幽门弯曲菌与胃炎及消化性溃疡关系的研究现状和展望

早在十九世纪末,就有人注意到人的胃粘膜组织中存在一种螺旋形细菌,其后陆续有类似报道,但均未引起人们重视。1983年Warren和Marshall报告,从人胃粘膜活检组织中分离出这种细菌,提出该菌很可能是慢性胃炎及消化性溃疡的病原菌,从而引起各国学者的极大关注。近年来,我国也开展了这方面的研究。这种细菌已被正式命名为幽门弯曲菌(Campylobacter pylori,简称CP)。国内外的研究提示,CP在胃炎及消化性溃     

幽门螺旋菌保存方法的初步研究

幽门螺旋菌(HP)过去称它为幽门弯曲菌(CP)是近年来从人体胃组织中发现的一种细菌,自1982年首次培养成功以来,已做了大量的研究工作,它与胃炎和消化性溃疡的发生有密切关系.幽门螺旋菌营养要求和培养条件都比较高,而且生物学特性,经多次传代比较容易产生变异,特别是菌种保存方面还存在不少问题,该菌的长期贮存很困难,而长期贮存对该菌的药敏,生物学特性的研究,动物模型的建立都是非常重要的。为了开展对幽门螺旋菌与慢性胃炎和消化性溃疡关系的基础研究,我们对临床胃及十二指肠患者粘膜分离出的幽门螺旋菌进行传代培养,在10％兔全血的布氏肉汤琼脂培养基上,在混合气体(10％CO_2,5％O_2,85％N_2条件下),4℃冰箱中保存于不同时间检查了存活情况,生物学特性的比较。实验表明,用这种方法保存细菌存活率,菌体形态生物学特性保存较好,取得了较满意的结果.     

慢性胃炎患者胃粘膜组织菌群研究

通过３０例慢性胃炎胃粘膜活检标本的细菌与Ｌ型的分离与菌落计数,结果显示除幽门螺杆外,尚分离到多种其它细菌和Ｌ型。胃液ｐＨ值的检测可见两者成正相关（ｒ＝０．６４）,提示胃液ｐＨ值直接影响细菌与Ｌ型的生长及其繁殖。因此,慢性胃炎和消化性溃疡的确切病因与发病机制尚有待深入研究。     

幽门螺杆菌毒力基因分型和宿主遗传多态性与胃病关系研究进展

幽门螺杆菌(Helicobacter pylori)感染能导致慢性胃炎、消化性溃疡、胃粘膜相关的淋巴样组织(Mu-cosa-associated lymphoid tissue,MALT)淋巴瘤和胃腺癌等疾病的发生。1994年世界卫生组织国际癌症研究中心(IARC)将H.pylori列为胃癌第一级因子。H.pylori感染引起的不同临床结局主要与H.pylori致病因子和宿主遗传易感性有关,大部分重大疾病发生在特定的细菌毒力因子(如cagA,vacA)与易感宿主遗传背景共同存在时。文章综述了H.pylori菌株的毒力基因的分型和宿主的遗传多态性对胃病发生的影响。     

幽门螺杆菌感染的微生态治疗

幽门螺杆菌 (H elicobacter pylori,H.pylori)是慢性胃炎、消化性溃疡的主要致病因素 ,也是胃癌的主要诱发因子 ,世界卫生组织已将其列为 类致癌物质 [1 ] 。有效地治疗和根除 H.pylori感染已成为人们关注的焦点。治疗 H.pylori的方案很多 ,目前多采用抗生素多联疗法 ,但细菌抗药性的出现导致 H.pylori根除率降低 ,并可能造成菌失调、霉菌感染 ,甚至发生肝功能异常性改变。 Adamasson等 [2 ] 报道了几例使用抗生素治疗 H.pylori导致的菌群失调 :口腔内出现抗药性链球菌和葡萄球菌 ;胃粘膜中细菌数增加 ,且出现抗药性共生菌 ;肠道内微生…     

日札幌医大制作抗消化性溃疡原因菌的单克隆抗体

札幌医科大学第一内科教授谷内昭和讲师今井浩三等制作出近年疑为消化性溃疡和慢性胃炎的原因菌的弯曲杆菌(Campylobacter pylori)的小鼠单克隆抗体。6月16～18日,在大阪召开的第16次日本临床免疫学会上发表了。利用这种抗体,今后会很可能非常明确弯曲杆菌和消化性溃疡的因果关系。其结果,合成抗菌剂和抗生     

