中国儿童幽门螺杆菌感染诊治专家共识(2022)

幽门螺杆菌(Hp)感染是人类常见的慢性感染之一, 根除Hp可以减少儿童消化性溃疡的发生和复发, 降低成年期胃癌的发生率。随着Hp耐药率的升高, 既往推荐的一线治疗方案已不能满足临床需要。儿童补救治疗可用的药物有限, 提高首次根除率尤为重要。结合国内外相关研究和指南, 中华医学会儿科学分会消化学组、国家儿童医学中心消化专科联盟、中华儿科杂志编辑委员会组织专家制定本共识, 以期规范儿童Hp感染的诊治, 提高Hp感染的根除率。     

小儿再发性腹痛与幽门螺杆菌感染的临床观察

目的研究小儿再发性腹痛与幽门螺杆菌（Hp）感染的关系。方法应用^14C-尿素呼气实验对56例再发性腹痛患儿进行幽门螺杆菌感染的检测，并对幽门螺杆菌感染阳性与幽门螺杆菌感染阴性患儿进行腹痛部位、腹痛与饮食的关系、伴随的症状（恶心、呕吐）以及家族中有无幽门螺杆菌的感染者进行比较。结果Hp感染阳性的再发性腹痛患儿其家族中感染率113．3％，明显高于Hp感染阴性的再发性腹痛患儿家族中的感染率12．5％，两组间差异有非常显著性（x^2=30．15，P〈0．01）。而腹痛部位、腹痛与饮食的关系、伴随的症状，两组间均无差别。结论小儿再发性腹痛与幽门螺杆菌感染有关，但不能以腹痛部位、腹痛与饮食的关系、伴随的症状（恶心、呕吐）等来确定再发性腹痛患儿是否存在Hp感染。     

幽门螺杆菌研究进展(下)

（一）幽门螺杆菌治疗共识：1990年第9届悉尼世界胃肠病学会议推荐对复发性或出血性十二指肠溃疡患者进行根除幽门螺杆菌治疗，而当时胃溃疡患者并未在推荐治疗的行列中，这一观点被相继多次召开的有关幽门螺杆菌治疗的国际共识会议所沿用。通过反复的临床研究以及药物治疗的引入，人们对这一领域的了解逐渐趋向成熟，发现幽门螺杆菌确实能引起消化性溃疡，而且在根除感染后能预防溃疡的复发。1994年在美国召开了由国立卫生院（NIH）主办的幽门螺杆菌与消化性溃疡的共识会议，     

儿童幽门螺杆菌感染与相关性疾病的临床研究

多项研究证实,幽门螺杆菌(Helicobacter pylo-ri,Hp)在正常人群中的感染率超过了50%,是世界上感染率最高的细菌。Hp感染是许多消化道疾病的主要病因之一,还与一些胃外疾病相关。近年来,随着Hp感染与相关性疾病的研究逐渐增多,儿童Hp感染越来越引起临床医师的重视。本文对我院确     

儿童胃十二指肠炎合并缺铁性贫血16例临床分析

幽门螺杆菌（Hp）感染已经被确定为儿童胃炎和十二指肠溃疡的病因之一。Hp的易感性与年龄呈负相关，在我国，Hp在儿童中的流行更为常见。Hp对胃黏膜的植入在儿童中与慢性胃炎有关，多数Hp感染者并无症状，部分感染者发展为症状性慢性胃炎及消化性溃疡。国内外大量文献证实了慢性胃炎及消化性溃疡与Hp密切相关，儿童也有类似报道，但儿童胃十二指肠炎合并缺铁性贫血与Hp感染之间的关系报道尚不多见。现就我院2003年3月～2006年10月收治的16例儿童胃十二指肠炎合并缺铁性贫血病例分析如下。     

幽门螺杆菌感染致难治性缺铁性贫血5例报告

我们在临床上遇到5例可能幽门螺杆菌（H．pylori）感染相关的难愈或易复发的缺铁性贫血（IDA）患儿，现报告如下。     

特发性血小板减少性紫癜患儿EB病毒、巨细胞病毒、人微小病毒B19、幽门螺杆菌感染的临床观察

特发性血小板减少性紫癜（idiopathic thrombocytopenic purpura，ITP）是儿童临床最常见的出血性疾病。该病血小板明显减低，严重威胁患儿生命。目前认为ITP的发病与病前感染有关，特别是与病毒感染有关，还与幽门螺杆菌（Helicobacter Pylori，Hp）感染有关。ITP患儿中各种病原感染率各家报道不一，成人与小儿感染种类不同.     

254例无症状儿童及22个家庭幽门螺杆菌感染的流行病学调查

目的 了解无症状儿童人群中幽门螺杆菌（Hp）感染率，探讨一级亲属Hp感染状况及其对儿童Hp感染的影响。方法 应用Hp尿素酶IgG抗体（ELISA）的方法检测254例4－14岁无症状儿童血清Hp-IgG抗体，并在其中选择22例已知有或无Hp感染的小儿作为标引对象，对其父母进行血清抗Hp-IgG检测。结果 小儿Hp总感染率为23．2％；4．14岁小儿Hp阳性率分别为10．5％，7．4％，13．3％，23．5％，25．0％，28．6％，25．8％，29．2％，35．4％；Hp阳性患儿的父母Hp阳性率为66．7％，Hp阴性患儿的父母Hp阳性抗率15．0％，两组差异有非常显著性（P＜0．01）。结论 小儿Hp感染具有随年龄增加而增加的总趋势，子女抗体阳性的父母的抗体阳性率显著高于子女抗体阴性的父母的抗体阳性率，提示Hp感染在家庭内有聚集现象。     

