雷贝拉唑、阿莫西林联合胶体果胶铋治疗Hp阳性消化性溃疡的临床研究

目的 探讨雷贝拉唑、阿莫西林联合胶体果胶铋治疗幽门螺杆菌（Helicobacter pylori,Hp）阳性消化性溃疡的临床疗效。方法 选取116例Hp阳性消化性溃疡患者,将其随机分为对照组和观察组,对照组给予雷贝拉唑、阿莫西林进行治疗,观察组给予雷贝拉唑、阿莫西林联合胶体果胶铋进行治疗。两组均连续治疗4周。观察两组患者的主要症状变化情况、临床疗效、Hp清除率及不良反应等。结果 经治疗后,观察组临床总有效率为94.8%,与对照组总有效率74.1%比较,差异有统计学意义（χ2=4.735,P＜0.05）;观察组上腹疼痛、反酸、腹胀等症状改善所需时间与对照组比较,差异均有统计学意义（t分别为7.557、4.067、9.346,Ps＜0.05）;观察组Hp清除率91.4%与对照组Hp清除率65.5%比较,差异有统计学意义（χ2=5.736,P＜0.05）;观察组不良反应发生率19.0%与对照组不良反应发生率20.7%比较,差异无统计学意义（χ2=0.027,P>0.05）。结论 雷贝拉唑、阿莫西林联合胶体果胶铋用于治疗Hp阳性消化性溃疡,可显著改善临床症状,提高Hp清除率和临床疗效,且安全性较好,具有一定的临床意义。     

消化性溃疡与幽门螺杆菌关系的内窥镜探查

目的:探讨幽门螺杆菌(Hp)与消化性溃疡(PU)的关系。方法:检测167例PU患者Hp阳性率,使用胃镜观察溃疡形态、大小和部位。结果:167例PU患者Hp阳性检出率为87.43%,胃溃直径大于1.5 cm者与,胃溃直径小于0.5cm,溃疡处于活动期者与愈合期和瘢痕期者,Hp阳性检出率有显著差异(P<0.05)。结论:Hp感染与溃疡的发生有密切关系,溃疡患者病情越重,Hp感染程度越高,但Hp阳性溃疡并不加重消化道出血现象发生。     

益生菌对幽门螺杆菌阳性消化性溃疡治疗有效性的Meta分析

目的 探讨益生菌+H.pylori标准疗法对消化性溃疡患者H.pylori感染的根除率与安全性.方法 计算机检索2019年3月20日以前公开发表的中英文数据库文献(知网数据库、万方数据库、EMBASE数据库、MEDLINE数据库以及PubMed数据库等),借助RevMan 5.2软件分析与评价相关数据.结果 检索符合条...     

标准四联法对幽门螺旋杆菌相关性消化道溃疡的临床研究

目的 观察标准四联对幽门螺旋杆菌（Helicobacter pylori,H. pylori）相关性消化道溃疡的临床效果和安全性。方法 选取我院2013年5月至2014年6月收治的H. pylori相关性消化道溃疡患者160例,按照随机数字法随机分为观察组和对照组,每组80例。观察组采用兰索拉唑、阿莫西林、克拉霉素联合胶体果胶铋的标准四联法治疗;对照组采用兰索拉唑、阿莫西林、克拉霉素标准三联法治疗,对比分析两组临床症状缓解率、溃疡愈合率、H. pylori根除率及不良反应情况。结果 两组治疗1周的临床症状缓解率相比差异无统计学意义（2=2.064,P>0.05）;治疗4周后观察组的临床症状缓解率为96.25%,显著性高于对照组的81.25%（2=9.014,P0.05）。结论 标准四联对H. pylori相关性消化道溃疡的临床症状缓解率高、H. pylori根除率高、溃疡愈合率高,安全性高,值得临床推广。     

