Research Progress of Radical Treatment of Helicobacter Pylori Based on Drug Sensitivity Test as First-Line Treatment

Helicobacter pylori (HP) infection is a global problem that affects about half of the world’s population and requires sufficient attention in clinical and scientific work. Due to differences in economic and medical conditions among countries around the world, there is currently no unified treatment plan for anti-HP. In China, empirical quadruple therapy is mainly used. With the abuse of antibiotics, many patients face the problem of secondary eradication after failure, and the resistance rate of HP is gradually increasing. After eradication failure, drug sensitivity cultivation is carried out to choose sensitive antibiotics for treatment. A new strategy is currently needed to address how to improve the eradication rate of HP during the first eradication. This article aims to discuss the first-line treatment plans and research progress for eradicating HP based on drug sensitivity testing before eradication. Compared with traditional empirical therapies, treatment based on drug sensitivity results can effectively improve the eradication rate of HP, and reduce drug resistance rates, and adverse reactions, among other benefits. .

Helicobacter pylori vacA genotypes and cagA status and their relationship to associated diseases

Helicobacter pylori (H. pylori ) is a major causativebacterium of chronic gastritis, peptic ulcer and mucosaassociated lymphoid tissue lymphoma in humans, and associated with an increased risk of gastric cancer[1 -8]. An important virulant factor of H. pylori is the vacuolating cytotoxin ( VacA ) encoded by vacA that induces cytoplasmic vacuolation in target cells both in vitro and in vivo[9-11]. VacA is produced as a 140 kDa precursor which contains an N-terminal signal peptide and an approximately 33 kDa C-terminal outer membrance exporter. The precursor is cleaved at both N-terminal and C-terminal and secreted into the extracellular milieu as a 95 kDa mature protein. The mature protein futher undergoes specific cleavage to yield 37 kDa and 58 kDa subunits[12-14] Although vacA is present in all H. pylori strains, only about 50% to 60% of strains can induce vacuolation of epithelial cells as assessed by the HeLa cell assay. vacA shows considerable genetic variation in H. pylori isolated from all over the world and contains at least two variable regions. The s region exists as sl or s2 allelic types. Among type sl strains, subtypes sla and slb have been identified. The m region occurs as ml or m2 allelic types. Specific vacA genotype of H. pylori strains are associated with the production of the cytotoxin in vitro, epithelial damage in vivo, and clinical consequences[15-27]. The other virulant factor is the cytotoxin-associated protein (CagA) encoded by the cytotoxin-associated gene (cagA). The cagA gene is present in about 60% to 70% of strains and all of these strains express the cagA. The presence of cagA is also associated with the production of the cytotoxin in vitro, and clinical outcome[24-30]. The aim of this study was (i) to identify vacA genotypes and cagA status of H. pylori isolated from Chinese patients; (ii) to evaluation the relatioship beween vacA genotypes, cagA status and related gastroenterological disorders.

Helicobacter pylori isolates from ethnic minority patients in Guangxi:Resistance rates,mechanisms,and genotype

AIM: To investigate the rate of Helicobacter pylori (H. pylori) resistance to clarithromycin among ethnic minority patients in Guangxi, explore the underlying mechanisms, and analyze factors influencing genotype distribution of H. pylori isolates.

Inducible nitric oxide synthetase genotype and Helicobacter pylori infection affect gastric cancer risk

AIM： To investigate the association of the inducible ni- tric oxide synthetase （iNOS） C150T polymorphism with Helicobacter pylori （H. pylor/） infection and gastric can- cer （GC） risk in Iran. METHODS： In order to determine whether there was a correlation between iNOS genotype and GC in Iran, we conducted a case-control study using samples from 329 individuals. For each sample, the C150T ilVOS poly- morphism was genotyped by polymerase chain reaction （PCR） and restriction digestion. Patients were grouped by cancer presence, demographic and behavior charac- teristics, and/-/, pylori infection status. Statistical tests were conducted to determine whether any behavioral factors or a particular iNOS genotype was associated with GC in the study population. RESULTS： In this population, we found that smok- ing, hot beverage consumption, a familial history of GC and H. pylori infection status were significantly associated with GC development （P = 0.015, P 〈 0.001, P = 0.0034, and P 〈 0.015, respectively）. The distribution of the C150T ilVOS genotypes among the two study groups was not statistically significant alone, but was impacted by H. pylori infection status. When compared to the non-/-/, pylori infected group, cancer patients who had a heterozygous CT genotype and were also infected with H. pylori were 2.1 times more at risk of developing GC [odds ratio （OR） = 2.1, P = 0.03] while those with a homozygous TT genotype and infected with H. pylori were 5.0 times more at risk of developing GC （OR = 5.0, P = 0.029）. In contrast, this association was not seen in patients in the control group.CONCLUSION： ACT or TT polymorphism at position 150 in the iNO$ gene significantly increases the risk of GC and may be a marker for GC susceptibility.

