中国居民家庭幽门螺杆菌感染的防控和管理专家共识(2021年),15条核心推荐必读!

2021-12-03 MedSci原创 MedSci原创

值得一看!

据数据显示,在全球范围内,幽门螺杆菌感染率超过50%,而在我国各个地区,感染幽门螺杆菌的概率有明显差异,平均感染率为59%,其中儿童40%。尽管我国流行趋势表明,近年来,我国幽门螺杆菌感染正持续下降,但目前仍在世界范围内处于中高水平。

幽门螺杆菌(H. pylori),以前称为幽门弯曲杆菌,是一种革兰氏阴性的微需氧细菌,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。

幽门螺杆菌,Medical news

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。据数据显示,我国25%30%的幽门螺杆菌感染者会出现不同程度的胃肠道疾病, 消化不良、慢性胃炎、消化性溃疡、胃恶性肿瘤等。此外, 幽门螺杆菌感染还与多种胃肠道外疾病(如缺铁性贫血、特发性血小板减少性紫癜、自身免疫病、心血管疾病、脑血管疾病等)密切相关。

近日,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全国幽门螺杆菌研究协作组共同发布了《中国居民家庭幽门螺杆菌感染的防控和管理专家共识2021年)》(以下简称共识),为幽门螺杆菌的防控和管理提供指导。

那么,共识具体包含了哪些核心内容呢?一起来看看~

核心内容1:幽门螺杆菌是一种可以在家庭成员之 间传播的致病菌。

人与人之间的相互传播是幽门螺杆菌传播的重要途径。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后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,少数感染者经多年缓慢发展后,出现慢性非萎缩性胃炎、萎缩性胃炎、肠化生、上皮内瘤变并导致胃癌发生。

核心内容2:幽门螺杆菌主要通过经口途径传播,家庭内传播是其感染的主要方式之一。

国内外多项研究提示,幽门螺杆菌主要通过口-口、 -口和水源途径传播,尤其是经口途径的传播。幽门螺杆菌感染通常由家庭成员传播,成员之间的菌株可以完全相同或经变异后相似,由于感染的个体可存在不同来源菌株的情况,提示也存在外源性感染的现象。

核心内容3:被幽门螺杆菌感染的家庭成员始终是潜在的传染源,具有持续传播的可能性。

由于幽门螺杆菌感染者不经治疗很少痊愈,被感染的家庭成员始终是潜在的传染源,存在持续传播的可能性。因此,对家庭成员进行宣教,提倡良好的卫生和饮食习惯,防止重复和交叉感染,如增强使用公筷、公勺的意识,提倡分餐制,避免食用受污 染的食品和饮用受污染的水等。

核心内容4:大多数幽门螺杆菌的感染发生在儿童和青少年时期,成年后也会感染。

儿童幽门螺杆菌感染率随着年龄的增长而升高,幽门螺杆菌感染主要发生在儿童和青少年时期,也会发生在成年后,但相对较少。 此外,生活环境和习惯、文化水平、社会和经济地位、 家庭规模等也影响幽门螺杆菌的传播。

核心内容5:对家庭中所有的成年幽门螺杆菌感染者,均应考虑给予根除治疗。

国内外多项指南指出,在胃黏膜萎缩和肠化生出现前根除幽门螺杆菌感染以降低胃癌风险。因此,除非有抗衡因素,建议对家庭中所有的成年幽门螺杆菌感染者进行根除治疗。

核心内容6:家庭中儿童幽门螺杆菌感染与胃黏膜病变的关系尚需进一步研究。

由于幽门螺杆菌感染在儿童中引起的胃黏膜病变 相对较少,目前有关家庭中儿童幽门螺杆菌感染与胃黏膜病变关系的研究尚少。

核心内容7: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。

对家庭中幽门螺杆菌感染患儿的治疗需根据风险获益评估和相关疾病状态进行处理,依照共识意见并与患儿家长磋商决定治疗与否。

核心内容8:对家庭中的老年幽门螺杆菌感染者,应当根据个体情况制订幽门螺杆菌感染处理策略。

在进行幽门螺杆菌根除治疗前,应进行风险获益评估,并根据患者既往服用药物情况、生理特点、疾病和药物不良反应等,选择个体化、规范化的治疗方案。同时,加强患者服药前和服药过程中的宣教工作,提高患者的依从性,使老年患者的个体化治疗更加合理、规范和安全。

核心内容9以家庭为单位防控幽门螺杆菌感染是阻断幽门螺杆菌感染和传播的重要策略。

目前,我国和国际上均采用以下2种幽门螺杆菌感染的诊治和管理策略。1检测和治疗:该策略是针对未经调查、有消化不良症状的年轻(年 龄<60岁)患者,在低幽门螺杆菌感染率地区具有成本效益,但不适用于有报警症状或年龄较大(60岁)的患者。2筛查和治疗:该策略适用于幽门螺杆菌感染率较高的地区,或有胃癌家族史、有报警症状且生活在胃癌流行地区的患者。

核心内容10:对感染的家庭成员进行共同治疗,有助于减少根除后的再感染。

共同生活的家庭成员由于生活习惯相似、共用生活器具、密切接触等原因可能导致幽门螺杆菌在家庭成员之间的传播,这也是部分患者幽门螺杆菌治疗失败的原因之一。有关幽门螺杆菌根除后的再感染和复发,不同地区的研究结果略有不同,幽门螺杆菌再感染和复发率为0 10%。

