根除幽门螺杆菌的可行性探讨  

Feasibility study on eradication of Helicobacter pylori

作　　者：王彬[1] 李小圆[1] 吴婷[1] 张凤云[1] 王靖[1] 

机构地区：[1]牡丹江医学院第二附属医院药剂科,黑龙江牡丹江157015

出　　处：《中国感染与化疗杂志》2016年第1期50-53,共4页Chinese Journal of Infection and Chemotherapy

基　　金：黑龙江省卫生计生委科研课题(2014-207)

摘　　要：目的分析口腔幽门螺杆菌(Hp)感染与胃内Hp感染的关系,探讨控制口腔Hp感染对彻底根除胃内Hp感染的临床意义及彻底根治Hp的疗效观察。方法通过测试板对体检人群口腔唾液进行Hp检测,确定口腔感染阳性病例;其中遴选经胃镜活检尿素酶检测阳性,病理诊断为胃炎或胃、十二指肠溃疡患者180例。随机分为两组,观察组90例,三联药物治疗同时用非药物治疗牙膏联合氟防龋材料刷牙;对照组90例,单纯进行三联药物治疗。检测两组各时间点有效清除Hp病例,分析口腔洁治对口腔和胃内Hp感染根除率的影响。结果观察组在药物治疗2周停药4周后,口腔和胃内Hp全转为阴性例数明显高于对照组,两组Hp转阴比例分别为80.0%和64.4%,P<0.05;坚持使用氟防龋材料联合口腔洁治的患者1年后,观察组幽门螺杆菌转阴率和根除率明显优于对照组(74.4%对40.0%和93.5%对62.1%,P<0.05)。观察组口腔和胃Hp的再感染比例显著降低。结论药物治疗Hp的根除率与患者口腔内Hp感染控制及口腔卫生状况有关。口腔Hp可能是胃Hp再感染的病原因素,因此对胃内Hp感染所致疾病进行三联药物治疗的同时应配合口腔抗Hp的治疗,对于彻底根治Hp感染并减少抗生素使用,具有重要临床意义。Objective To explore the relationship between oral Helicobacter pylori （Hp） infection and gastric Hp infection and examine the possibility of complete eradication of Hp by control of oral Hp infection. Methods Oral Hp was tested in saliva to identify cases of oral Hp infection. A total of 180 patients with gastritis or gastric or duodenal ulcer were randomly assigned to two groups, 90 patients in treatment group and 90 in control group. The diagnosis of gastritis or gastric or duodenal ulcer was made according to positive urease test and pathological examination. The patients in treatment group received triple therapy and brushing teeth with toothpaste containing caries-preventing fluorine material. The patients in control group received triple therapy alone. Hp eradication was detected and compared between groups at various time points to analyze the effect of oral hygiene on eradication of oral and gastric Hp. Results Four weeks after the end of 2-week treatment, positive-to-negative conversion rate of both oral and gastric Hp in treatment group was significantly higher than that in control group （80.0% vs 64.4%, P〈0.05）. After one-year oral hygiene treatment, the positive-to-negative conversion rate and eradication rate of Hp were significantly higher than those in control group （74.4% vs 40.0%, 93.5% vs 62.1%, all P〈0.05）. Hp re-infection rate in both oral cavity and stomach was significantly reduced in control group. Conclusions Eradication of Hp by drug therapy is associated with control of oral Hp and oral hygiene. Brushing teeth with toothpaste containing caries-preventing fluorine material in addition to triple drug therapy is beneficial for eradication of Hp and reduced use of antibiotics.

关 键 词：幽门螺杆菌 氟防龋材料 口腔洁治 胃炎 奥美拉唑 克拉霉素 阿莫西林 

分 类 号：R573[医药卫生—消化系统]