H.heilmannii与H.pylori相关性胃炎的对比研究

目的 评估上消化道H.heilmannii感染的临床表现、内镜诊断、病理特征,探讨该菌在上消化道疾病中的致病特点,并与Hpylori相关性胃炎相比较.方法 收集并分析2005至2007年间3107例胃镜受检者的临床资料、内镜表现及病理活检标本.结果 共检出25例H.heilmannii感染,1060例H.pylori感染,3例混合感染.H.heilmannii感染患者中,20例有不同程度的上消化道症状,主要为上腹胀痛、恶心、食欲下降,5例无明显自觉症状;患者内镜下均有慢性胃炎的表现,其中单纯慢性浅表性胃炎7例,伴糜烂3例,萎缩肠化4例,十二指肠球炎2例,胆汁反流、溃疡、息肉各1例;尿素酶试验强阳性3例,阳性3例,弱阳性7例,阴性12例.组织学上,H.heilmannii散在或聚集于胃小凹、腺腔内或上皮表面的黏液层内,1 例标本中可见H.heilmannii侵入壁细胞内.所有H.heilmannii感染者均可见散在的淋巴细胞、浆细胞浸润,12例见中性粒细胞浸润,4例见腺体萎缩和肠化,6例见淋巴滤泡形成.炎症程度总体上较H.pylori感染轻,H.heilmannii相关胃炎中螺杆菌密度、淋巴细胞浸润和中性粒细胞活性程度低于H.pylori相关性胃炎组(P<0.05).结论 H.heilmannii感染主要引起慢性胃炎,其炎症程度轻于H.pylori相关性胃炎.     

蒙古沙土鼠不同幽门螺杆菌菌株感染相关性胃病的研究进展

幽门螺杆菌(Helicobacter pylori,H.pylori)感染在世界范围内高发,他定植于人胃黏膜,导致慢性胃炎及胃癌的发生.蒙古沙鼠(mongolian gerbil,MG)很少患自发性胃炎,且不是H.pylori 的自然宿主.人工接种H.pylori后,蒙古沙鼠患H.pylori相关性胃病与胃病患者最相似...     

幽门螺杆菌疫苗接种小鼠产生免疫后胃炎的影响因素

目的:研究幽门螺杆菌(H pylorl)疫苗接种小鼠产生免疫后胃炎的影响因素．方法:将H pylori疫苗免疫C57BL／6和BALB／c的小鼠,观察攻击后胃黏膜H pylori定植和炎症情况．将H pylori疫苗免疫C57BL／6小鼠,然后予不同菌量的H pylori攻击,观察胃黏膜H Pylori定植和炎症情况．将H pylori疫苗经口和经腹腔免疫C57BL／6小鼠,观察攻击后胃黏膜H pylori定植和炎症情况.对感染H pylori的C57BL／6小鼠予H pylori疫苗治疗,观察治疗免疫后胃黏膜H pylori定植和炎症情况．结果:不同品系的小鼠免疫保护程度无明显差异,但C57BL／6小鼠免疫后胃炎重于BALB／c小鼠．接受不同攻击茵量的小鼠保护程度无明显差异,但大的攻击茵量可诱导更严重的免疫后炎症．不同免疫途径诱导的免疫保护程度及攻击后不同时间点的炎症程度均无显著性差异．治疗性免疫导致H pylori定植明显降低,同时也引发更为严重的胃炎．结论:在不同的免疫宿主、免疫途径和治疗性免疫中均存在免疫后胃炎．免疫后胃炎的强弱程度受免疫宿主和攻击菌量的影响．     

非幽门螺杆菌螺杆菌致胃黏膜病变研究进展

非幽门螺杆菌螺杆菌(Non-Helicobacter pylori Helicobacter,NHPH)是一类形态不同于幽门螺杆菌的、较长的、呈紧密螺旋形态的螺杆菌.NHPH自然宿主为哺乳动物,也可感染人,可见于约0.2％～6％的人体胃黏膜活检标本,与胃炎、胃溃疡、胃MALT瘤等有关.人体胃内NHPH包括猪螺杆菌(H....     