Prevalence of Helicobacter pylori virulence genotypes among children in Eastern Turkey

AIM:To identify the virulence genotypes of Helicobacter pylori(H.pylori)if present in children in Eastern Turkey and if those genotypes are mostly associated with severe clinical presentations.METHODS:A total of 49 H.pylori positive Turkish children(42 with antral nodularity and 7 with peptic ulcer)who underwent upper gastrointestinal endoscopy with abdominal symptoms during the period from March 2011 to September 2012 were enrolled in this study.Antral nodularity was diagnosed endoscopically by two of the authors.We determined for the presence of cagA,vacA,cagE,iceA and babA2 genotypes of H.pylori isolates in DNA obtained directly from frozen gastric biopsy samples by polymerase chain reaction test using specific primers.RESULTS:Of the 49 H.pylori isolates studied,61.2%,91.8%,22.4%,28.6%,57.1%and 40.8%were positive for the cagA,vacA s1,cagE,iceA1,iceA2 and babA2 genes,respectively.We showed that the most common vacA subtype was s1a(79.6%).However,the s2 gene was found less frequently with an isolation rate of 8.2%of the H.pylori isolates.The genotypes iceA2 and vacA s1m2 were the most frequently found types in children with antral nodularity.In addition,the genotypes iceA1,babA2 and vacA s1m1 were found in similar ratios in all the H.pylori isolates obtained from children with peptic ulcer.The genotypes vacA s2m1and s1c were not observed in any of isolates studied.CONCLUSION:This study showed that vacA s1m2,cagA and iceA2 were the most common genotypes,and no association between antral nodularity and genotypes was observed.

HP0953-hypothetical virulence factor overexpresion and localization during Helicobacter pylori infection of gastric epithelium

BACKGROUND The high prevalence and persistence of Helicobacter pylori(H. pylori) infection, as well as the diversity of pathologies related to it, suggest that the virulence factors used by this microorganism are varied. Moreover, as its proteome contains 340hypothetical proteins, it is important to investigate them to completely understand the mechanisms of its virulence and survival. We have previously reported that the hypothetical protein HP0953 is overexpressed during the first hours of adhesion to inert surfaces, under stress conditions, suggesting its role in the environmental survival of this bacterium and perhaps as a virulence factor.AIM To investigate the expression and localization of HP0953 during adhesion to an inert surface and against gastric(AGS) cells.METHODS Expression analysis was performed for HP0953 during H. pylori adhesion. HP0953 expression at 0,3, 12, 24, and 48 h was evaluated and compared using the Kruskal-Wallis equality-of-populations rank test. Recombinant protein was produced and used to obtain polyclonal antibodies for immunolocalization. Immunogold technique was performed on bacterial sections during adherence to inert surfaces and AGS cells, which was analyzed by transmission electron microscopy. HP0953 protein sequence was analyzed to predict the presence of a signal peptide and transmembrane helices, both provided by the ExPASy platform, and using the GLYCOPP platform for glycosylation sites. Different programs, via, I-TASSER, RaptorX, and HHalign-Kbest, were used to perform three-dimensional modeling.RESULTS HP0953 exhibited its maximum expression at 12 h of infection in gastric epithelium cells.Immunogold technique revealed HP0953 localization in the cytoplasm and accumulation in some peripheral areas of the bacterial body, with greater expression when it is close to AGS cells.Bioinformatics analysis revealed the presence of a signal peptide that interacts with the transmembrane region and then allows the release of the protein to the external environment. The programs also showed a similarity with the Tip-alpha protein of H. pylori. Tip-alpha is an exotoxin that penetrates cells and induces tumor necrosis factor alpha production, and HP0953 could have a similar function as posttranslational modification sites were found;modifications in turn require enzymes located in eukaryotic cells. Thus, to be functional, HP0953 may necessarily need to be translocated inside the cell where it can trigger different mechanisms producing cellular damage.CONCLUSION The location of HP0953 around infected cells, the probable posttranslational modifications, and its similarity to an exotoxin suggest that this protein is a virulence factor.

