胃癌是常见的消化道恶性肿瘤.胃镜检查是检出胃癌的主要手段,尤其是窄带成像放大内镜对判断胃黏膜病变的准确性具有显著优势.而胃蛋白酶和胃泌素-17作为临床上筛查早期胃癌无创、简单、易普及的血清学标志物,广泛应用于临床.本文综述胃蛋白酶原、胃泌素-17、窄带成像技术及放大内镜在早期胃癌筛查中的临床应用. 1 胃蛋白酶原与早期胃癌 胃蛋白酶原(PG)是胃粘膜分泌的具有特异功能性酶-天冬氨酸蛋白酶的前体,在酸性条件下易被激活,主要由2个亚型组成,即胃蛋白酶原-I(PG-I)和胃蛋白酶原-Ⅱ(PG-II).PG-I主要由胃底腺体的胃主细胞和颈粘液细胞分泌.

目的 分析幽门螺杆菌感染与胃部疾病的相关性.方法 将2014年1月～2015年12月在本院进行治疗的1200例胃部疾病作为研究对象,应用Hp培养及药敏试验对研究对象的幽门螺杆菌感染阳性率进行检测,并根据检测结果分析幽门螺杆菌感染与胃部疾病的相关性.结果 不同胃部疾病类型中以胃癌的阳性率最高、慢性浅表性胃炎的阳性率最低,慢性萎缩性胃炎、胃食管反流、胃溃疡及十二指肠溃疡、胃溃疡非典型性增生的阳性率差异无统计学意义;幽门螺杆菌感染阳性率在慢性胃炎中会随着病情程度的加重而增加,但不同病情程度的阳性率差异无统计学意义;51～60岁年龄段胃部疾病患者的幽门螺杆菌感染阳性率最高,21～30岁年龄段胃部疾病患者的幽门螺杆菌感染阳性率最低.结论 幽门螺杆菌感染是引起胃部疾病的危险因素,临床确认胃部疾病是由幽门螺杆菌感染引起后给予抗幽门螺杆菌感染治疗,可有效提高临床疗效.

目的：探讨本地区下消化道出血的病因。方法回顾性分析2005年10月至2013年12月结肠镜检查的下消化道出血患者857例的临床资料。结果本组明确病因者772例（90.08%），病因前三位依次为大肠癌（31.97%）、大肠息肉（29.87%）、非特异性结肠炎（9.22%）。病灶分布以直肠、乙状结肠较多见。大肠癌、大肠息肉及非特异性结肠炎病例发病时间分别为（21±4.74）d、（16±2.94）d、（7±1.58）d，三组比较差异有统计学意义（P<0.05）。结论血吸虫流行对本地区影响减小情况下，大肠癌、大肠息肉在本地区发病率仍偏高，可能与本地区人群饮食结构、生活习惯变化有关。对于反复便血者需格外重视，尽早行肠镜检查。

目的 评价雷贝拉唑+胶体果胶铋+可莫西林+左氧氟沙星(四联疗法)治疗幽门螺杆菌性消化性溃疡的临床疗效.方法 收集130例幽门螺杆菌性消化性溃疡患者,分为观察组和对照组,各65例.对照组患者采用雷贝拉唑+阿莫西林+左氧氟沙星三联疗法治疗,观察组患者采用四联疗法治疗,观察两组患者治疗后临床效果.结果 治疗后观察组患者的根除率及溃疡愈合率差异均有统计学意义(均P＜ 0.05);治疗后,幽门螺杆菌根除与否与溃疡愈合明显相关;两组患者不良反应发生率差异无统计学意义(P＞0.05).结论 四联疗法可以提高消化性溃疡幽门螺杆菌的根除率,促进溃疡愈合,安全可靠,适合临床推广应用.

Objective To investigate the clinical value of the Hp saliva test plate(HPS) and 14C urease breath test(14C-UBT) for Hp infection. Methods Urease was detected in saliva of patients by means of HPS,and Hp infection were detected in the biopsy specimen of gastric mucosa with 14C-UBT and the combined detection of RUT,modified Giemsa staining and bacterial culture at the same time. Then comparisons were made between HPS and 14C-UBT groups by the positive rate,sensitivity,specificity,and the positive(or negative) predictive value. Results 102 from 160 patients were diagnosed as positive for Hp infection by a combined method,and the positive rate was 63.75%. Among them,the positive rates of HPS and 14C-UBT were 47.50%,58.75%,respectively;while the sensitivity is 72.55 % for diagnosing Hp infection by HPS,80.39 % by 14C-UBT;The specificity,the correct rate,the positive and the negative values were 96.55%,81.25%,97.37% and 66.67% by HPS;80.00%,87.23%,79.31%,69.70% by 14C-UBT,but the difference between them was not statistically significant. Conclusions The positive rate,correct rate,sensitivity and specificity for detecting urease in saliva by HPS are similar to them of 14C-UBT. The method is rapid,simple,cheap,and worthy of further clinical validation as a new non-invasive diagnostic method for Hp.

【Objective】To explore the clinical value of the saliva test plate in detection of Helicobacter pylori(Hp).【Methods】Saliva test plate was used to detect urease in saliva of patients.Hp infection in biopsy specimen of gastric mucosa was detected with the combined tests of RUT,modified Giemsa staining,14C urease breath test(14C-UBT) and bacterial culture at the same time.【Results】In 80 patients,51 cases were detected to be positive by the combined tests with the positive rate of 63.75%.For saliva test plate,RUT,modified Giemsa staining,14C-UBT and bacterial cultures,the positive rates were 47.50%,56.25%,58.75%,58.75%,47.50%,respectively;while their sensitivities for diagnosing Hp infection were 72.55%,80.39%,88.24%,80.39%,74.51%,respectively;their specificities were 96.55%,86.21%,93.10%,79.31%,100.00%;the correct rates were 81.25%,82.50%,90.00%,80.00%,83.75%.The positive predictive rates were 97.37%,91.11%,95.74%,87.23%,100.00%,respectively;while the negative predictive rates were 66.67%,71.43%,81.82%,69.70%,69.05%,respectively.Χ2 test suggested that the differences were not statistically significant.【Conclusions】The positive rate,correct rate,sensitivity and specificity of detecting urease in saliva with saliva test plate are similar to those with RUT and other methods.This method is non-invasive,rapid,simple and cheap,does not require any other equipment and is worthy of further clinical confirmation as a new diagnostic method for Hp.