根除幽门螺杆菌对胃黏膜病变的影响

幽门螺杆菌（H.pylori）被认为是导致胃黏膜病变的重要因子，根除H.pylori能使胃黏膜病变改善。目的：观察根除H.pylori对胃黏膜病变的影响。方法：予100例经胃镜和组织病理学检查确诊为萎缩性胃炎伴H．pylori感染患者抗H.pylori治疗，1年后复查胃镜和组织病理学，评定组织学变化。结果：所有患者均有不同程度的活动性炎症和慢性炎症。抗H.pylori治疗后，86例被根除。与根除前相比，根除后慢性炎症、活动性炎症、腺体萎缩程度评分均明显下降（P〈0．01），肠化生评分无显著改善。结论：根除H.pylori对胃黏膜病变具有临床治疗意义。     

幽门螺杆菌感染与胃不同部位组织学病变的关系

目的 明确幽门螺杆菌(Helicobacter pylori,H,pylori)感染与胃不同部位粘膜组织学病变的关系。方法 在215例胃镜受检者胃窦、角、体三点取材进行组织学检查，Giemsa染色明确H.pylori感染情况，HE染色计量观察组织学病变情况，分析两者的相关关系。结果 从胃窦到胃角、胃体，炎症程度(单个核细胞浸润)、活动度(中性粒细胞浸润)、糜烂及淋巴滤泡形成均递减，H.pylori阳性者积分高于阴性者。在胃窦和胃角部，H.pylori感染更常引起近腔面上皮分泌下降，而在胃体部无此发现，H.pylori感染在三个部位均可引起腺体萎缩。结论 H.pylori感染是胃多部位组织学病变如淋巴细胞、中性粒细胞浸润、糜烂和淋巴滤泡形成与粘膜萎缩的病因，在胃窦和胃角引起的病变重于胃体。     

高海拔地区军人胃肠疾病与幽门螺杆菌感染的相关性研究

目的探讨高海拔地区军人胃、十二指肠等胃肠疾病的高发病率与幽门螺杆菌(H.pylori)感染的相关性。方法对2011年长期驻扎在西藏那曲地区申扎县军人,经申扎县人民医院门诊并确定有胃肠疾病的412例患者,行胃镜及胃黏膜病理组织学检查,采用美蓝染色检测H.pylori感染情况,观察胃黏膜组织炎症活动程度。结果 412例患者H.pylori总感染率为71.6%。胃溃疡、十二指肠溃疡、糜烂性胃炎患者H.pylori感染率分别为81.5%、93.9%、89.1%,萎缩性胃炎、肠化、异型增生患者H.pylori感染率分别为63.8%、67.4%、73.3%,明显高于浅表性胃炎患者的49.1%(P<0.05)。士兵入伍后的前3年,随军龄的增加,H.pylori感染率逐渐增加(P<0.05),3年以上军龄者H.pylori感染率无明显差异。所有慢性胃炎患者胃黏膜组织炎症活动从轻度(+)→中度(++)→重度(+++),其H.pylori感染率逐级增加,分别为42.7%、56.2%、76.2%,差异有统计学意义(P<0.05)。结论高海拔地区的军人胃、十二指肠等胃肠疾病患者H.pylori感染率高,军人的军营生活特点可能促使H.pylori感染。     

以胃黏膜胆汁酸浓度评估胆汁反流对胃黏膜组织的作用

背景:胃黏膜胆汁酸水平可直接反映胃黏膜细胞胆汁酸暴露的程度,并体现胆汁酸对胃黏膜的损伤程度。目的:探讨以胃黏膜组织胆汁酸浓度评估胆汁反流对胃黏膜病理改变的影响。方法:选取经内镜检查和黏膜胆汁酸浓度确诊的40例胆汁反流性胃炎患者和20例无胆汁反流性胃炎患者,评估幽门螺杆菌(H.pylori)检出率,行组织病理学评分,并分析胃黏膜胆汁酸浓度与组织病理学评分的相关性。结果:与无胆汁反流性胃炎患者相比,胆汁反流性胃炎患者H.pylori检出率无明显差异;胃窦、胃体黏膜组织胆汁酸含量显著升高(P0.05);胃窦黏膜慢性炎症和肠化生评分显著升高(P0.05),胃体黏膜慢性炎症、炎症活动性、萎缩和肠化生评分均显著升高(P0.05)。胆汁反流性胃炎患者胃窦、胃体组织病理学改变均与胆汁酸浓度相关(P0.05)。结论:以胃黏膜胆汁酸浓度评估的胆汁反流与胃黏膜病理损伤严重程度呈正相关。与无胆汁反流性胃炎相比,胃内胆汁反流主要加重胃体部组织病理学损伤。     

幽门螺杆菌尿素酶B亚单位的疫苗研究进展

幽门螺杆菌（Helicobacter pylori,H.pylori）是一种定植在人胃和十二指肠的微需氧、革兰氏阴性、螺旋弯曲菌。H.pylori是上消化道的主要致病菌,与胃炎、消化性溃疡、胃粘膜相关淋巴组织淋巴瘤（MALT）和胃癌等疾病的发生密切相关。     

