【摘要】目的：探讨多元化健康宣教在幽门螺旋杆菌（Hp）感染碳13（13C）呼气试验筛查中的应用效果。方法：将2024年5月~2026年4月至我院体检科进行无痛胃肠镜检查后，结果提示Hp阳性的300例患者作为研究对象，开展前瞻性临床试验。经数字表法将入组患者随机列为常规组和试验组，每组150例。两组患者均行13C呼气试验，常规组检查前实施常规健康宣教，试验组检查前实施多元化健康宣教，比较两组患者的心理状态，准备情况，检查情况及整体满意度。结果：试验组的疾病不确定感（MUIS）评分、广泛性焦虑量表-7（GAD-7）评分均低于常规组（t=7.644，10.923；P＜0.05）。试验组的药物停用依从率、饮食依从率、空腹依从率分别92.00%（138/150）、93.33%（140/150）、96.67%（145/150），均高于常规组[80.00%（120/150）、81.33%（122/150）、85.33%（128/150）]（x2=8.970，9.763，11.762；P＜0.05）。试验组的吹气一次成功率、肺泡气样本质量达标率、检查完成率、检查结果准确率分别为94.67%（142/150）、94.00%（141/150）、96.67%（145/150）、96.00%（144/150），均高于常规组[82.67%（124/150）、83.33%（125/150）、84.67%（127/150）、84.00%（126/150），]（x2=10.748，8.492，12.763，12.000；P＜0.05）。试验组的心理舒适、信息获取、检查流畅、结果可靠满意度评分均高于常规组（t=5.279，4.625，4.592，5.729；P＜0.05）。结论：多元化健康宣教可改善Hp感染患者的心理状态，并优化13C呼气试验的准备情况、检查情况，对提升检查结果准确性及患者满意度均有积极影响

[Abstract]Objective:Exploring the application effect of diversified health education in screening for Hp infection with 13C breath test.Methods:A prospective clinical trial will be conducted on 300 patients who were found to be Hp positive after undergoing painless gastroscopy in our hospital from May 2024 to April 2026. The enrolled patients were randomly divided into a control group and an experimental group using a numerical table method, with 150 cases in each group. Both groups of patients underwent 13C breath tests. The routine group received routine health education before the examination, while the experimental group received diversified health education before the examination. The psychological status, preparation, examination results, and overall satisfaction of the two groups of patients were compared.Results:Compare to the control group,the experimental group had lower MUIS scores and GAD-7 scores (t=7.644，10.923; P<0.05). The medication discontinuation compliance rate, dietary compliance rate, and fasting compliance rate of the experimental group were 92.00% (138/150), 93.33% (140/150), and 96.67% (145/150), respectively, all higher than those of the conventional group [80.00% (120/150), 81.33% (122/150), 85.33% (128/150)] (x2=8.970，9.763，11.762; P<0.05). The success rate of one-time blowing, the quality compliance rate of alveolar gas samples, the completion rate of examination, and the accuracy of examination results in the experimental group were 94.67% (142/150), 94.00% (141/150), 96.67% (145/150), and 96.00% (144/150), respectively, which were higher than those in the conventional group [82.67% (124/150), 83.33% (125/150), 84.67% (127/150), 84.00% (126/150)] (x2=10.748，8.492，12.763，12.000; P<0.05). Compare to the control group,the experimental group had higher satisfaction scores of psychological comfort, information acquisition, smooth examination, and reliable results (t=5.279，4.625，4.592，5.729; P<0.05).Conclusion:Diversified health education can improve the psychological state of Hp infected patients, optimize the preparation and examination of 13C breath tests, and have a positive impact on improving the accuracy of examination results and patient satisfaction.

