本文選題：老年人　切入點(diǎn)：慢性萎縮性胃炎　出處：《鄭州大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景幽門(mén)螺桿菌(Helicobacter pylori,Hp)在全球平均感染率超過(guò)50%,是世界范圍內(nèi)最流行的人類感染性疾病,其中發(fā)展中國(guó)家感染率明顯高于發(fā)達(dá)國(guó)家[1-2]。我國(guó)是Hp感染高發(fā)地區(qū),因地域的不同,其感染率在42%~90%[3]。與此同時(shí),相關(guān)流行病學(xué)統(tǒng)計(jì)結(jié)果顯示,我國(guó)老年人群中幽門(mén)螺桿菌感染率高達(dá)50%~70%,而Hp是引發(fā)慢性萎縮性胃炎的一大誘因[4],老年人因全身機(jī)能減退,消化系統(tǒng)發(fā)病率較高,且更容易感染Hp[5]。由于近年來(lái)抗生素的廣泛使用,導(dǎo)致Hp的耐藥性逐年上升,老年患者肝腎清除率下降,根治Hp的抗生素類藥物引起的不良反應(yīng)發(fā)生率也逐年增加.因不易區(qū)分相關(guān)抗生素產(chǎn)生的不良反應(yīng)與Hp感染引起的胃黏膜損傷產(chǎn)生的臨床癥狀,所以難以評(píng)估老年患者Hp相關(guān)性慢性萎縮性胃炎根治Hp療效。因此,本文通過(guò)對(duì)根治幽門(mén)螺桿菌前后老年慢性萎縮性胃炎患者的臨床療效及病理學(xué)變化進(jìn)行闡述,探討根治Hp在治療老年人慢性萎縮性胃炎過(guò)程中的近、遠(yuǎn)期臨床意義。目的探討根治幽門(mén)螺桿菌(Helicobacter pylori,Hp)在老年慢性萎縮性胃炎治療過(guò)程中的近、遠(yuǎn)期臨床意義。對(duì)象與方法1.選取2014年6月~2015年9月期間,就診于鄭州大學(xué)第一附屬醫(yī)院老年科的慢性萎縮性胃炎患者(≥60歲)99例,所有病例均符合病例收集標(biāo)準(zhǔn)。并將其分為Hp根治組和非根治組。2.采用13C尿素呼氣試驗(yàn)及胃鏡下對(duì)胃黏膜進(jìn)行活檢,HE染色檢測(cè)各組Hp感染情況。3.本研究選用埃索美拉唑、阿莫西林及克拉霉素三聯(lián)療法。初次根除失敗的患者可采用補(bǔ)救治療,補(bǔ)救治療采用四聯(lián)療法:埃索美拉唑+膠體鉍+阿莫西林+左氧氟沙星。4.觀察記錄治療結(jié)束4周后、隨訪12個(gè)月后的臨床癥狀、胃鏡及組織病理檢查結(jié)果。對(duì)所有Hp根除治療的患者分別進(jìn)行統(tǒng)計(jì)學(xué)分析,計(jì)數(shù)資料均采用SPSS21.0統(tǒng)計(jì)軟件進(jìn)行檢驗(yàn),以P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果治療結(jié)束4周后行胃鏡下取病理活檢,活檢結(jié)果顯示炎癥程度差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.636)。兩組治療過(guò)程中均未發(fā)生嚴(yán)重的藥物不良反應(yīng),且兩組臨床癥狀差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.696)。治療結(jié)束12個(gè)月后行胃鏡取病理活檢結(jié)果顯示,A組炎癥恢復(fù)情況優(yōu)于B組,兩組胃鏡檢查結(jié)果差異有統(tǒng)計(jì)學(xué)意義(P=0.006)。兩組治療過(guò)程中均未發(fā)生嚴(yán)重的藥物不良反應(yīng),且A組臨床癥狀較B組得到明顯好轉(zhuǎn),差異有統(tǒng)計(jì)學(xué)意義(P=0.041)。結(jié)論對(duì)Hp相關(guān)性慢性萎縮性胃炎的老年患者進(jìn)行正規(guī)的根除Hp治療,近期療效不顯著,但可以提高遠(yuǎn)期慢性萎縮性胃炎的療效,并且對(duì)于預(yù)防胃癌的發(fā)生,有著非常重要的臨床意義。
[Abstract]:Background Helicobacter pylori Helicobacter pylori (Helicobacter pylori) infection rate is more than 50 per cent in the world. It is the most prevalent human infectious disease in the world, and the infection rate in developing countries is significantly higher than that in developed countries [1-2]. At the same time, the related epidemiological statistics showed that the infection rate of Helicobacter pylori was as high as 50% in the elderly in China, and HP was a major cause of chronic atrophic gastritis. The incidence of digestive system is high, and it is more likely to be infected with HP [5]. Due to the widespread use of antibiotics in recent years, the resistance to HP has increased year by year, and the clearance rate of liver and kidney in elderly patients has decreased. The incidence of adverse reactions caused by antibiotics after HP eradication increased year by year. It is difficult to distinguish the adverse reactions caused by related antibiotics from the clinical symptoms caused by gastric mucosal injury caused by HP infection. Therefore, it is difficult to evaluate the curative effect of HP related chronic atrophic gastritis in elderly patients. Therefore, the clinical efficacy and pathological changes of elderly patients with chronic atrophic gastritis before and after the radical treatment of Helicobacter pylori were expounded. Objective to investigate the clinical significance of radical therapy of HP in the treatment of chronic atrophic gastritis in the elderly. Objective to investigate the clinical significance of Helicobacter pylori pylorus in the treatment of chronic atrophic gastritis in the elderly. Long-term clinical significance. Participants and methods 1. From June 2014 to September 2015, 99 patients with chronic atrophic gastritis (鈮，

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