229例慢性胃炎患者幽门螺杆菌培养及耐药情况

目的了解慢性胃炎患者H.pylori感染及其耐药情况,为临床治疗提供参考。方法慢性胃炎患者胃镜活检标本培养分离H.pylori,对分离的H.pylori采用纸片扩散法进行耐药性检测。结果229例患者分离出97株H.pylori;H.pylori分离阳性率为42．36％（97／229）,其中男性分离率为43．79％（67／153）,女性分离率为39．47（30／76）;92株H.pylori对抗生素的耐药性分别为：甲硝唑8．7％,克拉霉素7．6％,阿莫西林1．1％、呋喃唑酮1．1％,阿奇霉素4．4％,左氧氟沙星0％。结论慢性胃炎患者H.pylori感染率较高,但与性别、年龄无关;慢性胃炎H.pylori对常用抗生素敏感,建议采用左氧氟沙星、阿莫西林、呋喃唑酮进行治疗。     

浅谈幽门螺杆菌的根除疗法

自 1 98 3年幽门螺杆菌 ( HP)被发现至今被公认是慢性胃炎、溃疡病、胃癌及胃相关性淋巴瘤的致病因素之一。我国又属 HP高感染国家 ,故根除HP成为从事胃肠疾病工作者的研究热点。现就近几年临床研究确切的根除方案作一概述。1　 1 999年 4月我国举行第一次 H.pylori专家共识会议 ,会议推荐治疗方案 [1]1 .1　质子泵抑制剂 ( PPI)加两种抗生素　 ( 1 ) PPI标准剂量加克拉霉素 0 .5 g和阿莫西林 1 .0 g,每日2次 ,用药 1周 ;( 2 ) PPI标准剂量加阿莫西林 1 .0 g和甲硝唑 0 .4g,每日 2次 ,用药 1周 ;( 3) PPI标准剂量加克拉霉素 0 .2 5 …     

猪胃螺杆样细菌与幽门螺杆菌的比较研究

我们检测１０例普通猪的胄组织,有８例分离到螺杆菌样细菌（ＨＬＯ）。其菌落、菌体形态和某些生化反应与幽门螺杆菌（ＨＰ）相似,但其尿素酶活性较低,ＨＬＯ全菌蛋白的ＳＤＳ一ｐＡＧＥ图谱也与ＨＰ的不同。本文就ＨＰ和ＨＬＯ及其伴发的人、猪慢性胃炎的特点,作了比较和讨论。     

幽门螺杆菌脲酶的研究现状

幽门螺杆菌与慢性胃炎、胃十二指肠溃疡甚至胃癌等关系密切。脲酶是其主要的定植因子和致病因于,也是主要抗原成分和疫苗候选抗原之一。本文就脲酶的理化性质、基因结构、细胞定位、致病机制以及检测方法和疫苗应用等方面的研究现状作一介绍。     

幽门螺杆菌与胃癌关系的研究进展

幽门螺杆菌（ＨＰ）是胃炎和胃溃疡的重要病原体,越年越多的流行病学调查表明,ＨＰ的感染与胃癌的发生也密切相关,因而对其致癌机制的研究日益成为人们关注的热点。但目前对其机制所知不多,有关文章主要分析了ＨＰ感染所引起的炎性刺激,ＨＰ感染对人染色体结构和功能的改变,以及ＨＰ感染所致细胞程序性死亡变化对肿瘤发生的影响。本文就将这几方面的内容作一综述。     

幽门螺杆菌对PCNA及HSP60在慢性胃炎中的表达的影响

目的研究HSP60与PCNA在幽门螺杆菌感染慢性胃炎组织中的表达及其意义。方法免疫细胞化学检测Hp 和Hp-慢性胃炎患者胃窦粘膜内的PCNA和HSP60。结果PCNA在浅表性胃炎以弱阳性或阳性表达为主,在萎缩性胃炎以阳性或强阳性表达为主。与Hp-患者相比,Hp 患者胃粘膜PCNA的表达显著增强,两者之间差异显著(P<0·05);HSP60在Hp 患者浅表性胃炎、萎缩性胃炎的阳性率分别为40·0%和76·9%,Hp 患者胃粘膜HSP60的表达比Hp-患者强(P<0·05)。结论幽门螺杆菌的感染增强了PCNA、HSP60在胃粘膜中的表达,与胃粘膜的病理特征有密切的关系,两者可能是胃粘膜病变趋势或临床病理特征的重要指标。     

