nqkk58 发表于 2024-6-22 16:47:34

儿童有必要进行幽门螺旋杆菌筛查吗?


    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">相信<span style="color: black;">大众</span>都听过幽门螺杆菌(Helicobacter Pylori,简<span style="color: black;">叫作</span> HP),毕竟在中国幽门螺杆菌的感染率还是很高的,大约50%左</span><span style="color: black;">右<span style="color: black;"></span></span><span style="color: black;">。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">我国不同地区的HP感染率差别很大,<span style="color: black;">处在</span>20%-70%之间。随着经济的发展、生活方式的改变、卫生<span style="color: black;">情况</span>的改善、医疗水平的<span style="color: black;">加强</span>,感染率呈现了<span style="color: black;">显著</span>的下降趋势,但下降速度还不是很理想。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">以上说是成人的HP感染<span style="color: black;">状况</span>,至于儿童呢?儿童<span style="color: black;">亦</span>会感染幽门螺杆菌,<span style="color: black;">重点</span><span style="color: black;">经过</span>口途径传播,通俗<span style="color: black;">来讲</span><span style="color: black;">便是</span>病从口入。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://q5.itc.cn/q_70/images03/20240415/a1fcdbd1d5f54f24b4a5f914342550b2.jpeg" style="width: 50%; margin-bottom: 20px;"></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">照片</span><span style="color: black;">源自</span>:bigstock</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">儿童的HP感染<span style="color: black;">重点</span>来自于家庭内传播<span style="color: black;"><span style="color: black;"></span></span></span><span style="color: black;">,与家庭成员的感染<span style="color: black;">状况</span>、喂养方式、卫生习惯等有很大关系。但<span style="color: black;">由于</span>儿童年龄小、<span style="color: black;">检测</span><span style="color: black;">办法</span>有限,<span style="color: black;">因此</span>儿童HP感染率的调查更加困难,<span style="color: black;">尤其</span>是3岁以内的儿童。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">文献<span style="color: black;">报告</span>,中国自然人群儿童及青少年Hp总感染率为29%,呈<span style="color: black;">明显</span>的地域分布性差异;</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">在胃癌低发区域,中国自然人群儿童Hp总感染率为20%,在胃癌高发地区Hp总感染率高达55%,并随着年龄增长有<span style="color: black;">提升</span>趋势<span style="color: black;"><span style="color: black;"></span></span>,平均年递增率达3.2%,12岁儿童的感染率接近成人<span style="color: black;"><span style="color: black;"></span></span>。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">宝宝家长</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">Q1. 幽门螺杆菌感染有什么<span style="color: black;">害处</span>呢?</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">幽门螺杆菌感染者,虽然有很大一部分<span style="color: black;">没</span>症状,仅25%到30%的<span style="color: black;">病人</span>会<span style="color: black;">显现</span>不同程度的胃肠道<span style="color: black;">疾患</span>。但它与慢性胃炎、消化道溃疡密切<span style="color: black;">关联</span>,<span style="color: black;">更加是</span>胃癌的一级致癌因子。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;">照片</span><span style="color: black;">源自</span>:</span><span style="color: black;">bigstock</span></span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">中国是个胃癌高发国家,这和幽门螺杆菌的高感染率是息息<span style="color: black;">关联</span>的。<span style="color: black;">因此</span><span style="color: black;">掌控</span>幽门螺杆菌感染是一个严峻的公共卫生问题。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">咱们</span>的邻居日本,在过去的20年里日本幽门螺杆菌感染率从40-60%降到了6-10%。可见<span style="color: black;">咱们</span>要更加<span style="color: black;">注意</span>幽门螺杆菌感染,<span style="color: black;">尤其</span>是成人幽门螺杆菌的防治。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">至于儿童,<span style="color: black;">由于</span>群体的特殊性,并不强调积极<span style="color: black;">检测</span>、积极治疗,而更<span style="color: black;">要紧</span>的是从生活方式上改变、从认知上强化,争取减少感染率。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">宝宝家长</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">Q2. <span style="color: black;">为何</span>儿童幽门螺杆菌感染并不强调"早<span style="color: black;">发掘</span>早治疗"呢?</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">儿童是不同于成人的个体,有<span style="color: black;">自己</span>的生理病理特点和<span style="color: black;">药品</span>局限性,<span style="color: black;">因此呢</span>中华医学会<span style="color: black;">尤其</span>制定了《儿童幽门螺杆菌感染专家共识》。