摘要
幽門螺旋桿菌是世界上最常見的致病菌之一，世界上50%的人口體內帶有此菌，此菌與十二指腸潰瘍、胃潰瘍、胃炎與胃癌的發生關係密切，但大多數的人臨床並無症狀。雖然自發現幽門螺旋桿菌以來已過了二十多年的光陰，但幽門螺旋桿菌如何傳播，仍無定論。牙菌斑及牙周囊袋能提供微氧的環境，有利於微需氧的幽門螺旋桿菌生長，幽門螺旋桿菌最主要是靠人和人之間的相互感染所傳播，至於除了胃部，口腔是否也是幽門螺旋桿菌的儲存槽，藉此造成胃部幽門螺旋桿菌的再感染至今仍是具有爭議性。 目的:本研究的目的在探討胃部及牙菌斑中之幽門螺旋桿菌彼此的關係，以及牙菌斑控制能否有助幽門螺旋桿菌的根除治療。 材料與方法：本研究對象為初次至高雄醫學大學胃腸內科接受胃鏡檢查之患者42位，排除條件包括曾接受過腸胃道手術、無牙、以及一個月內曾接受藥物治療（包括質子幫浦抑制劑、抗生素、鉍鹽）者。所有患者均接受胃鏡檢查並同時於胃竇及胃體部切片，施行快速尿素酶測試、細菌培養、組織學檢查及13-C尿素呼氣試驗，並以幽門螺旋桿菌培養陽性或其他三項中二項陽性為胃部幽門螺旋桿菌陽性。在胃鏡檢查當天，收集患者牙菌斑樣本並記錄患者之牙菌斑指數、牙齦指數及牙周囊袋深度，以快速尿素酶測試及聚合酶鏈鎖反應檢測cagA基因。再依參加者的意願，是否接受全口洗牙和口腔衛生教導。這些患者經藥物治療四個月後，胃部以13-C尿素呼氣試驗檢測而牙菌斑做和之前相同的檢測，以確定幽門螺旋桿菌根除治療的結果。 結果：在接受全口洗牙方面，願意接受全口洗牙之口中牙菌斑及胃部治療前為幽門螺旋桿菌陽性而治療後為陰性者約占44.00%及48.00%，全口洗牙對消除口中牙菌斑幽門螺旋桿菌達統計顯著，但對胃部幽門螺旋桿菌未達統計顯著，不過對整個根除治療仍具有正面的趨向。不願接受全口洗牙者在根除治療後，牙菌斑中仍有幽門螺旋桿菌存在，顯示抗生素可能無法有效根除牙菌斑中的細菌。牙菌斑指數、牙齦指數及牙周囊袋深度明顯在牙菌斑中幽門螺旋桿菌為陽性者高於陰性者，顯示口腔衛生對幽門螺旋桿菌的感染與否具有影響。 結論：1.牙菌斑中有幽門螺旋桿菌的存在，2. 全口洗牙對整個幽門螺旋桿菌根除治療有正面的影響且3.口腔衛生對幽門螺旋桿菌的感染有關聯性。口腔也許有可能成為幽門螺旋桿菌的儲存槽，為胃部再感染的來源之一。
並列摘要
Background: Helicobacter pylori is one of the most common pathogens worldwide,and approximately 50% of the world population is infected with it . Many investigators had reported strong correlation between H. pylori and duodenal ulcer, gastric ulcer, gastritis, and even gastric cancer, but most of all have no clinical symptom . Microaerophilic acidic environment of dental plaque can be an ideal environment for growth of H pylori. However, whether dental plaque is a potential reservoir for gastric H. pylori reinfection remains controversial. Objective : The aim of this study is to investigate the relationship of H. pylori in the stomach and dental plaque, and plaque control would benefit therapy of gastric ulcer by full mouth scaling. Material & Methods: forty-two patients who first received gastric endoscopic biopsy in Kaohsiung Medical University Hospital were enrolled in our study. Patients were excluded if they were edentulous or had received gastrointestinal tract surgery and medical therapy that may alter the results (include proton pump inhibitors, antibiotics and compounds containing bismuth) within one month. Gastric specimens were obtained from gastric antrum and body, and were assessed by rapid urease test, culture, histology and 13-C urea breath test. Gastric H. pylori infection was confirmed when the culture was positive or a concordance of two of the other three tests was positive. At the same day of endoscopy ,dental plaque specimens were collected after recording the plaque index、 gingival index and probing depth of patients, and then assessed by rapid urease test (RUT) and polymerase chain reaction (PCR) (cagA gene). According to patients’mind to receive full mouth scaling and oral hygiene instruction, or not. Four months after H. pylori eradication therapy for 4 months, above assessments were repeated to confirm the outcome of therapy. Results: Those patients to receive full mouth scaling and oral hygiene instruction H. pylori before eradication therapy is positive and after is negative in dental plaque and stomach is 44% and 48 % individually. It shows that plaque control has a tendency towards eradication therapy of H. pylori . The existence of H. pylori in the dental plaque after the eradication therapy indicated that the antibiotics might not be as effective in such a biofilm as in the stomach and oral cavity . It shows that the presence of H. pylori in dental plaque is one of the risk factors of gastric infection. The fact that the plaque index、 gingival index and probing depth of gastric H. pylori (+) patients were significantly higher than gastric H. pylori (-) patients suggested that oral hygiene is important to gastric H. pylori infection status. Conclusions: 1.Oral cavity is a reservoir of H. pylori,2. plaque control has a tendency towards eradication therapy of H. pylori , 3. oral hygiene is important to gastric H. pylori infection status .The existence of H. pylori in the dental plaque after the eradication therapy infers that the recolonization of H. pylori from dental plaque may be a source of the transmission and recrudescence of gastsric infection.