关于幽门螺杆菌的全面科普,一篇终结你所有疑问!

2021-09-16 MedSci原创 MedSci原创

感染了就一定会得胃癌吗?要不要查?要不要治?别急,咱们一条一条解答~

1983年以来,科学家首次从慢性活动性胃炎患者的胃粘膜活检组织中将幽门螺杆菌分离成功后,是目前所知能够在人胃中生存的唯一微生物种类。

幽门螺杆菌,Medical news

幽门螺旋杆菌不但与胃炎、消化道溃疡相关,还与淋巴增生性胃淋巴瘤有着密切的关系。然而,很多人并不知道,幽门螺杆菌感染是一种基于家庭和人群传播的疾病。那么,幽门螺杆菌如何在家庭传播?感染后危害有多大?需要不需要治疗?本文就有关幽门螺杆菌从专业角度,详解相关误区与真相!

1、什么是幽门螺杆菌?

幽门螺杆菌是存在于胃及十二指肠球部的一种螺旋状细菌,该细菌为革兰氏阴性菌,长期稳定地定居于胃窦部,具有尿素酶,能分解尿素产生氨,并能分泌细胞毒素,引起炎症及免疫反应。目前,科学家认为它是造成肠型胃癌最重要的、也是可以控制的因素。

目前我国Hp感染率约50%,是目前最明确的胃癌发生危险因素。

2、传播途径有哪些?

国内外多项研究提示,幽门螺杆菌主要通过口-口、粪-口和水源途径传播,家庭内传播是其感染的主要方式之一。研究显示,幽门螺杆菌存在明显的家庭聚集现象。

家庭成员之间常见的感染途径包括共用餐具、共用食物、咀嚼食物喂食、亲吻、不良的卫生习惯等。

3、感染后没有症状,可以不治疗吗?

目前已知所有的幽门螺杆菌感染者均会出现组织学上的胃炎,不同患者感染幽门螺杆菌的临床表现差异也较大。部分幽门螺杆菌感染者无任何症状和体征,仅在健康体检时才被发现。感染后可能出现的症状:

1)主要症状是反酸、烧心以及胃痛、口臭;

2)引起慢性胃炎,主要临床表现包括上腹部不适、隐痛,有时发生嗳气、反酸、恶心、呕吐;

3)可能引起胃黏膜损害,临床疾病的发生呈现多样性,患者多出现反酸、嗳气、饱胀感等;

对于一般人群来说,如果没有症状,根据个人意愿,也可以选择暂时不予治疗。但是对于一些高危人群来说,即便没有任何症状,也要治疗,比如萎缩性胃炎、胃癌家族史、不良生活习惯如酗酒、抽烟,以及长期服用非甾体药物者等。

同时,对家庭中所有的成年幽门螺杆菌感染者,应当遵循我国《第五次全国幽门螺杆菌感染处理共识报 告》给予根除治疗,除非有抗衡因素。

对家庭中的儿童幽门螺杆菌感染者,需根据风险获益评估和相关疾病状态进行管理。

1)对有消化性溃疡、胃MALT淋巴瘤的幽门螺杆菌感染患儿必须进行幽门螺杆菌根除治疗;

2)对有慢性胃炎、胃癌家族史、不明原因的难治性缺铁性贫血、计划长期服用NSAID(包括低剂量阿司匹林)、 监护人或年长(年龄为12 14岁)儿童自己强烈要 求治疗的幽门螺杆菌感染患儿可给予根除治疗。

4、检测方法有哪些?

侵入式检查:胃镜除了可以看到胃部的情况,还可以顺手取一些组织做活检,在做活检时可以对幽门螺杆菌进行检测。如幽门螺杆菌呈阳性,还可加做一个细菌培养和药物敏感试验,对后续的药物治疗有帮助。

非侵入式检查:包括尿素呼气试验、血清抗体检测和粪便抗原检测,是目前临床常用的检测方法,适用于家庭成员的幽门螺杆菌检测,被国内外多部幽门螺杆菌感染处理共识推荐,但以上方法各有特点和使用限制,需根据其特点和优势选用。

5、治疗方式有哪些?