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">首要</span>,HP感染在儿童中<span style="color: black;">导致</span>胃粘膜病变相对较少,致癌<span style="color: black;">危害</span>极低,大多都是<span style="color: black;">没</span>症状感染者<span style="color: black;"><span style="color: black;"></span></span>。虽然儿童常常有腹痛、厌食、<span style="color: black;">乃至</span>生长迟缓的表现,但尚<span style="color: black;">没</span>足够的证据<span style="color: black;">表示</span>这些与HP感染<span style="color: black;">关联</span><span style="color: black;"><span style="color: black;"></span></span>。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://q7.itc.cn/q_70/images03/20240415/5cd5af7b0e48491bab1f6ee56466510e.jpeg" style="width: 50%; margin-bottom: 20px;"></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">照片</span><span style="color: black;">源自</span>:</span><span style="color: black;">bigstock</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">针对</span>慢性腹痛等消化道症状的儿童,<span style="color: black;">意见</span>积极寻找潜在病因,而不<span style="color: black;">举荐</span>一味<span style="color: black;">检测</span>和治疗HP感染,反而耽误了病情、<span style="color: black;">乱用</span>了抗生素。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">共识还指出,<span style="color: black;">日前</span>尚<span style="color: black;">没</span>足够证据<span style="color: black;">表示</span>Hp感染与中耳炎、牙周<span style="color: black;">疾患</span>、<span style="color: black;">食品</span>过敏、特发性血小板减少性紫癜及生长<span style="color: black;">生长</span>迟缓<span style="color: black;">相关</span><span style="color: black;"></span>。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">当然这些结论还有所争议,<span style="color: black;">咱们</span>期待<span style="color: black;">更加多</span>更<span style="color: black;">靠谱</span>的大规模<span style="color: black;">科研</span>来揭示新的结论。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">宝宝家长</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">Q3. 那什么样的患儿要<span style="color: black;">思虑</span>检测幽门螺杆菌呢?</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">Hp的检测指征:</span></strong></span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">1. </span></strong></span><span style="color: black;">消化性溃疡。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">2. </span></strong><span style="color: black;">胃黏膜<span style="color: black;">关联</span>淋巴组织(mucosa associated lymphoid tissue,MALT)淋巴瘤。</span></span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">3.</span></strong></span><span style="color: black;">慢性胃炎。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">4.</span></strong></span><span style="color: black;">一级亲属中有胃癌的患儿。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">5.</span></strong></span><span style="color: black;">不明<span style="color: black;">原由</span>的难治性缺铁性贫血。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">6.</span></strong></span><span style="color: black;">计划<span style="color: black;">长时间</span><span style="color: black;">吃下</span>非甾体消炎药(non steroid anti-inflammatory drug,NSAID)(<span style="color: black;">包含</span>低剂量阿司匹林)。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">7. </span></strong></span><span style="color: black;">不<span style="color: black;">意见</span>做为常规检测。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">临床上,我遇到<span style="color: black;">非常多</span>父母<span style="color: black;">自己</span>体检<span style="color: black;">发掘</span>HP感染,<span style="color: black;">需求</span>来给<span style="color: black;">孩儿</span>做检测的<span style="color: black;">状况</span>。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">首要</span>我要<span style="color: black;">认识</span><span style="color: black;">孩儿</span>的<span style="color: black;">实质</span>年龄,生长<span style="color: black;">生长</span><span style="color: black;">状况</span>,营养状态,有<span style="color: black;">没</span>不适症状,家族史<span style="color: black;">状况</span>。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">倘若</span><span style="color: black;">孩儿</span>不属于检测适用人群,我会<span style="color: black;">尽可能</span>和家长沟通检测的必要性以及阳性时治疗的必要性。