ABO血型与幽门螺旋菌感染关系及其意义

本文采用细菌学和血清学方法检测了２１７例胃、十二指肠疾病患者和１６９例健康输血员幽门螺旋菌（ＨｅｌｉｃｏｂａｃｔｅｒｐｙｌｏｒｉＨＰ）感染情况和ＡＢＯ血型,以探讨ＨＰ感染与ＡＢＯ血型系统之间的关系。结果表明：消化性溃疡各组患者Ｏ型血所占的比例均较高;胃十二指肠疾病患者和健康输血员中Ｏ型血人群ＨＰ阳性率分别为８９．５８％和５１．７８％,显著高于其它血型（Ｐ＜０．００５、０．０５）;并且在同一疾病中ＨＰ阳性者Ｏ型血所占的比例显著高于ＨＰ阴性者（Ｐ＜０．０２５）。提示：Ｏ型血人群对ＨＰ易感染,这可     

cagA gene variants in Malaysian Helicobacter pylori strains isolated from patients of different ethnic groups

Helicobacter pylori infection of a distinct subtype of cagA may lead to different pathological manifestation. The aim of this study is to determine the presence of cagA gene and its variants in H. pylori infection among different ethnic groups and its effect on gastroduodenal diseases. Overall detection of cagA among the 205 clinical isolates of H. pylori was 94%. Variations in size of the 3' region of cagA gene were examined among 192 Malaysian H. pylori cagA-positive strains. Results showed that three cagA variants differing in fragment length of PCR products were detected and designated as type A (621-651bp), type B (732-735bp) and type C (525 bp). Although there was no association between any of the cagA subtypes with peptic ulcer disease (p>0.05), an association between cagA subtypes with a specific ethnic group was observed. Specific-cagA subtype A strains were predominantly isolated from Chinese compared to Malays and Indians (p<0.0005), and cagA subtype B strains were predominantly isolated from Malays and Indians compared to Chinese (p<0.05). The cagA type A strains of H. pylori is commonly found in the Chinese patients who have a higher risk of peptic ulcer disease, thus indicating that it could be used as an important clinical biomarker for a more severe infection.     

Rank order of success favors longer duration of imidazole-based therapy for Helicobacter pylori in duodenal ulcer disease: a randomized pilot study

Background. Studies on eradication therapy in developing countries have shown a success rate of 70–85%, which is suboptimal. Duration of therapy may be an important factor dictating eradication success in such regions. Aim. The study was undertaken to evaluate the effect of increasing the treatment period on eradication of Helicobacter pylori in duodenal ulcer disease. Methods. A randomized trial was carried out in which 64 consecutive H. pylori‐infected patients with duodenal ulcer disease were enrolled. The patients were randomized to one of the three trial arms. Therapy consisted of lansoprazole 30 mg twice a day (b.i.d.), amoxycillin 1 g b.i.d. and tinidazole 500 mg b.i.d. The treatment period was 1 week in group I, 2 weeks in group II and 3 weeks in group III. At inclusion, patients underwent endoscopy and the presence of H. pylori was documented by a positive urease test and C14 urea breath test. Four weeks after completion of eradication therapy, the patients were subjected to repeat endoscopy to assess ulcer healing and tests for H. pylori infection. Results. Sixty‐four patients (55 male and nine female; mean age 35.5 years) were enrolled in each group. The H. pylori eradication rate for group I (1 week of therapy) was 47.6%, that for group II (2 weeks of therapy) was 80%, and that for group III (3 weeks of therapy) was 91.3% (p = .003). The ulcer healing rates were 71.4, 80 and 95.6% in groups I, II and III, respectively (p = .09). Conclusion. The 3‐week regimen significantly improved the eradication rate as compared with the 1‐week regime. Increasing the duration of therapy significantly improved the chances of eradication of H. pylori in duodenal ulcer disease.     

