消化性溃疡(双语).pptVIP

消化性溃疡 概 念(Conception) 流 行 病 学(Epidemiology) 发病率 世界性常见病（人口10%） DU＞GU，约为2-3∶1 性别 男性＞女性 3.9-8.5∶1 年龄 DU：青壮年 20-50岁 GU：中老年 50-60岁 发作季节 冬春季常见 病 因 和 发 病 机 制 (Cause and Pathogenesis) 一 、侵袭因子(Aggressive factor) 1、 幽门螺杆菌（ H. pylori ） ⑴ HP的来源 ⑵ HP的流行病学 ⑶ HP与疾病的相关性 Great new discovery Many people have H. pylori infections Marshall and Warren the bacterium Helicobacter pylori(H pylori) 幽门螺杆菌（ H. pylori ）的致病机制 2 、胃酸和胃蛋白酶 3 、非甾体抗炎药（NSAIDs ） 4、 其他因素 2.Acid and pepsin Finally, the formation of peptic ulcers would rely on the digestive effect of acid and pepsin. Pepsin can decompose protein molecule, so H.p can invade mucus. The biologic activity of pepsin is depended on the pH value. When local pH value elevates to 4, pepsin can’t work well. So we often say that “No acid-pepsin active, no ulcer.” Gastric acid is the keyword of the formation of peptic ulcer. Duodenal ulcer: increased Gastric ulcer: normal or decrease 3.NSAID After H.p infection, NSAID is the next important cause of altered mucosal defence leading to peptic ulceration in the presence of activated pepsin. 4.stress 5. Heredity Patients with peptic ulcer often have a family history of ulcer, particularly the patient with DU that develop below the age of 20 years. Some studies show that blood group O have a high risk to developing peptic ulcer, but the pathogenic significant of these finding is uncertain. 二、黏膜防御因子(Mucosal defensive factor) 黏液和碳酸氢盐（mucus/bicarbonate barrier） 黏膜屏障(mucosa barrier) 黏膜的局部血流(mucosal blood flux) 细胞整复和更新(cellular metabolism) 其他：表皮生长因子（EGF）、前列腺素E （PGE） mechanism mecha