关于幽门螺杆菌疫苗及其相关性研究的报告

幽门螺杆菌感染是慢性胃炎、消化性溃疡的主要致病因素,并且与胃癌的发生有关。本文报告了幽门螺杆菌疫苗及其相关性研究的成果,包括细菌的分离培养、毒力基因分型、抗原的纯化及单克隆抗体的研制、动物模型的建立及其基因工程株的构建等。     

幽门弯曲菌的生物学特性的研究

我们对各型胃病患者共300例进行了幽门弯曲菌(Campylobacter pylori 以下简称CP)检查。以10%小牛血清布鲁氏菌肉汤为保存液,6%羊血布鲁氏菌琼脂平皿作培养基,在微氧条件下分离 CP,阳性率为65%。用改良尿素酶快速诊断的(4小时敏感性)阳性率为34.6%,及95.4%(24小时),特异性为100%。胃粘膜研磨液直接涂片,用0.3%碱性复红染色后镜检,二者阳性符合率为87.2%。CP 的生化试验表明,氧化酶、过氧化氢酶、尿素酶呈阳性反应;葡萄糖发酵、硝酸盐还原及3.5%NaCl 均为阴性。药敏试验的结果显示 CP 对庆大霉素、四环素、红霉素、氯霉素、羧苄青霉素,痢特灵、卡那霉素、先锋霉素等敏感;而对磺胺、萘啶酮酸、多粘菌素 B 等耐药。CP 经口感染小鼠 C57、及 BALb/c,与金黄色地鼠,均无致病性表现。     

幽门弯曲菌DNA G+C mol%含量及菌体脂肪酸组成分析

对上海地区分离所得的幽门弯曲菌(CP)用高压液相色谱法和气相色谱法分别进行了DNA G+Cmol%含置测定及菌体脂肪酸组成分析,并同空肠弯曲菌(CJ)和结肠弯曲菌(CC)进行了比较。CP DNA G+Cmol%含量为35.7—38.3,与CJ和CC相近;CP的主要脂肪酸组成为19cyc、14:0、18:1和18:0,与CJ和CC明显不同。     

胃窦弯曲菌—一种新的胃病致病因子

<正>人体胃内弯曲样细菌早在1906年就曾有过报道。此后,一些学者相继进行了研究。直到1983年,Marshall等才在微氧条件下从人体胃粘膜活检中培养出一种类弯曲菌(Campylobacter-like organism,CLO),现称之为胃窦弯曲菌(Cappylobacter pyl,oridis)认为该菌参与胃病的致病过程。现将有关胃窦弯曲菌的研究进展综述如下。     

Chronic gastritis associated with Helicobacter pylori. Correlation between histological and bacteriological findings.

Biopsy specimens of gastric and duodenal mucosa from 326 patients were examined bacteriologically and histologically to determine the correlation between chronic gastritis and H. pylori colonization. H. pylori was identified in 111 (66.5%) patients with evidence of chronic gastritis and in 97 (82.2%) individuals who had gastritis associated with other pathology (gastric o duodenal ulcer, carcinoma o bulboduodenitis). The spiral bacteria was found more frequently in specimens with chronic superficial gastritis (88/107) and no significant difference was observed between the grade of activity of gastritis and H. pylori colonization. Giemsa stain was the most suitable method for detecting H. pylori in histological sections. By electron microscopy the microorganism was seen on the surface of the gastric mucosa, beneath the mucous layer, and more occasionally in intercellular junctions and the gastric pit.     