幽门螺杆菌感染对慢性胃炎胃窦部EC细胞和CgA细胞的影响

目的探讨幽门螺杆菌（Helicobacter pylori Hp）感染与慢性胃炎（CG）患者胃窦粘膜内肠嗜铬细胞（Enterochromaffin,EC细胞）、嗜铬粒素A细胞（CgA细胞）变化的关系。方法采用免疫细胞化学方法,检测Hp相关性慢性胃炎胃窦部粘膜内EC细胞、CgA细胞的分布。结果1．Hp^＋组CgA^＋细胞数低,与Hp^＋组和正常组比较差异显著（P〈0．01）;2.EC细胞数随病理类型加重呈下降趋势,三组间的差异性极显著（P〈0．01）,慢性萎缩性胃炎组（CAG）CgA^＋细胞数与慢性非萎缩性胃炎（CNAG）组和正常组比较,差异极显著（P〈0．01）。结论Hp感染和慢性胃炎胃窦部EC细胞和CgA细胞之间存在密切关系。     

越鞠方加减联合益生菌对幽门螺杆菌阳性慢性胃炎患者的疗效

目的 探讨越鞠方加减联合益生菌对幽门螺杆菌(H.pylori)阳性慢性胃炎患者胃肠功能及血清血管活性肠肽(VIP)、生长激素释放肽(Ghrelin)的影响.方法 选取2017年6月至2019年6月我院收治的128例H.pylori阳性慢性胃炎患者为研究对象,采用随机数字表法分为研究组和对照组,各64例.两组患者均给予标...     

幽门螺杆菌感染与慢性口臭关系的初步研究

目的 调查主诉口臭患者的幽门螺杆菌（H．pylori）感染率和主诉消化不良的口臭发生率。方法 研究对象为125例主诉慢性口臭患者和212例主诉慢性消化不良患者。口臭以口气挥发性硫化物（VSC）检测与闻诊联合诊断,H．pylori感染以^14C-尿素呼气试验诊断。结果 125例主诉慢性口臭的患者有87例是真性口臭,其余38例为假性口臭,真性口臭患者的H．pylori感染率显著高于假性口臭（40．2％和13．2％,P〈0．01）。212例主诉慢性消化不良的患者发生口臭105例（49．5％）、感染H．pylori 94例（44．3％）,H．pylori阳性患者的口臭发生率显著高于H．pylori阴性患者（57．5％和43．2％,P〈0．05）。无论何种主诉,大部分口臭患者属于VSC阳性（88．5％）,但H．pylori阳性患者和H．pylor阴性患者口气VSC水平差异无显著性,VSC阳性口臭和VSC阴性口臭的H．pylori感染率差异也无显著性。结论 H．pylori感染可能与口臭的发生有一定关系,但口气VSC并非由H．pylori直接产生。     

