复方嗜酸乳杆菌片治疗幽门螺杆菌感染的Meta分析

系统评价复方嗜酸乳杆菌片治疗幽门螺杆菌感染的有效性、安全性。

以“复方嗜酸乳杆菌片”“幽门螺杆菌感染”“Compound Eosinophil-Lactobacillus Tablets”“Helicobacter pylori infection”为主题词, 系统检索The Cochrane Library、PubMed、Springer、ProQuest、中国知网、万方和维普等数据库(建库-2020年5月)的随机对照试验文献。利用RevMan 5.3软件对复方嗜酸乳杆菌片的有效性、安全性进行Meta分析。

依据严格的纳入排除标准, 最终纳入18篇随机对照试验文献。Meta分析结果显示: 复方嗜酸乳杆菌片与一线治疗方案联合用药治疗幽门螺杆菌感染临床疗效更优[RR=0.84, 95%CI(0.80, 0.87), P < 0.000 01], 安全性更好[OR=2.83, 95%CI(2.30, 3.49), P < 0.000 01]。进一步亚组分析表明, 复方嗜酸乳杆菌片与四联疗法联合用药治疗幽门螺杆菌感染与四联疗法相比, 临床疗效更优[RR=0.88, 95%CI(0.83, 0.93), P < 0.000 01], 安全性更优[OR=2.58, 95%CI(1.92, 3.48), P < 0.000 01];复方嗜酸乳杆菌片联合三联疗法治疗幽门螺杆菌感染较三联疗法临床疗效更优[RR=0.81, 95%CI(0.76, 0.85), P < 0.000 01], 且安全性好[OR=3.09, 95%CI(2.31, 4.14), P < 0.000 01]。

基于现有文献, 在治疗幽门螺杆菌感染时, 复方嗜酸乳杆菌片与四联疗法或三联疗法联合用药具有一定的临床优势, 能提高幽门螺杆菌根除率, 降低不良反应发生率, 提高安全性。

     

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。     

幽门螺杆菌VacA+BCS致胃上皮细胞基因表达谱的改变

目的：通过观察VacA^ BCS作用胃癌来源的SGC7901细胞后,细胞基因表达谱的改变,分析VacA等分泌性细胞毒力因子的致病性和致病意义。方法：利用常规方法获得VacA^ BCS和VacA^-BCS,然后作用细胞,最后利用cDNA基因表达谱芯片技术观察细胞基因表达谱的变化。结果：发生明显表达差异的基因占基因总数的5％左右,其中已经明确功能的表达差异基因涉及许多重要的细胞功能和生命活动,如基因表达调控、信号转导相关基因的差异表达、细胞骨架相关蛋白表达的变化、细胞凋亡相关因子编码基因表达的变化、以及肿瘤发生相关基因的表达变化等。结论：VacA^ BCS可致细胞基因表达谱发生多层次和多方面的改变,几乎涉及H.pylori相关疾病所有重要病理过程,提示其在H.pylori致病机制中具有重要作用。     

Wnt信号通路GS蛋白在胃癌中的表达和临床意义

目的：研究wnt信号通路的中GS蛋白（谷氨酰胺合成酶）在胃癌组织中的表达,探索其在胃癌发生、发展中的意义。方法：用免疫组织化学法测定胃癌组织（110例）、肠化生组织（30例）、不典型增生组织（20例）及慢性浅表性胃炎组织（60例）中GS蛋白表达。用快速尿素酶法与病理组织切片染色法检测上述各组织中HP感染的情况,并予统计学分析比较其差异。结果：胃癌组织GS高蛋白表达与组织分型、分化程度、淋巴结转移密切相关（P〈0．05）,与肿瘤大小、部位、TNM分期、Borrmann分型、性别、年龄等无明显相关（P〉0．05）。GS表达与HP感染密切相关。结论：GS蛋白高表达同胃癌生物学行为密切相关,在胃癌的发生、发展中起重要作用。     

The functional status of the Helicobacter pylori sabB adhesin gene as a putative marker for disease outcome

