清除H pylori有助於慢性開角型青光眼的治療

成功清除H pylori後,有助於眼內壓和視野的改善

  2002年6月11日報導─Helicobacter pylori感染已被發現與慢性開角型青光眼的發生有關,而《Archives of Internal Medicine》雜誌6月10日一期中報導的一項研究的結果顯示,清除Helicobacter pylori的感染有助於改善患者的治療結果。

  希臘馬其頓地區Thessaloniki的醫師,Jannis Kountouras博士寫道:「清除H pylori可以正向的影響青光眼患者的病情,這提示,H pylori和青光眼可能存在病因學關聯。」

  研究者們對41名青光眼患者和30名進行了年齡配比的貧血患者,進行了上消化道內窺鏡和胃粘膜病理檢查,採用組織病理檢查和快速尿素酵素檢測(CLOtest)的技術,檢查H pylori的感染情況。唾液也用CLOtest方法進行了檢測,採用並聯免疫吸附試驗檢測血清抗H pylor特異的IgG抗體。所有的患者接受了為期2年的抗青光眼治療,而H pylor感染陽性的患者還服用omeprazole、clarithromycin、和amoxicillin來清除感染。

  證據顯示,88%的青光眼患者存在H pylori的感染,而對照中,只有47%的人存在H pylori的感染(P < 0.001),藥物治療組的患者中,有83%的人成功的清除了H pylori的感染。完全清除H pylori感染的患者,而不是其他患者,其平均眼內壓和平均視野參數在2年的治療中得到改善(眼內壓是P < 0.001,視野參數是P < 0.01)

  作者強調應進行進一步的研究澄清其中的問題,同時寫道:「現有的結果顯示,清除感染可以在一定程度上可以改善眼睛中液體的流出。可能的機制是H pylor誘導多種中間介質(例如,細胞激酵素)的產生,而這些物質對眼內液體的排除系統正是會損害的。」

H pylori Eradication Benefits Chronic Open-Angle Glaucoma

Intraocular Pressure, Visual Fields Improve With Successful Eradication

By Laurie Barclay, MD
WebMD Medical News

Reviewed by Gary D. Vogin, MD

June 11, 2002 -- Helicobacter pylori infection has previously been linked to chronic open-angle glaucoma, and results of a study reported in the June 10 issue of the Archives of Internal Medicine suggest that eradicating the infection may improve outcome.

"H pylori eradication may positively influence glaucoma parameters, suggesting a possible causal link between H pylori and glaucoma," write Jannis Kountouras, MD, PhD, from Thessaloniki in Macedonia, Greece.

The investigators performed upper gastrointestinal endoscopies and gastric mucosal biopsies on 41 patients with glaucoma and 30 age-matched anemic controls to detect H pylori infection by histologic analysis and rapid urease test (CLOtest). Saliva was also tested with CLOtest, and enzyme-linked immunosorbent assay detected serum anti-H pylori-specific IgG. All patients received stable antiglaucoma therapy for 2 years, while H pylori-positive patients also received omeprazole, clarithromycin, and amoxicillin for eradication.

There was evidence of H pylori infection in 88% of glaucoma cases and in 47% of controls (P < 0.001), and eradication was successful in 83% of treated patients. In patients with successful eradication, but not in other patients, mean intraocular pressure and mean visual field parameters improved over 2 years (P < 0.001 for intraocular pressure; P < 0.01 for visual field parameters).

"Results of the present study suggest that eradication therapy may somehow improve the outflow facility of the eye," the authors write, noting that additional studies are needed to help elucidate the mechanism. "It is conceivable that H pylori induces the synthesis of various mediators (e.g. cytokines), which may be detrimental to the outflow system."

© 2002 WebMD Inc. All rights reserved.

    
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