       目的  调查深圳地区综合性医院门诊幽门螺杆菌（Hp）对8种常见抗菌药物的耐药情况。方法  采集¹³C呼气试验阳性的患者胃黏膜标本313例，进行Hp分离培养及抗菌药物敏感性试验。结果  313例患者分离培养得到247例Hp菌株，培养阳性率78.91%，不同性别、不同年龄患者Hp分离培养阳性率比较差异无统计学意义（P＞0.05）。Hp对甲硝唑、克拉霉素、左氧氟沙星、利福平、阿莫西林、四环素、呋喃唑酮、庆大霉素耐药率依次为88.66%（219/247）、38.46%（95/247）、38.06%（94/247）、4.05%（10/247）、1.21%（3/247）、0.40%（1/247）、0.40%（1/247）、0（0/247）。双重耐药率为38.46%（95/247），其中Hp对克拉霉素+甲硝唑组合耐药率最高（18.62%，46/247），对甲硝唑+左氧氟沙星耐药率居其次（17.00%，42/247）。多重耐药率为19.84%（49/247）。不同年龄、性别患者双重耐药率、多重耐药率比较差异均无统计学意义（P＞0.05）。结论  深圳地区分离的Hp菌株对甲硝唑、克拉霉素、左氧氟沙星耐药率相对更高，且双重耐药、多重耐药情况严重。

        Objective  To investigate the antibiotic resistance of Helicobacter pylori（Hp）to eight commonly  used antibiotics in outpatients of general hospitals in Shenzhen．Methods  Gastric mucosal samples were collected from 313 patients who tested positive for the  ¹³C breath test，and Hp strains were isolated and cultured．Antibiotic susceptibility testing was performed on the isolated Hp strains．Results  Of the 313 patients，247 Hp strains were isolated，with a culture-positive rate of 78.91%．There was no significant difference in culture-positive rates between different genders and age groups（P＞0.05）．The resistance rates to metronidazole，clarithromycin，levofloxacin，rifampicin，amoxicillin，tetracycline，furazolidone，and gentamicin were 88.66%（219/247），38.46%（95/247），38.06%（94/247），4.05%（10/247），1.21%（3/247），0.40%（1/247），0.40%（1/247），0（0/247），respectively．The dual resistance rate was 38.46%（95/247），with the highest combination  resistance observed in clarithromycin + metronidazole（18.62%，46/247），followed by metronidazole + levofloxacin（17.00%，42/247）．The multi-drug resistance rate was 19.84%（49/247）．There were no significant differences in dual resistance rates（P＞0.05）or multiple resistance rates（P＞0.05）between different age groups and genders．Conclusions  The Hp strains isolated in Shenzhen exhibited relatively higher resistance rates to metronidazole，clarithromycin，and levofloxacin，with substantial dual and multi-drug resistance．

目的 探究伏诺拉生三联疗法根除幽门螺杆菌（Hp）的疗效。方法 入组2022年5月—12月经¹³C尿素呼气试验确诊的Hp现症感染者200例,分为观察组和对照组,每组100例。观察组方案为阿莫西林、呋喃唑酮、伏诺拉生三联疗法,对照组方案为阿莫西林、呋喃唑酮、艾司奥美拉唑镁、枸橼酸铋钾四联疗法;疗程均为14 d。在治疗停药后1个月复查¹³C尿素呼气试验判定是否Hp根除成功,并观察药物不良反应发生率。结果 观察组Hp根除率为96.97%,高于对照组的89.80%,差异有统计学意义（P<0.05）;观察组不良反应发生率和对照组比较差异无统计学意义（P>0.05）。结论 伏诺拉生、阿莫西林、呋喃唑酮三联疗法的Hp根除率较高且安全性良好,可作为Hp感染的治疗方案之一。

