幽门螺杆菌感染与血清抗体及滴度的相关性研究

为了解幽门螺杆菌（ＨｅｌｉｃｏｂａｃｔｅｒＰｙｌｏｒｉ,ＨＰ）感染时机体的免疫状况,我们对１３４例上消化道疾病患者的血清免疫球蛋白进行了检测。结果表明,细菌培养阳性患者的三种血清抗体滴度显著高于细菌培养阴性患者。血清ＩｇＧ、ＩｇＡ、ＩｇＭ阳性与细菌培养阳性的符合率分别为７９．１％,７４．６％和４３．２％。活动性胃炎和非活动性胃炎的细菌培养阳性率分别为６６％和４２％。证实ＨＰ菌感染与活动性胃炎的发生密切相关,而与胃炎的严重程度无显著性差异。并证实了抗ＨＰ菌ＩｇＧ、ＩｇＡ检测具有较高的诊断ＨＰ菌感染的敏感性和特异性。     

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(P0.05);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(P0.05);乳酸杆菌细菌数(Log)与胃黏膜总细菌数(Log)无显著相关性(P0.05);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(P0.05);肠化组和未肠化组乳酸杆菌检出率差异无统计学意义(P0.05);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(P0.05)和中度胃炎组(P0.05)。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。     

幽门螺杆菌感染对肝硬化患者高氨血症的影响

目的探讨幽门螺杆菌(Hp)感染对肝硬化患者血氨浓度的影响.方法 51例确诊为Hp阳性的肝硬化患者为阳性组,27例Hp阴性的肝硬化患者为阴性组,40例Hp阳性的消化性溃疡或胃炎患者为对照组.分别检验3组的血氨浓度并进行比较,应用三联法治疗1周,于4周后再测定3组的血氨并进行比较.结果阳性组与阴性组、对照组血氨浓度相比差异有显著性(P＜0.01).阴性组与对照组相比差异无显著性(P＞0.05),阳性组治疗前后血氨浓度变化差异有显著性(P＜0.01).阳性组不同肝功能分级组血氨浓度之间差异有显著性(P＜0.05);阴性组不同肝功能分级组血氨浓度之间差异无显著性(P＞0.05).结论幽门螺杆菌感染可导致肝硬化患者血氨的升高,根除Hp后可使血氨水平明显下降.     

中西医结合治疗胆汁返流性胃炎的观察

目的：探讨中西医结合在胆汁反流性胃炎治疗中的应用及疗效。方法：将64例胆汁反流性胃炎患者随机平均分为对照组和观察组,对照组采用多潘立酮和铝碳酸镁进行治疗,观察组在对照组的基础上加用中药大柴胡汤,疗程为6周。观察治疗后患者主要症状改善情况和胃镜下表现情况,并行疗效比较。结果：观察组患者上腹痛、恶心、胃内胆汁、胃黏膜充血、胃黏膜糜烂等症状的改善率高于对照组（P〈0．05）;观察组治愈14例、显效9例、有效6例、无效3例,疗效优于对照组,差异有显著性（Z=2．864,P〈0．01）。结论：中西医结合是治疗胆汁反流性胃炎的有效治疗方案,建议临床推广应用。     

幽门螺杆菌分离培养的研究

采用细菌培养法及快速尿素酶法分别检测了１６９例消化道疾病患者幽门螺杆菌（Ｈｅｌｉ－ｃｏｂａｃｔｅｒｐｙｌｏｒｉ,ＨＰ）感染情况。标本经２０％葡萄糖运送培养基运送后,分别涂布于选择性培养基和本室改良的选择性培养基,３７℃微氧环境（５％Ｏ２,１０％ＣＯ２,８５％Ｎ２）培养８天。标本同时采用快速尿毒酶法进行检测。结果表明,细菌培养法与尿素酶法检测阳性率接近,分别为４６％和５５％;细菌培养第６天与第８天其阳性检出率相同;选择性培养基与本室改良选择性培养基对幽门螺杆菌的检出率差别明显,分别为３４％（１７／４９）和５１％（６１／１２０）,同时其杂菌生长率分别为５４％（２９／４９）和２５％（３０／１２０）。     

幽门螺杆菌与糜烂性食管炎的相关性研究

目的：探讨幽门螺杆菌与糜烂性食管炎的相关性。方法：回顾性分析2010年1月-2012年10月期间的胃镜患者,根据胃窦活检、快速尿素酶试验等检测幽门螺杆菌感染所诊断出的105例糜烂性食管炎,观察幽门螺杆菌阴阳性的发生率和病变程度,选择中度糜烂性食管炎分别予以质子泵抑制剂和质子泵抑制剂加抗生素治疗,观察其疗效情况。结果：HP阴性组在重度EE上较HP阳性组多,而轻、中度刚好相反（P〈0．05）;治疗1组和治疗2、3组在总有效率上比较有明显差异性（P〈0．05）,而治疗2组和治疗3组的总有效率则无差异性（P〉0．05）,但是治疗2组的显效率明显高于治疗3组,在显效率上比较有明显差异性（P〈0．05）。结论：HP感染不是造成糜烂性食管炎的病因,Hp感染能减轻糜烂性食管炎粘膜损伤程度并增强抑酸剂的疗效。     

