I. Helicobacter pylori: Its epidemiology and its role in duodenal ulcer disease
I. Helicobacter pylori: Its epidemiology and its role in duodenal ulcer disease
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一、幽门螺杆菌：其流行病学及其在十二指肠溃疡病中的作用
DOI：
--
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发表时间：
1991
影响因子：
4.1
通讯作者：
D. Graham
中科院分区：
文献类型：
--
作者：
D. Graham
幽门螺杆菌现在被认为是人类慢性胃炎的主要原因。组织学类型：H。幽门螺杆菌胃炎是一种典型的斑块状急性慢性炎症，以胃窦部最为严重。慢性胃炎与环境或流行类型胃癌的相关性促使了许多关于胃炎流行病学的研究，这些研究的结果可以合理地转移到H。幽门螺杆菌提供H.幽门螺杆菌研究人员在一种新疾病H。幽门螺杆菌胃炎。这种数据传输使重要问题得以及早定义，这些问题旨在证实以前与胃炎的关联，并将其扩展到H。幽门螺杆菌。已知与胃炎相关的因素包括低社会经济阶层、大家庭、拥挤和种族。lV2在慢性胃炎的发病机制中不重要的因素包括使用酒精、尼古丁或非类固醇消炎药(表L)。胃炎的患病率随着年龄的增长而增加。多年来，人们一直认为老年患者的胃粘膜通常是萎缩的，这是一种“磨损”现象。虽然很难区分衰老引起的胃肠道变化和长期环境影响引起的胃肠道变化，但现在大多数人认为老年人的慢性胃炎通常是H。幽门螺杆菌感染。a-6获得H。幽门螺杆菌感染在一生中持续，但一旦感染，感染的持续时间似乎很长，可能是终身感染。幽门螺杆菌感染在人群之间和人群内存在显著差异。幽门螺杆菌感染的特定年龄段的流行率(通常以抗-Hi。发展中国家的幽门螺杆菌抗体(Pylori)高于发达国家(图1)。在一个特定的国家内，还有更多的分层；年龄特定的H的获得率。无论是以收入、住房、教育水平、族裔还是宗教群体来评估，社会经济地位较低的人幽门螺杆菌感染率都较高。统一不同流行病学结果的一个因素似乎是卫生和个人卫生做法的差异。8传播方式(S)未知，但幽门螺杆菌感染的地理和社会模式与作为主要途径之一的粪便-口腔传播相一致。这也与秘鲁最近的数据一致，表明幽门螺杆菌感染与饮用水来源之间存在直接联系(图2)。9最近一个特别引人注目的发现是，游动的螺旋形幽门螺杆菌可以在河水中存活至少一周。幽门螺杆菌的球状形态也可以在河水中存活一年或更长时间，但这一观察的临床相关性尚不清楚。在胃里也发现了椰子状病毒。虽然球状病毒不太可能在胃中存活很长时间，因为胃上皮细胞的快速更新可能会阻止它们长时间停留，但它们可能是抗菌治疗后某些复发的原因。h.目前还没有从环境中分离出‘塔’，但现有的技术(例如，cdna探针)可以解决这个问题。幽门螺杆菌感染的医源性传播已被记录12*13，幽门螺杆菌感染在不总是戴手套的内窥镜医生中的高流行率表明，S使用的仪器受到胃液(胃液！口腔传播)的污染。‘J最后，幽门螺杆菌已经从牙菌斑中恢复15，尽管这似乎是一个罕见的现象，但它强调可能有许多潜在的传播途径。在发达国家，H。幽门螺杆菌感染在儿童中很少见，每年以1-270的速度增加(图3)，与先前描述的胃炎或新的消化不良病例的发病率大致相同。幽门螺杆菌感染似乎在美国、澳大利亚和英国类似。即使在发达国家，H的患病率也存在种族和种族差异。例如，在美国，黑人感染幽门螺杆菌的比率高于白人，初步研究表明，在美国学习或最近移民到美国的中国人、东印度人和墨西哥人，经年龄调整后的感染率很高。7.23.24在大多数情况下，族裔或种族之间的感染率差异代表了暴露的差异，例如生活水平或卫生做法的差异(S)。重要的是，在美国白人和黑人之间，年龄调整后的H.pylon频率的差异仍然存在
Helicobacter pylori is now accepted as the major cause of chronic gastritis in humans. The histologic pattern of H . pylori gastritis is typically one of patchy acute on chronic inflammation, most severe in the antrum. The association of chronic gastritis with the environmental or epidemic type of gastric carcinoma prompted a number of investigations of the epidemiology of gastritis, and the results of those studies could be reasonably transferred to H . pylori to provide H . pylori investigators with a head start in the study of the epidemiology of a new disease, H . pylori gastritis. This data transfer allowed early definition of important questions designed to confirm previous associations with gastritis and extend them to H . pylori. Factors known to be associated with gastritis include low socioeconomic class, large family size, crowding, and ethnic group.lV2 Factors found to be unimportant in the pathogenesis of chronic gastritis included use of drugs such as ethanol, nicotine, or nonsteroidal anti-inflammatory drugs (Table l).' The prevalence of gastritis increases with age. For many years it was thought that the gastric mucosa of geriatric patients was normally atrophic, a 'wear-and-tear' phenomenon. Although it is difficult to distinguish changes in the gastrointestinal tract due to ageing from those resulting from environmental effects acting over long periods of time, most now believe that chronic gastritis in the elderly is generally the end result of H . pylori infection.a-6 The acquisition of H . pylori infection continues throughout life but, once acquired, the duration of the infection appears to be very long, possibly for life.7 The rate of acquisition of H . pylori infection varies remarkably between and within populations. The age-specific prevalence of H. pylori infections (usually measured as presence of anti-Hi. pylori IgG) is higher in developing countries than developed countries (Fig. 1). Within a specific country there are further stratifications; the age-specific rate of acquisition of H . pylori infection is higher in those of lower socio-economic status whether assessed by income, housing, educational level, ethnic or religious group. One factor that appears to unify the disparate epidemiology results is differences in sanitation and hygiene practices.8 The mode(s) of transmission is unknown but the geographic and social patterns of H. pylori infection are consistent with faecal-oral transmission as one major pathway. This is also consistent with recent data Peru, demonstrating a direct association bet valence of H. pylori infection and source of drinking water (Fig. 2).9 One particularly striking recent finding is that motile spiral forms of H. pylori can survive for at least a week in river water.I0 Coccoid forms of H. pylori can also survive in river water for a year or more, but the clinical relevance of that observation remains unclear.tX"rin my opinion, coccoid forms from nature are unlikely to be infectious for %mans. Coccoid forms have also been found in the stomach. Although coccoid forms are unlikely to survive long in the stomach becsuse the rapid turnover of the gastric epithelium probably precludc; prolonged residence, they may be responsible for some instances of relapse after antimicrobial therapy. H . pylon' has not yet been isolated from the environment but the technology now available (e.g. cDNA probes) can address this question. Iatrogenic transmission of H. pylori infection has been documented12*13 and the high prevalence of H. pylori infection in endoscopists who did not always use gloves suggests s p r e e o m instruments contaminated with gastric secretions (gastric secretion!oral spread).'j Finally, H. pylori has been recovered from dental plaque15 and, although this appears to be a rare phenomenon, it emphasizes that there may be many potential pathways for transmission. In developed countries, H . pylori infection is infrequent in children and increases at 1-270 per year (Fig. 3), approximately the same rate as previously described for gastritis or for the onset of new cases of dyspepsia.16-z1 The rate of acquisition of H . pylori infection appears to be similar in the United States, Australia and the United Kingdom. Even within developed countries, there are ethnic and racial differences in the prevalence of H . pylm' For example, in the United States, the rate of acquisition of H. pylori infection is higher in blacks than whites and preliminary studies have shown high ageadjusted rates in Chinese, East Indians and Mexicans studying in, or recently emigrating to, the United States.7.23.24 In most instances the difference in prevalence Between ethnic group or race represents a surrogate xrwb~ for differences in exposure(s), such as differences in standards of living or sanitation practices. Importantly, the differences in age-adjusted frequency of H. pylon' between whites and blacks in the United State8 remains when
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胺捕获：胃酸度对餐后胃泌素释放抑制作用的物理解释。
影响因子：
29.4
作者：
Lichtenberger,LM;Nelson,AA;Graziani,LA
通讯作者：
Graziani,LA
清除幽门螺杆菌（弯曲杆菌）感染后，消除十二指肠溃疡患者膳食刺激的胃泌素过度释放。
DOI：
--
发表时间：
1990
期刊：
The American journal of gastroenterology
影响因子：
--
作者：
Graham,DY;Opekun,A;Lew,GM;EvansJr,DJ;Klein,PD;Evans,DG
通讯作者：
Evans,DG
胃癌风险增加人群中幽门弯曲菌相关性胃炎和免疫反应。
DOI：
--
发表时间：
1989
期刊：
The American journal of gastroenterology
影响因子：
--
作者：
Fox,JG;Correa,P;Taylor,NS;Zavala,D;Fontham,E;Janney,F;Rodriguez,E;Hunter,F;Diavolitsis,S
通讯作者：
Diavolitsis,S
影响因子：
29.4
作者：
EVANS, DJ;EVANS, DG;KLEIN, PD
通讯作者：
KLEIN, PD
幽门弯曲杆菌感染的流行病学：种族考虑。
DOI：
--
发表时间：
1988
期刊：
Scandinavian journal of gastroenterology. Supplement
影响因子：
--
作者：
Graham,DY;Klein,PD;Opekun,AR;Boutton,TW;EvansJr,DJ;Evans,DG;Alpert,LC;Michaletz,PA;Yoshimura,HH;Adam,E
通讯作者：
Adam,E