核心内容11:对胃癌或胃黏膜癌前病变患者,应对其共同生活的家庭成员进行幽门螺杆菌筛查。

幽门螺杆菌感染有典型的家庭聚集特点,胃癌患者一级亲属中幽门螺杆菌感染者通常有较高的胃黏膜病变风险。以家庭为单位根除幽门螺杆菌感染这一理念也反映在已有的国际共识中。

消化性溃疡患者通常有较高的幽门螺杆菌感染率,约为70 90 ,与患者共同生活的家庭成员因而也可能有较高的感染风险,对家庭中的成年幽门螺杆菌感染者,除非有抗衡因素,均建议给予根除治疗。

核心内容12:推荐含铋剂的四联方案(PPI+铋剂+ 2抗生素)作为主要的根除幽门螺杆菌的经验性治疗方案

目前,我国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。

核心内容13:幽门螺杆菌首次治疗即根除的理念适用于家庭成员幽门螺杆菌感染的治疗。

对于幽门螺杆菌感染的儿童和青少年患者,应根据个人感染和抗生素使用情况认真考虑根除的安全性和获益,实施根除时需根据儿童体重调整抗生素的剂量。

核心内容14:尿素呼气试验、血清抗体检测和粪便抗原检测适用于家庭成员的幽门螺杆菌检测。

非侵入性的幽门螺杆菌检测包括尿素呼气试验、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,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。

核心内容15:在尚无有效疫苗的情况下,预防新生的幽门螺杆菌感染和根除家庭成员已存在的感染均是较为有效的感染防控策略。

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。

参考资料

1.Systematic review of time trends in the prevalence of Helicobacter pylori infection in China and the USA.https://doi.org/10.1186/s13099-016-0091-7

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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    2022-09-20 kcb069
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    2021-12-12 ms1000000203803067

    收益大

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1811867, encodeId=3096181186e7b, 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=48, 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 Sep 20 08:09:08 CST 2022, time=2022-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1845878, encodeId=453c18458e857, content=<a href='/topic/show?id=5d2f206482e' target=_blank style='color:#2F92EE;'>#专家共识#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20648, encryptionId=5d2f206482e, topicName=专家共识)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=568152, createdName=snowpeakxu, createdTime=Thu Oct 27 01:09:08 CST 2022, time=2022-10-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1079308, encodeId=5eca10e9308ce, content=收益大, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bfce6397944, createdName=ms1000000203803067, createdTime=Sun Dec 12 20:00:46 CST 2021, time=2021-12-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1348754, encodeId=f8c81348e54b0, content=<a href='/topic/show?id=cfeb49103af' target=_blank style='color:#2F92EE;'>#幽门螺杆菌感染#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49103, encryptionId=cfeb49103af, topicName=幽门螺杆菌感染)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6ab940, createdName=hukaixun, createdTime=Sun Dec 05 06:09:08 CST 2021, time=2021-12-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1076882, encodeId=e73e10e688209, content=真棒, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=33385539357, createdName=ms6000000097855691, createdTime=Sat Dec 04 16:56:47 CST 2021, time=2021-12-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1076611, encodeId=495410e661134, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=65e25548057, createdName=可以不填嚒, createdTime=Fri Dec 03 17:46:57 CST 2021, time=2021-12-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1076594, encodeId=970f10e6594fb, content=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=null, createdBy=a2b85466921, createdName=ms4000001441347419, createdTime=Fri Dec 03 16:44:15 CST 2021, time=2021-12-03, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1811867, encodeId=3096181186e7b, 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=48, 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 Sep 20 08:09:08 CST 2022, time=2022-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1845878, encodeId=453c18458e857, content=<a href='/topic/show?id=5d2f206482e' target=_blank style='color:#2F92EE;'>#专家共识#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20648, encryptionId=5d2f206482e, topicName=专家共识)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=568152, createdName=snowpeakxu, createdTime=Thu Oct 27 01:09:08 CST 2022, time=2022-10-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1079308, encodeId=5eca10e9308ce, content=收益大, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bfce6397944, createdName=ms1000000203803067, createdTime=Sun Dec 12 20:00:46 CST 2021, time=2021-12-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1348754, encodeId=f8c81348e54b0, content=<a href='/topic/show?id=cfeb49103af' target=_blank style='color:#2F92EE;'>#幽门螺杆菌感染#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49103, encryptionId=cfeb49103af, topicName=幽门螺杆菌感染)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6ab940, createdName=hukaixun, createdTime=Sun Dec 05 06:09:08 CST 2021, time=2021-12-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1076882, encodeId=e73e10e688209, content=真棒, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=33385539357, createdName=ms6000000097855691, createdTime=Sat Dec 04 16:56:47 CST 2021, time=2021-12-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1076611, encodeId=495410e661134, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=65e25548057, createdName=可以不填嚒, createdTime=Fri Dec 03 17:46:57 CST 2021, time=2021-12-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1076594, encodeId=970f10e6594fb, content=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=null, createdBy=a2b85466921, createdName=ms4000001441347419, createdTime=Fri Dec 03 16:44:15 CST 2021, time=2021-12-03, status=1, ipAttribution=)]
    2021-12-04 ms6000000097855691

    真棒

    0

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    2021-12-03 可以不填嚒

    学习了

    0

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    2021-12-03 ms4000001441347419

    学习了

    0

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关于幽门螺杆菌的全面科普,一篇终结你所有疑问!

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~

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