Primary clarithromycin resistance to Helicobacter pylori : Is this the main reason for triple therapy failure?

Conventional triple therapies for Helicobacter pylori (H. pylori ) eradication have recently shown a disappointing reduction in effectiveness in many countries. The main reason for failure was found to be bacterial resistance to one of the most commonly used antibiotics, clarithromycin. An additional problem for conventional triple therapy is the high rate of resistance to metronidazole found in Europe, America and Asia. In Italy, in the last 15 years a 2-fold increase in resistance has occurred. A recent study of the whole of Italy included about 20 patients from each region at the first endoscopic diagnosis of H. pylori infection. The most surprising result was the patchy distribution of resistance, which was almost absent in two regions (one northern and one southern), although the highest prevalence was found in some regions of the South. In the paediatricpopulation we found a 25% prevalence of resistance in a sample of H. pylori positive children observed between 2002 and 2007, mirroring data obtained in southern European countries. Clarithromycin resistance assessment is currently based on phenotypic detection performed after culture the agar dilution method or E-test, and genotypic methods based on polymerase chain reaction (PCR). In a recent comparative study we found a 71.2% agreement between the two methods. Culture-free techniques are highly accurate in finding even minimal traces of genotypically resistant strains. Moreover, PCR-based tools are accurate in detecting a heteroresistant status, defined as the co-existence of some strains that are susceptible and some resistant to the same antibiotic in an individual patient. Three point mutations, namely A2143G , A2142G and A2142C , are responsible for 90% of cases of primary clarithromycin resistance in H. pylori strains isolated in Western countries, although we previously demonstrated that the presence of the A2143G mutation, but not A2142G or A2142C , significantly lowered the H. pylori eradication rate. Treatment failure has considerable cost/benefit implications because of 'waste' of National Health System and patient resources, in terms of drugs, further diagnostic tests and medical examination expenses. Therefore, in future it would be very useful to be able to test for clarithromycin resistance before starting conventional triple therapy. Hopefully, fast, effective noninvasive tests may soon be devised to determine this condition.

Effect of biofilm formation by clinical isolates of Helicobacter pylori on the efflux-mediated resistance to commonly used antibiotics

To evaluate the role of biofilm formation on the resistance of Helicobacter pylori (H. pylori) to commonly prescribed antibiotics, the expression rates of resistance genes in biofilm-forming and planktonic cells were compared.METHODSA collection of 33 H. pylori isolates from children and adult patients with chronic infection were taken for the present study. The isolates were screened for biofilm formation ability, as well as for polymerase chain reaction (PCR) reaction with HP1165 and hp1165 efflux pump genes. Susceptibilities of the selected strains to antibiotic and differences between susceptibilities of planktonic and biofilm-forming cell populations were determined. Quantitative real-time PCR (qPCR) analysis was performed using 16S rRNA gene as a H. pylori-specific primer, and two efflux pumps-specific primers, hp1165 and hefA.RESULTSThe strains were resistant to amoxicillin, metronidazole, and erythromycin, except for one strain, but they were all susceptible to tetracycline. Minimum bactericidal concentrations of antibiotics in the biofilm-forming cells were significantly higher than those of planktonic cells. qPCR demonstrated that the expression of efflux pump genes was significantly higher in the biofilm-forming cells as compared to the planktonic ones.CONCLUSIONThe present work demonstrated an association between H. pylori biofilm formation and decreased susceptibility to all the antibiotics tested. This decreased susceptibility to antibiotics was associated with enhanced functional activity of two efflux pumps: hp1165 and hefA.

Distribution of Helicobacter pylori in north China

AIM: To compare the distribution of virulence-associatedgenotypes of Helicobacter pylori(H pylori) in two areas of north China with different gastric cancer risk and furthermore probe into the pathogenicity of the bacterium. METHODS: Gastric biopsies were taken from 355 subjects from Zhuanghe, a high risk area of gastric cancer, and 136 subjects from Shenyang, a low risk area of gastric cancer. A total of 149 H pylori strains isolated from these patients were studied by PCR for differences in the genotypes of cagA, vac A, and iceA.RESULTS: In patients with high risk for gastric cancer, higher frequencies of vacA s1 or s1m1b genotypes were found as compared to those from the low risk area. CONCLUSION: There is significantly different distribution of H pylori genotypes between Zhuanghe and Shenyang areas in north China.

