13/14 c 呼气试验 诊断 hp 感染的临床应用
DESCRIPTION
13/14 C 呼气试验 诊断 HP 感染的临床应用. 武汉协和医院 徐三平. 电脑模拟 Hp 菌株 ( 10,000 ). H. pylori 的生物学特性. 电镜下螺杆状 Hp. 世界范围内幽门螺旋杆菌感染的发生率. 西 欧 30-50%. 东欧 70-90%. 美国 / 加拿大 30-40%. 亚洲 70-80%. 拉丁美洲 70-90%. 非 洲 70-90%. 澳大利亚 20%. 西藏喇嘛 90.00±8.77%. 合计 59.24±0.77%. 广东胃癌低发区农民 40.50±6.41%. - PowerPoint PPT PresentationTRANSCRIPT
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13/14 CHP
-
Hp10,000HpH.pylori
-
30-50%70-90%/30-40%70-80%70-90% 70-90% 20%
-
59%90% 40%
-
0.5-1
5
0.16671-0.34150.30530.1858
0.43756-0.35940.52640.327
0.529410-0.43780.59040.3972
0.43090.53680.68050.57480.3896
0.52470.55560.55650.63990.3919
0.48310.58410.67370.64750.367
0.44990.62710.4690.64750.3438
0.53380.42220.6490.66540.3038
UBT
HPWB
ELISA-IgG
IgG
IgM
Hp
data
np1-pp(1-p)/nkaifang1.96sp
213119940.5586854460.4413145540.00207189930.04551812070.0892155166
10767213550.67007434940.32992565060.00030662240.01751063540.0343208454
14638606030.58783321940.41216678060.00028172710.01678472890.0328980686
2415137510400.56935817810.43064182190.00017831960.0133536360.0261731266
229136930.59388646290.40611353710.00177342160.04211201210.0825395436
3171871300.58990536280.41009463720.00129367390.0359676790.0704966509
2451261190.51428571430.48571428570.00198250730.04452535560.0872696969
193213605720.70393374740.29606625260.00015324340.01237915190.0242631377
4001162840.290.710.0017750.04213074890.0825762678
4372551820.58352402750.41647597250.00095303430.0308712530.0605076559
149511063890.73979933110.26020066890.00017404730.01319269760.0258576873
5562253310.4046762590.5953237410.00107072620.03272195220.0641350262
706298110.42209631730.57790368270.00081856050.02861049560.0560765713
6434300.531250.468750.00732421880.08558164960.1677400332
170106640.62352941180.37647058820.00221453290.04705882350.0922352941
5403252150.60185185190.39814814810.00073731140.02715347830.0532208175
10355480.53398058250.46601941750.00452446040.0672641090.1318376537
9882477410.250.750.00075910930.02755193840.0540017993
9884025860.40688259110.59311740890.00060032130.02450145430.0480228505
3436232411120.67636786960.32363213040.00009418860.00970508270.019021962
211596011550.45390070920.54609929080.0002582030.01606869550.0314946431
5113451660.6751467710.3248532290.00063572060.02521350040.0494184609
4802662140.55416666670.44583333330.00092881940.03047653920.0597340169
2461441020.58536585370.41463414630.00168550470.04105489810.0804676003
256172840.6718750.3281250.00128173830.03580137260.0701706903
9525154370.54096638660.45903361340.00048217820.02195855560.043038769
198105930.53030303030.46969696970.00237220690.04870530690.0954624015
6414242170.66146645870.33853354130.00052813340.02298115420.0450430623
3401481920.43529411760.56470588240.00166089970.04075413660.0798781078
200011628380.5810.4190.00020950.01447411480.0283692651
11171400.63963963960.36036036040.00324648970.05697797590.1116768327
4002091910.52250.47750.001193750.03455068740.0677193473
182410008240.5482456140.4517543860.00024767240.01573760980.0308457151
2812160.42857142860.57142857140.02040816330.14285714290.28
3932131800.54198473280.45801526720.00116543320.03413844240.0669113471
4673011660.64453961460.35546038540.00076115710.02758907650.0540745899
504550.90.10.0020.04472135950.0876538647
282170.750.250.00892857140.09449111830.1852025918
10845545300.51107011070.48892988930.00045104230.02123775730.0416260042
adult
0.59240.0077
0.5586854460.0892155166
0.67007434940.0343208454
0.58783321940.0328980686
0.56935817810.0261731266
0.59388646290.0825395436
0.51428571430.0872696969
0.70393374740.0242631377
0.58352402750.0605076559
0.73979933110.0258576873
0.4046762590.0641350262
0.42209631730.0560765713
0.531250.1677400332
0.62352941180.0922352941
0.53398058250.1318376537
0.67636786960.019021962
0.45390070920.0314946431
0.6751467710.0494184609
0.55416666670.0597340169
0.58536585370.0804676003
0.6718750.0701706903
0.54096638660.043038769