我国《第五次全国幽门螺杆菌感染 处理共识报告》提出的治疗方案适用于家庭成员幽门螺杆菌的根除。推荐含铋剂的四联方案(PPI+铋剂+ 2种抗生素)作为主要的根除幽门螺杆菌的经验性治疗方案,疗程为1014天,这些方案目前在临床上被广泛使用。由于铋剂不存在耐药性,短期应用安全性高,除非有铋剂禁忌,我国根除幽门螺杆菌的经验治疗方案推荐尽可能应用铋剂四联方案。

1)一线方案:适用于克拉霉素耐 药率较低(<20)地区,方案为:PPI+克拉霉素+ 阿莫西林,疗程1014 d;若青霉素过敏,则换用甲硝唑或替硝唑。克拉霉素耐药率较高(>20) 地区,含铋剂的三联疗法(阿莫西林+甲硝唑+ 体次枸橼酸铋剂)以及序贯疗法(PPI+阿莫西林 5 dPH+克拉霉素+甲硝唑5 d)可作为一线疗 引。

2)二线方案:用于一线方案失败者,PPI+ 莫西林+甲硝唑(或替硝唑)+胶体次枸橼酸铋剂 或伴同疗法(PPI+克拉霉素+阿莫西林+甲硝唑),疗程1014 d

6、是否有疫苗可接种?

有关幽门螺杆菌疫苗的开发,多年来国内外已经 有过不少尝试 ,但由于其抗原制备和机体反应 的复杂性,目前仍处于实验室和临床研发阶段,短期 内尚无法应用于临床。因此,国内外幽门螺杆菌感染的防控现阶段仍需使用抗生素控制感染和预防复 发。在尚无有效的疫苗可用之前,预防家庭中新生的幽门螺杆菌感染和根除家庭成员已存在的感染同等重要,两者均是较为有效的幽门螺杆菌感染防控策略。

7、治好了,容易复发吗?

据数据显示,幽门螺杆菌在幼年时期,甚至是婴儿时期,相对来说成年人不是易感人群。我国幽门螺杆菌感染的年复发率为2.2%。所谓的复发,很大一部分是上次根本没有根除成功。

1)了解患儿以前治疗时用药的依从性,判断治疗失败的原因;

2)有条件者根据药敏试验结果选择有效抗生 素,无条件者用分子检测方法(如原位免疫荧光杂 )检测克拉霉素的耐药性帕;

3)无条件行药敏试验,再次治疗时应尽量避 免重复使用初次治疗时的抗生素或加用铋剂,对青 霉素过敏的患儿可供选择的药物有限,能否选用氟 喹诺酮类等药物,需根据儿童的年龄来考虑使用;

4)延长治疗时问或加大药物剂量¨’61(建议不 超过药物说明书用量)

5)抑酸剂在根除治疗中起重要作用,但PPI 代谢的CYP2C19基因多态性会影响根除效果。因 此,可选择作用稳定、疗效高、受CYP2C19基因多态 性影响较小的PPI,如埃索美拉唑,可提高根除率;

6)对多次治疗失败者,可考虑停药3个月或 半年,使细菌恢复一定的负荷量,以便提高下一次治 疗时Hp的根除率。

7)根除治疗失败,但症状缓解者,可暂缓再次根除治疗。

8、如何预防?

对于普通人群来说,最重要的依旧是日常预防。众所周知,幽门螺杆菌具有传染性,可能主要通过口-口或粪-口途径进行传播。生活在拥挤的环境中、不注意卫生或生活中没有可靠的干净水源,都是日常生活中导致幽门螺杆菌感染的危险因素。

因此以下几点措施需要努力遵守:

1)跟家人分餐或用公筷、公勺盛饭夹菜,不要相互夹菜。

2)禁止用嘴喂孩子食物,情侣间亲热前,要充分清洁口腔。

3)饭前便后洗手,蔬菜、瓜果要洗净或削皮。

4)不吃刺激性食物,不喝生冷水,不吃太烫的东西。

5)餐具要定期煮沸消毒20分钟。

尤其是使用公筷这一点,目前来看在大多数家庭或餐馆里未能得到有效普及。从科学上来看,人体呼吸道的唾液、飞沫等是许多传染病的主要传播途径。而对幽门螺杆菌感染以及其他病菌和传染病而言,公筷公勺是一道有效的屏障。包括在当前的新冠大流行中,遵守这一原则至关重要。

参考资料

1.佚名. 儿童幽门螺杆菌感染诊治专家共识[J]. 中华儿科杂志, 2015, 53(007):496-498.