Objective To explore the effect of vonoprazan triple therapy on Helicobacter pylori（Hp）．Methods A total of 200 patients with Hp infection confirmed by ¹³C urea breath test from May-December 2022 were selected and divided into observation group and control group with 100 patients in each group．The observation group was treated with triple therapy of amoxicillin,furazolidone and vonoprazan,while the control group was treated with quadruple therapy of amoxicillin,furazolidone,esomeprazole magnesium and bismuth potassium citrate．The treatment course was 14 days．The ¹³C urea breath test was reviewed one month after treatment withdrawal to determine whether Hp eradication was successful,and the incidence of adverse drug reactions was observed．Results The eradication rate of Hp in the observation group was 96.97%,higher than 89.80% in the control group,and the difference was statistically significant（P<0.05）．There was no significant difference in the incidence of adverse reactions between the observation group and the control group（P>0.05）．Conclusions The triple therapy of vonoprazan,amoxicillin and furazolidone has a very high eradication rate and good safety,which can be used as one of the treatment options for Hp．

目的 探讨先天性肥厚性幽门狭窄(congenital hypertrophic pyloric stenosis,IHPS)中神经元型一氧化氮合酶(neuronal nitric oxide synthase,nNOS)的表达情况,以进一步研究IHPS的发病机制。方法 选取4只Beagle孕犬按3:1分为模型组和对照组,自孕期第1天至分娩前1天,模型组孕犬每天腹腔注射一次L-NAME 6 mg/(kg.d),对照组给予同样方式注射等量的生理盐水。所有新生犬均在生后第31天、38天、45天及52天分别称重,生后52天,选取模型组中体质量增长缓慢的新生犬和对照组新生犬各5只作为实验对象,取幽门组织HE染色后显微镜下测量幽门环肌厚度,免疫组化后运用图像分析技术测定nNOS表达量。结果 与对照组新生犬比较,模型组中新生犬体质量增长慢,幽门环肌增厚,nNOS表达量减少,两组间有差异(P<0.01,P<0.01,P<0.05)。结论 幽门区nNOS表达减少与CHPS相关。

Objective To further study the pathogenesis of infantile hypertrophic pyloric stenosis(IHPS) by analyzing the expression of neuronal nitric oxide synthase(nNOS) in pylorus of CHPS. Methods According to 3:1,four Beagle pregnant dogs were selected and divided into model group and control group,from the first day of pregnancy to the first day before delivery, L-NAME was intraperitoneally injected into pregnant dogs in the model group, dose for 6mg/(kg.d),while normal saline was intraperitoneally injected into pregnant dogs in the control group.The two groups newborn dogs were weighed at 31, 38, 45 and 52 days after birth,At 52 days after birth, 5 newborn dogs were selected respectively between model group and control group as experimental subjects, obtained pyloric tissue for HE staining and measured the muscular thickness of pyloric,The expression of nNOS was determined by image analysis after immunohistochemistry. Results Compared with newborn dogs in the control group, newborn dogs in the model group had slow weight growth, increased pyloric annulus muscle thickness, and decreased expression of nNOS(P<0.01,P<0.01,P<0.05). Conclusion The decreased expression of nNOS in the pyloric region associated with IHPS.

目的 探讨幽门螺杆菌(Helicobacter pylori,Hp)感染与儿童过敏性紫癜(Henoch-Schnlein purpura,HSP)的相关性及预后关系,为临床疾病诊治提供一定依据。方法 随机选取2016年12月—2018年2月于我院就诊并经确诊的HSP儿童患者90例为观察组,另选取同期于我院就诊行体检的健康儿童90例为对照组,比较两组患者Hp感染情况。根据Hp感染情况及治疗方式将观察组分为A、B、C三组,其中A组(29例)为Hp(-)组,行常规治疗;B组(31例)为Hp(+)组,行常规治疗;C组(30例)为Hp(+)组,行常规治疗联合抗Hp治疗,比较三组患者治疗疗效。结果 观察组患者Hp感染阳性率高于对照组,差异有统计学意义(P<0.05);合并腹部症状的HSP患者Hp感染阳性率高于不合并腹部症状的HSP患者,差异有统计学意义(P<0.05);B组患者治疗有效率低于A组,C组患者治疗有效率高于B组,差异有统计学意义(P<0.05)。结论 Hp感染可能是HSP发病的原因之一,其腹部症状与Hp密切相关,根除Hp治疗可改善HSP患者预后。