</span><span style="color: black;"><span style="color: black;">由于</span>随着年龄的增长,儿童的感染率<span style="color: black;">连续</span><span style="color: black;">上升</span>,说明再感染的<span style="color: black;">危害</span>还是有的。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://q7.itc.cn/q_70/images03/20240415/e579c5bd747f4c868c52f4b50e71a0e8.jpeg" style="width: 50%; margin-bottom: 20px;"></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">照片</span><span style="color: black;">源自</span>:</span><span style="color: black;">bigstock</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">另外</span>,抗HP根治策略,<span style="color: black;">必须</span>用到2种抗生素(如阿莫西林、克拉霉素、或甲硝唑)+抑酸<span style="color: black;">药品</span>,疗程2周。</span><span style="color: black;">就算是成人<span style="color: black;">亦</span>很难<span style="color: black;">保持</span>完成疗程,何况是儿童,还存在高不良反应的<span style="color: black;">危害</span>。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">况且</span><span style="color: black;">日前</span></span><span style="color: black;">HP的抗生素耐药性比例逐年攀升,<span style="color: black;">引起</span>根治率<span style="color: black;">不睬</span>想,当<span style="color: black;">第1</span>次治疗失败后,<span style="color: black;">针对</span>儿童再次治疗可选的<span style="color: black;">药品</span>极其有限。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">因此</span>,<span style="color: black;">倘若</span><span style="color: black;">孩儿</span>不属于检测适应范围,我不<span style="color: black;">意见</span>做HP<span style="color: black;">关联</span>检测,更不<span style="color: black;">意见</span>进一步治疗。每年常规健康体检,监测<span style="color: black;">孩儿</span>的健康<span style="color: black;">情况</span><span style="color: black;">就可</span>,<span style="color: black;">亦</span>有很少部分儿童的幽门螺杆菌感染可能自然清除。</span><span style="color: black;">最最<span style="color: black;">要紧</span>的是良好生活习惯和卫生<span style="color: black;">认识</span>。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">总之<span style="color: black;">针对</span>HP感染家庭中的儿童,<span style="color: black;">必须</span><span style="color: black;">按照</span><span style="color: black;">危害</span>获益<span style="color: black;">评定</span>和<span style="color: black;">关联</span><span style="color: black;">疾患</span>状态进行综合<span style="color: black;">评定</span>和管理。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">宝宝家长</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">Q4. <span style="color: black;">怎么样</span>检测幽门螺杆菌感染呢?</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">分为侵入性和非侵入性检测。<span style="color: black;">必定</span><span style="color: black;">重视</span>在检测4周内<span style="color: black;">不可</span><span style="color: black;">运用</span>抗生素,2周内<span style="color: black;">不可</span><span style="color: black;">运用</span><span style="color: black;">控制</span>胃酸的<span style="color: black;">药品</span>,否则容易<span style="color: black;">引起</span>检测结果假阴性。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">侵入性操作</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">指<span style="color: black;">必须</span>做胃镜取胃粘膜病理进行的快速尿素酶检测、胃黏膜组织切片 染色和胃黏膜Hp培养、核酸检测等。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">优点:</span>胃镜<span style="color: black;">能够</span>看到食管、胃十二指肠的病变<span style="color: black;">状况</span>,<span style="color: black;">能够</span>对幽门螺杆菌分型并确定抗生素耐药性,从而更好的<span style="color: black;">指点</span>用药。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">缺点:</span><span style="color: black;">检测</span>本身比较痛苦,操作相对<span style="color: black;">繁杂</span>,价格昂贵,在儿童中难以普及。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">况且</span><span style="color: black;">检测</span>本身的<span style="color: black;">敏锐</span>度并不高,<span style="color: black;">例如</span>快速尿素酶检测的<span style="color: black;">敏锐</span>度为75% - 100%,容易受取材部位细菌分布不均、试剂影响、环境温度和胃炎严重程度等<span style="color: black;">原因</span>影响,存在结果假阴性的可能。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://q0.itc.cn/q_70/images03/20240415/39e7277519d340f5b349bb7e00bde870.jpeg" style="width: 50%; margin-bottom: 20px;"></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">照片</span><span style="color: black;">源自</span>:</span><span style="color: black;">bigstock</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">非侵入性检测</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">便是</span>不<span style="color: black;">必须</span>胃镜这么痛苦的<span style="color: black;">检测</span>。