Background. Helicobacter pylori factors that contribute to disease outcome are largely unknown, but intimate contact with host cells mediated by outer membrane proteins is thought to play an important role. Expression of the outer membrane proteins OipA, HopZ, SabA, and SabB is regulated by phase‐variable dinucleotide repeats in the coding regions of the respective genes. We have evaluated the correlation between the expression status of these four genes and disease outcome of H. pylori infection in a Dutch patient population. Materials and Methods. H. pylori strains, isolated from 96 Dutch patients with gastritis (n = 29), duodenal ulcer (n = 28), gastric ulcer (n = 21), gastric carcinoma (n = 9), and lymphoma (n = 9), were analyzed for the ‘on/off’ expression status of the H. pylori genes oipA, hopZ, sabA, and sabB by direct DNA sequence analysis of amplified fragments. Results. The off‐status of sabB was significantly associated with duodenal ulcer (p = .036), but not with gastric ulcer. In contrast, the expression status of oipA, hopZ, and sabA did not correlate with disease outcome. Furthermore, lymphoma strains appeared to express a significantly smaller amount of putative adhesins when compared to gastritis, gastric ulcer, duodenal ulcer and gastric carcinoma strains (p < .02 for all groups tested). Conclusion. The off‐status of sabB was found to be associated with duodenal ulcer disease, and thus represents a putative marker for disease outcome. Assuming that SabB is involved in bacterial adhesion, this association suggests that adherent H. pylori are more prone to elimination by the host immune system.     

Expression of T-cell immunoglobulin- and mucin-domain-containing molecules-1 and -3 (Tim-1 and Tim-3) in Helicobacter pylori infection

Background: Th immune response plays an important role in Helicobacter pylori (H. pylori) infection. Tim‐1 and Tim‐3 are expressed on terminally differentiated Th2 and Th1 cells, respectively, and participate in the regulation of Th immune response. Until now, the role of Tim in H. pylori infection remains unclear. Materials and Methods: (1) Lymphocytes isolated from the spleen of BALB/c mice were co‐cultured with different concentrations of viable H. pylori. Alternatively, mice were challenged by viable H. pylori to set up the H. pylori infection model. (2) The expression of Tim‐1 and Tim‐3 on mRNA level in lymphocytes or spleen of mice was determined by RT‐PCR. The percentage of Tim‐3‐positive cells was determined by flow cytometric analysis. The production of cytokine in supernatants was measured by standard sandwich cytokine ELISA. Results: (1) Co‐culture: At 12 hours, there was markedly decreased production of Tim‐1 and increased production of Tim‐3 in lymphocytes co‐cultured with H. pylori compared with normal control. The change of Th2 cytokine had the similar tendency as that of Tim‐1 expression; alternatively, the change of Th1 cytokine had the similar tendency as that of Tim‐3 expression. (2) Infection: Tim‐1 expression was declined in infected mice compared with control group; in the contrast, Tim‐3 expression was increased. Furthermore, the expression of Tim‐1 and Tim‐3 mRNA in spleen was significantly positively correlated with the level of Th2 and Th1 cytokine in gastric homogenized supernatant, respectively. Conclusion: H. pylori could inhibit the differentiation of T lymphocytes toward Th2 cells, promote the Th1 cell differentiation, and induce Th1‐biased immune response. The expression of Tim‐1 and Tim‐3 could reflect Th2 and Th1 immune response, respectively, which provide evidence for the prevention and treatment of H. pylori infection and correlation diseases through regulation of Tim‐1 and Tim‐3.     

幽门螺杆菌感染激活NF-κB信号通路促进胃癌SGC-7901细胞炎症因子释放

为了探讨幽门螺杆菌对胃癌SGC-7901细胞炎症因子释放的影响,本研究将幽门螺杆菌感染SGC-7901细胞后,采用细胞计数盒(CCK-8)检测SGC-7901细胞活力,酶联免疫吸附实验(ELISA)检测炎症因子TNF-α、IL-1β以及IL-8的水平,Real-time PCR检测细胞TNF-α、IL-1β以及IL-8 m RNA的表达,蛋白免疫印迹法(Western blotting)检测NF-κB信号通路相关蛋白NF-κB p65蛋白表达以及IκBα磷酸化水平。研究结果表明,幽门螺杆菌感染后,SGC-7901细胞活力显著增加;幽门螺杆菌感染明显上调SGC-7901细胞TNF-α、IL-1β以及IL-8 mRNA的表达;本研究还进一步发现幽门螺杆菌感染显著增加SGC-7901细胞TNF-α、IL-1β以及IL-8的水平;此外,幽门螺杆菌处理的SGC-7901细胞,其NF-κB p65的蛋白表达以及IκBα磷酸化水平均显著上调。本研究的结论初步表明,幽门螺杆菌感染促进胃癌SGC-7901细胞炎症因子的释放,其机制可能涉及激活NF-κB信号通路。     

Screening of anti-Helicobacter pylori herbs deriving from Taiwanese folk medicinal plants

