Graham D Y, Evans D G, Evans D J
Department of Medicine, Baylor College of Medicine, Houston, Texas.
J Clin Gastroenterol. 1989;11 Suppl 1:S43-8.
Campylobacter pylori causes type B gastritis and C. pylori infection has been associated with duodenal ulcer, gastric ulcer, non-ulcer dyspepsia, and gastric cancer. Although we have been able to culture C. pylori for only about 5 years, what we now know about this organism can explain many mysteries surrounding peptic ulcer disease. Whenever one investigates a population of ulcer patients for the presence of any accepted potentially important pathogenetic factors, one finds that the population of patients with duodenal ulcer disease differs (statistically) from those without duodenal ulcer disease, but that to a large degree they also overlap. None of the traditional factors can be considered essential and characteristic of chronic duodenal ulcer. The exception is the presence of a C. pylori infection, the presence of which is almost invariable. Several properties of C. pylori have been identified that might be virulence factors, including (a) provoking a marked acute and chronic inflammatory response, (b) rapid motility through gastric mucus, (c) urease activity, (d) a fibrillar adhesin(s), (e) several putative exotoxins, and (f) microinvasion. We can now add to the old dictum "no acid-no ulcer," "no C. pylori-no ulcer" at least as far as chronic duodenal ulcer disease in adults is concerned.
幽门螺杆菌可引起B型胃炎，幽门螺杆菌感染与十二指肠溃疡、胃溃疡、非溃疡性消化不良及胃癌相关。虽然我们能够培养幽门螺杆菌的时间仅约5年，但我们目前对这种微生物的了解可以解释许多围绕消化性溃疡病的谜团。每当有人调查溃疡患者群体中是否存在任何公认的潜在重要致病因素时，都会发现十二指肠溃疡病患者群体与无十二指肠溃疡病患者群体（在统计学上）存在差异，但在很大程度上他们也有重叠。没有任何传统因素可被视为慢性十二指肠溃疡的必要和特征性因素。唯一的例外是幽门螺杆菌感染的存在，其存在几乎是恒定不变的。已确定幽门螺杆菌的几种特性可能是毒力因子，包括（a）引发明显的急性和慢性炎症反应，（b）通过胃黏液快速运动，（c）尿素酶活性，（d）一种或多种纤维状黏附素，（e）几种假定的外毒素，以及（f）微侵袭。就成人慢性十二指肠溃疡病而言，我们现在可以在古老的格言“无酸无溃疡”之外再加上“无幽门螺杆菌无溃疡”。