Stigmata of recent haemorrhage in diagnosis and prognosis of upper gastrointestinal bleeding

In 277 consecutive episodes of suspected upper gastrointestinal bleeding, lesions bearing stigmata of recent haemorrhage (stigmata) were found by endoscopy in 110 (47%) out of 233 patients who were judged to have bled; 78 (33%) had lesions without stigmata, and in 45 (19%) no lesion was seen. Results in 176 entirely unselected admissions for upper gastrointestinal bleeding were similar.Forty-eight chronic duodenal and 41 chronic gastric ulcers were identified by endoscopy. Stigmata were found in 27 (56%) and 33 (80%) of these cases respectively. Sixteen patients had multiple lesions, and in 12 (75%) the presence of stigmata permitted diagnosis of the source of the haemorrhage. Stigmata were more likely to be seen in cases of duodenal ulcer, Mallory-Weiss lesions, and oesophageal varices when endoscopy was performed within 12 hours of bleeding, but were as common in cases of gastric ulcer after longer intervals.In the absence of stigmata one out of 21 patients with duodenal ulcer had further haemorrhage and one other needed emergency surgery; no patient with gastric ulcer had further haemorrhage or needed emergency surgery. In contrast, when stigmata were present 15 of the 27 patients with duodenal ulcer (56%) had further haemorrhage and 17 (63%) needed emergency surgery; of the 33 patients with gastric ulcer, 10 (30%) had further haemorrhage and 15 (45%) required emergency surgery. Superficial mucosal lesions may have been the source of haemorrhage when an ulcer unmarked by stigmata was seen at endoscopy. Stigmata were superior to any other single factor or combination of factors in predicting rebleeding and the need for emergency surgery.     

A study of some immunological and clinical characteristics of gastritis, gastric ulcer, and duodenal ulcer in three racial groups of the Venezuelan population

Circulating gastric-mucosa antibodies were found more frequently among patients with different forms of chronic gastritis than among a miscellaneous control group and groups that presented prepyloric ulcer or duodenal ulcer. A higher incidence of circulating antibodies and of chronic gastritis lesions among Caucasians and “Mestizos” than among Negroes was also observed. The latter showed a higher tendency to duodenal ulcer and prepyloric ulcer. The high incidence of gastritis and gastric ulcer of the Chinese and the Mestizos support the ethnic relation between these two human groups. Our study favors the hypothesis that genetic and ethnic factors influence, on the one hand, chronic gastritis and gastric ulcer and, on the other hand, duodenal and prepyloric ulcers.     

Changes in gastric mucosa after vagotomy and gastrojejunostomy for duodenal ulcer.

Gastric mucosa was studied histologically in 141 patients. Eighty two had undergone vagotomy and gastrojejunostomy between 15 and 25 years previously for duodenal ulcer, and 59 control patients had a long history (minimum 15 years) of duodenal ulcer treated medically. No carcinoma was found in either group. Two patients with severe dysplasia and 13 patients with moderate dysplasia were found in the study group, compared with none in the control group (p less than 0.01). Intestinal metaplasia was seen in 44 (53%) of the study group and 16 (27%) of the control group (p less than 0.01). Atrophy and gastritis were more severe (p less than 0.01 for atrophy; p = 0.05 for gastritis) in the study group. Gastric mucosal changes were more severe after surgical treatment for duodenal ulcer than after medical treatment, and possibly a high incidence of gastric carcinoma may occur 25 years after vagotomy and gastrojejunostomy.     

Occurrence of Campylobacter pylori in gastric mucosa and selected parameters of cell-mediated immunity in patients with duodenal ulcer and individuals with non-ulcerative dyspepsia]

The study was aimed at investigating a relationship between Campylobacter pylori infection in the gastric mucosa and selected parameters of cell-mediated immunity in patients with duodenal ulcer and the individuals with non-ulcerative dyspepsia. A relationship between Campylobacter pylori and gastritis has also been studied. Endoscopic and immunological tests were carried out in the group of 45 patients, including 14 patients with duodenal ulcer and 29 with non-ulcerative dyspepsia. Specimens of gastric mucosa were collected endoscopically for histological and bacteriological examinations. Immunological tests included an assessment of the number of lymphocytes T (and their subpopulations) forming active rosettes (ARFC); total - (TRFC) and theophylline-resistant in active rosettes fraction (ARFC-TR); total (TRFC-TR) and theophylline-sensitive lymphocytes in both fractions (ARFC-TS and TRFC-TS) in 1 mm3 of the peripheral blood. Results suggest, that there is correlation between an infection of the gastric mucosa by Campylobacter pylori and duodenal ulcer and gastritis. No correlation between the infection by Campylobacter pylori and examined parameters of immunity in both patients with duodenal ulcer and non-ulcerative dyspepsia was found.     