In this study, extracts from 50 Taiwanese folk medicinal plants were examined and screened for anti-Helicobacter pylori activity. Ninety-five percent ethanol was used for herbal extraction. Paederia scandens (Lour.) Merr. (PSM), Plumbago zeylanica L. (PZL), Anisomeles indica (L.) O. Kuntze (AIOK), Bombax malabaricum DC. (BMDC) and Alpinia speciosa (J. C. Wendl.) K. Schum. (ASKS) and Bombax malabaricum DC. (BMDC) all demonstrated strong anti-H. pylori activities. The minimum inhibitory concentration values of the anti-H. pylori activity given by the five ethanol herb extracts ranged from 0.64 to 10.24 mg ml(-1). Twenty-six herbs, including Artemisia argvi Levl. et Vant (AALEV), Phyla nodiflora (Linn.) Greene (PNG) and others, showed moderate anti-H. pylori activity. The additional 19 herbs, including Areca catechu Linn. (ACL), Euphorbia hirta Linn. (EHL) and Gnaphalium adnatum Wall. ex DC. (GAWEDC), possessed lower anti-H. pylori effects. About half of the Taiwanese folk medicinal plants tested, demonstrated to possess higher anti-H. pylori activity.     

幽门螺杆菌多价表位疫苗CWAE的表达及其免疫学性质的研究 *

目的 利用生物信息学软件评价幽门螺杆菌(Helicobacter pylori)多价表位疫苗CWAE的抗原结构,经原核表达获得高纯度CWAE蛋白,进而鉴定多价表位疫苗CWAE的免疫学性质。方法 通过生物信息学软件分析H. pylori多价表位疫苗CWAE的抗原结构;用人工合成的H. pylori多价表位肽融合基因WAE替换重组质粒pET28a-CUE中的UE基因,构建重组质粒pET28a-CWAE。然后,将pET28a-CWAE转入大肠杆菌BL21(DE3)中,经IPTG诱导表达,并通过Ni-NTP镍离子亲和层析纯化抗原蛋白CWAE;利用GM1-ELISA鉴定CWAE中CTB组分的黏膜免疫佐剂活性。最后,通过ELISA和小鼠脾脏淋巴细胞增殖实验检测CWAE激发BALB/c小鼠产生抗H. pylori抗体体液免疫和淋巴细胞免疫应答的能力。结果 通过生物信息学软件证实H. pylori多价表位疫苗CWAE具有科学合理的结构;重组表达质粒pET28a-CWAE经PCR、双酶切和基因测序鉴定,融合基因CWAE与设计序列完全一致;重组基因工程菌株pET28a-CWAE/BL21(DE3)经IPTG诱导表达,抗原蛋白CWAE主要以包涵体形式存在,经Ni-NTP镍离子亲和层析纯化,纯度约达93.2%;GM1-ELISA实验证实,CWAE中CTB组分依旧保持有较好的黏膜佐剂活性;ELISA结果证实CWAE能够激发BALB/c小鼠产生H. pylori特异性抗体,而小鼠脾脏淋巴细胞增殖实验进一步证实CWAE能够激发针对H. pylori多种致病因子的淋巴细胞免疫反应。结论 H. pylori多价表位疫苗CWAE具有科学合理的抗原结构,经原核表达可获得高纯度抗原蛋白,能够激发BALB/c小鼠产生H. pylori特异性抗体体液免疫和淋巴细胞免疫应答。为研发防治H. pylori感染的多价表位疫苗奠定实验基础。     

Sociocultural and dietary practices among Malay subjects in the north-eastern region of Peninsular Malaysia: a region of low prevalence of Helicobacter pylori infection

Background and Aim: The prevalence of Helicobacter pylori infection is exceptionally low among the Malays in the north‐eastern region of Peninsular Malaysia. The reasons are unknown. Our aim was to compare environmental factors that differed in relation to H. pylori prevalence among Malays born and residing in Kelantan. Methods: A case–control study was conducted among Malays in Kelantan who underwent upper endoscopy between 2000 and 2008. Helicobacter pylori status was determined by gastric histology. Sociocultural and dietary factors were assessed using a validated investigator‐directed questionnaire administered after 2008, and the data were analyzed using logistic regression analysis. Results: The study group consisted of 161 subjects (79 H. pylori positive and 82 controls). Univariable analysis identified five poor sanitary practices associated with an increased prevalence of H. pylori infection: use of well water, use of pit latrine, less frequent boiling of drinking water, and infrequent hand wash practice after toilet use and before meals. Multivariable logistic regression analysis identified three variables inversely associated with H. pylori infection: frequent consumption of tea (OR: 0.023, 95% CI: 0.01–0.07), frequent use of “budu” or local anchovy sauce (OR: 0.09, 95% CI: 0.1–0.7), and frequent use of “pegaga” or centenella asiatica (OR: 0.25, 95% CI: 0.1–0.65). Conclusions: Under the assumption that sanitary, sociocultural, and dietary habits have not changed over the years, we can conclude that an increased risk of H. pylori was associated with unsanitary practices whereas protection was associated with consumption of tea and locally produced foods, “pegaga” and “budu.” These dietary factors are candidates for future study on the effects on H. pylori transmission.