Objective To explore the correlation between helicobacter pylori infection and children allergic purpura disease and its prognosis, and provide some basis for clinical diagnosis and treatment. Methods A total of 90 children with allergic purpura who were treated in our hospital from December 2016 to Feb 2018 were randomly selected as observation group. 90 healthy children who were admitted to our hospital for physical examination during the same period were selected as the control group, and the Hp infection in the two groups was compared. According to Hp infection and treatment, the observation group was divided into three groups: A, B and C, among which group A (29 cases) was Hp (-) group, and routine treatment was performed.Group B (31 cases) were Hp (+) group, and routine treatment was performed. group C (30 cases) were Hp (+) group, and conventional treatment combined with anti-hp treatment were performed. We compared three groups of .curative effects. Results The positive rate of Hp infection in the observation group was higher than that in the control group, and the difference was statistically significant (P<0.05).The positive rate of Hp infection in HSP patients with abdominal symptoms was higher than that in HSP patients without abdominal symptoms, and the difference was statistically significant (P<0.05). The effective rate of treatment in group B was significantly lower than that in group A, and the effective rate of treatment in group C was higher than that in group B, and the difference was statistically significant (P<0.05). Conclusion Hp infection may be one of the causes of HSP, and its abdominal symptoms are closely related to Hp, and the eradication of Hp treatment would improve the prognosis of HSP patients.

目的 探讨含双歧杆菌乳杆菌三联活菌新四联疗法对消化性溃疡患者幽门螺杆菌(Helicobacter pylori, Hp)根除治疗中的疗效。方法 将342例Hp阳性的消化性溃疡患者随机分为三个治疗组:A组(三联疗法)、B组(含铋剂四联疗法)及C组(含益生菌四联疗法),疗程均2周。疗程结束4周后复查¹³C-尿素呼气试验评估根除疗效。治疗期间记录患者不良反应发生情况。结果 300例(87.72%)患者按方案完成治疗,A、B及C组治疗完成率分别为85.71%(96/112)、82.50%(99/120)和95.45%(105/110),C组显著高于A及B组(P＜0.05)。在胃溃疡Hp根除率比较中,按意愿(方案)分析,A、B及C组疗法的Hp根除率分别为64.71%(75.86%)、71.43%(85.71%)及84.38%(87.10%),各组间差异无统计学意义(P均>0.05)。在十二指肠球部溃疡Hp根除率比较中,按意愿(ITT)分析,C组(85.90%)明显高于A组(62.82%)及B组(71.79%),差异有统计学意义(χ²=10.893,P=0.001;χ²=4.650,P=0.031);按方案(PP)分析,B组(87.50%)与C组(90.54%)明显高于A组(73.13%),差异有统计学意义(χ²=4.246,P=0.039;χ²=7.304,P=0.007),但B组与C组之间差异无统计学意义(P<0.05)。胃肠道不良反应中,便秘、味觉异常及腹胀的发生率,含益生菌疗法组明显少于另两组,差异有统计学意义(P均<0.05)。结论 含双歧杆菌乳杆菌三联活菌新四联疗法能够显著降低传统三联及四联根除疗法的胃肠道不良反应,提高患者依从性,从而提高消化性溃疡患者Hp的根除率。