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">包含</span><span style="color: black;">咱们</span>熟知的C13或C14呼气<span style="color: black;">实验</span>、粪便幽门螺杆菌抗原检测、血清幽门螺杆菌抗体检测。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">●</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">C13呼气<span style="color: black;">实验</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">操作简单,<span style="color: black;">没</span>痛苦,<span style="color: black;">敏锐</span>度和特异度较高,可反映全胃Hp感染<span style="color: black;">情况</span>,不会<span style="color: black;">显现</span>因细菌灶性分布而<span style="color: black;">导致</span>的假阴性结果。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C13尿素呼气<span style="color: black;">实验</span>并<span style="color: black;">无</span>放射性,适用于儿童,可用于诊断Hp现症感染,还可用于治疗后的复查,复查前务必停药间隔4周以上。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">缺点<span style="color: black;">便是</span>部分小年龄儿童,<span style="color: black;">尤其</span>是6岁以内,难以<span style="color: black;">协同</span>完成<span style="color: black;">吃下</span>含有C13的酸味试剂,难以<span style="color: black;">协同</span>呼气采样。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">●</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">粪便HP抗原检测</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">便是</span>采集<span style="color: black;">鲜嫩</span>大便2小时内送检,<span style="color: black;">敏锐</span>度97%~98%,特异度95%~100%,<span style="color: black;">敏锐</span>度和特异度都很好。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">检测</span>时不<span style="color: black;">必须</span>口服任何试剂,任何年龄组儿童都<span style="color: black;">能够</span>实施,<span style="color: black;">无</span>痛苦,<span style="color: black;">尤其</span>适合<span style="color: black;">做为</span>大规模流行病学调查。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">照片</span><span style="color: black;">源自</span>:</span><span style="color: black;">bigstock</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">日前</span>该<span style="color: black;">检测</span>还没能普及,可能与并不是所有医院配备了该检测试剂盒,<span style="color: black;">大夫</span>们对该<span style="color: black;">检测</span>的<span style="color: black;">认识</span>程度不同<span style="color: black;">相关</span>。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">3</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">●</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">血清抗体检测</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">敏锐</span>度和特异度都不算高。身体里的抗体只能反映感染过幽门螺杆菌,就算HP<span style="color: black;">已然</span>根除,血清抗体还<span style="color: black;">能够</span><span style="color: black;">连续</span>很久,<span style="color: black;">因此呢</span><span style="color: black;">没</span>法诊断现症感染。<span style="color: black;">通常</span>这个检测用于流行病学调查,不<span style="color: black;">做为</span>诊断和治疗依据。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">门诊经常会遇到外院查过幽门螺杆菌抗体结果来寻求治疗的<span style="color: black;">孩儿</span>,但我都会向家长说明抗体检测的局限性,<span style="color: black;">没</span>法诊断现症感染,并再次重新<span style="color: black;">评定</span>一下<span style="color: black;">孩儿</span>做进一步检测的必要性。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">宝宝家长</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">Q5. 什么<span style="color: black;">状况</span>下<span style="color: black;">必须</span>对儿童幽门螺杆菌感染进行根除治疗呢?</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">消化性溃疡、胃MALT淋巴瘤<span style="color: black;">必要</span>根治。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">以下<span style="color: black;">状况</span>可考虑根治:</span></strong></span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">●</span><span style="color: black;">慢性胃炎;</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">●</span><span style="color: black;">胃癌家族史;</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">●</span><span style="color: black;">不明<span style="color: black;">原由</span>的难治性缺铁性贫血;</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">●</span><span style="color: black;">计划<span style="color: black;">长时间</span><span style="color: black;">吃下</span>非甾体类抗炎<span style="color: black;">药品</span>(<span style="color: black;">包含</span>低剂量阿司匹林);</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">●</span><span style="color: black;">监护人、年长儿童<span style="color: black;">剧烈</span><span style="color: black;">需求</span>治疗。