幽门弯曲菌与慢性胃炎和消化性溃疡关系的系列研究

Campyiobacter Pylori, Gastritis and Peptic Ulcer Disease

我院自1986年6月至1989年6月检查了634例病人的胃粘膜,从幽门弯曲菌(CP)的细菌学、致病性、病理学、诊断方法及药物治疗等方面进行了研究,探讨CP与慢性胃炎及消化性溃疡的关系。结果发现CP有两种形态并与空弯菌不同,不产生肠毒素;消化性溃疡的CP检出率为80.9％,慢性胃炎为41.6％,显著高于正常胃粘膜(3.7％);CP与消化性溃疡、慢性胃炎,十二指肠炎特别是活动性炎症有密切关系;CP对胃型上皮或粘液有某种亲和性;观察到上皮细胞破溃处有大量细菌聚集,CP有致细胞病变的能力。用阿的平代替吖啶橙荧光染色,并制成CP感染快速诊断试剂盒。呋喃唑酮促进溃疡愈合,使45～73％病例CP消失,50～70％胃炎好转。但有复发,根除CP有困难。

The aim of this study was to assess the incidence of Campylobacter Pylori (CP) in various upper CI disorders, to correlate CP presence with histological abnomalities and to evaluate the efficacy of several agents in clearing CP. 607 patients with CI symptoms and 27 asymptomatic vohmteers were studied. Antral biopsies were taken for culture, histological and electron microscopic examinations. CP was found from antral biopsies in 37 of 48 gastric ulcer, in 191 of 232 duodenal ulcer, in 14 of 19 complex ulcer, in 121 of 219 NUD, in 8 of 17 gastric cancer, and in one of 27 normal, mucosa. There was a significant difference in the percentage of CP positive between chronic active gatritis(94%) and chronic simple gastritis (34%). CP was identified in a of 13 biopsies of Barrett's esophagus. In the duodenum CP was seen only in the areas showing gastric metaplasia. UltratructuraI study shows the presence of adherence pedestals and shallow cup shaped surface projections. Microvilli were depleted. In the ara of destroyed epithelial cells CP was seen. 90 patients with both duodenal ulcer and CP associated gastritis were treated with agents. CP didn't disappear upon H_2-antagonists therapy but did disappear in 70% patients after furazolidone. Clearing of CP results in resolution of gastritis. CP is stronly associated with gastritis and peptic ulcer disease and appears to play a role in the pathogenesis of those chronic gastric disease.