0.53030303030.0954624015
0.66146645870.0450430623
0.43529411760.0798781078
0.5810.0283692651
0.63963963960.1116768327
0.5482456140.0308457151
0.42857142860.28
0.54198473280.0669113471
0.64453961460.0540745899
0.90.0876538647
0.750.1852025918
0.51107011070.0416260042
0.58990536280.0704966509
0.290.0825762678
0.60185185190.0532208175
0.250.0540017993
0.40688259110.0480228505
0.52250.0677193473
adult
00.00770.0077
00.08921551660.0892155166
00.03432084540.0343208454
00.03289806860.0328980686
00.02617312660.0261731266
00.08253954360.0825395436
00.08726969690.0872696969
00.02426313770.0242631377
00.06050765590.0605076559
00.02585768730.0258576873
00.06413502620.0641350262
00.05607657130.0560765713
00.16774003320.1677400332
00.09223529410.0922352941
00.13183765370.1318376537
00.0190219620.019021962
00.03149464310.0314946431
00.04941846090.0494184609
00.05973401690.0597340169
00.08046760030.0804676003
00.07017069030.0701706903
00.0430387690.043038769
00.09546240150.0954624015
00.04504306230.0450430623
00.07987810780.0798781078
00.02836926510.0283692651
00.11167683270.1116768327
00.03084571510.0308457151
00.280.28
00.06691134710.0669113471
00.05407458990.0540745899
00.08765386470.0876538647
00.18520259180.1852025918
00.04162600420.0416260042
(%95%CI)
children
0.58990536280.0704966509
0.290.0825762678
0.60185185190.0532208175
0.250.0540017993
0.40688259110.0480228505
0.52250.0677193473
0.40902835120.0249980824
0.58990536280.0704966509
0.290.0825762678
0.60185185190.0532208175
0.250.0540017993
0.40688259110.0480228505
0.52250.0677193473
children
00.07049665090.0704966509
00.08257626780.0825762678
00.05322081750.0532208175
00.05400179930.0540017993
00.04802285050.0480228505
00.06771934730.0677193473
00.02499808240.0249980824
(%95%CI)
data2
np1-pp(1-p)/nkaifang1.96sp
213119940.5586854460.4413145540.00207189930.04551812070.0892155166
10767213550.67007434940.32992565060.00030662240.01751063540.0343208454
14638606030.58783321940.41216678060.00028172710.01678472890.0328980686
2415137510400.56935817810.43064182190.00017831960.0133536360.0261731266
229136930.59388646290.40611353710.00177342160.04211201210.0825395436
2451261190.51428571430.48571428570.00198250730.04452535560.0872696969
193213605720.70393374740.29606625260.00015324340.01237915190.0242631377
4372551820.58352402750.41647597250.00095303430.0308712530.0605076559
149511063890.73979933110.26020066890.00017404730.01319269760.0258576873
5562253310.4046762590.5953237410.00107072620.03272195220.0641350262
706298110.42209631730.57790368270.00081856050.02861049560.0560765713
6434300.531250.468750.00732421880.08558164960.1677400332
ELISA170106640.62352941180.37647058820.00221453290.04705882350.0922352941
10355480.53398058250.46601941750.00452446040.0672641090.1318376537
3436232411120.67636786960.32363213040.00009418860.00970508270.019021962
211596011550.45390070920.54609929080.0002582030.01606869550.0314946431
5113451660.6751467710.3248532290.00063572060.02521350040.0494184609
4802662140.55416666670.44583333330.00092881940.03047653920.0597340169
2461441020.58536585370.41463414630.00168550470.04105489810.0804676003
256172840.6718750.3281250.00128173830.03580137260.0701706903
9525154370.54096638660.45903361340.00048217820.02195855560.043038769
198105930.53030303030.46969696970.00237220690.04870530690.0954624015
6414242170.66146645870.33853354130.00052813340.02298115420.0450430623
ELISA3401481920.43529411760.56470588240.00166089970.04075413660.0798781078
200011628380.5810.4190.00020950.01447411480.0283692651
UAT11171400.63963963960.36036036040.00324648970.05697797590.1116768327
182410008240.5482456140.4517543860.00024767240.01573760980.0308457151
2812160.42857142860.57142857140.02040816330.14285714290.28
3932131800.54198473280.45801526720.00116543320.03413844240.0669113471
4673011660.64453961460.35546038540.00076115710.02758907650.0540745899
504550.90.10.0020.04472135950.0876538647