Objective To investigate the efficacy of quadruple therapy containing bifidobacterium and lactobacillus triple live bacteria on eradication of Helicobater pylori (Hp) among the patients with peptic ulcer. Methods 342 Hp-infected peptic ulcer patients were randomly divided into three groups:A, B and C. The patients in group A were treated with standard triple therapy. The patients in group B and group C were treated with Colloidal Bismuth Subcitrate and Bifidobacterium and Lactobacillus combined with standard triple therapy, respectively. All patients in three groups were treated for 14 days. In the 4th week after end of treatment, Hp eradication was assessed by ¹³C-urea breath test. Adverse effects during the course of treatment were recorded. Results A total of 300(87.72%) patients completed the treatment. The completion rates in group A, B and C were 85.71%(96/112), 82.50%(99/120) and 95.45%(105/110) respectively, and the completion rate in group C were significantly higher than that in group A and group B(P<0.05). With intention to treat and per-protocol analysis in gastric ulcer, the eradication rates of group A, B and C were 64.71%(75.86%), 71.43%(85.71%)and 84.38%(87.10%) respectively, but there were not significant difference in the three groups(P>0.05). With intention to treat analysis in duodenal ulcer, the Hp eradication rate in group C was 85.90%, which was significantly higher than that in group A (62.82%;χ²=10.893,P=0.001) and in group B (71.79%;χ²=4.650,P=0.031). With per-protocol analysis in duodenal ulcer, the Hp eradication rate was 90.54% in group C and 87.50% in group B. No Obviously difference was found between group B and group C (P<0.05), but both were higher than that in group A(73.13%) (χ²=4.246,P=0.039;χ²=7.304,P=0.007). The incidence of adverse reactions including constipation, taste distortion and bloating in group C were significantly lower than those in the other two groups (P<0.05). Conclusion The quadruple therapy containing bifidobacterium and lactobacillus triple live bacteria can obviously enhance the patient's compliance and decrease the adverse reactions, thereby may increase the Hp eradication rate among the patients with peptic ulcer.

目的 探讨幽门螺杆菌(HP)感染与不同年龄段健康体检人群中血脂异常发病率的相关性。方法 在健康体检人群中开展¹³C尿素呼气试验及血脂等检测,对比不同年龄段人群中HP感染率,研究HP感染与年龄及血脂异常的相关性。结果 不同年龄段人群之间的HP感染率无差异。HP阳性组的血脂异常患病率在30岁后的每个年龄段内均高于HP阴性人群,在60～69岁阶段两组人群差异最明显,血脂异常的发生率分别为74.29%vs 26.15%。结论 HP的感染与血脂异常相关,HP阳性组人群血脂异常患病率随年龄增高而增高的趋势较HP阴性组更加明显。

目的 探讨幽门螺杆菌(Helicobacter pylori,H.pylori)感染与反流性食管炎(Reflux esophagitis,RE)二者之间的关系。方法 选取 2010年1—12月在我院消化内科门诊就诊,经内镜检查确诊为反流性食管炎的 364 例患者作为研究对象。364 例患者的食管炎程度按洛杉矶标准进行分级,记为相应的 A(156 例)、B(196 例)、C(7 例)、D(5 例) 4 组。内镜下常规取胃窦黏膜组织 2～3 块送病理检查,标本分别行 HE 染色明确胃炎类型、炎症活动度及快速尿素酶实验、改良 Giemsa 染色明确 H.pylori 感染情况等。结果 反流性食管炎患者中以男性多见,平均发病年龄早于女性平均发病年龄[(52.4± 11.6)岁 vs(56.6±12.4)岁,P=0.002];门诊反流性食管炎患者的总体 H.pylori 感染率为 90.9%,以轻度 H.pylori 感染为主,四组的 H.pylori 感染率及感染程度的比较差别无统计学意义(P值分别为 0.419,0.332);反流性食管炎患者以慢性浅表性胃炎、中度活动性炎症为主,四组比较差别无统计学意义(P值分别为 0.146,0.496);H.pylori 阳性、阴性患者的食管炎程度比较差别无统计学意义(P>0.05);不同程度 H.pylori 感 染情况下,患者的食管炎程度比较差别无统计学意义。结论 四组反流性食管炎患者的 H.pylori 感染率及感染程度的比较无差别,H.pylori 阳性患者与阴性患者的食管炎程度比较无差别,不同程度 H.pylori 感染情况下,患者的食管炎程度比较无明显差别。提示 H.pylori 感染与反流性食管炎程度无关。