幽门螺杆菌感染并发消化性溃疡的危险因素及预防对策分析

目的:分析幽门螺杆菌感染并发消化性溃疡的危险因素,并实施预防对策。方法:选取我院收治的消化性溃疡的患者201例,对其临床资料进行回顾性分析,分析其危险因素。结果:消化性溃疡患者201例,Hp感染162例,Hp阳性率80.60%,不同类型的消化性溃疡的Hp阳性率比较,差异无统计学意义(P0.05)。单因素分析结果显示,年龄在36-60岁、共食、男性、暴饮暴食、喜爱辛辣食物、吸烟饮酒、个人卫生、家族病史、以往病史,均是消化性溃疡Hp感染的高危因素。进餐习惯、喜欢酸奶、个人卫生均是Hp感染的保护因素,而暴饮暴食、喜爱辛辣食物、年龄、以往病史、吸烟饮酒、家族病史均是Hp感染的危险因素。结论:分餐习惯、喜欢酸奶、个人卫生均是Hp感染的保护因素,而暴饮暴食、喜爱辛辣食物、年龄、以往病史、吸烟饮酒、家族病史是Hp感染的危险因素,进行有针对性的预防可降低疾病发生率。     

幽门螺杆菌根除治疗对消化性溃疡患者血清胃泌素水平的影响

目的 观察幽门螺杆菌(H.pylori)根除治疗对消化性溃疡患者血清胃泌素水平的影响,为该病治疗提供参考。 方法 选择我院2017年8月至2019年8月收治的120例H.pylori感染的消化性溃疡患者作为观察组,根据H.pylori分型结果进一步分为HPⅠ型组和HPⅡ型组,观察组患者接受根除幽门螺杆菌治疗。选择同期入院的40例非幽门螺杆菌感染消化性溃疡患者作为对照组,对照组患者接受常规治疗。比较两组患者治疗效果、胃镜检查结果、H.pylori清除情况及血清胃泌素、IL10、IL17水平。 结果 HPⅠ型组、HPⅡ型组和对照组患者临床总有效率差异无统计学意义(92.75%、96.08%、97.50%,χ2=1.384,P=0.051)。HPⅠ型组、HPⅡ型组、对照组患者胃镜检查总有效率差异无统计学意义(91.30%,96.08%,97.50%,χ2=1.384,P=0.051)。HPⅡ型组患者幽门螺杆菌根除率高于HPⅠ型组(98.04% vs 85.51%,χ2=4.129,P=0.042)。HPⅠ型组患者治疗后血清胃泌素、IL10、IL17水平均高于对照组(均P结论 不同类型H.pylori感染消化性溃疡患者行幽门螺杆菌根除治疗后临床效果无显著差异。幽门螺杆菌根除治疗可降低消化性溃疡患者血清胃泌素、IL10、IL17水平。     

益生菌联合抗幽门螺杆菌治疗对消化性溃疡患者的疗效

目的 探讨益生菌联合抗幽门螺杆菌（H. pylori）治疗对消化性溃疡患者的疗效及其对患者肠道菌群的影响。方法 将120例经14C呼气试验（14C-UBT）检测确定为H. pylori感染阳性的消化性溃疡患者随机分为观察组和对照组,每组60例。其中,对照组采用四联疗法（奥美拉唑+阿莫西林+克拉霉素+铋剂）治疗,观察组采用四联疗法联合益生菌治疗;比较两组患者H. pylori根除情况、溃疡愈合质量及不良反应情况。治疗前后留取全部患者的新鲜粪便标本进行细菌培养,比较两组患者肠道菌群数量和肠道微生物定植抗力（B/E值）。结果 观察组患者H. pylori根除率和溃疡愈合率分别为88.3%、95.0%,显著高于对照组的70.0%和76.7%（P＜0.05）,不良反应率为3.3%,显著低于对照组的20.0%（P＜0.05）。与治疗前比,对照组患者治疗后肠道内产气荚膜梭菌、双歧杆菌及乳杆菌数量显著减少（P＜0.05）,肠杆菌、肠球菌及酵母菌数量显著增加（P＜0.05）,B/E值显著降低（P＜0.05）;观察组患者治疗后双歧杆菌和乳杆菌均显著增加（P＜0.05）,产气荚膜梭菌显著减少（P＜0.05）,肠杆菌、肠球菌及酵母菌无明显变化（P＞0.05）,B/E值显著升高（P＜0.05）。结论 常规抗H. pylori治疗易引起消化性溃疡患者肠道菌群紊乱,降低肠道定植抗力。益生菌联合治疗可有效改善患者肠道微生态,提高H. pylori根除率和溃疡愈合质量,减少不良反应。     