早期胃癌和进展期胃癌患者幽门螺杆菌感染与胃黏膜组织学特点的关系

背景幽门螺杆菌(H.pylori)感染已被确认为慢性胃炎的主要病因,由慢性非萎缩性胃炎、慢性萎缩性胃炎至肠化生,经过数十年最终可能导致胃癌发生。目的评价H.pylori感染与胃镜检查正常者、慢性胃炎、早期胃癌和进展期胃癌患者胃黏膜组织学特点的关系。方法在受检者胃窦大弯侧、胃体大弯侧和胃角处各取一块黏膜活检标本,以Giemsa染色和免疫组化染色检测H.pylori感染情况;以HE染色评价胃黏膜炎症、活动性、萎缩和肠化生情况。结果慢性胃炎、早期胃癌和进展期胃癌患者的总体H.pylori感染率均显著高于胃镜检查正常者(52.4%、52.4%和81.2%对44.9%,P<0.05),慢性胃炎与早期胃癌患者的感染率无显著差异,但均显著低于进展期胃癌患者(P<0.05)。胃镜检查正常和慢性胃炎组H.pylori感染者的胃黏膜炎症、活动性、萎缩和肠化生检出率均显著高于无感染者(P<0.05);早期胃癌和进展期胃癌组H.pylori感染者的炎症活动性检出率显著高于无感染者(P<0.05),而炎症、萎缩和肠化生检出率与无感染者无显著差异。结论由H.pylori感染引起的胃黏膜慢性炎症、萎缩和肠化生可能在胃癌的发生、发展过程中起直接或间接作用。     

Helicobacter pylori

PURPOSE OF REVIEW: Helicobacter pylori is an important human pathogen, responsible for most peptic ulcer disease, gastritis and gastric malignancies. H. pylori has several unique features: it is highly adapted for gastric colonization, yet it produces clinical consequences in a small minority, its genome is known, and it is the only bacterium strongly associated with cancer. H. pylori is therefore of great interest to clinicians and researchers of many, often disparate, disciplines. We highlight recent advances in this fast changing field from many different areas. RECENT FINDINGS: The major contentious clinical issues relate to the synergistic gastrotoxic interactions of H. pylori with non-steroidal anti-inflammatory drugs, and a possible association of H. pylori with atherosclerotic events. Accumulating evidence implicates genetic variation in the inflammatory response to H. pylori in the etiology of the increased risk of gastric cancer after H. pylori infection. Studies of pathogenesis have been aided by increasingly sophisticated murine models. The effects in gastric epithelial cells of two of the major virulence factors (genes within the cag pathogenicity island and the vacuolating cytotoxin, VacA) of H. pylori illustrate the complex network of cellular reactions activated by H. pylori. The metabolism of H. pylori is dependent on the availability of hydrogen. SUMMARY: Basic science research into H. pylori continues to elucidate the mechanisms by which H. pylori infection causes disease. These findings have implications for the design of novel therapies and for improving clinical strategies to identify at-risk individuals. Many are also worthy of consideration for other epithelial-microbial interactions.     

Helicobacter pylori-Infektion

Ohne Zusammenfassung     

Helicobacter pylori

The diagnostics and treatment of Helicobacter pylori infections have substantially changed in recent years. Instead of a general test-and-treat strategy, differentiated treatment methods are increasingly being used. Practical problems in many cases were that a useful combination was often not employed after the failure of an initial antibiotic treatment. In 2009 new guidelines on the diagnostics and treatment of Helicobacter pylori infections were published. Various expert groups from gastro-enterology, microbiology and rheumatology provided new general frameworks and concrete treatment suggestions for Helicobacter pylori infections of the stomach. The statements are grouped according to ?should“ and ?can“ recommendations and the consensus opinion is divided into various subgroups. The new S3 guidelines specify the therapy indications with respect to first and second line procedures and now give different durations of therapy (7 days for first line, 10 days for second line after treatment failure) as well as concrete algorithms. Before treatment two positive diagnostic procedures are required because the prevalence in Germany is decreasing. In addition to the rapid test and histological investigations, the 13-C breath test and stool tests with excellent sensitivity and specificity are also now available. Probiotics can improve therapy success especially for long-term antibiotic regimes and in the future bismuth could again play an increasingly more important role because antibiotic resistance to metronidazol and clarithromycin is increasing.     