胃黏膜定植乳酸杆菌对幽门螺杆菌感染的影响

目的 探讨胃黏膜定植乳酸杆菌对幽门螺杆菌感染及胃黏膜菌群数量的影响。方法 收集130例慢性胃炎患者胃窦黏膜组织,病理学检测幽门螺杆菌,提取胃黏膜基因组DNA,采用荧光定量PCR法检测乳酸杆菌和总细菌数。结果 幽门螺杆菌阳性组和阴性组的乳酸杆菌检出率和乳酸杆菌数（Log）差异均无统计学意义（P>0.05）;乳酸杆菌阳性者和阴性者之间胃黏膜总细菌数（Log）差异无统计学意义（P>0.05）;乳酸杆菌细菌数（Log）与胃黏膜总细菌数（Log）无显著相关性（P>0.05）;不同炎症程度胃炎患者乳酸杆菌检出率差异无统计学意义（P>0.05）;肠化组和未肠化组乳酸杆菌检出率差异无统计学意义（P>0.05）;但是重度胃炎组幽门螺杆菌感染率和总细菌数量均显著高于轻度（P<0.05）和中度胃炎组（P<0.05）。结论 胃黏膜定植乳酸杆菌对幽门螺杆菌的感染无影响,其存在与否及细菌数量对胃黏膜总细菌数亦无明显影响,并与胃炎炎症程度及肠化无关。乳酸杆菌不能通过抑制幽门螺杆菌定植、调节胃黏膜菌群而减轻炎症反应。     

Persisting chronic gastritis and elevated Helicobacter pylori antibodies after successful eradication therapy

AIM: The persistence of chronic inflammation in gastric mucosa and elevated Helicobacter pylori antibodies after successful eradication therapy are common findings in clinical practice. We studied their possible association with each other and disappearance in long-term follow up, as well as their possible connection with gastric atrophy. PATIENTS AND METHODS: The study population consisted of 108 dyspeptic patients with successful eradication therapy median 6.4 years earlier. The patients underwent gastroscopy, and biopsies from antrum and corpus were evaluated by an experienced pathologist. Serum samples collected from 77 patients were studied for H. pylori antibodies, parietal cell antibodies, as well as for pepsinogen I, pepsinogen II, and gastrin-17 levels. RESULTS: The prevalence of chronic gastric inflammation and elevated H. pylori antibodies after successful eradication therapy decreased by time, but still after 5 years, 17 of 51 (33%) subjects had elevated H. pylori antibodies and 14 of 68 (21%) had a mild inactive chronic inflammation in gastric mucosa. In patients with and without chronic inflammation in gastric mucosa, elevated H. pylori antibodies were detected in three of 10 (30%) and 14 of 41 (34%), elevated parietal cell antibodies in one of 10 (10%) and six of 41 (15%), low pepsinogen I in one of 10 (10%) and none of 41, and elevated gastrin-17 in three of 10 (30%) and six of 41 (15%), respectively. CONCLUSION: More than 5 years after successful H. pylori eradication therapy, mild persistent chronic inflammation may occur in gastric mucosa in up to one-fifth and elevated H. pylori antibodies even in one-third of patients, although these two are independent phenomena.     

Apoptosis in Helicobacter pylori gastritis is related to cagA status

BACKGROUND: Helicobacter pylori infection increases gastric epithelial cell apoptosis; however, the influence of cagA status is still controversial. We aimed to investigate if cagA status is related to apoptosis in H. pylori gastritis at different anatomic sites of the gastric mucosa. MATERIALS AND METHODS: We studied by immunohistochemistry (streptavidin-biotin method) pro-apoptotic (Bax and Bak) and antiapoptotic (Bcl-2 and Bcl-x) proteins expression, scored from 0 to 4, in gastric biopsies, at the antrum (lesser and greater curvatures), incisura, and corpus (greater curvature) from 50 patients with H. pylori gastritis (22 males, 28 females, median age 40 years) and eight non-infected patients (6 males, median age 39.6 years). H. pylori and cagA status were determined by polymerase chain reaction. RESULTS: Apoptotic proteins were expressed in a granular pattern, in the cytoplasm of foveolar cells; Bax and Bak expression was higher than Bcl-2 and Bcl-x in most cases and was significantly higher in patients infected by cagA-positive strains than in those infected by cagA-negative strains (p = .001). Bak expression was higher at the lesser curvature (antrum and incisura) than in the other regions (p = .002) and was correlated with atrophy. Anti-apoptotic proteins were significantly more expressed at the antral lesser curvature than in the other regions of the stomach (Bcl-2: p = .02; Bcl-x: p < .001). CONCLUSIONS: Infection with cagA-positive strains is significantly associated with overexpression of pro-apoptotic proteins in the gastric mucosa, mainly at the antral lesser curvature, which may have a role on atrophy development. Anti-apoptotic proteins were also overexpressed at the lesser curvature, which may occur to keep epithelial cell turnover or might be related to malignant transformation.     