Accuracy of diagnostic tests for Helicobacter pylori in patients with peptic ulcer bleeding

Background and Aims: To assess the validity of biopsy‐based tests (histology, culture, and urease test) and serology in detecting current H. pylori infection for the peptic ulcer patients who had gastric bleeding. Methods: A total of 398 peptic ulcer patients were enrolled and divided into two groups, according to the presence or absence of bleeding. The diagnosis for current H. pylori infection was verified using the gold standard combining individual H. pylori tests. Sensitivity, specificity, and positive and negative predictive values of the culture, Campylobacter‐like organism (CLO) test (urease test), histology, and serology were compared. Results: Of the total study population (N = 398), 157 (39.4%) patients were categorized into the bleeding group. The sensitivities of the culture (40.0%) and CLO (85.0%) in the bleeding group were significantly lower than culture (58.1%) and CLO (96.4%) in the nonbleeding group (p = .012 and p < .001, respectively). In the bleeding group, the sensitivity of CLO (85.0%) was significantly lower than histology (92.5%) and serology (97.4%) (p = .013 and p = .002, respectively), which was not found in the nonbleeding group. The specificity of serology in the bleeding group (56.3%) was significantly lower than that of nonbleeding group (74.2%) (p = .038). Similarly, the specificity of serology was significantly lower than the other H. pylori tests in the bleeders. Conclusions: Bleeding decreased the sensitivity of H. pylori tests in patients with peptic ulcer, especially in urease test or culture. In contrast, histology was found to be a quite reliable test, regardless of the presence of bleeding.     

不同基因型幽门螺杆菌感染与消化性溃疡患者血清炎症因子及CD4+T细胞、PINP水平的关系

目的探讨不同基因型H.pylori感染与消化性溃疡(PU)患者血清炎症因子及CD4⁺T细胞、Ⅰ型原胶原N端前肽(PINP)水平的关系,为后续研究提供参考。方法选择2017年8月至2019年3月于我院消化科就诊的122例PU患者为研究对象,其中H.pylori阴性患者50例[HP(-)组],H.pyloriⅠ型感染患者38例[HP(Ⅰ)组],H.pyloriⅡ型感染患者34例[HP(Ⅱ)组],对比各组患者血清炎症因子IL-17、IL-10、TNF-α和PINP及CD4⁺T淋巴细胞水平。采用Logistic回归对不同菌型H.pylori感染患者血清炎症因子及CD4⁺T细胞、PINP水平的相关性进行评估,并结合ROC曲线对其相应诊断价值进行评估。结果HP(-)组患者IL-17、IL-10、TNF-α水平最低,HP(Ⅰ)组患者IL-17、IL-10、TNF-α水平最高,组间差异有统计学意义(均P<0.001)。HP(-)组患者CD4⁺T细胞及PINP水平最低,HP(Ⅰ)组CD4⁺T细胞及PINP水平最高,组间差异有统计学意义(均P<0.001)。多因素Logistic回归显示,血清炎症因子及CD4⁺T细胞、PINP水平与H.pyloriⅠ型、H.pyloriⅡ型感染均有显著正相关性(均P<0.05)。ROC曲线分析显示,IL-17、IL-10、TNF-α、CD4⁺T细胞和PINP诊断H.pyloriⅠ型感染的AUC分别为0.863(95%CI:0.786~0.941)、0.844(95%CI:0.754~0.935)、0.907(95%CI:0.847~0.967)、0.921(95%CI:0.864~0.977)、0.742(95%CI:0.639~0.845),而诊断H.pyloriⅡ型感染的AUC分别为0.711(95%CI:0.599~0.823)、0.747(95%CI:0.641~0.854)、0.930(95%CI:0.874~0.986)、0.918(95%CI:0.861~0.974)、0.736(95%CI:0.631~0.840)。H.pylori阴性与CD4⁺T细胞和PINP水平无明显相关性(r=0.226,P=0.225),H.pyloriⅠ型、H.pyloriⅡ型感染与CD4⁺T细胞和PINP水平具有显著正相关性(r=0.428、0.367,P=0.007、0.033)。结论血清炎症因子及CD4⁺T细胞和PINP水平与PU患者H.pylori感染具有相关性,可作为临床辅助监测指标。     

