幽门螺杆菌在人体的角色之谜:游离于寄生菌和病原体之间
在过去的半个世纪内，幽门螺杆菌的成功分离使胃肠病学家、免疫学家、遗传学家、病理学家和微生物学家对胃十二指肠疾病的认识发生了重大变化。但是近十几年的研究结果显示，幽门螺杆菌感染相关疾病往往只发生于40岁以上的人群，而且幽门螺杆菌阴性亦与一些新兴疾病的发生相关，尤其在青少年群体中。幽门螺杆菌定植的不同结果导致了于幽门螺杆菌的两种相反的观点：“好的”和“坏的”幽门螺杆菌菌。这也说明我们需要对幽门螺杆菌进行重新审视，其有可能是古代人类胃微生物中的正常一员，只是随着环境的变化，在人类体内正逐渐消失。
译者小结：根据近年来人们对幽门螺杆菌和胃肠外疾病关系的研究结果，有学者提出该细菌可能与某些免疫相关疾病如哮喘、炎症性肠病等呈负相关。结合随着历史上人类迁徙的幽门螺杆菌的迁徙，有人提出幽门螺杆菌原本就是胃内定植菌的假说。对于“好”菌和“坏”菌的争论由来已久。在争论与探索中，无论怎样曲折，总会离真理越来越近。
Best Pract Res Clin Gastroenterol. 2014 Dec;28(6):1017-29. doi: 10.1016/j.bpg.2014.09.003. Epub 2014 Sep 28.
Helicobacter pylori: the balance between a role as colonizer and pathogen.
Otero LL1, Ruiz VE2, Perez Perez GI3.
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Abstract
The isolation of Helicobacter pylori from the human stomach produced significant changes in how gastroenterologists, immunologists, epidemiologists, pathologists and microbiologists have approached gastro-duodenal diseases in the last half of the XX century. However, research of this organism has progressed greatly in the first decade of this century, evidence suggest that H. pylori is associated with disease only in humans older than 40 years, while, the lack of H. pylori colonization is associated with the emergence of new diseases, particularly in younger individuals. These differing effects of H. pylori colonization have created two contrasting concepts: the 'bad' and the 'good' Helicobacter. Following from renewed interest in the normal human microbiome, we need to reconsider our definitions and perhaps recognize that H. pylori might be a normal member of the human gastric microbiome in ancient humans that gradually, as results of the improvement in our environment, is disappearing.
Copyright © 2014 Elsevier Ltd. All rights reserved.
KEYWORDS:
Commensal; Gastric microbiome; Helicobacter pylori; Pathogen
幽门螺杆菌感染阴性的MALT的胃边缘区B细胞淋巴瘤患者的预后良好。
背景：幽门螺杆菌根除治疗在胃黏膜相关性淋巴样组织淋巴瘤（MALT）患者中被推荐作为一线疗法。但是对于HP阴性的MALT患者的治疗和临床过程观察的相关报道比较少。
目的：评估幽门螺旋杆菌阴性的胃MALT淋巴瘤患者的治疗结果。
方法：该研究对21例（13男8女;平均年龄63.9年，范围43 - 80）Hp阴性MALT患者进行了回顾性分析。通过组织学检查，快速尿素酶试验，或13C尿素呼气试验以及血清学检查等方法鉴定HP的阴性结果。随访时间为56.4（5 - 142）个月。
结果：
有10例患者接受了HP根除治疗，这10例患者中4例在接受Hp根除治疗后未再接受其他治疗，另外6例患者后续接受了手术、放疗、化疗等治疗。此外的11例未接受了HP根除治疗的患者中，3例接受了放疗，1例化疗，2例口服PPIs治疗,4例未接受一线治疗，2例未接受作为二线疗法的放疗，1例治疗情况不明。21例患者中13例患者完全缓解，7例患者显示部分组织残留。总体和无病生存率分别为95％和90％。
结论：HP阴性MALT患者具有较好的预后。研究者支持对MALT淋巴瘤微小组织学残留的患者实行初始幽门螺杆菌根除治疗和之后的“观察-等待”结合的治疗策略。对于对根除治疗无效的患者也可通过放化疗达到成功治疗的目的。
译者小结：研究者通过小样本的幽门螺杆菌阴性的MALT淋巴瘤患者治疗的回顾性分析，得到其多数预后较好的结论。并推荐初始根除细菌治疗+随访观察的治疗策略。作者认为即使对根除治疗无效的病例，放化疗依然有效。
Z Gastroenterol. 2014 Dec;52(12):1389-1393. Epub 2014 Dec 4.
Patients with Helicobacter pylori negative gastric marginal zone b-cell lymphoma (MZBCL) of MALT have a good prognosis.
Al-Taie O1, Al-Taie E1, Fischbach W2.
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Abstract
Background: In current guidelines H. pylori eradication is recommended as first-line therapy in patients with gastric MALT lymphoma irrespective of stage and H. pylori status. However, data on treatment and clinical course of patients with H. pylori negative MALT lymphoma are rare. Aim: To evaluate therapeutical results in patients with H. pylori negative gastric MALT lymphoma. Methods: 21 patients (13 male and 8 female; 63.9 years, range 43 - 80) with gastric MALT lymphoma were analysed retrospectively on the basis of medical reports in all cases and repeated outpatient visits at our center in 17 cases. H. pylori infection was excluded by negative histology, rapid urease test, or C13 urease breath test, and serology in all cases. Follow-up was 56.4 (5 - 142) months. Results: Ten of 21 patients were treated with H. pylori eradication, and four of them received no further therapy. The other six patients underwent surgery, chemotherapy, and radiation, after eradication therapy. Those eleven patients without H. pylori eradication received radiation (n = 3), chemotherapy (n = 1), PPIs (n = 2), no treatment (n = 4) as first-line and radiation (n = 2) as second-line therapy while initial therapy remained unknown in one case. 13 patients (61.9 %) reached complete remission of lymphoma, and seven patients (33.3 %) showed minimal histological residuals. Overall and disease-free survival was found in 95 % and 90 %, respectively. Conclusion: Patients with H. pylori negative gastric MALT lymphoma have a good prognosis. We favor initial H. pylori eradication therapy and a watch-and-wait strategy in case of minimal histological residuals of MALT lymphoma. Non-responders to eradication therapy can be successfully treated by radiation and chemotherapy.