Monoclonal gammopathy of undetermined significance and Russell body formation in Helicobacter pylori gastritis

BACKGROUND: Infection by Helicobacter pylori has been linked to monoclonal gammopathy of undetermined significance (MGUS). MGUS is thought to develop due to chronic antigenic stimulation in people with a specific genetic predisposition. METHODS AND RESULTS: We describe a patient presenting with dyspepsia associated with H. pylori-related erosive gastritis. Histopathologic findings revealed infiltration with plasma cells containing accumulated condensed intercisternal immunoglobulins, the so-called 'Russell bodies'. In addition, MGUS was present with total immunoglobulins within the normal range but a significantly decreased serum concentration of IgG subtype 3. Molecular analyses demonstrated IgH formation, T-cell receptor gamma rearrangement, and alterations within the IgHG3 gene sequence. Following H. pylori eradication, gastritis and dyspepsia gradually resolved but MGUS persisted for at least 22 months. CONCLUSIONS: This is the first report to demonstrate that upon infection with H. pylori, an impaired secretory capacity of plasma cells due to specific molecular changes can present as Russell body gastritis. The molecular findings question a pathogenetic link between Russell bodies and H. pylori, but suggest genetic alterations in the immunoglobulin locus as the possible cause for both MGUS and Russell body gastritis.     

Long-term statin therapy affects the severity of chronic gastritis

Background: Helicobacter pylori (H. pylori) is a major cause of chronic gastritis. Statins have several pleotropic effects and their mechanisms of action could be related to anti‐inflammatory, antioxidants, and immunomodulatory effects. Aim: To determine whether statin therapy affects the severity of chronic gastritis. Materials and Methods: In a retrospective study, we evaluated 516 patients who underwent upper endoscopy. One‐hundred and ninety‐eight patients had chronic gastritis, The 198 patients with chronic gastritis were divided into two groups: group 1 comprised patients with a history of statin therapy and group 2 comprised patients with no history of statin therapy. Both groups were compared for age, gender, body mass index (BMI), underlying diseases, drug therapy, alcohol consumption, smoking and the serum levels of C‐reactive protein (CRP). The presence of H. pylori was determined by gastric biopsy and rapid urease test. The grade and severity of gastritis were assessed using the updated Sydney classification system in two gastric biopsy specimens that were taken from each participant in each group. Results: Of the 198 patients with chronic gastritis, 49% of the patients had mild gastritis and 51% had moderate to severe gastritis. From the results of a multiple logistic regression analysis after adjusting for confounding variables that included age, gender, and BMI, we found that elevated serum CRP levels (odds ratio (OR) 2.33; 95% confidence interval (CI) = 0.8–2.6, p = .02), H. pylori (OR 1.99; CI 0.14–2.4, p = .04), and the use of statin (OR 1.64; CI = 0.71–1.77, p = .05) independently predict the severity of chronic gastritis. Conclusion: Long‐standing statin therapy may reduce the severity of chronic gastritis. Mild increased CRP levels in absence of obvious source can predict the severity of chronic gastritis. Further researches are needed to assess the effect of statin in chronic gastritis.     

