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1700629714 [28] Jancezewska I, Sagar M, Sjostedt S, et al. Comparison of the effect of lansoprazole and omeprazole on intragastric acidity and gastroesophageal reflux disease. Scand J Gastroenterol, 1998, 33(12):1239-1243.

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1700629716 [29] Thoring M, Hedenstrom H, Eriksson LS. Rapid effect of lansoprazole intragastric pH: a crossover comparison of omeprazole. Scand J Gastroenterol, 1999, 34(4):341.

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1700629718 [30] Richter JE, Long JF. Cisaprice for gastroesophageal reflux disease: A placebo controlled, double blind study. Am J Gastroenterol, 1995, 90(3):423-430.

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1700629720 [31] Miyamoto M, Haruma K, Takeuchi K, et al. Frequency scale for symptoms of gastroesophageal reflux disease predicts the need for addition of pmkinetics to proton pump inhibitor therapy. J Gastroenteml Hepatol, 2007, 19（online published).

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1700629722 [32] Hameeteman W. Clinical studies of Sucralfate in reflux esophagitis. The European experience. J Clin Gastroenterol, 1991, 1313:s16-s20.

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1700629726 [34] Kenneth R, Devault, MD. Overview of medical therapy for GERD. Gastroenterol Clin North Am. 1999, 28(4):831-845.

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1700629728 [35] 王良静，赵岚，姒健敏．不同联合疗法对反流性食管炎的疗效、生活质量和经济投入．中华内科杂志，2002，41(7):485-486.

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1700629730 [36] Vigneris, Termini R, Leandro G, et al. A comparison of five maintenace therapies for reflux esophagitis. N Engl J Med, 1995, 333(17):1106-1110.

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1700629734 [38] Harris RA, Kuppermann M, Richter JE. Prevention of recurrences of erosive reflux esophagitis: A cost effectiveness analysis of maintenance proton pump inhibition. Am J Med, 1997, 102:78-88.

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1700629738 [40] Montes CG, Brandal NA, Deliza R, et al. Antireflux surgery followed by bipolar electrocoagulation in the treatment of Barrett’s esophagus. Gastrointest Endosc, 1999, 50(2):173-177.

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1700629740 （姒健敏）

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1700629745 内科学新进展 [:1700627002]

1700629746 内科学新进展 第三节　幽门螺杆菌与胃十二指肠疾病

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1700629748 摘　要　幽门螺杆菌是一种定植于胃黏膜的专性微需氧的革兰阴性菌。幽门螺杆菌是慢性胃炎和消化性溃疡的重要病因。Hp与胃癌的关系也十分密切，世界卫生组织已明确指出Hp为第一类致癌因子。根除Hp的治疗显得尤为重要，但随着抗生素的广泛使用，Hp的耐药性也逐渐增加。除了传统的三联或四联根除方案，对于耐药菌株可改换用左氧氟沙星等抗生素，必要时根据体外Hp培养和药敏试验结果选择抗生素。

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1700629750 Abstract　H. pylori is a gram-negative, microaerophilic bacterium that colonizes the human stomach. It is a pathogenic bacterium associated with the development of gastritis and peptic ulcers as well as gastric adenocarcinoma. H. pylori has been classified as a carcinogen for stomach cancer by the World Health Organization（WHO）and eradication of this organism is very important. Current treatment options for the eradication of H. pylori commonly include multiple drug therapy with antibiotics and other compounds such as proton pump inhibitors. However, with the extensive use of antibiotics, the emergence of drug-resistant strains of H. pylori deserves particular mention. Except conditional triple or quadruple eradication therapeutic, Levofloxacin is available for antimicrobial-resistant H. pylori strains. If necessary, antibiotics is chosen based on the results of H. pylori culture and susceptibility test in vitro

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1700629752 一、幽门螺杆菌概述

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1700629754 1983年，澳大利亚学者Warren和Marshall首次成功从胃内分离出该菌，引起医学界的广泛关注，至1989正式命名为幽门螺杆菌（helicobacter pyloyi, Hp)。Hp是一种专性微需氧的革兰阴性菌，长2.5～4.0μm，宽0.5～1.0μm。在胃黏膜上皮细胞表面常呈典型的螺型或弧型。延长培养时间，典型的细菌形状会发生圆球体样的形态变化，这可能属于Hp的L型。Hp能特异地定居于胃黏膜上皮细胞表面，胃窦部较为多见，也可见于胃肠道的其他胃上皮化生区域。体外试验显示Hp具有严格的嗜组织性，只与胃黏膜的分泌上皮细胞黏附，而不与颈黏液细胞、壁细胞和主细胞黏附，说明Hp在胃内或胃上皮化生区定居，可能与胃黏膜上皮细胞表面的特异性受体有关。Hp传播途径至今尚未完全明了。多数学者认为，在自然环境中，Hp仅寄居于人类，人是唯一传染源，人—人间传播是唯一传播途径。通过粪—口传播、口—口传播，还是其他途径传播目前尚有争论。中华消化病学分会Hp学组织的我国自然人群Hp感染的流行病学调查和我国Hp对抗生素耐药的流行病学调查两项大规模的全国多中心协作研究显示：全国自然人群的Hp感染流行病学调查历时3～4年，涉及全国19个省、10个城市、39个中心。其调查结果显示，全国各地Hp感染率存在很大差异，我国Hp感染率为40％～90％，平均为59％，Hp感染率最低的地区是广东省，为42％；Hp感染率最高的是西藏喇嘛，为90％。研究结果表明，我国是Hp感染率相当高的国家。在不同地区和城市，Hp感染率有较大差异，证实了Hp感染与生活环境和生活习惯等因素相关，并具有家族聚集性。贫穷、教育程度低、卫生条件差、居住拥挤以及宿主胃酸分泌减少、营养状况差、免疫功能低下等是Hp感染的高危因素。Hp较为顽固，一时受感染，如未能接受正规方案治疗将终生受累，自愈率接近零，感染率随年龄上升。对正常人群的大量血清流行病学调查资料显示，Hp感染率随年龄上升的模式有两类。第一类为儿童易感型，即儿童期为感染率剧增期，至10岁有40％～60％人受感染，以后感染速度减慢，以每年0.5％～1.0％速度缓增，至50岁左右感染率基本平衡。发展中国家包括我国属这一类型。第二类为感染均衡型，感染率随年龄增加的速率在儿童期和成年期基本一致，以每年0.5％～1.0％的速度上升，发达国家属这一类型。

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1700629756 Hp的发现使慢性胃炎和消化性溃疡的发病学和治疗学研究面临着一场革命；Hp与胃癌的关系也十分密切，世界卫生组织已明确指出Hp为第一类致癌因子，可见Hp感染与上胃肠道疾病关系极为密切。

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1700629758 二、幽门螺杆菌与慢性胃炎

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