Presence of the cagA Gene in the Majority of Helicobacter pylori Strains Is Independent of Whether the Individual Has Duodenal Ulcer or Asymptomatic Gastritis

Background Helicobacter pylori infection presents as many different diseases, including asymptomatic gastritis, peptic ulcer disease, and gastric cancer. Although the virulence factor(s) responsible for different H. pylori-related diseases have not been identified, several candidate genes are being investigated for such an association. The polymerase chain reaction (PCR) frequently is used to assess the presence of genetic factors associated with pathogenesis of disease; the cagA gene and its product have been postulated to have a disease-specific relationship to peptic ulcer and gastric cancer because of differential expression in these diseases compared to histological gastritis alone. Materials and Methods. Genomic DNA was amplified by PCR, using synthetic oligonucleotide primers to the cagA gene to determine the prevalence of the cagA gene in 60 H. pylori isolates obtained from well-documented duodenal ulcer or asymptomatic gastritis patients (30 each). Results were confirmed by hybridization with a 1.4-Kb cagA probe. Results. The expected PCR product was obtained in 90% of isolates from duodenal ulcer patients, compared to 70% of isolates from individuals with asymptomatic gastritis. The PCR products were polymorphic in size, suggesting cagA gene sequence differences among isolates. Evaluation for the presence of the cagA gene by hybridization with a 1.4-Kb cagA probe showed a homologous product in 29 of 30 strains [96.7%; 95% confidence interval (CI) = 83–100%] from duodenal ulcer patients versus 25 of 30 strains (83.3%; 95% CI = 65–94%) obtained from individuals with asymptomatic gastritis (p= 0.19). Conclusions. The high prevalence of the cagA gene in asymptomatic gastritis suggests that it will not prove to be a useful marker to distinguish more virulent or disease-specific H. pylori strains. The genetic heterogeneity among H. pylori strains makes PCR an unwise choice as the single method to determine prevalence of a putative virulence factor. In evaluation of the prevalence of a gene or genetic factor in a population of H. pylori, hybridization with extended probes might be important to ensure that the results are representative of the organism's genotype.     

Risk factors associated with gastric cancer in patients with a duodenal ulcer

Background: Although gastric cancer (GC) and duodenal ulcer (DU) are both strongly associated with Helicobacter pylori infection, a DU is negatively associated with the risk of GC. The aim of the study is to evaluate histologic risk factors for GC among patients with a DU. Materials and Methods: A total of 541 consecutive patients with GC were prospectively evaluated for the presence of a DU. Control patients with only a DU (n = 89) were recruited from health screening population. Histologic grading was assessed using the updated Sydney system for six gastric biopsies from three regions. GC risk among patients with a DU was evaluated using logistic regression analysis. Results: Among patients with GC, 7.6% (41/541) had a concomitant DU or an ulcer scar. Corpus‐predominant/pangastritis were more frequently found in concomitant GC patients with a DU (90%) than in patients with a DU alone (62%) (p = .001). In patients with a DU, moderate–severe chronic inflammation at the lesser and greater curvatures of corpus was associated with GC risk (OR, 3.70; 95% CI, 1.46–9.36, and OR, 7.72; 95% CI, 3.18–18.7, respectively). Additionally, moderate–severe intestinal metaplasia (IM) at the antrum and corpus lesser curvature was associated with GC risk (OR, 7.52; 95% CI, 3.06–18.5, and OR, 9.25, 95% CI, 2.39–35.8, respectively). Conclusions: A DU is not rare in patients with GC in a high‐risk region of GC. Patients with a DU with chronic corpus gastritis and IM have an increased risk of GC, thus those patients should be followed up for GC development.     