慢性胃炎患者胃黏膜菌群定位及定量分析

目的对慢性胃炎患者胃黏膜菌群进行定位及定量分析,探究其与胃炎及幽门螺杆菌(Helicobacter pylori,H.pylori)感染的相关性。方法收集58例慢性胃炎患者胃黏膜标本,提取胃黏膜菌群DNA,行荧光定量PCR定量胃黏膜总细菌及H.pylori,并进行相关性分析;另收集12例慢性胃炎患者胃黏膜标本石蜡包埋切片行荧光原位杂交定位胃黏膜菌群;慢性胃炎、肠化生程度的分类依据新悉尼分类系统。结果慢性胃炎患者胃黏膜细菌主要分布于胃黏膜表面、胃小凹及腺体中,细菌单个散在分布或聚集成团。多元线性回归分析显示胃黏膜总细菌数与性别、年龄、肠化生程度无关,与H.pylori感染、慢性胃炎程度有关(P0.05)。H.pylori阳性组胃黏膜总细菌数与H.pylori细菌数目呈明显正相关(r=0.536,P0.01)。不同胃炎程度之间胃黏膜总细菌数差异有统计学意义(P0.05),其中重度胃炎组胃黏膜总细菌数明显高于轻、中度胃炎组(P0.05、0.01)。不同肠化生程度之间胃黏膜总细菌数差异无统计学意义(P0.05)。H.pylori阳性组胃黏膜总细菌数明显高于阴性组(P0.01)。结论慢性胃炎患者胃黏膜菌群主要分布于胃黏膜表面、胃小凹及腺体中,细菌单个散在分布或聚集成团。胃黏膜菌群与慢性胃炎程度、H.pylori感染有关,与性别、年龄、肠化生程度无关,提示胃黏膜菌群的改变参与慢性胃炎的发展,H.pylori感染可改变胃黏膜菌群。     

Diversity of Helicobacter pylori cagA and vacA genes in Costa Rica: its relationship with atrophic gastritis and gastric cancer

BACKGROUND: Associations between Helicobacter pylori gene diversity and gastric cancer have not been reported on in Costa Rica, despite its being one of the countries with the highest gastric cancer incidence and mortality rates in the world. The aim of this study was to determine the prevalence of H. pylori cagA and vacA genes and investigate whether it could be correlated with atrophic gastritis (AG) and gastric cancer (GC) in Costa Rica. MATERIALS AND METHODS: Genomic DNAs from isolates of 104 patients classified into two groups: non-atrophic gastritis group (n = 68) and atrophic gastritis group (n = 36), were subjected to PCR-based genotyping of cagA and vacA genes and their correlation with clinical outcome was investigated. Total DNA extractions from gastric tissues of 25 H. pylori-infected gastric cancer patients were utilized for comparative purposes. RESULTS: The presence of cagA (75.3%), vacA s1b (75.3%), and vacA m1 (74.2%) was detected, and colonization by strains with different vacA genotypes in the same stomach was found in 9.7% of the patients. Age- and sex-adjusted vacA s1b and vacA m1 were associated with GC while only vacA m1 was significantly associated with AG. A tendency for association between cagA and vacA s1b, and AG was reported. CONCLUSIONS: The prevalence status of the cagA and vacA (s1/m1) genes in Costa Rica seems to fall between that found in European/North American and East Asian countries, and both cagA and vacA seem to have clinical relevance in this country.     

Oxidative damage of the gastric mucosa in Helicobacter pylori positive chronic atrophic and nonatrophic gastritis, before and after eradication

Background. Helicobacter pylori is the main cause of gastritis and a primary carcinogen. The aim of this study was to assess oxidative damage in mucosal compartments of gastric mucosa in H. pylori positive and negative atrophic and nonatrophic gastritis. Materials and methods. Five groups of 10 patients each were identified according to H. pylori positive or negative chronic atrophic (Hp‐CAG and CAG, respectively) and nonatrophic gastritis (Hp‐CG and CG, respectively), and H. pylori negative normal mucosa (controls). Oxidative damage was evaluated by nitrotyrosine immunohistochemistry in the whole mucosa and in each compartment at baseline and at 2 and 12 months after eradication. Types of intestinal metaplasia were classified by histochemistry. Results. Total nitrotyrosine levels appeared significantly higher in H. pylori positive than in negative patients, and in Hp‐CAG than in Hp‐CG (p < .001); no differences were found between H. pylori negative gastritis and normal mucosa. Nitrotyrosine were found in foveolae and intestinal metaplasia only in Hp‐CAG. At 12 months after H. pylori eradication, total nitrotyrosine levels showed a trend toward a decrease in Hp‐CG and decreased significantly in Hp‐CAG (p = .002), disappearing from the foveolae (p = .002), but remaining unchanged in intestinal metaplasia. Type I and II of intestinal metaplasia were present with the same prevalence in Hp‐CAG and CAG, and did not change after H. pylori eradication. Conclusions. Oxidative damage of the gastric mucosa increases from Hp‐CG to Hp‐CAG, involving the foveolae and intestinal metaplasia. H. pylori eradication induces a complete healing of foveolae but not of intestinal metaplasia, reducing the overall oxidative damage in the mucosa.     

