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

2008)HpHpIbBHp200813142-46Malfertheiner 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-2008)(2007)HpHpHp2008),HpIA

WGO-OMGE 200712140-52Fock KM, Talley NJ, Moayyedi P, et al. Asia Pacific consensus guideline on gastric cancer prevention. J Gastroenterol Hepatol 2008;23:351-365.

HP

(1)()

(2) Hp

313C/14CUBT . 4Hp

(1)()

(2) Hp ;

(3);

(4)13C/14CHP

HP413C14CHp

HPHpHp,MALT

13/14 C-

13C 14C(1):Hp,Hp,.,CO2.(2):,13C 14C(13C 14C UBT).

13C Urea Breath Test (UBT)

14C-UBT4

13C-UBTbase-line breath

drugtest breath30 minutes4test breath30 minutes25 minutes

C13C13Hp,90%100%

C13

Gomolln F .Dig Liver Dis. 2003 Sep;35(9):612-8

145 2 Hp 3 4 5NSAID6Hp

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14C

13C : 14C : 5730 years 10-12 days

14C-UBT 14C-UBTs 1 X1/7 1/1000 Pathak CM.Nucl Med Commun. 2010 Sep;31(9):830-51Ci (37 KBq)

1 20Sv(3 mSv)

14C

714

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4

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Kobayashi D.J Med Microbiol. 2002 Apr;51(4):305-11Research 1

Research 2Matthews GM.J Gastroenterol Hepatol. 2005 Feb;20(2):270-4

Tummala S.Dig Dis Sci. 2007 Feb;52(2):396-401. Epub 2007 Jan 12.

Research 313/14 C-urea13/14 C-urea

Conflicting research results

13/14 C-

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.*Wong 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.*Fock KM, Talley NJ, Moayyedi P, et al. Asia Pacific consensus guideline on gastric cancer prevention. J Gastroenterol Hepatol 2008;23:351-365.***20081HPMALTHpNSAIDHpMenetrier**HpHp**