幽门弯曲菌与慢性胃炎和消化性溃疡关系的系列研究

我院自1986年6月至1989年6月检查了634例病人的胃粘膜,从幽门弯曲菌(CP)的细菌学、致病性、病理学、诊断方法及药物治疗等方面进行了研究,探讨CP与慢性胃炎及消化性溃疡的关系。结果发现CP有两种形态并与空弯菌不同,不产生肠毒素;消化性溃疡的CP检出率为80.9％,慢性胃炎为41.6％,显著高于正常胃粘膜(3.7％);CP与消化性溃疡、慢性胃炎,十二指肠炎特别是活动性炎症有密切关系;CP对胃型上皮或粘液有某种亲和性;观察到上皮细胞破溃处有大量细菌聚集,CP有致细胞病变的能力。用阿的平代替吖啶橙荧光染色,并制成CP感染快速诊断试剂盒。呋喃唑酮促进溃疡愈合,使45～73％病例CP消失,50～70％胃炎好转。但有复发,根除CP有困难。     

乳酸菌素治疗消化性溃疡的临床分析

目的：观察乳酸菌素治疗消化性溃疡的疗效。方法：共28例患者,治疗组12例,对照组16例。治疗组口服乳酸菌素、思密达,对照组口服西米替丁、阿莫西林、硫糖铝片。二组均用药4w。结果：腹疼症状缓解率治疗组为100％,对照组为95％。呕吐症状缓解率均为100％。溃疡愈合率治疗组为100％,对照组为75％。结论：乳酸菌素在抑制幽门螺杆菌感染,保持消化道微生态的平衡和调节机体免疫方面效果明显。     

Genetic and evolutionary implications in peptic ulcer disease

The evidence for a genetic component in peptic ulcer disease has been based on twin, family, and blood group studies. A polygenic model for the inheritance of peptic ulcers has been displaced by a genetic heterogeneity model based on several lines of evidence, some of the most powerful being recent work using subclinical markers. One marker in particular, an elevated level of serum pepsinogen I (PG I), a pepsin precursor produced by the gastric mucosa, secreted into the stomach lumen and also appearing in the bloodstream, has been found to be associated with a subgroup of duodenal ulcer patients. Segregation analysis of elevated serum PG I in duodenal ulcer sibships demonstrates familial aggregation consistent with autosomal dominant inheritance. Elevated PG I is also accompanied by gastric hyperacidity and presumably indicates those individuals with an increased mass of chief and parietal cells, and thus an increased capacity for peptic activity, an important element in the pathogenesis of ulcer disease. An evolutionary hypothesis based on selection for peptic activity and acidity is offered to explain several of the epidemiologic and genetic elements of this group of chronic diseases.     

