【摘要】 目的:为探讨十二指肠溃疡(DU)患者血清试餐胃泌素(MSG)对幽门螺杆菌(HP)感染的反应,评估抗HP治疗后MSG的降低水平及其用于判定HP根除效果的可靠性.方法:采用自身对照的方法对84例HP阳性DU患者进行了前瞻性研究,治疗前行胃镜检查,钳取胃窦粘膜,在进行组织学检查的同时,分别进行HP培养、改良Giemsa染色及快速尿素酶试验,并测定其血清MSG浓度,然后给予患者抗HP三联药物治疗(德诺120mg、羟氨苄青酶素500mg、甲硝唑200mg,4次/天×14天),停药4周后,再次重复上述检查(加做胃体粘膜活检),结果进行统计学处理,并另取同期16例轻度慢性胃炎HP检查阴性者进行空白对照.结果:DU组血清MSG浓度(165.0±85.6pg/ml)较对照组(48.9±14.3pg/ml)明显升高(P<0.001),但经治疗后,HP被根除者MSG明显下降门(73.5±44.6pg/ml,下降度为53.8%±16.5%,与治疗前比较差异有非常显著性(P<0.001).HP未根除者MSC下降不明显(134.8±91.4pg/ml),下降度仅为11.4±17.8%,与治疗前比较差异无显著性(p>0.05),如果选择MSG下降度≥30%为界值,预测HP治疗效果,与HP培养、病检及尿素酶方法比较,其敏感性为89.7%,特异性为93.8%、符合率为90.5%.结论:HP感染可引起DU患者血清MSG升高,HP根除后则迅速下降,其一定的下降度可能对判定HP根除是一可靠的、元创性更多还原

【Abstract】 Objective:To assess the utility of serum gastrin measurement in confirming the eradication of Heli-cobacter pylori (HP) . Methods: 84 duodenal ulcer (DU) patients with HP infection were included to undergo meal - stimulated serum gastrin (MSG) measurement at base line and 4 weeks after triple therapy completion with tripotassium dicitrate bismuthate (De-Mol) 120mg Qid,amoxycillin 0.5 Qid,metronidazole 0.2 Qid for 14 days. Baseline infection was defined by the identification of the organism on antral biopsies by positive bacterial culture or both the positive histological examination and rapid urea test. Eradication was defined as the above three negative examinations on both antral and corpus biopsies. A simultaneous blank - control group consisted of 16 patients with non - active chronic superficial gastritis without HP infection. Results: MSG in DU patients (165.0±85.6pg/ml)Which was significantly higher than in the blank control group (48.9±14.3 pg/ml)(p<0.001).decreased 4 wk after completion of therapy in 68/84 HP eradicated cases (73.5±44.6 pg/ml).The decseasing rate (53.8%±16.5%) showed significant difference(p<0.001) as compared to pre - therapy. However,MSG did not decrease significantly in 16/84 cases who had failed in treatment(134.8 ±91.4pg/ml).The decreasing rate was only 11.4±17.9%,not significantly different as Compared to pre -therapy .Selecting the decreasing rate≥30% as cut - off value to comfirm eradication of HP,the sensitivity and specificity were 89.7 % and 93.8 % , respectively , the positive and negative predictive values were 98 .4 % and 68.2%. And the accuracy rate was 90.5% . Conclusions:HP associated hypergastrinaemia expressed by MSG could be reduced significantly by successful HP eradication at 4wk post completion of therapy. Hence, selecting a decreasing rate as cut - off value to comfirm eradication of HP might be an appropriate indicator, making a repeat of endoscopic biopsy unnecessaty.更多还原