探索根治幽门螺杆菌在治疗老年慢性萎缩性胃炎中的临床意义

发布时间：2018-03-05 03:00

  本文选题：老年人　切入点：慢性萎缩性胃炎　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景幽门螺杆菌(Helicobacter pylori,Hp)在全球平均感染率超过50%,是世界范围内最流行的人类感染性疾病,其中发展中国家感染率明显高于发达国家[1-2]。我国是Hp感染高发地区,因地域的不同,其感染率在42%~90%[3]。与此同时,相关流行病学统计结果显示,我国老年人群中幽门螺杆菌感染率高达50%~70%,而Hp是引发慢性萎缩性胃炎的一大诱因[4],老年人因全身机能减退,消化系统发病率较高,且更容易感染Hp[5]。由于近年来抗生素的广泛使用,导致Hp的耐药性逐年上升,老年患者肝肾清除率下降,根治Hp的抗生素类药物引起的不良反应发生率也逐年增加.因不易区分相关抗生素产生的不良反应与Hp感染引起的胃黏膜损伤产生的临床症状,所以难以评估老年患者Hp相关性慢性萎缩性胃炎根治Hp疗效。因此,本文通过对根治幽门螺杆菌前后老年慢性萎缩性胃炎患者的临床疗效及病理学变化进行阐述,探讨根治Hp在治疗老年人慢性萎缩性胃炎过程中的近、远期临床意义。目的探讨根治幽门螺杆菌(Helicobacter pylori,Hp)在老年慢性萎缩性胃炎治疗过程中的近、远期临床意义。对象与方法1.选取2014年6月~2015年9月期间,就诊于郑州大学第一附属医院老年科的慢性萎缩性胃炎患者(≥60岁)99例,所有病例均符合病例收集标准。并将其分为Hp根治组和非根治组。2.采用13C尿素呼气试验及胃镜下对胃黏膜进行活检,HE染色检测各组Hp感染情况。3.本研究选用埃索美拉唑、阿莫西林及克拉霉素三联疗法。初次根除失败的患者可采用补救治疗,补救治疗采用四联疗法:埃索美拉唑+胶体铋+阿莫西林+左氧氟沙星。4.观察记录治疗结束4周后、随访12个月后的临床症状、胃镜及组织病理检查结果。对所有Hp根除治疗的患者分别进行统计学分析,计数资料均采用SPSS21.0统计软件进行检验,以P0.05为差异有统计学意义。结果治疗结束4周后行胃镜下取病理活检,活检结果显示炎症程度差异无统计学意义(P=0.636)。两组治疗过程中均未发生严重的药物不良反应,且两组临床症状差异无统计学意义(P=0.696)。治疗结束12个月后行胃镜取病理活检结果显示,A组炎症恢复情况优于B组,两组胃镜检查结果差异有统计学意义(P=0.006)。两组治疗过程中均未发生严重的药物不良反应,且A组临床症状较B组得到明显好转,差异有统计学意义(P=0.041)。结论对Hp相关性慢性萎缩性胃炎的老年患者进行正规的根除Hp治疗,近期疗效不显著,但可以提高远期慢性萎缩性胃炎的疗效,并且对于预防胃癌的发生,有着非常重要的临床意义。
[Abstract]:Background Helicobacter pylori Helicobacter pylori (Helicobacter pylori) infection rate is more than 50 per cent in the world. It is the most prevalent human infectious disease in the world, and the infection rate in developing countries is significantly higher than that in developed countries [1-2]. At the same time, the related epidemiological statistics showed that the infection rate of Helicobacter pylori was as high as 50% in the elderly in China, and HP was a major cause of chronic atrophic gastritis. The incidence of digestive system is high, and it is more likely to be infected with HP [5]. Due to the widespread use of antibiotics in recent years, the resistance to HP has increased year by year, and the clearance rate of liver and kidney in elderly patients has decreased. The incidence of adverse reactions caused by antibiotics after HP eradication increased year by year. It is difficult to distinguish the adverse reactions caused by related antibiotics from the clinical symptoms caused by gastric mucosal injury caused by HP infection. Therefore, it is difficult to evaluate the curative effect of HP related chronic atrophic gastritis in elderly patients. Therefore, the clinical efficacy and pathological changes of elderly patients with chronic atrophic gastritis before and after the radical treatment of Helicobacter pylori were expounded. Objective to investigate the clinical significance of radical therapy of HP in the treatment of chronic atrophic gastritis in the elderly. Objective to investigate the clinical significance of Helicobacter pylori pylorus in the treatment of chronic atrophic gastritis in the elderly. Long-term clinical significance. Participants and methods 1. From June 2014 to September 2015, 99 patients with chronic atrophic gastritis (鈮，

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