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">宝宝家长</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">Q6. <span style="color: black;">怎么样</span>进行儿童幽门螺杆菌感染的根除治疗呢?</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">分为常用的三联或四联疗法,疗程<span style="color: black;">通常</span>10-14天。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">其中<span style="color: black;">包含</span>2种抗生素(如阿莫西林、克拉霉素、或甲硝唑、替硝唑)+ 1种抑酸<span style="color: black;">药品</span>(如奥美拉唑),这三种<span style="color: black;">药品</span>搭配,叫做三联疗法。<span style="color: black;">倘若</span>再加上胶体铋剂(6岁以上),<span style="color: black;">便是</span>四种<span style="color: black;">药品</span>,叫四联疗法。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">但<span style="color: black;">日前</span>克拉霉素和甲硝唑的耐药性都较高,大大降低了根除成功率。文献<span style="color: black;">报告</span>,成都地区2012-2019年间对974例幽门螺杆菌感染的患儿进行根治治疗成功率仅69.82%<span style="color: black;"></span>,远<span style="color: black;">小于</span><span style="color: black;">目的</span>80%。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://q2.itc.cn/q_70/images03/20240415/78f2c28a8aa44912ba3e55129d9029eb.jpeg" style="width: 50%; margin-bottom: 20px;"></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">照片</span><span style="color: black;">源自</span>:</span><span style="color: black;">bigstock</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">成人常用的喹诺酮类<span style="color: black;">药品</span>或呋喃唑酮、四环素,并不适用于儿童。<span style="color: black;">引起</span>在现有<span style="color: black;">药品</span>高耐药率、低根除率的<span style="color: black;">状况</span>下可能<span style="color: black;">没</span>药可用。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">日前</span>幽门螺杆菌疫苗<span style="color: black;">科研</span><span style="color: black;">亦</span>在进行中,相信这<span style="color: black;">亦</span>将是<span style="color: black;">将来</span>的另一种<span style="color: black;">选取</span>。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">宝宝家长</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">Q7. 家长<span style="color: black;">怎样</span><span style="color: black;">帮忙</span><span style="color: black;">孩儿</span>预防幽门螺旋杆菌感染?</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">综上所述,要<span style="color: black;">注意</span>幽门螺杆菌感染,但成人和儿童<span style="color: black;">状况</span>不同,要正确认识它,<span style="color: black;">准许</span>它与儿童和谐共处。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">与其纠结于HP感染,不如综合考量<span style="color: black;">孩儿</span>的<span style="color: black;">详细</span><span style="color: black;">状况</span>,注重卫生习惯、改善生活方式才是最<span style="color: black;">要紧</span>的,<span style="color: black;">包含</span>饭前便后要洗手,<span style="color: black;">尽可能</span>分餐,公勺公筷,不共用水杯、刷牙杯,餐具清洁消毒。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://q6.itc.cn/q_70/images03/20240415/34ed1d1dd5d34bb9a58df512ff11ad6c.jpeg" style="width: 50%; margin-bottom: 20px;"></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;">照片</span><span style="color: black;">源自</span>:</span><span style="color: black;">bigstock</span></span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">很欢迎各位家长与我<span style="color: black;">一块</span>探讨<span style="color: black;">孩儿</span>们的消化问题,毕竟<span style="color: black;">每一个</span><span style="color: black;">孩儿</span>面临不同的问题,<span style="color: black;">咱们</span><span style="color: black;">详细</span>问题<span style="color: black;">详细</span>分析,<span style="color: black;">按照</span><span style="color: black;">危害</span>获益<span style="color: black;">评定</span>和<span style="color: black;">关联</span><span style="color: black;">疾患</span>状态进行管理,给<span style="color: black;">孩儿</span>找到一个最适合自己的<span style="color: black;">方法</span>。