幽门螺杆菌球形菌与溃疡复发关系的临床研究

A Clinical Research on the Coccoid Form of Helicobacter Pylori and the Recurrence of Duodenal Ulcer

目的：探讨幽门螺杆菌（Ｈｐ）球形菌与溃疡复发的关系。方法：１１例Ｈｐ阳性活动期十二指肠溃疡（ＤＵ）患者，经标准三联疗法（铋剂１０ｍｇ、四环素５００ｍｇ、甲硝唑４０ｍｇ，每日３次共１４天）治疗后４周，复查胃镜，胃粘膜涂片Ｇｒａｍ及免疫组织化学染色检查Ｈｐ球形菌，以及尿素酶试验和ＰＣＲ检测。结果：ＤＵ愈合率９６％，Ｈｐ根除率８５％。１２人检出Ｈｐ球形菌且ＤＵ均愈合占１０４％，其中９人完成一年随访，溃疡均复发占１０％，涂片均检出典型Ｈｐ。而Ｈｐ根除组８６人随访一年４人溃疡复发占４７％，均为Ｈｐ阳性。比较两组溃疡复发率差异显著（Ｐ＜００５）。

Aim: To investigate the coccoid form of Helicobacter pylori (Hp) and its relationship with the recurrence of duodenal ulcer (DU).Methods: 111 cases with active DU with Hp infection were treated with a standard triple therapy including bismuth 110 mg tid, tetracycline 500 mg tid and metronidazole 400 mg tid for 2 weeks.Four weeks after stopping therapy,all cases were reexamined by gastroscopy and 3 biopsies of antral mucosa were taken for Hp detection including smear with Gram and immunohistochemical stains,urease test and PCR.Results: The rates of DU cure and Hp eradication were 96% and 85%, respectively.The coccoid form of Hp was found in 12 cases (10.4%) with DU cure.9 cases were followed up for 1 year and their DU recurred with typecal Hp(100%),in contrast,only 4 in 86 cases with DU cured and Hp eradicated had recurrent ulcer with Hp positive (4.6%).There was a very significant difference between two groups' recurrence rates of DU ( P <0.005).Conclusion: The coccoid form of Hp is associated with the recurrence of DU.