Objective To explore the relationship between helicobacter pylori infection and reflux esophagitis. Methods 364 patients with reflux esophagitis were enrolled in our hospital from Jan to Dec in 2010.The severity grade of reflux esophagitis was according to Los Angles standard. All the patients received biopsies from gastric antrum,then received pathologic examinations. Results Reflux esophagitis in men was more common, with an average age of onset earlier than the female(52.4±11.6 years vs 56.6±12.4 years,P=0.002);Reflux esophagitis in patients with H.pylori infection rate was 90.9% overall,mainly with mild infection,four groups of H.pylori infection rate and extent of infection was no significant difference (P values were 0.419,0.702);reflux esophagitis in patients with chronic superficial gastritis(CSG),moderate active inflammation based was more common,there was no statistically significant difference in four group(P values were 0.146,0.496). There was no significant difference between H.pylori positive patients and H.pylori negative patients in esophageal mucosal damage(P> 0.05). There was no significant difference in reflux esophagitis with varying degrees of H.pylori infection on the degree of esophagitis. Conclusion Four groups of H.pylori infection rate and extent of infection was no significant difference; there was also no significant difference between H.pylori positive patients and H.pylori negative patients in esophageal mucosal damage. There was no significant difference in RE with varying degrees of H.pylori infection on the degree of esophagitis. Our research showed H.pylori infection had no relationship with degree of RE.

目的 观察多西环素联合阿莫西林、泮托拉唑、枸橼酸铋钾治疗幽门螺杆菌(Hp)感染消化性溃疡的临床疗效和不良反应。方法 选取于2013年7月—2015年7月收治的98例Hp感染消化性溃疡患者,根据不同的治疗方式,随机将其分为治疗组和对照组,每组各49例,治疗组患者给予多西环素联合阿莫西林、泮托拉唑、枸橼酸铋钾治疗;对照组给予克拉霉素联合阿莫西林、泮托拉唑、枸橼酸铋钾治疗, 两组患者连续服用10天后,均口服泮托拉唑40 mg,每天1次,总疗程为4周。疗程结束4周后,予胃镜复查和Hp检查,观察两组患者的临床疗效、溃疡愈合率、Hp根除率及不良反应。结果 治疗组与对照组患者的临床效果总有效率分别是95.91％、81.63％;治疗组与对照组患者的溃疡愈合率分别是83.67％、61.22％ ;治疗组与对照组患者的Hp根除率分别是89.79％、65.30％;治疗组患者的临床疗效总有效率、溃疡愈合率和Hp根除率均明显优于对照组,差异均有统计学意义(P<0.05),两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论 多西环素联合阿莫西林、泮托拉唑、枸橼酸铋钾治疗Hp感染消化性溃疡疗效显著、溃疡愈合率高、Hp根除率高、且安全无明显不良反应,值得临床广泛推广使用。

目的 了解CHPS患儿经胃镜下幽门肌切开术治疗后幽门部黏膜近期各种并发症的发生情况及对预后的影响。方法 选取2006—2012年我院新生儿科确诊的34例CHPS患儿。以超细胃镜进入十二指肠乳头处,使用电切刀按上行性方向,沿幽门管纵轴切割肥厚狭窄的幽门管黏膜及环形肌以解除幽门部梗阻。术后第1、3、6月复查胃镜。结果 34例CHPS患儿共行胃镜下幽门肌切开术48次,均未发生胃及幽门穿孔、撕裂等严重并发症。24例患儿术后通过胃镜进行了复查,胃镜见幽门部及黏膜改变主要有黏膜充血肿胀、切口未完全愈合、切口疤痕形成、幽门部息肉形成等。结论 经胃镜下幽门肌切开术是一种安全性较高的治疗CHPS的新技术。术后黏膜充血肿胀、切口未完全愈合等幽门部黏膜改变的发生率随时间下降。切口疤痕形成并未影响幽门功能。