中药芪莪合剂联合西药治疗幽门螺杆菌诱导的慢性胃炎模型的实验研

目的观察芪莪合剂联合西药对幽门螺杆菌（Hpylori）诱导的慢性胃炎模型的治疗作用,从胃黏膜血流及Cx32、Cx43表达改变探讨其作用机制。方法70只BALB／C小鼠随机分为模型组54只,正常对照组16只。模型组采用东亚型CagA’Hpylori菌株造模,其中48只随机分为4组,分别用芪莪合剂1联合西药组（A组）、芪莪合剂2联合西药组（B组）、三联西药（c组）灌胃治疗14d,对照组用生理盐水（D组）。停用治疗后4周观察Hpylori根除率、胃黏膜炎症改变、胃黏膜血流及Cx32、Cx43表达情况。结果A、B、C组Hpylori根除率分别为83．3％、91．6％与75．0％,胃黏膜炎症评分A、B组与c组均低于D组（P〈0．05）,且A、B组均低于C组（P〈0．05）。A、B组胃黏膜血流量均增加,高于C组和D组,与正常对照组比较差异无统计学意义,A、B、C组Cx32、Cx43mRNA表达均明显高于D组（P〈0．05）,与正常对照组比较差异无统计学意义。结论芪莪合剂与西药合用在减小西药剂量的情况下仍能有效根除Hpylori,且提高胃黏膜血流量,改善胃黏膜炎症,上调Cx32、Cx43mRNA表达。     

以左氧氟沙星为基础的三联疗法根除幽门螺杆菌的疗效分析

目的：本研究的目的是评估以左氧氟沙星为基础的三联疗法根除幽门螺杆菌的疗效分析。方法：112例通过快速尿素酶试验和13C．尿素呼气试验证实感染了幽门螺杆菌的非溃疡性消化不良的患者入组本实验,患者被随机分为7d组（54例）和14d组（58例）,接受包括雷贝拉唑Oomgb-i．d．）加左氧氟沙星（500mgq．d．）和阿莫西林（1000mgb．i．d．）的治疗,并进行6周的随访,治疗结束至少4周后通过13C．尿素呼气试验确定根除率。结果：幽门螺杆菌总的根除率为83．9％（ITT）和88．7％（PP）。7d组51名患者完成了治疗。其根除率为75．9％（ITT）、80．4％（PP）,而14d组的根除率达到91．4％（ITT）、96．4％（PP）,P〈0．05。结论：包含雷贝拉唑、左氧氟沙星和阿莫西林的三联疗法对于根除幽门螺杆菌是有效的,但相同方案的14d疗法疗效明显优于7d疗法。     

PDGF-D、MPO与CD15在大肠癌中的表达及临床相关性研究

目的：探讨血小板源性生长因子D（PDGF-D）、髓过氧化物酶（MPO）YL粒细胞相关抗原（CD15）在大肠癌组织中的表达及其与临床特征之间的关系。方法：采用免疫组化染色方法检测88例大肠癌组织、72例大肠腺瘤组织及50例正常大肠粘膜组织中PDGF-D、MPO及CD15的表达情况。结果：PDGF—D、MPO、CD15在大肠癌组织中的阳性表达率分别为85．23％、63．64％、61．36％。PDGF—D、MPO在正常组、大肠腺瘤组和大肠癌组三者之间的表达均有显著性差异（P〈0．05）。CD15在正常组、大肠腺瘤组中的阳性表达率与大肠癌组中的阳性表达率有显著性差异（P〈0．05）,但在正常组与大肠腺瘤组中的阳性表达率无显著性差异（P〉0．05）。PDGF—D、MPO、CD15的表达在有淋巴结转移组织中的阳性率分别为92_31％、75．00％,73．08％;在无淋巴结转移组织中的阳性率分别为75．00％、52．78％,47．22％,三者在有无淋巴结转移组织中的阳性率均有显著性差异（P〈0．05）。PDGF．D、MPO、CD15在大肠癌中的表达与性别、年龄及组织分化程度均无相关（P〉0．05）。经Spearman相关性分析,PDGF—D及MPO在大肠癌的表达具有相关性（P〈O．05）。大肠癌中CD15与PDGF—D、MPO的表达无明显相关性（P〉0．05）：结论：PDGF—D、MPO与CDl5在大肠癌中的高表达,提示均参与了大肠癌的发生发展,可作为大肠癌恶性程度和侵袭转移的分子生物学标志物。     