Helicobacter pylori

Helicobacter pylori is associated with various gastroduodenal diseases such as peptic ulcer, functional dyspepsia, MALT lymphoma and distal gastric cancer. Diagnosis of H. pylori can be established by non-invasive (^13Curea breath test, stool antigen test, serology) and invasive (histology, rapid urease test, culture) tests. In adults, culture and susceptibility testing should or must be performed after failing of first-line therapy in case of a control endoscopy and before third-line therapy, respectively. Peptic ulcer and gastric MALT lymphoma represent obligatory indications for eradication therapy. Other potential indications are functional dyspepsia, prevention of gastric cancer in individuals being at risk, and before starting treatment with traditional non-steroid antiphlogistics. First-line therapy is performed with a 7-days combination of proton pump inhibitor with clarithromycin and amoxicillin or metronidazole. In second-line therapy levofloxacin and rifabutin are good rescue antibiotics.     

Helicobacter Pylori

Opinion Statement All infected patients with a peptic ulcer should be treated for H. pylori. The role of treating H. pylori in patients with undiagnosed dyspepsia or non-ulcer dyspepsia, those taking nonsteroidal anti-inflammatory medications, or with a family history of gastric cancer remains controversial. Triple therapies consisting of a proton pump inhibitor or ranitidine bismuth citrate and two antibiotics are the current standard of therapy for H. pylori. In general, dual therapies should no longer be used to treat H. pylori. Bismuth triple therapy consisting of bismuth, tetracycline, and metronidazole is a less expensive alternative to proton pump inhibitor-or ranitidine bismuth citrate-based triple therapies. However, bismuth triple therapy is hampered by frequent side effects and the need for qid dosing. In Europe, a 7-day course of therapy appears to be adequate. In the United States, 10-14 days of therapy are currently recommended. Metronidazole resistance in H. pylori strains varies geographically, and negatively influences the effectiveness of therapies containing this antibiotic. Clarithromycin resistance is relatively infrequent at the current time but may be rising in countries where this antibiotic is in use. If a patient remains infected after a course of therapy for H. pylori, the second treatment should avoid the antibiotics used initially.     

Diagnosis of Helicobacter pylori infection and diseases associated with Helicobacter pylori by Helicobacter pylori outer membrane proteins

sAIM: To examine the serological response of patients with upper gastrointestinal diseases and Helicobocter pylon (Hpy/on)infection to two Hpyloriouter membrane proteins (OMPs) (Mr18 000 and Mr26 000) acquired by gene recombinant technique, and to determine the diagnostic significance of serological tests derived from these OMPs.METHODS: Recombinant vectors encoding the two Hpylori OMPs were used to transform and express in BL21 (DE3) E.coli After purification with NP-NTA agarose resin, colloid gold kits were prepared with purified recombinant proteins to detect H pyloH infection and H pylori-associated diseases by the immunity-marker technology. We selected 150 patients with Hpy/on‘infection and digestive symptoms wibhout previous treabnent, including chronic gastritis (n = 60), duodenal ulcer (n = 30), gastric ulcer (n = 30), and gastric cancer (n=30).As controls, 33 Hpylori-negative healthy volunteers were also recruited. Serum samples were collected from all subjects, and the antibodies to specific proteins of Hpylori were tested with the colloid gold test kits. The sensitivity,specificity and accuracy of the colloid gold tests were evaluated, by using the combination of standard diagnostic methods (^13C urea breath test and bacteria culture) and classic enzyme-linked immunosorbent assay (ELISA) as reference.RESULTS: After purification with Ni^2+-NTA agarose resin,the purity of recombinant fusion proteins was about 95%.The recombinant fusion proteins were recognized by the specific monodonal antibodies against bhe two Hpy/oriOMPs,as demonstrated by the ELISA. Of the 150 serum samples from patients infected with Hpy/oH 141 (94.0%) responded positively to the recombinant protein with Mr26 000, while the seropositive rates were 95.0%, 96.7%, 96.7% and 90.0% for patients with H pylori-associated chronic gastritis,duodenal ulcer, gastric ulcer, and gastric cancer respectively.The sensitivity, specificity, and accuracy of the colloid gold kit with Mr26 000 protein were 94.0%, 97.0%, and 94.5%,respe.ctively. Compared with the classic ELISA, bacteria culture and ^13C urea breath test results in detecting Hpyloriinfection, there was no significant difference (P&gt;O.O5). For the colloid gold kit with Mr18 000, the seropositive rates were 52.0%, 40.0%, 40.0%, 53.3% and 86.7%, respectively,in Hpylori-infected palJents, and bhose wibh Hpylori-associated chronic gastritis, duodenal ulcer, gastric ulcer, and gastric cancer. There was a significant difference (P&lt;0.05) in seropositivity between patient with gastric cancer (86.7%) and those with other diseases (43.3%).CONCLUSION: The two colloid gold kits derived from the recombinant OMPs are useful tools either for detecting Hpyloriinfection, or for, predicting Hpylori-associated gastric malignancy.