幽门螺杆菌根除后再感染与溃疡复发

目的明确广州地区十二指肠溃疡患者幽门螺杆菌（Ｈｐ）根除后再感染和溃疡复发情况。方法以１４Ｃ－尿素呼气试验和胃镜检查（尿素酶、组织学及细菌培养），对十二指肠溃疡患者Ｈｐ根除后共１８４例进行２年定期随访，并配合随机引物扩增的ＤＮＡ多态指模技术鉴定Ｈｐ菌株复发与再感染。结果Ｈｐ根除后第１、２年再感染率分别为１．１０％和０．５６％；溃疡复发率分别为２．７２％和０．５６％；全部病例未发生溃疡出血，而同期Ｈｐ未根除的对照组２年溃疡累积再出血率为２６．９％（Ｐ＜０．００５）。结论成人患者Ｈｐ根除后对Ｈｐ再感染不易感，而且发展中国家Ｈｐ根除后再感染率也相当低，以预防溃疡复发为目的的Ｈｐ根除疗法同样适用于高Ｈｐ感染率地区。

Helicobacter pylori- reinfection and ulcer recurrence in patients with duodenal ulcer healing: a 2-year following-up in an area with high prevalence of helicobacter pylori

Objective To determine Helicobacter pylori- (Hp) reinfection and ulcer recurrence following Hp eradication in an area with high prevalence of Hp. Methods 184 cases with endoscopy confirmed Hp eradication and ulcer healing as well as and negative 14 C urea breath test three months after cessation of treatment for 2 years were followed. 14 C urea breath test was performed at the 6th, 12th, 18th, and 24th month after the ending of treatment, and endoscopy (including urease test, histology and culture for Hp) performed at the 12th and 24th month or whenever breath test was positive or ulcer symptom recurred. Recurrence of Hp was discriminated as recrudescence or reinfection by means of a randomly amplified polymorphic DNA fingerprinting by comparison of the isolates obtained from recurrence and pretreatment. Results The 1st and 2nd year reinfection rates were 1.10% and 0 56% respectively; ulcer recurrence rates 2.72% and 0.56% respectively; ulcer rebleeding did not occur in any of the follow up cases, as compared with 26.9% of two year cumulated ulcer rebleeding rate in a Hp positive control group ( P <0.005). Conclusion The results of this study suggest that adult patients are not susceptible to Hp reinfection, reinfection rate is very low in developing country as in Western developed countries and thus Hp eradication therapy aimed at prevention of ulcer recurrence is also worthwhile in an area with high Hp prevalence.