林晓洁采用中药治疗儿童幽门螺旋杆菌相关性胃炎的用药规律探讨

回顾性分析林晓洁教授采用中药治疗儿童幽门螺旋杆菌相关性胃炎的有效病例的病案资料,采用频数分析及聚类分析的统计方法,探讨其用药规律。收集中药处方220首,涉及中药36味,其中单味中药使用频次> 50次的共24味,居前8位的高频药物为太子参、山药、茯苓、甘草、白术、葛根、鸡蛋花、陈皮;聚类分析显示,24味中药聚为3大类。Ⅰ类药的太子参、山药、茯苓、甘草、白术、葛根、鸡蛋花、陈皮、谷芽、麦芽为林晓洁教授基于“胃气为本”治疗本病而创立的脾胃康方的主要组成药物。分析结果提示,林晓洁教授治疗儿童幽门螺旋杆菌相关性胃炎主张以健脾益气、清热利湿、消食化积为治法,辅以调理肺、胃、肝等脏腑气机,同时注重结合岭南气候特点而选择用药。

儿童幽门螺杆菌感染多种检测方法比较

目的比较分析多种儿童幽门螺杆菌感染检测效果。方法从2009年6月至2011年5月在我院诊治的消化道不适儿童中筛选出符合本次研究的患儿97例,实施病理组织切片、细菌培养、14C尿素呼气试验、快速尿素酶检测等4种方法检测。结果病理组织切片、细菌培养、14C尿素呼气试验、快速尿素酶检测的敏感性分别达95.0%、96.7%、95.0%、91.7%,特异性分别达100%、100%、97.3%、78.4%,差异不具显著性。结论儿童幽门螺旋杆菌感染检测可以考虑以非侵入性14C尿素呼气试验为主,以病理组织切片、细菌培养为辅。

三联疗法联合猴头菌提取物颗粒治疗儿童幽门螺杆菌感染55例临床观察

目的:观察三联疗法联合猴头菌提取物颗粒治疗儿童幽门螺杆菌感染的临床疗效。方法:将110例患儿分为对照组观察组各55例。观察组采用三联疗法联合猴头菌提取物颗粒治疗,对照组采用三联疗法治疗,对比两组患者的总有效率、Hp清除率及不良反应发生率。结果:观察组治疗总有效率明显高于对照组(P<0.05),观察组Hp清除率明显高于对照组(P<0.05);观察组不良反应发生率明显低于对照组(P<0.05)。结论:采用三联疗法联合猴头菌提取物颗粒治疗儿童幽门螺杆菌感染可取得较好的治疗效果,有一定的临床推广应用价值。

Influence of Helicobacter pylori infection on ghrelin levels in children

AIM:To compare ghrelin levels in plasma and gastric mucosa before and after Helicobacter pylori(H.pylori) treatment in children with H.pylori-associated functional dyspepsia.METHODS:Children with H.pylori-associated functional dyspepsia were enrolled in this study.H.pylori infection was confirmed by positive bacterial culture results.All of the children received triple H.pylori eradication therapy(a 2 wk course of omeprazole,amoxicillin,and clarithromycin).The children were divided into two groups based on the success of the H.pylori treatment:group 1(eradicated)-patients who had a negative 13C-urea breath test 2 mo after the end of therapy;and group 2(non-eradicated)-patients who had a positive 13C-urea breath test.Plasma ghrelin,gastric ghrelin mRNA,and the body mass index were evaluated in both groups before and after the H.pylori treatment.The plasma ghrelin levels were measured by a radioimmunoassay.The expression of gastric ghrelin mRNA was determined by real-time reverse transcription polymerase chain reaction.RESULTS:A total of 50 children with H.pylori-associated functional dyspepsia were treated with triple H.pylori eradication therapy.The mean age of the children was 5.52 ± 0.83 years,and there were 28 males and 22 females.Among the 50 H.pylori-positive children,30 successfully achieved eradication,and 20 did not.The mean plasma ghrelin levels of group 1 were 22.17 ± 1.73 ng/L and 26.59 ± 2.05 ng/L before and after the treatment,respectively,which was a significant increase(P = 0.001).However,the mean plasma ghrelin level of group 2 before and after the H.pylori treatment was 21.34 ± 2.40 ng/L and 22.24 ± 2.10 ng/L(P = 0.785).The plasma ghrelin levels increased substantially after treatment in group 1 but showed only minor changes in group 2.Similarly,the gastric ghrelin mRNA expression in group 1 before treatment was 2.84 ± 0.08.After treatment,the level was 3.11 ± 0.65,which was significantly different(P = 0.023).The gastric ghrelin mRNA expression in group 2 did not change significantly during the treatment(2.82 ± 0.44 vs 2.79 ± 0.31,P = 0.875).The plasma ghrelin and gastric ghrelin mRNA levels in group 1 increased substantially after the treatment but did not do so in group 2.In addition,the body mass index the two groups did not differ significantly 2 mo before and after the H.pylori treatment.CONCLUSION:H.pylori eradication increases the plasma and tissue ghrelin levels in children with H.pylori-associated functional dyspepsia.

Eradication of Helicobacter pylori increases childhood growth and serum acylated ghrelin levels

AIM: To determine whether Helicobacter pylori (H. pylori)infected children have reduced body weight (BW) and height (BH) growth, and if H. pylori eradication may restore growth while improving serum acylated ghrelin. METHODS: This longitudinal cohort study with oneyear follow-up enrolled 1222 children aged 4 to 12 years old into an observation cohort (18 with and 318 without H. pylori ) and intervention cohort (75 with and 811 without). The 7-d triple therapy was used for eradication in the intervention cohort. The net increases of BW and BH as well serum acylated ghrelin after oneyear follow-up were compared between successful eradicated H. pylori-infected children and controls. RESULTS: In the observation cohort, the H. pylori - infected children had lower z score of BW (-1.11 ± 0.47 vs 0.35 ± 0.69, P = 0.01) and body mass index (BMI) (0.06 ± 0.45 vs 0.44 ± 0.73, P = 0.02) at enrollment and lower net BW gain after one-year follow-up (3.3 ± 2.1 kg vs 4.5 ± 2.4 kg, P = 0.04) than the non-infected controls. In the intervention cohort, the H. pylori - infected children had lower z score of BMI (0.25 ± 1.09 vs 0.68 ± 0.87, P = 0.009) and serum acylated ghrelin levels (41.8 ± 35.6 pg/mL vs 83.6 ± 24.2 pg/mL, P < 0.001) than the non-infected controls. In addition to restoring decreased serum ghrelin levels (87.7 ± 38.0 pg/mL vs 44.2 ± 39.0 pg/mL, P < 0.001), the H. pylori - infected children with successful eradication had higher net gains (P < 0.05) and increase of z scores (P < 0.05) of both BW and BH as compared with non-infected controls after one-year follow-up. CONCLUSION:H. pylori-infected children are associated with low serum acylated ghrelin and growth retardation. Successful eradication of H. pylori restores ghrelin levels and increases growth in children.