复治肺结核患者结核分枝杆菌L型培养结果分析

目的：了解复治肺结核患者的结核分枝杆菌L型培养情况,探讨结核分枝杆菌L型阳性与耐多药的关系。方法：选择180例肺结核患者的痰标本进行结核分枝杆菌培养和结核分枝杆菌L型培养,同时对110例复治组中培养阳性的标本行耐药监测。结果：复治组的L型阳性率为43．6％,初治组的L型阳性率为15．7％,复治组显著高于初治组（P〈0．01）;菌阳复治组的L型阳性率50％,菌阴复治组的L型阳性率39．4％,菌阳组明显高于菌阴组（P〈0．05）;L型菌阳性患者的耐药率显著高于L型菌阴性组（P〈0．05）。结论：结核分枝杆菌L型阳性是引起结核病复发、耐药的重要原因;MDR-TB与结核分枝杆菌L型感染有关。     

Study on the relationship between Helicobacter pylori in the dental plaque and the occurrence of dental caries or oral hygiene index

Background: The aims of our study were to determine the presence of Helicobacter pylori DNA in the dental plaque of Chinese children aged 3–6 years by nested polymerase chain reaction (PCR) and to investigate the relationship between this infection and the occurrence of dental caries or oral hygiene index.
Methods: Two hundred and fourteen children from a kindergarten in Guangzhou City of China were evaluated. The children's plaques were assessed by plaque indices of Quigley–Hein. Dental plaque was analyzed using nested PCR for two sets of primers directed to the 860-bp fragment of H. pylori genomic DNA, which have been reported to be highly sensitive and specific by other researchers.
Results: H. pylori was detected in dental plaque samples from 126 children, and 70 children with dental caries carried H. pylori in dental plaque. Of these children without infection, only 36 of 88 suffered dental caries. Besides, the average dental plaque index of 126 H. pylori -positive children was higher than that of 88 children without infection. In the present study, there was a significant correlation between H. pylori infection and dental caries or dental hygiene.
Conclusion: The oral cavity may be a reservoir for H. pylori infection in children. H. pylori in dental plaque may play a role in the occurrence of dental caries, and poor oral hygiene may represent a risk factor for H. pylori in the oral cavity.     

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。     

Simultaneous Amplification of Two Bacterial Genes: More Reliable Method of <Emphasis Type="Italic">Helicobacter pylori</Emphasis> Detection in Microbial Rich Dental Plaque Samples

Polymerase Chain reaction (PCR) assay is considered superior to other methods for detection of Helicobacter pylori (H. pylori) in oral cavity; however, it also has limitations when sample under study is microbial rich dental plaque. The type of gene targeted and number of primers used for bacterial detection in dental plaque samples can have a significant effect on the results obtained as there are a number of closely related bacterial species residing in plaque biofilm. Also due to high recombination rate of H. pylori some of the genes might be down regulated or absent. The present study was conducted to determine the frequency of H. pylori colonization of dental plaque by simultaneously amplifying two genes of the bacterium. One hundred dental plaque specimens were collected from dyspeptic patients before their upper gastrointestinal endoscopy and presence of H. pylori was determined through PCR assay using primers targeting two different genes of the bacterium. Eighty-nine of the 100 samples were included in final analysis. With simultaneous amplification of two bacterial genes 51.6% of the dental plaque samples were positive for H. pylori while this prevalence increased to 73% when only one gene amplification was used for bacterial identification. Detection of H. pylori in dental plaque samples is more reliable when two genes of the bacterium are simultaneously amplified as compared to one gene amplification only.     

Eicosanoid synthesis and Helicobacter pylori associated gastritis: increase in leukotriene C4 generation associated with H. pylori colonization.

The importance of pro-inflammatory leukotriene C4 in Helicobacter pylori (H. pylori) associated gastritis in man is unknown. Fresh gastric biopsy specimens from 28 dyspeptic patients were obtained: 10 showed normal antral histology with no evidence of H. pylori, the remaining 18 patients exhibited histological gastritis and were H. pylori positive as assessed by histology, culture and urease test. Twelve of these 18 patients received 240 mg twice daily colloidal bismuth subcitrate for four weeks before re-endoscopy. Gastric biopsies from H. pylori positive patients were incubated under basal and Ca(2+)-ionophore mediated conditions: Radioimmunoassay analysis of the supernatant showed basal release of prostaglandin E2 and leukotriene C4 was slightly but not significantly elevated in H. pylori positive mucosa. However in H. pylori positive mucosa there was an 85% increase in leukotriene C4 synthesis when biopsies were incubated with ionophore, compared to only 13% increase in H. pylori negative mucosa (p less than 0.02). After eradication of H. pylori by colloidal bismuth subcitrate, there was a clearance of inflammatory cell infiltrate as assessed by histology and a significant reduction in ionophore-mediated leukotriene C4 formation compared with before treatment (p less than 0.02). These results suggest that H. pylori gastritis is associated with increased capacity to generate leukotriene C4, which may amplify the damaging effects of the bacteria on gastric mucosa.     

