂、线状红斑作为预测Hp感染的表现有较大价值;黏膜水肿、皱襞肿大、增生性息肉、黏膜出血、斑片状发红作为单独诊断Hp阳性的指标不推荐;胃底腺息肉对于预测Hp阴性有较大价值;RE作为单独诊断Hp阴性的指标不推荐。     

血清胃蛋白酶原与胃泌素检测对慢性萎缩性胃炎的诊断价值

目的探讨血清胃蛋白酶原Ⅰ（PGⅠ）、胃蛋白酶原Ⅰ/胃蛋白酶原Ⅱ（PGⅠ/PGⅡ）比值（PGR）和胃泌素-17（G-17）与慢性萎缩性胃炎的关系,确定其在萎缩性胃炎中的变化规律。方法 选择在我院消化科行胃镜检查符合入选研究标准的300例患者,根据组织病理学诊断结果分为慢性非萎缩性胃炎组（202例）和慢性萎缩性胃炎组（98例）。采用酶联免疫吸附试验（ELISA）方法定量测定空腹血清PGⅠ、PGⅡ和G-17水平,并计算PGⅠ/PGⅡ比值（PGR）。采用14C-或13C-呼气试验和快速尿素酶试验两种方法联合判定幽门螺杆菌（Hp）感染情况。结果 慢性萎缩性胃炎组与非萎缩性胃炎组相比,血清PGⅠ分别为128.55±61.42μg/L和150.61±75.33μg/L,比较有显著差异（P〈0.05）。PGR分别为10.09±5.15和10.95±7.18,比较无显著差异（P〉0.05）;G-17分别为9.68±15.51pmol/L和18.93±18.92pmol/L,比较有显著差异（P〈0.05）。Hp阳性组PGR（8.96±7.72）与阴性组（11.63±5.56）比较有显著差异（P〈0.05）;Hp阳性组PGⅠ（125.39±65.90μg/L）与阴性组（154.19±65.13μg/L）比较有显著差异（P〈0.05）;Hp阳性组G-17（10.91±15.50pmol/L）与阴性组（10.68±19.12pmol/L）比较无显著差异（P〉0.05）。结论 联合检测血清PG和G-17水平可用于慢性萎缩性胃炎的筛查,如有异常,应进一步行胃镜检查以确诊并指导治疗。Hp感染与PG水平的变化有关。     

Discrepancy between Helicobacter pylori stool antigen assay and urea breath test in the detection of Helicobacter pylori infection

Background. The reference diagnostic methods available for detection of Helicobacter pylori infection are either invasive (histology) or expensive and highly sophisticated (Urea Breath Test). A new enzyme immunoassay, which can be easily performed in any laboratory, has been developed to detect Helicobacter pylori in stool specimens (HpSA - Meridian Diagnostics, Cincinnati, USA). Aim of the study was to compare HpSA to Urea Breath Test.Patients and methods. A total of 125 patients (52 never treated for Helicobacter pylori infection and 73 after Helicobacter pylori eradication therapy) referring to our Department, underwent both tests within two weeks.Results. Contrasting results between the two tests were found in 30% of cases: in 19% of the untreated patients and in 37% of the treated patients (p<0.001). The main discrepancy consisted in positive HpSA associated with negative Urea Breath Test. Mean HpSA value in such conditions was 0.273 optical density, while in patients with both positive tests, it was 1.192 optical density. In untreated, but not in treated patients, raising the HpSA cut off value significantly decreased the percentage of conflicting results.Conclusions. Some disagreement was detected between HpSA and Urea Breath Test results, especially in treated patients. Possible explanations for our findings are a low HpSA cut off value together with the identification of Helicobacter pylori coccoid forms by the immunoassay but not by the urease based Urea Breath Test. The higher percentage of discrepancy detected in treated patients might support this hypothesis.     

~(13)C-尿素呼气试验诊断幽门螺杆菌感染的临床意义

对 6 5例胃、十二指肠疾病患者和 36例健康人行 1 3 C-尿素呼气试验 (C- UBT)、病理组织学和快速尿素酶(RUT)三种方法检测幽门螺杆菌 (HP) ,其中任两项阳性者认为有 HP感染。结果显示 ,C- U BT、病理组织学和 RUT检测的阳性率分别为 81.5 4%、83.1%、84.6 2 % ;敏感性分别为 96 .2 3%、86 .8%、84.91% ;特异性分别为 10 0 %、91.6 7%、83.33%。认为 C- UBT和病理组织学是检测 HP感染较准确的方法 ,RU T的敏感性与特异性较前两种方法低 ,其操作方便 ,费用低 ,仍是临床常用的检测手段 ,但不能单独作为诊断 HP感染指标。病理组织学和 RU T均为侵入性检查 ,取材也受“灶性”分布的影响 ,而 C- UBT是非侵入性操作 ,更能反映“全胃”HP感染状况 ,临床应用时无任何禁忌和限制 ,如果仅为了检测 HP状态或抗 HP药物疗效监测 ,C- UBT可替代病理组织学及 RUT检查。     

河西走廊中段地区上消化道疾病患者幽门螺杆菌感染状况

目的探讨河西走廊中段地区上消化道疾病患者幽门螺杆菌(Hp)感染状况,分析Hp感染与上消化道疾病的关系。方法收集上消化道疾病患者胃粘膜石蜡标本及病理资料,采用W-S银染和革兰染色检查患者组织中Hp感染状况,分析Hp感染与性别、年龄及病理特征之间的关系。结果受检标本Hp阳性率为81.3%(178/219)。浅表性胃炎组、癌前病变组和胃癌组Hp阳性率依次为60.7%、77.4%和85.6%。浅表性胃炎组Hp感染率与胃癌组比较差异有统计学意义(P<0.05);61岁以上组Hp感染率与60岁以下各组比较差异有统计学意义(P<0.05);有淋巴结转移胃癌组Hp感染率与无转移组比较差异有统计学意义(P<0.05);Hp感染率在不同性别、不同胃癌组织病理类型、癌组织大小及浸润深度间差异无统计学意义(P>0.05)。结论在河西走廊中段地区胃癌的发生及其淋巴结转移与Hp感染有关。Hp感染率随年龄增大呈上升趋势。