282170.750.250.00892857140.09449111830.1852025918
10845545300.51107011070.48892988930.00045104230.02123775730.0416260042
2626415558103090.59236978370.40763021630.00001552050.00393960560.007721627
np1-pp(1-p)/nkaifang1.96sp
3171871300.58990536280.41009463720.00129367390.0359676790.0704966509
4001162840.290.710.0017750.04213074890.0825762678
5403252150.60185185190.39814814810.00073731140.02715347830.0532208175
9882477410.250.750.00075910930.02755193840.0540017993
9884025860.40688259110.59311740890.00060032130.02450145430.0480228505
4002091910.52250.47750.001193750.03455068740.0677193473
3633148621470.40902835120.59097164880.00016266770.01275412370.0249980824
area
np1-pp(1-p)/nkaifang1.96sp
113265573720.42006033180.57993966820.00043736020.02091315930.0409897923
23401481920.43529411760.56470588240.00166089970.04075413660.0798781078
3211596011550.45390070920.54609929080.0002582030.01606869550.0314946431
410845545300.51107011070.48892988930.00045104230.02123775730.0416260042
5198105930.53030303030.46969696970.00237220690.04870530690.0954624015
69525154370.54096638660.45903361340.00048217820.02195855560.043038769
7196310838800.55170657160.44829342840.00022837160.01511196840.029619458
84742622120.5527426160.4472573840.0009435810.03071776320.060206816
94802662140.55416666670.44583333330.00092881940.03047653920.0597340169
103878223516430.57632800410.42367199590.00010925010.01045227860.0204864661
11200011628380.5810.4190.00020950.01447411480.0283692651
122731611120.58974358970.41025641030.00150277070.0387655870.0759805505
138605143460.59767441860.40232558140.00046782040.02162915730.0423931482
145023161860.62948207170.37051792830.00073808350.02716769260.0532486775
1512898404490.65166795970.34833204030.00027023430.01643880540.0322200585
165113451660.6751467710.3248532290.00063572060.02521350040.0494184609
173436232411120.67636786960.32363213040.00009418860.00970508270.019021962
183864272111430.70419254660.29580745340.00007655470.00874955560.0171491291
197866120.84615384620.15384615380.00197238660.04441155920.087046656
area
0.04098979230.0409897923
0.07987810780.0798781078
0.03149464310.0314946431
0.04162600420.0416260042
0.09546240150.0954624015
0.0430387690.043038769
0.0296194580.029619458
0.0602068160.060206816
0.05973401690.0597340169
0.02048646610.0204864661
0.02836926510.0283692651
0.07598055050.0759805505
0.04239314820.0423931482
0.05324867750.0532486775
0.03222005850.0322200585
0.04941846090.0494184609
0.0190219620.019021962
0.01714912910.0171491291
0.0870466560.087046656
bigarea
np1.96sp
348259.16548546.84%0.0132059207
398650.08398650.08%0.0155223286
1587058.271587058.27%0.007672101
548546.84348259.16%0.0163267084
267366.26267366.26%0.0179248218
np1-pp(1-p)/nkaifang1.96sp
34820.59160.40840.00006938810.00832995330.0163267084
39860.50080.49920.00006271940.00791955540.0155223286
158700.58270.41730.0000153220.00391433720.007672101
54850.46840.53160.00004539680.00673771460.0132059207
26730.66260.33740.00008363680.00914531720.0179248218
bigarea
0.01320592070.0132059207
0.01552232860.0155223286
0.0076721010.007672101
0.01632670840.0163267084
0.01792482180.0179248218
Hp
agedistribution
1-6-10-21-31-41-51-61-
UBT16.67%43.75%52.94%43.09%52.47%48.31%44.99%53.38%
HPWB53.68%55.56%58.41%62.71%42.22%
ELISA-IgG34.15%35.94%43.78%68.05%55.65%67.37%46.90%64.90%
IgG30.53%52.64%59.04%57.48%63.99%64.75%64.75%66.54%
IgM18.58%32.70%39.72%38.96%39.19%36.70%34.38%30.38%
agedistribution
UBT
HPWB
ELISA-IgG
IgG
IgM
Hp
population
np1-pp(1-p)/nkaifang1.96sp
213119940.5586854460.4413145540.00207189930.04551812070.0892155166
229136930.59388646290.40611353710.00177342160.04211201210.0825395436
5562253310.4046762590.5953237410.00107072620.03272195220.0641350262
2415137510400.56935817810.43064182190.00017831960.0133536360.0261731266
2451261190.51428571430.48571428570.00198250730.04452535560.0872696969
10767213550.67007434940.32992565060.00030662240.01751063540.0343208454