Neither gastric topological distribution nor principle virulence genes of Helicobacter pylori contributes to clinical outcomes

AIM: Studies on Helicobacter pylori (H pylon) and gastroduodenal diseases have focused mainly on the distal sites of the stomach, but relationship with the gastric cardia is lacking. The aim of this study is to determine if the gastric topology and genotypic distribution of Hpyloriwere associated with different upper gastrointestinal pathologies in a multiethnic Asian population. METHODS: Gastric biopsies from the cardia, body/corpus and antrum were endoscoped from a total of 155 patients with dyspepsia and/or reflux symptoms, with informed consent. H pylori isolates obtained were tested for the presence of 26kDa, ureC, cagA, vacA, iceA1, iceA2 and babA2 genes using PCR while DNA fingerprints were generated using random amplification polymorphic DNA (RAPD). RESULTS: Hpyloriwas present in 51/155 (33%) of patients studied. Of these, 16, 15 and 20 were isolated from patients with peptic ulcer diseases, gastroesophageal reflux diseases and non-ulcer dyspepsia, respectively. Of the Hpyloripositive patients, 75% (38/51) had Hpyloriin all three gastric sites. The prevalence of various genes in the H pylori isolates was shown to be similar irrespective of their colonization sites as well as among the same site of different patients. The RAPD profiles of H pylori isolates from different gastric sites were highly similar among intra-patients but varied greatly between different patients. CONCLUSION: Topographic colonization of H pylori and the virulence genes harboured by these isolates have no direct bearing to the clinical state of the patients. In multiethnic Singapore, the stomach of each patient is colonized by a predominant strain of H pylori，irrespective of the clinical diagnosis.

荆花胃康、复合乳酸菌及三联疗法治疗HP感染患者的临床疗效及对不良反应的影响

目的探讨荆花胃康、复合乳酸菌及三联疗法治疗HP感染患者的临床疗效及对不良反应的影响。方法选取2017年1月至2019年10月我院收治的120例HP感染患者,根据随机数字表法分为A、B、C组,各40例。A组采用标准三联疗法,B组采用复合乳酸菌联合三联疗法,C组采用荆花胃康、复合乳酸菌联合三联疗法。将患者的幽门螺杆菌根除率、临床症状治疗效果及不良反应作为研究指标。结果治疗后,B、C组HP根除率明显高于A组(P<0.05);治疗后,B、C组较A组总有效率明显升高(P<0.05),且C组较B组总有效率明显升高(P<0.05);治疗后,三组较治疗前症状积分均明显降低(P<0.05),且B、C组较A组明显降低(P<0.05),C组较B组明显降低(P<0.05);治疗后,B、C组较A组不良反应总发生率明显降低(P<0.05)。结论荆花胃康、复合乳酸菌联合三联疗法在HP感染患者中的疗效显著,并且对于患者的症状改善有较好的作用,同时能明显清除幽门螺旋杆菌,在临床治疗上且安全有效。

山橿抗Hp有效组分筛选及其对Hp感染胃癌AGS细胞的影响

目的探究山橿乙酸乙酯部位及其化学成分对幽门螺杆菌(Helicobacter pylori,Hp)的体外抑菌活性,筛选抗Hp有效组分;进一步研究有效组分对Hp感染人胃癌AGS细胞的影响。方法药敏纸片法比较山橿乙酸乙酯部位及其化学成分对Hp的体外抑菌效果,筛选山橿乙酸乙酯部位抗Hp有效成分,组建有效组分;对有效组分及抗Hp最强的化合物,以标准菌株Hp P12、三株多重耐药Hp菌株为实验菌株,克拉霉素为阳性对照药,采用倍比稀释法测定其最低抑菌浓度(MIC)值;细胞实验检测二者对人胃癌AGS细胞增殖、凋亡,Hp感染AGS细胞黏附能力的影响。结果山橿乙酸乙酯部位中二苯乙烯类成分的抗Hp作用优于黄酮类成分,其中银松素的抗Hp作用最为显著;依据山橿乙酸乙酯部位中8个二苯乙烯类成分的含量组建山橿抗Hp有效组分;山橿抗Hp有效组分对Hp标准菌株的MIC值为12~16μg/mL,对Hp耐药菌株的MIC值为256~512μg/mL;银松素对Hp标准菌株的MIC值为16~32μg/mL,对Hp耐药菌株的MIC值为64~128μg/mL,均明显优于山橿乙酸乙酯部位。山橿抗Hp有效组分、银松素对AGS细胞的IC50分别为14.10μg/mL,59.75μg/mL,且二者均不影响AGS细胞凋亡,又可在一定程度上减少Hp的定植。结论山橿乙酸乙酯部位抗Hp的主要有效成分为其中的二苯乙烯类化合物,其中以银松素的作用最强,其抗Hp机制与减少Hp的定植有关。