^14C-尿素呼气试验在儿童上消化道疾病中临床应用

上消化道疾病是儿童的常见病、多发病，临床表现既多样化又不典型，如果没查出病因，则治愈率低，复诊率高，严重影响儿童的身体健康。近年来，幽门螺杆菌（Helicobacter pylori，Hp）在儿童上消化道疾病中的作用逐渐受到重视，为进一步探讨其病因，我们从2002年11月-2004年11月应用^14C-尿素呼气试验^14C-UBT）检测该类患儿是否存在幽门螺杆菌感染，根据结果指导治疗，取得了满意的临床疗效，现报告如下。     

深圳市龙岗区儿童幽门螺杆菌感染的流行病学调查

目的对龙岗区儿童幽门螺杆菌(Hp)感染率进行流行病学调查，探讨儿童：Hp感染的相关因素及预防儿童Hp感染的有效措施。方法对902例区及镇幼儿园、小学和散居儿童，采静脉血(1．5ml)作幽门螺杆菌IgG抗体(Hp-IgG)及产细胞毒幽门螺杆菌IgG抗体(CagA-Hp-IgG)检测。结果龙岗区儿童Hp感染率为41．24％(372／902)。集体儿童定时进餐、不吃零食者明显低于散居儿童、饮食无规律多吃零食者，感染率分别为30．94％和46．55％(P＜O．001)；男童感染率高于女童，分别为53．21％、32．16％(P＜0．001)；儿童随年龄增长发病率显著增高，学龄组高于学龄前组，分别为51．39％、33．33％(P＜0．001)；有消化道症状者Hp感染率显著高于无症状组，分别为57．43％、36．57％(P＜0．05)。Hp感染者做CagA-Hp-IgG检测阳性率为65．1％。结论儿童感染Hp主要途径为口一手一口，口一粪一口传播方式。在儿童时期检测Hp感染并对Hp感染者进一步做CagA-Ho-IgG检测，以及及时、合理药物治疗，对于减少成人消化系统疾病具有重要的临床意义。     

Helicobacter pylori infection in children

Helicobacter pylori colonizes the human stomach, especially during childhood. However, a variety of H. pylori strains exists, with major differences in virulence characteristics which probably account for different clinical symptoms, and the majority of infected subjects remains asymptomatic. Helicobacter pylori infection is correlated with socioeconomic conditions and hygienic circumstances, resulting in an extremely high prevalence in children in developing countries. Commercial screening tests are not capable of separating the more virulent strains (type I with vacuolating toxin VacA and CagA protein) from the less virulent strains (type II, VacA and CagA negative). Type I strains, but not type II, are associated with an increased risk for duodenal ulcer and gastric cancer. Therefore, future screening tests and vaccinations should focus on the type I strains.     

Helicobacter pylori infection in children

A number of scientific breakthroughs since H pylori first became recognized as a human pathogen have increased our understanding of the pathogenesis of gastroduodenal disease. In particular, advances in molecular bacteriology and the complete sequencing of the H pylori genome in 1999, and soon thereafter the human genome, provide tools allowing better delineation of the pathogenesis of disease. These molecular tools for both bacteria and host should now be applied to multicenter pediatric studies that evaluate disease outcome. More recent developments indicate that a better understanding of the microbial-host interaction is critical to furthering knowledge with respect to H pylori-induced diseases. Studies are needed to evaluate either DNA-based or more traditional protein-based vaccines, to evaluate more specific antimicrobials that confer minimal resistance, and to evaluate probiotics for the management of H pylori infection. Multicenter multinational studies of H pylori infection in the pediatric population, which include specific, randomized controlled eradication trials, are essential to extend current knowledge and develop better predictors of disease outcome.     

Flies and Helicobacter pylori infection

Houseflies have been proposed to be a reservoir and vector for Helicobacter pylori. We assessed the effect of insecticide spraying in villages in The Gambia on H. pylori infection in young children. Effective control of flies did not prevent infection with H. pylori.     

Helicobacter pylori stool antigen test

Objective :Helicobacter pylori (H.pylori) infection is usually acquired in early childhood. Invasive techniques used for diagnosis ofH.pylori infection require endoscopic examination which is expensive and inconvenient and may cause complications. the aim of this study was to evaluate the performance of a new noninvasive diagnostic method, stool antigen test forH.pylori in untreated children with recurrent abdominal pain.Methods: Eighty children (35 female, 45 male) who have undergone upper gastrointestinal endoscopy due to recurrent abdominal pain were included in the study. theH.pylori stool antigen test (HpSA) is based on a sandwich enzyme immunoassay with antigen detection. HpSA sensitivity, specificity, and positive and negative predictive values were determined with reference to the results of both histology and rapid urease test as a gold standard (H. pylori status).Results: While 49 of the 80 children (61%) tested were positive forH.pylori according to the results of both histology and rapid urease test, 28 children had negativeH.pylori status. Among those 49 children, 48 were found to be positive by HpSA. Of 28 patients with negativeH.pylori status, 28 were H.py/ori-negative also in the stool test. the sensitivity, specificity, and positive and negative predictive values of HpSA were found to be 98%, 100%, 100%, and 96.5%, respectively.Conclusion: these findings have demonstrated that HpSA as a relatively simple, inexpensive and time saving noninvasive test is a reliable method for detection ofH.pylori infections in children.