慢性腹痛患儿C~(13)-尿素呼气试验与胃镜检查的临床意义

目的了解慢性腹痛患儿幽门螺杆菌(H.pylori)的感染状态及幽门螺杆菌感染患儿内镜下表现的特点。方法应用C13尿素呼气试验,对905例以慢性腹痛为主要症状的患儿进行检测,对C13呼气试验阳性者进行电子胃镜检查。结果905例慢性腹痛患儿中H.pylori呈阳性185例(20.44%),随年龄增长,其H.pylori阳性率升高,学年组已达高峰。对H.pylori阳性者进行胃镜检查结果显示十二指肠隆起病变47例占25.40%,结节性胃炎41例占22.1%,慢性浅表性`胃炎38例占20.5%,结节性胃炎伴十二指肠隆起病变23例占12.43%,十二指肠球部溃疡23例占12.4%。胃溃疡7例,占3.7%(其中包括1例复合性溃疡),结节性胃炎伴十二指肠炎6例,占3.2%。结论H.pylori感染为小儿慢性腹痛的主要原因之一,也是导致慢性胃炎及消化性溃疡的主要原因之一。C13尿素呼气试验方便,快速,无痛苦,无放射性,是一较好的H.pylori检测方法;对既有消化道症状同时C13呼气试验阳性者进行胃镜检查能够协助临床诊断及治疗。     

Diagnosis of Helicobacter pylori in gastric brush and biopsy specimens stained by Rowmanowsky and immunocytochemical methods: comparison with the CLOtest

Helicobacter pylori has been implicated in the pathogenesis of chronic gastritis, gastric and duodenal ulcer, and possibly gastric carcinoma. The organism may be detected by invasive or non‐invasive methods with variable sensitivity. Paired gastric biopsy and gastric brush specimens were collected from 83 patients presenting with non‐ulcer dyspepsia. One biopsy was tested for urease using the CLOtest, the other was processed to paraffin and consecutive sections were stained with haematoxylin and eosin, modified Giemsa and anti‐ H. pylori antisera. The brush specimens were stained with a rapid Romanowsky stain (Hema‐Gurr) and anti‐ H. pylori . The CLOtest was positive in 31 cases, the Giemsa biopsy in 25, the anti‐ H. pylori biopsy in 27, the Hema‐Gurr smear in 27 and the anti‐ H. pylori smear in 19. The sensitivities of the methods after omitting one inadequate biopsy were 96%, 93%, 100%, 96% and 78%, respectively. The specificities were 93% for the CLOtest and 100% for the other methods. While immunocytochemical staining of gastric biopsies may be the most sensitive method for H. pylori identification, the cost and turn around time of the technique may preclude its routine use. Gastric brush cytology is a highly sensitive and specific method for H. pylori detection that is quick and simple to perform. Its application is recommended for the routine diagnosis of H. pylori infection.     

Helicobacter pylori. One bacterium and a broad spectrum of human disease! An overview.

Since the historical rediscovery of gastric spiral Helicobacter pylori in the gastric mucosa of patients with chronic gastritis by Warren and Marshall in 1983, peptic ulcer disease has been largely viewed as being of infectious aetiology. Indeed, there is a strong association between the presence of H. pylori and chronic active gastritis in histology. The bacterium can be isolated in not less than 70% of gastric and in over 90% of duodenal ulcer patients. Eradication of the organism has been associated with histologic improvement of gastritis, lower relapse rate and less risk of bleeding from duodenal ulcer. The bacterium possesses several virulence factors enabling it to survive the strong acid milieu inside the stomach and possibly damaging host tissues. The sequence of events by which the bacterium might cause gastric or duodenal ulcer is still not fully elucidated and Koch's postulates have never been fulfilled. In the majority of individuals, H. pylori infection is largely or entirely asymptomatic and there is no convincing data to suggest an increase in the prevalence of peptic ulcer disease among these subjects. An increasingly growing body of literature suggests an association between colonization by H. pylori in the stomach and a risk for developing gastric mucosa-associated lymphoid tissue (MALT), MALT lymphoma, gastric adenocarcinoma and even pancreatic adenocarcinoma. The bacterium has been implicated also in a number of extra-gastrointestinal disorders such as ischaemic heart disease, ischaemic cerebrovascular disease, atherosclerosis, and skin diseases such as rosacea, but a causal role for the bacterium is missing. Eradication of H. pylori thus seems to be a beneficial impact on human health. Various drug regimens are in use to eradicate H. pylori involving the administration of three or four drugs including bismuth compounds, metronidazole, clarithromycin, tetracyclines, amoxycillin, ranitidine, omeprazole for 1-2 weeks. The financial burden, side effects and emergence of drug resistant strains due to an increase in the use in antibiotics for H. pylori eradication therapy need further reconsideration.