Novel CagA ELISA exhibits enhanced sensitivity of Helicobacter pylori CagA antibody

AIMTo develop a novel Helicobacter pylori (H. pylori) CagA antibody enzyme-linked immunosorbent assay (ELISA) suitable for detecting serum anti-CagA antibodies with high sensitivity.METHODSRecombinant East Asian-type CagA protein was purified and immobilized for ELISA. Serum samples from 217 Vietnamese individuals (110 H. pylori-infected and 107 uninfected individuals) were applied. Conventional ELISA from Western-type CagA and our East Asian-type CagA ELISA were evaluated by comparing 38 subjects with the Western-type genotype and 72 subjects with the East Asian-type cagA genotype. Histological scores of the gastric mucosa were determined using the updated Sydney System to examine the relationship with anti-CagA antibody titers.RESULTSRecombinant 70-100 kDa fragments were immobilized on the ELISA plate. In ROC analysis, the area under the curve of our East Asian-type CagA ELISA was comparable to that of conventional CagA ELISA. The sensitivity of the two ELISAs differed depending on the cagA genotype. The sensitivity of East Asian-type CagA ELISA was higher for subjects infected with East Asian-type cagA H. pylori (P &#x0003c; 0.001), and the sensitivity of the conventional CagA ELISA tended to be higher for subjects infected with Western cagA H. pylori (P = 0.056). The titer of anti-CagA antibody tended to correlate with monocyte infiltration scores (r = 0.25, P = 0.058) and was inversely correlated with H. pylori density (r = -0.26, P = 0.043).CONCLUSIONThe novel ELISA is useful to detect anti-CagA antibodies in East Asian countries, and the titer may be a marker for predicting chronic gastritis.

Presence of the Genes <i>cag</i>A, <i>cag</i>E, <i>vir</i>B11 and Allelic Variation of <i>vac</i>A of <i>Helicobacter pylori</i>Are Associated with the Activity of Gastritis

Non-atrophic active chronic gastritis (ACG) is characterized by the presence of H. pylori in the gastric epithelium, known to be one of the first steps that precede progression to gastric adenocarcinoma. Inactive chronic gastritis (ICG) suggests that the patient has H. pylori gastritis, but this diagnosis is rarely made in routine histopathology. Clinical manifestations associated with H. pylori infection are potentially due to differences in virulence between strains;however, it is unclear if the progression of ACG to ICG depends on the H. pylori strain. The aim of this study was to compare the prevalence of the virulence factors of H. pylori found in patients with ACG and ICG, and its influence on the development of ICG. A significant association was observed between H. pylori detection by histological examination and the activity of gastritis (p 1 year) was reported by 28.6% of the ACG group and 42.5% of the ICG, while no evidence of association between long-term use of PPI and decreased inflammation was found in the patients studied. The genes cagA, cagE and virB11 were statistically associated with ACG (p = 0.01, p vacAs1 allele groups, ACG was associated with the most virulent group (p = 0.0015), while ICG was associated with the less virulent group (p < 0.001). The rate of co-infection was significantly higher in ICG than in ACG cases (p = 0.02). In conclusion, this study points to the role of virulent strains of H. pylori in the non-resolution of gastritis.

