This study aimed to evaluate the composition of the gastric microbiota in the gastric mucosa and gastric fluid of patients with chronic antral gastritis. Specifically, we sought to determine whether Helicobacter pylori (Hp) infection changes the bacterial community in the gastric mucosa or alters the microbiota in the gastric fluid. The bacterial community at another site in the stomach was also investigated. DNA was extracted from 160 samples collected from 40 patients with chronic antral gastritis (20 Hp-positive and 20 Hp-negative cases). Three tissue samples of the gastric mucosa (gastric angle, body, and antral mucosa) and one tube of gastric fluid were collected from every patient. A 16S rRNA amplification library was created, and high-throughput sequencing was performed. A profile of the community composition was obtained using bioinformatics methods, including cluster, taxonomy, and diversity analyses. Analysis of the gastric bacterial community revealed that the community compositions of the gastric mucosa and gastric fluid of patients without Hp are similar to but show differences from those of Hp-positive patients. The microbiota in Hp-positive patients exhibited reduced microbial diversity, and the gastric fluid of these patients contained a small proportion of Hp. The richness of Leptotrichia in mucosal samples was greater than that in gastric fluid samples from Hp-negative patients with chronic antral gastritis. Hp changes the growth of other microbiota in the mucosa and affects the microbiota in the gastric fluid of patients with chronic antral gastritis. In addition to Hp, the presence of other bacteria might be related to the development of chronic an-tral gastritis.

目的:观察化瘀解毒健脾汤联合胃复春片治疗胃癌前病变的临床疗效及对患者血清胃泌素(GAS)和生长抑素(SST)表达的影响.方法:选择胃癌前病变患者82例,按随机数字表法分为观察组和对照组各41例.对照组给予胃复春片治疗,观察组在对照组基础上给予化瘀解毒健脾汤治疗.比较2组临床疗效,分析治疗前后主要症状积分、胃黏膜病理积分、血清GAS及SST水平变化.结果:观察组总有效率为92.68％,高于对照组70.73％,差异有统计学意义(P＜0.05).2组治疗前的胃脘疼痛、胃脘胀满、纳呆及胃脘灼热评分比较,差异无统计学意义(P＞0.05).2组治疗后的胃脘疼痛、胃脘胀满、纳呆及胃脘灼热评分较治疗前降低(P＜0.05),且观察组胃脘疼痛、胃脘胀满、纳呆和胃脘灼热评分均低于对照组(P＜0.05).治疗前,2组肠上皮化生及异型增生积分比较,差异均无统计学意义(P＞0.05).治疗后,2组肠上皮化生及异型增生积分较治疗前降低(P＜0.05),且观察组肠上皮化生及异型增生积分低于对照组(P＜0.05).2组治疗前的血清GAS、SST水平比较,差异均无统计学意义(P＞0.05).2组治疗后的血清GAS水平较治疗前降低而SST水平较治疗前升高(P＜0.05),且观察组血清GAS水平低于对照组而SST水平高于对照组(P＜0.05).结论:化瘀解毒健脾汤治疗胃癌前病变临床疗效较好,可减轻患者症状,降低肠上皮化生和异型增生,降低GAS而提高SST表达.

背景 世界上50％以上的人口感染幽门螺杆菌(Helicobacter pylori,H pylori).随着抗生素的广泛使用,抗生素耐药成为H.pylori感染患者根除失败的主要原因.目前有不少研究报道外排泵基因过表达和耐药的产生相关.目的 为了未来的H.pylori感染治疗有更多方法,探索外排泵基因的变异与双重耐药菌株耐药性产生的内在联系.方法 使用13C呼气试验及药物敏感试验进行双重耐药菌株及敏感菌株的筛选,用特异性PCR的常规方法进行耐药基因突变位点的验证,基于MiSeq平台,对10例临床菌株进行全基因组测序,以鉴定双重耐药表型与敏感表型的外排泵基因的单核苷酸变体(single nucleotide variants,SNV)并分析,参考菌株使用ATCC26695.结果 H.pylori药敏试验结果显示,丽水地区H.pylori对克拉霉素及左氧氟沙星都具有较高的耐药率.采用特异性PCR法在5株临床双重耐药菌株中检测到23S rRNA基因及gyrA的点突变,在5株临床敏感菌株中未检测到.全基因测序检测了涉及多耐药性的TolC同源物的四个基因簇(HP0605-HP0607,HP0971-HP0969,HP1327-HP1329和HP1489-HP1487)的遗传变异.在双重耐药性H.pylori菌株中发现一个突变的SNV.结论 丽水地区抗生素使用应严格监控,避免滥用.TolC同源基因的基因簇与H.pylori菌株的抗生素耐药性相关.全基因组测序对基因型与表型的关系有了新的认识.