幽门螺杆菌感染促进胃炎儿童胃粘膜细胞的增殖

本研究旨在探讨幽门螺杆菌感染对小儿慢性胃炎患者细胞增殖的影响,使用内镜检查消化不良患者的上消化道症状,使用改良的Giemsa染色检测胃粘膜活组织中幽门螺杆菌,用苏木精/曙红和改良的吉姆萨染色活组织,并通过光学显微镜研究染色后胃粘膜样品组织病理学变化,RT-PCR检测各组胃粘膜细胞中调控细胞凋亡的Bcl-2、Bcl-xl、Bax和PCNA的mRNA表达,提取胃粘膜细胞蛋白质,利用蛋白质免疫印迹分析蛋白质浓度。组织化学染色结果表明,与对照相比,患有胃炎和幽门杆菌感染后的胃炎患者胃粘膜细胞明显增加,且幽门螺杆菌感染后细胞增殖更显著(p<0.05);幽门螺杆菌感染后Bcl-2和Bcl-xl,PCNA在患者体内表达显著上调(p<0.05),而细胞促凋亡因子Bax基因在胃炎患者感染幽门螺杆菌后被显著下调(p<0.05),蛋白免疫印迹分析Bcl-2,Bcl-xl,Bax和PCNA蛋白表达趋势与基因表达一致,说明结果可靠。幽门螺杆菌感染会显著提高慢性胃炎儿童患者胃粘膜细胞的增殖。     

幽门螺杆菌在牙菌斑及胃粘膜分布研究

目的:探讨幽门螺杆菌(Helicobacter pylori,Hp)在牙菌斑及胃粘膜分布状况。方法:采用聚合酶链式反应(polym erase chain reaction,PCR)技术对80 例慢性胃溃疡患者的牙菌斑及胃粘膜组织进行Hp 检测。结果:48 例胃粘膜Hp 阳性的患者中12 例牙菌斑Hp 阳性;胃粘膜Hp 阴性的患者无一例牙菌斑Hp 阳性;胃Hp 阳性检出率大于牙菌斑。结论:幽门螺杆菌不仅存在于胃粘膜组织中,也存在于口腔牙周组织中。提示牙菌斑可能是Hp 的重要寄居地。     

口腔中幽门螺杆菌PCR检测方法的建立

全世界大约有50%的人口感染幽门螺杆菌(Helicobacter pylori, Hp),Hp感染容易造成慢性胃炎、消化性溃疡、低度恶性胃MALT淋巴瘤及胃癌,对人类造成严重的危害。为寻求一种简便、准确、非创伤性的方法用于口腔中Hp的检测,本研究建立了口腔中幽门螺杆菌的PCR检测方法,并对建立的PCR方法的敏感性、特异性进行分析,并应用于检测唾液样品和牙菌斑共50份。结果显示,50份样品中,阳性率为82%。结果表明,本研究建立的口腔中Hp的PCR检测方法特异性强、敏感性高,可以用于临床上Hp诊断的重要参考。     

Neutralisation of vacuolating activity of cytotoxin by serum antibodies of Helicobacter pylori infected patients

The study involved 196 H. pylori strains and 196 serum samples taken from the same patients. H. pylori strains were investigated for the production of vacuolating cytotoxin. Antibodies to the vacuolating cytotoxin produced by H. pylori were detected in the sera samples by neutralisation assay (on Intestine 407 cells) and ELISA. Of the 196 H. pylori strains tested, 80 (40.8%) were found to express vacuolating cytotoxic activity. The titres of vacuolating cytotoxic were ranged from 1:2 to 1:128. The vacuolating assay was positive in 37.1% strains isolated from children, and in 50% strains isolated from adults. Cytotoxin-positive H. pylori strains were found more frequently in duodenal ulcer (71%) than in chronic gastritis (35.2%) patients, and this difference was statistically significant p<0.05. Neutralising antibodies to vacuolating cytotoxin were present in 51% and 49% of the serum samples tested by neutralisation and ELISA, respectively. Duodenal ulcer patients had antibodies to vacuolating cytotoxin more frequently (p<0.05) than chronic gastritis patients. Antibodies to cytotoxin were detected in 100% of the serum samples from patients infected by cytotoxic H. pylori strains. This suggests that the presence of anticytotoxic antibodies in the serum samples may be regarded as a sensitive indicator of infection by cytotoxic H. pylori strains.     

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。