胃复春联合铋剂四联疗法治疗萎缩性胃炎并Hp感染临床研究

目的:观察胃复春联合铋剂四联疗法治疗萎缩性胃炎并幽门螺杆菌(Hp)感染的临床疗效及对Hp的根除效果。方法:选取80例萎缩性胃炎并Hp感染患者为研究对象,按随机数字表法分为观察组和对照组各40例。对照组采用铋剂四联疗法治疗,观察组采用胃复春联合铋剂四联疗法治疗。比较2组临床疗效、Hp根除率、中医证候评分、炎症因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-4(IL-4)、白细胞介素-33(IL-33)]水平、生长因子[表皮细胞生长因子(EGF)、血管内皮细胞生长因子(VEGF)]水平及不良反应发生情况。结果:观察组总有效率为92.50%,对照组为75.00%,2组比较,差异有统计学意义(P<0.05)。随访1个月,观察组Hp根除率为95.00%,对照组为80.00%,2组比较,差异有统计学意义(P<0.05)。治疗后,2组中医证候评分均较治疗前降低(P<0.05),且观察组中医证候评分低于对照组(P<0.05)。治疗后,2组TNF-α、IL-4、IL-33水平均较治疗前降低(P<0.05),且观察组3项指标均低于对照组(P<0.05)。治疗后,2组EGF水平均较治疗前降低(P<0.05),VEGF水平均较治疗前升高(P<0.05);且观察组EGF水平低于对照组(P<0.05),VEGF水平高于对照组(P<0.05)。治疗期间,2组患者均未出现严重不良反应。结论:胃复春联合铋剂四联疗法可改善萎缩性胃炎并Hp感染患者的临床症状,降低机体炎症反应水平,恢复内皮功能,Hp根除效果良好。

康复新液联合雷贝拉唑四联疗法治疗Hp阳性胃溃疡的有效性及安全性分析

目的探讨康复新液联合雷贝拉唑四联疗法治疗幽门螺杆菌(Hp)阳性胃溃疡的有效性及安全性。方法选择2021年8月—2023年11月邹城市人民医院收治的78例Hp阳性胃溃疡患者为研究对象,按随机数字表法将其分为对照组和观察组,各39例。对照组采用雷贝拉唑四联疗法,观察组在对照组基础上采用康复新液治疗。对比两组的临床疗效、Hp清除率、血脂水平、不良反应发生情况。结果观察组的治疗总有效率、Hp清除率均较对照组高,组间差异有统计学意义(P<0.05)。治疗后,观察组总胆固醇、三酰甘油、低密度脂蛋白胆固醇水平均低于对照组,高密度脂蛋白胆固醇水平高于对照组,组间差异有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论在Hp阳性胃溃疡患者中使用康复新液联合雷贝拉唑四联疗法,可显著加强疗效,有效根除Hp,改善血脂水平,且用药安全性较高。

Meta-analysis on Efficacy and Safety of Compound Stomachache Inflammation Caused by Helicobacter Pylori

Objective:To systematically evaluate the efficacy and safety of Compound Stomachache Capsule(复方胃痛胶囊)in the treatment of digestive ulcer and inflammation Helicobacter pylori-Peptic Ulcer(Hp-PU)caused by Helicobacter pylori(Hp).Methods:Randomized controlled trials(RCTs)of Compound Stomachache Capsule(复方胃痛胶囊)in the treatment of Hp-PU were screened out by searching CNKI,VIP,Wanfang,China Biomedical Literature Service System,Cochrane Library,Pub Med,EMbase,Web of Science and Clinical Trials.gov.Meta-analysis was performed with Rev Man 5.4 software.Results:Three RCTs were included,including 331 patients of 166 patients in the experimental group(Compound Stomachache Capsule(复方胃痛胶囊)+conventional western medicine treatment)and 165 patients in the control group(conventional western medicine treatment).Meta-analysis data showed that Hp eradication rate(RR=1.10,95%CI[1.01-1.19],P=0.03)was significantly higher in the experimental group than in the control group.The experimental group was superior to the control group in improving clinical symptoms(RR=1.59,95%CI[1.22-2.06],P=0.0006).Conclusion:According to the current evidence,the Compound Stomachache Capsule(复方胃痛胶囊)combined with conventional Western medicine treatment can improve the Hp eradication rate of Hp-PU,relieve symptoms,and do not increase the incidence of adverse reactions.However,the number of included studies is small and the sample size is small,so its effectiveness and safety need further verification.