2.国家消化系疾病临床医学研究中心(上海), 国家消化道早癌防治中心联盟, 中华医学会消化病学分会幽门螺杆菌和消化性溃疡学组,. 中国居民家庭幽门螺杆菌感染的防控和管理专家共识(2021)[J]. 中华消化杂志, 2021, 41(04):221-233.

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    2022-05-10 kcb069
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    2021-10-20 1482963am12暂无昵称

    学习了,学习了

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1811863, encodeId=62b8181186340, content=<a href='/topic/show?id=751f8889423' target=_blank style='color:#2F92EE;'>#螺杆菌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88894, encryptionId=751f8889423, topicName=螺杆菌)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=87b1109, createdName=kcb069, createdTime=Tue May 10 12:03:22 CST 2022, time=2022-05-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1062371, encodeId=629b10623e161, content=学习了,学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2020/02/15/7274ed1be4747d648e4e2f7f62fae403.jpg, createdBy=d8d65273314, createdName=1482963am12暂无昵称, createdTime=Wed Oct 20 20:31:47 CST 2021, time=2021-10-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1052225, encodeId=006b10522256f, content=IPO咯读咯虞摩托处女情结账号吗, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIrrxxDxnLic8t6EAs38Qfwo6H2h6JMleIgb9OSYf6LMnVDkQEqUXWoSDWboibjhOBI9SJDTXweqQIA/132, createdBy=50aa5321359, createdName=查查佳佳, createdTime=Fri Sep 17 08:42:28 CST 2021, time=2021-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1052214, encodeId=42a7105221453, content=学习了,学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/101296147/3C5352AE039C6AEBC068CE315DEEE989/100, createdBy=9b5f2143740, createdName=城墙城门与翁城, createdTime=Fri Sep 17 08:02:32 CST 2021, time=2021-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1052132, encodeId=39c8105213260, content=和指南内容基本一致,就是精炼提纯的, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/05/08/0e700d813dcbcae60922e548e3671339.jpg, createdBy=4b082565885, createdName=清的, createdTime=Thu Sep 16 22:41:24 CST 2021, time=2021-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1051932, encodeId=54ac105193277, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=659f3850578, createdName=137756abm51暂无昵称, createdTime=Thu Sep 16 12:33:23 CST 2021, time=2021-09-16, status=1, ipAttribution=)]
    2021-09-17 查查佳佳

    IPO咯读咯虞摩托处女情结账号吗

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1811863, encodeId=62b8181186340, content=<a href='/topic/show?id=751f8889423' target=_blank style='color:#2F92EE;'>#螺杆菌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88894, encryptionId=751f8889423, topicName=螺杆菌)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=87b1109, createdName=kcb069, createdTime=Tue May 10 12:03:22 CST 2022, time=2022-05-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1062371, encodeId=629b10623e161, content=学习了,学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2020/02/15/7274ed1be4747d648e4e2f7f62fae403.jpg, createdBy=d8d65273314, createdName=1482963am12暂无昵称, createdTime=Wed Oct 20 20:31:47 CST 2021, time=2021-10-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1052225, encodeId=006b10522256f, content=IPO咯读咯虞摩托处女情结账号吗, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIrrxxDxnLic8t6EAs38Qfwo6H2h6JMleIgb9OSYf6LMnVDkQEqUXWoSDWboibjhOBI9SJDTXweqQIA/132, createdBy=50aa5321359, createdName=查查佳佳, createdTime=Fri Sep 17 08:42:28 CST 2021, time=2021-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1052214, encodeId=42a7105221453, content=学习了,学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/101296147/3C5352AE039C6AEBC068CE315DEEE989/100, createdBy=9b5f2143740, createdName=城墙城门与翁城, createdTime=Fri Sep 17 08:02:32 CST 2021, time=2021-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1052132, encodeId=39c8105213260, content=和指南内容基本一致,就是精炼提纯的, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/05/08/0e700d813dcbcae60922e548e3671339.jpg, createdBy=4b082565885, createdName=清的, createdTime=Thu Sep 16 22:41:24 CST 2021, time=2021-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1051932, encodeId=54ac105193277, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=659f3850578, createdName=137756abm51暂无昵称, createdTime=Thu Sep 16 12:33:23 CST 2021, time=2021-09-16, status=1, ipAttribution=)]
    2021-09-17 城墙城门与翁城