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">* 本文仅为科普,不<span style="color: black;">做为</span>诊疗依据,个人<span style="color: black;">状况</span>请遵医嘱。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">医</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">生</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">介</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">绍</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">金丽敏</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">和睦家京北院区</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">儿科门急诊<span style="color: black;">专家</span></span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">点击预约门诊</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">◆ 金丽敏<span style="color: black;">大夫</span>毕业于北京大学医学部,<span style="color: black;">得到</span>儿科临床医学硕士学位。毕业后在首都儿<span style="color: black;">研究</span>究所工作,于2014年加入北京和睦家医院。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">◆ 金<span style="color: black;">大夫</span>完<span style="color: black;">成为了</span>悉尼儿童医院和悉尼医学院举办的为期2年的悉尼儿童健康培训。<span style="color: black;">同期</span><span style="color: black;">拥有</span><span style="color: black;">基本</span>生命支持、儿童高级生命支持和新生儿复苏资质。<span style="color: black;">持有</span>ASQ-3和ASQ:SE-2量表、格里菲斯<span style="color: black;">生长</span>量表操作资质。参加了协和变态反应学习班,<span style="color: black;">拥有</span>过敏原制剂<span style="color: black;">运用</span>资质。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">◆ 金<span style="color: black;">大夫</span><span style="color: black;">持有</span>丰富的儿科临床经验,<span style="color: black;">善于</span>儿童<span style="color: black;">疾患</span>和保健<span style="color: black;">行业</span>。临床亚专业是儿童消化内科,<span style="color: black;">善于</span>儿童腹泻、喂养困难、<span style="color: black;">食品</span>过敏、腹痛、呕吐、便秘等儿童消化问题的诊断与治疗。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">参考文献:</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"> 谢川,吕农华。中国幽门螺杆菌感染的<span style="color: black;">状况</span>(A)。<span style="color: black;">疾患</span>监测,2018,33(4):272-275.</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"> 国家消化系<span style="color: black;">疾患</span>临床医学研究中心,等。中国居民家庭幽门螺杆菌感染的防控和管理专家共识(2021).中华消化杂志,2021,41(04).</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"> 李兴川,王海东,张妮,等.中国儿童及青少年幽门螺杆菌感染流行病学调查的系统<span style="color: black;">评估</span>和 meta 分析.临床儿科杂志,2017,35(10): 782-787.</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"> 刘伟,许春娣,等。上海地区不同家庭环境中儿童幽门螺杆菌感染的流行病学(J)。中国实用儿科杂志,2006,21(1):19-21.</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"> Okuda M,Lin YS,etc。Helicobacter Pylori infection in children and adolescents (J). Adv Exp Med Biol, 2019,1149:107-120.</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"> Masoodpoor N, Sheikhvatan M (2010) Helicobacter pylori infection in Iranian children with recurrent abdominal pain. Trop Gastroenterol 29(4):221–223。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"> Parisa Sabbagh, Mostafa Javanian, etc. Helicobacter pylori infection in children: an overview of diagnostic methods. European Journal of Clinical Microbiology &amp; Infectious Diseases(2019) 38:1035-1045.</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"> 中华医学会儿科学分会消化学组。儿童幽门螺杆菌感染诊治专家共识。中华儿科杂志,2015,53(7):496-498.</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"> 熊励晶、向梅,等。2012至2019年成都地区儿童幽门螺杆菌根除疗效及<span style="color: black;">关联</span><span style="color: black;">原因</span>分析(J)。中华临床医师杂志(电子版),2020,14(05)。</span><a style="color: black;"><span style="color: black;">返回<span style="color: black;">外链论坛:http://www.fok120.com/</span>,查看<span style="color: black;">更加多</span></span></a></p>

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youxijiasuqi 发表于 2024-8-29 00:26:29

我深受你的启发,你的话语是我前进的动力。

youxijiasuqi 发表于 2024-8-29 15:34:39

你的见解独到,让我受益匪浅,非常感谢。

4lqedz 发表于 2024-9-28 23:54:28

我深受你的启发,你的话语是我前进的动力。

4zhvml8 发表于 2024-9-29 08:05:16

感谢你的精彩评论,为我的思绪打开了新的窗口。

j8typz 发表于 2024-10-12 22:36:27

交流如星光璀璨,点亮思想夜空。
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