双歧杆菌活菌肠溶胶囊联合Hp根除疗法治疗Hp相关消化性溃疡的疗效研究

目的探讨双歧杆菌活菌肠溶胶囊联合含富马酸伏诺拉生片的幽门螺杆菌(Hp)根除疗法治疗Hp相关消化性溃疡的疗效。方法选取2020年9月至2022年8月于台山市第二人民医院消化内科治疗的70例Hp相关消化性溃疡患者为研究对象,依据随机数表法分为对照组和研究组各35例。对照组患者接受含富马酸伏诺拉生片的Hp根除疗法治疗,研究组患者在对照组治疗的基础上联合双歧杆菌活菌肠溶胶囊治疗。治疗4周后,比较两组患者的临床疗效以及治疗前后的胃蛋白酶Ⅰ和胃蛋白酶Ⅱ水平,同时比较两组患者的溃疡症状改善时间、Hp根除率、Hp复发率和治疗期间的不良反应发生情况。结果研究组患者的治疗总有效率为94.29%,明显高于对照组的77.14%,差异有统计学意义(P<0.05);治疗前,两组患者的胃蛋白酶Ⅰ、胃蛋白酶Ⅱ水平比较差异均无统计学意义(P>0.05);治疗后,研究组患者的胃蛋白酶Ⅰ、胃蛋白酶Ⅱ水平分别为(125.37±21.06)μg/L、(8.17±1.94)μg/L,明显低于对照组的(175.33±24.27)μg/L、(12.39±2.1)μg/L,差异均有统计学意义(P<0.05);研究组患者的溃疡症状改善时间为(1.27±0.38)d,明显短于对照组的(3.45±0.47)d、Hp根除率为94.29%,明显高于对照组的77.14%,Hp复发率为8.57%,明显低于对照组的28.57%,差异均有统计学意义(P<0.05);研究组患者的不良反应发生率为5.71%,明显低于对照组的25.71%,差异有统计学意义(P<0.05)。结论双歧杆菌活菌肠溶胶囊联合含富马酸伏诺拉生片的Hp根除疗法治疗Hp相关消化性溃疡能有效调节患者的胃蛋白酶原,提高Hp根除率,降低Hp复发率,疗效显著且不良反应少,值得推广应用。

清胃祛湿汤联合四联疗法治疗Hp相关性胃炎消化不良患者的效果

目的:探讨清胃祛湿汤联合四联疗法治疗幽门螺杆菌(Hp)相关性胃炎消化不良患者的效果。方法:将当阳市中医医院2020年1月—2022年4月收治的122例Hp相关性胃炎消化不良患者,按照随机数表法分为观察组和对照组,各61例。对照组予以四联疗法(雷贝拉唑肠溶片+阿莫西林胶囊+呋喃唑酮+胶体果胶铋胶囊)治疗,观察组在对照组基础上予以清胃祛湿汤治疗。治疗14 d后,评估两组的临床疗效、中医症候积分、Hp根除率及炎症水平。结果:观察组总有效率为95.08%,高于对照组的81.97%,差异有统计学意义(P<0.05)。治疗14 d后,观察组口干口苦、恶心呕吐、食欲不振、胃脘胀满、嗳气泛酸症状评分低于对照组,差异有统计学意义(P<0.05)。治疗14 d后,观察组Hp根除率为73.77%,高于对照组的55.74%,差异有统计学意义(P<0.05)。治疗14 d后,观察组肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)水平低于对照组,差异有统计学意义(P<0.05)。结论:清胃祛湿汤联合四联疗法治疗Hp相关性胃炎消化不良患者有助于减轻炎症反应,提高Hp根除率,增强临床疗效,缓解临床症状。

加味半夏泻心汤联合西药治疗对脾胃湿热型HP阳性慢性胃炎的临床观察

目的探究加味半夏泻心汤联合西药治疗在脾胃湿热型幽门螺杆菌(HP)阳性慢性胃炎患者中的应用效果。方法选取新余市中医院2020年1月至2022年8月收治的118例脾胃湿热型HP阳性慢性胃炎患者,按照随机数字表法分为两组,各59例。对照组采用西药四联疗法治疗,在上述基础上,观察组加服加味半夏泻心汤。对比两组临床疗效、中医证候积分、HP清除率、HP复发率、不良反应。结果观察组治疗总有效率高于对照组(P<0.05)。治疗后,观察组中医证候积分低于对照组(P<0.05);HP清除率高于对照组;随访半年HP复发率低于对照组(P<0.05)。两组不良反应对比,差异无统计学意义(P>0.05)。结论脾胃湿热型HP阳性慢性胃炎患者采用加味半夏泻心汤联合西药治疗,效果显著,利于改善中医证候积分,提升HP清除率,降低复发率,且临床应用安全性较高。