Atrophic gastritis, Helicobacter pylori, and colorectal cancer risk: a case-control study

BACKGROUND: Helicobacter pylori is a major risk factor for atrophic gastritis and gastric cancer. Various extragastric manifestations of H. pylori infection have also recently been suggested. However, the correlation between H. pylori and colorectal cancer (CRC) is controversial. The aim of this study was to examine the correlation between H. pylori, serum gastrin level, and atrophic gastritis with CRC. MATERIALS AND METHODS: Subjects were patients with CRC; controls were participants of a health check-up program that was conducted between October 1998 and March 2002 at four hospitals in Nagano Prefecture. For 121 newly diagnosed CRC cases, two controls matched by age (within 3 years), gender, and residence were randomly selected from the program participants. We conducted questionnaires and obtained blood samples from the cases and their controls. Consequently, the CRC cancer pairs consisted of 113 cases and 226 controls. RESULTS: Neither H. pylori infection nor gastrin level nor atrophic gastritis showed any association with a risk for CRC. However, serologically determined atrophic gastritis demonstrated significant elevation in odds ratios (ORs) for rectal cancer (OR = 3.15, 95% confidence interval; 1.19-8.35). CONCLUSIONS: Gastric conditions such as chronic H. pylori infection and atrophic gastritis are unlikely to increase the risk for CRC, although atrophic gastritis may increase the risk of rectal cancer.     

A coordinated cytotoxic effect of IFN-gamma and cross-reactive antibodies in the pathogenesis of Helicobacter pylori gastritis

Background. Helicobacter pylori (H. pylori) infection is associated with chronic infiltration into the stomach by T cells and plasma cells producing IFN‐γ and antibodies of various specificities, respectively. It is unknown whether these lymphocyte‐products may play coordinated roles in the gastric pathology of this infection. Aims. To know how IFN‐γ may relate to anti‐H. pylori antibodies in their roles in pathogenesis, we determined the isotype subclass of those antibodies as well as their cross‐reactivity and cytotoxicity to gastric epithelium. Methods and Results. We infected BALB/c mice with H. pylori (SS1, Sydney Strain 1) and generated monoclonal antibodies, which were comprised of 240 independent clones secreting immunoglobulin and included 80 clones reactive to SS1. Ninety percent of the SS1‐reactive clones had IgG2a isotype. Two clones, 2B10 and 1A9, were cross reactive to cell surface antigens in H. pylori and to antigens of 28 KDa and 42 KDa, respectively, which were present on the cell surface of and shared by both mouse and human gastric epithelial cells. The antigens recognized by these monoclonal antibodies localized a distinctive area in the gastric glands. In the presence of complement, 2B10 showed cytotoxicity to gastric epithelial cells. The effect was dose dependant and augmented by IFN‐γ. Finally, administration of 2B10 to mice with SS1 infection aggravated gastritis by increasing cellular infiltration. Conclusion. IFN‐γ by gastric T cells may participate in pathogenesis of the H. pylori infected stomach by directing an isotype‐switch of anti‐H. pylori antibodies to complement‐binding subclass and by augmenting cytotoxic activity of a certain autoantibody. This may explain a host‐dependent diversity in gastric pathology of the patients with H. pylori infection.