3436232411120.67636786960.32363213040.00009418860.00970508270.019021962
14638606030.58783321940.41216678060.00028172710.01678472890.0328980686
193213605720.70393374740.29606625260.00015324340.01237915190.0242631377
4372551820.58352402750.41647597250.00095303430.0308712530.0605076559
149511063890.73979933110.26020066890.00017404730.01319269760.0258576873
6434300.531250.468750.00732421880.08558164960.1677400332
ELISA170106640.62352941180.37647058820.00221453290.04705882350.0922352941
211596011550.45390070920.54609929080.0002582030.01606869550.0314946431
5113451660.6751467710.3248532290.00063572060.02521350040.0494184609
ELISA3401481920.43529411760.56470588240.00166089970.04075413660.0798781078
200011628380.5810.4190.00020950.01447411480.0283692651
2461441020.58536585370.41463414630.00168550470.04105489810.0804676003
9525154370.54096638660.45903361340.00048217820.02195855560.043038769
6414242170.66146645870.33853354130.00052813340.02298115420.0450430623
3932131800.54198473280.45801526720.00116543320.03413844240.0669113471
4673011660.64453961460.35546038540.00076115710.02758907650.0540745899
10845545300.51107011070.48892988930.00045104230.02123775730.0416260042
182410008240.5482456140.4517543860.00024767240.01573760980.0308457151
10355480.53398058250.46601941750.00452446040.0672641090.1318376537
256172840.6718750.3281250.00128173830.03580137260.0701706903
UAT11171400.63963963960.36036036040.00324648970.05697797590.1116768327
4802662140.55416666670.44583333330.00092881940.03047653920.0597340169
198105930.53030303030.46969696970.00237220690.04870530690.0954624015
2812160.42857142860.57142857140.02040816330.14285714290.28
282170.750.250.00892857140.09449111830.1852025918
706298110.42209631730.57790368270.00081856050.02861049560.0560765713
504550.90.10.0020.04472135950.0876538647
-
HP- 15%-20%HP HPMALT2-6(WGO-OMGE).. 2007;12(1):40-52.
-
1999Hp-20002003Hp- 20042007HpHp2003Hp2000Maastricht-22005Maastricht-3
-
2200614.84%226.08/1034.82/1017.21/1020062010196356-365
Chart1
25.13
14.84
14.7
8.69
7.62
3.99
2.61
2.33
2.32
2.07
15.69
1
2006%
Sheet1
1
25.13
14.84
14.7
8.69
7.62
3.99
2.61
2.33
2.32
2.07
15.69
-
Hp1994~2002Hp7.5n=4851n=50362P=0.02KaplanMeierWong BC, Lam SK, Wong WM, et a1. Helicobacter pylori eradication to prevent gastric cancer in a high-risk region of ChinaA randomized cont rolled trial. JAMA 2004;291:187-194.
-
HpHp2008),HpIA2008HpIAMaastricht III,Hp
2009211-219Malfertheiner P, Megraud F, Morain CO, et al. Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut 2007;56:772781.Fock KM, Talley NJ, Moayyedi P, et al. Asia Pacific consensus guideline on gastric cancer prevention. J Gastroenterol Hepatol 2008;23:351-365.
-
Hp-Fock KM, Talley NJ, Moayyedi P, et al. Asia Pacific consensus guideline on gastric cancer prevention. J Gastroenterol Hepatol 2008;23:351-365.18~60Hp1Hp234Hp2
-
HpHpMarkovHp5030-40Hp16.610405641374Hp
Markov2003242135-139
-
Hp1China J Gastroenterol, 2008,Vol.13.No.1
-
Hp
1
76.527.30
100205
76.233.30
60.737.78.2
67.322.50
8433.90
77.19.10
5033.30
758.38.3
81.813.60
6000
100200
100400
64.723.55.8
Metronidazole
Clarithromycin
Amoxicillin
Sheet1
RegionsResistant Rate (%)
MetronidazoleClarithromycinAmoxicillin
76.527.30
100205
76.233.30
60.737.78.2
67.322.50
8433.90
77.19.10
5033.30
758.38.3
81.813.60
6000
100200
100400
64.723.55.8
-
20072010HP HP%
-
/*H pylori. .Monique M Gerrits, et al.Lancet Infect Dis 2006; 6:699709
20-95,DNA ( RdxA, FrxA, FdxB) 0-5023SrRNA23S rRNA0-30-PBP PBP D PBP 1A ,0-10tRNA16S rRNA,,0-20DNADNADNAgyrA 0-2RNARNArpoB 0-5DNAPPI,,RBCATP
-
Hp
Hp ,
-
Hp:(RUT)W-SGiemsa(PCR) (IRUT)()
-
Hp:13C14C(UBT)15Hp()
-
Hp
-
Hp13CUBTHp-202-369%HpUBTHp
Malfertheiner P, Megraud F, Morain CO, et al. Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut 2007;56:772781.2009180-186MaastrichtIII45Hp
-
HPPPIHp2Hp42009180-186200813142-46
-
HPMALT
-
HPHpNSAIDsHp>95%Hp
-
MALTPPI
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