埃索美拉唑为基础的四联疗法对消化性溃疡患者幽门螺杆菌根除率、炎性因子及生活质量的影响

目的:探讨埃索美拉唑为基础的四联疗法对消化性溃疡(PU)患者幽门螺杆菌(Hp)根除率、炎性因子及生活质量的影响。方法:选取2016年3月～2018年11月间我院接收的117例PU患者,根据数表法将患者随机分为对照组(n=58)和研究组(n=59),对照组给予以奥美拉唑为基础的四联疗法治疗,研究组给予以埃索美拉唑为基础的四联疗法治疗,比较两组患者临床疗效、Hp根除率、炎性因子、生活质量及不良反应。结果:研究组治疗后总有效率为74.58%(44/59),高于对照组患者的53.45%(31/58)(P0.05)。两组患者治疗后白介素-6(IL-6)、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)较治疗前降低,且研究组低于对照组(P0.05)。研究组的HP根除率高于对照组(P0.05)。两组患者治疗后临床症状、心理情感、社交及任务完成评分均较治疗前升高,且研究组高于对照组(P0.05)。两组不良反应发生率比较无统计学差异(P0.05)。结论:埃索美拉唑为基础的四联疗法治疗PU,可有效改善炎性因子水平、Hp根除率和生活质量,疗效确切,安全性好,临床应用价值较高。     

瑞巴派特四联疗法对幽门螺杆菌阳性消化性溃疡患者血清氧化应激指标和胃蛋白酶原的影响

摘要 目的：观察瑞巴派特四联疗法治疗幽门螺杆菌（Hp）阳性消化性溃疡的疗效及对患者血清氧化应激指标和胃蛋白酶原的影响。方法：选取2020年7月至2021年12月期间广西壮族自治区胸科医院收治的Hp阳性消化性溃疡患者（n=100）,按照随机数字表法分为联合组（50例,瑞巴派特四联疗法）、对照组（50例,标准四联疗法）。对比两组疗效、量表评分、血清氧化应激指标、胃蛋白酶原（PG）、不良反应发生率、Hp根除率、复发率。结果：联合组的临床总有效率高于对照组（P<0.05）。联合组的消化性溃疡愈合率高于对照组（P<0.05）。治疗后,联合组胃食管反流性疾病症状频率量表（FSSG）各项评分、临床症状各项评分低于对照组（P<0.05）。治疗后,联合组血清丙二醛（MDA）低于对照组,血清谷胱甘肽过氧化物酶（GSH-PX）、超氧化物歧化酶（SOD）高于对照组（P<0.05）。治疗后,联合组胃蛋白酶原（PG）Ⅰ、PGⅡ低于对照组（P<0.05）。两组不良反应总发生率组间对比无差异（P>0.05）。联合组的Hp根除率高于对照组,复发率低于对照组（P<0.05）。结论：瑞巴派特四联疗法治疗Hp阳性消化性溃疡患者,可有效促进溃疡愈合,缓解临床症状,改善机体应激状态和胃蛋白酶原水平,提高Hp根除率,减少不良反应及复发情况。     

Helicobacter pylori recurrence in patients with duodenal ulcer: Clinical, endoscopic, histologic, and genotypic aspects. A 10-year Brazilian series

BACKGROUND: Recurrence infection following successful eradication of Helicobacter pylori is usually low, except for countries with high prevalence of H. pylori. The aim of this study was to verify H. pylori recurrence rate in patients with duodenal ulcer after eradication and the possible relationship with environmental factors, histologic pattern of the mucosa and bacterial genotype. MATERIALS AND METHODS: One-hundred and ninety-four patients with an active duodenal ulcer and who were successfully treated for H. pylori infection from 1990 to 1999 were studied. A questionnaire was answered about their living conditions, and a 14C-urea breath test was performed. Patients with a positive breath test underwent an upper endoscopy to investigate for possible ulcer recurrence; gastric biopsy samples were than collected for rapid urease test and for histologic assessment. H. pylori vacA and cagA genotype was determined by polymerase chain reaction in those samples with positive urease test. RESULTS: H. pylori infection was detected in 11 patients (recurrence rate of 5.7%) that were not associated with the type of bacterial virulence. In 10 patients the ulcer was healed and all of them were clinically asymptomatic. In eight, histology showed an intensification of gastritis. All 11 patients had adequate housing and sanitary conditions and no other risk for H. pylori recurrence was identified. CONCLUSIONS: The recurrence rate of H. pylori in Brazil was higher than that reported in developed countries, but lower than usually reported in developing ones. Ulcer relapse rarely occurs even in long-term follow up.