    学习了,学习了。

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1811863, encodeId=62b8181186340, content=<a href='/topic/show?id=751f8889423' target=_blank style='color:#2F92EE;'>#螺杆菌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88894, encryptionId=751f8889423, topicName=螺杆菌)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=87b1109, createdName=kcb069, createdTime=Tue May 10 12:03:22 CST 2022, time=2022-05-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1062371, encodeId=629b10623e161, content=学习了,学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2020/02/15/7274ed1be4747d648e4e2f7f62fae403.jpg, createdBy=d8d65273314, createdName=1482963am12暂无昵称, createdTime=Wed Oct 20 20:31:47 CST 2021, time=2021-10-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1052225, encodeId=006b10522256f, content=IPO咯读咯虞摩托处女情结账号吗, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIrrxxDxnLic8t6EAs38Qfwo6H2h6JMleIgb9OSYf6LMnVDkQEqUXWoSDWboibjhOBI9SJDTXweqQIA/132, createdBy=50aa5321359, createdName=查查佳佳, createdTime=Fri Sep 17 08:42:28 CST 2021, time=2021-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1052214, encodeId=42a7105221453, content=学习了,学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/101296147/3C5352AE039C6AEBC068CE315DEEE989/100, createdBy=9b5f2143740, createdName=城墙城门与翁城, createdTime=Fri Sep 17 08:02:32 CST 2021, time=2021-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1052132, encodeId=39c8105213260, content=和指南内容基本一致,就是精炼提纯的, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/05/08/0e700d813dcbcae60922e548e3671339.jpg, createdBy=4b082565885, createdName=清的, createdTime=Thu Sep 16 22:41:24 CST 2021, time=2021-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1051932, encodeId=54ac105193277, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=659f3850578, createdName=137756abm51暂无昵称, createdTime=Thu Sep 16 12:33:23 CST 2021, time=2021-09-16, status=1, ipAttribution=)]
    2021-09-16 清的

    和指南内容基本一致,就是精炼提纯的

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1811863, encodeId=62b8181186340, content=<a href='/topic/show?id=751f8889423' target=_blank style='color:#2F92EE;'>#螺杆菌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88894, encryptionId=751f8889423, topicName=螺杆菌)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=87b1109, createdName=kcb069, createdTime=Tue May 10 12:03:22 CST 2022, time=2022-05-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1062371, encodeId=629b10623e161, content=学习了,学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2020/02/15/7274ed1be4747d648e4e2f7f62fae403.jpg, createdBy=d8d65273314, createdName=1482963am12暂无昵称, createdTime=Wed Oct 20 20:31:47 CST 2021, time=2021-10-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1052225, encodeId=006b10522256f, content=IPO咯读咯虞摩托处女情结账号吗, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIrrxxDxnLic8t6EAs38Qfwo6H2h6JMleIgb9OSYf6LMnVDkQEqUXWoSDWboibjhOBI9SJDTXweqQIA/132, createdBy=50aa5321359, createdName=查查佳佳, createdTime=Fri Sep 17 08:42:28 CST 2021, time=2021-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1052214, encodeId=42a7105221453, content=学习了,学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/101296147/3C5352AE039C6AEBC068CE315DEEE989/100, createdBy=9b5f2143740, createdName=城墙城门与翁城, createdTime=Fri Sep 17 08:02:32 CST 2021, time=2021-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1052132, encodeId=39c8105213260, content=和指南内容基本一致,就是精炼提纯的, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/05/08/0e700d813dcbcae60922e548e3671339.jpg, createdBy=4b082565885, createdName=清的, createdTime=Thu Sep 16 22:41:24 CST 2021, time=2021-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1051932, encodeId=54ac105193277, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=659f3850578, createdName=137756abm51暂无昵称, createdTime=Thu Sep 16 12:33:23 CST 2021, time=2021-09-16, status=1, ipAttribution=)]
    2021-09-16 137756abm51暂无昵称

    学习学习

    0

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