消化性溃疡形成的原因-英文课件.ppt

武汉大学 ThecausesaboutPepticUlcer 消化性溃疡的形成原因 causes aggressivefactors defensivefactors pepticulceroccur AggressiveFactors 3 Gastricacidandpepsin 胃酸与胃蛋白酶 2 Adverseeffectsofdrugs suchasNSAID 1 Helicobacterpyloriinfection 幽门螺杆菌感染 4 others 1 Helicobacterpylori H p theevidences thedetectionrateofH pinGUisapproximately70 80 thedetectionrateofH pinDUisapproximately90 EradicationofH pwouldboostthehealingofulcer HowcanH pdestroylocalmucosaldefective repairedmechanism 1 colonizethegastricmucosa 胃粘膜 2 increasedacidsecretion 2 NSAID AfterH pinfection NSAIDisthenextimportantcause ResearchdatashowthatNSAIDuseinpatientswithpepticulcerandtheriskofcomplicationswassignificantlyhigherthanthegeneralpopulation Byweakeningmucosaldefenseandrepairfunctionseventuallyleadtopepticulcer 案例展示 3 Acidandpepsin Theeventualformationofpepticulcerisduetoacidandpepsindigestionofthemucosaitself BecausethebiologicactivityofpepsinisdependedonthepHvalue WhenlocalpHvalueelevatesto4 pepsincan tworkwell Soweoftensaythat Noacid noulcer 4 Otherriskfactors 1 SmokingSmokingisanincreasedriskofpepticulcer Smokingcanaffectthehealingofulcer accelerateulcerrecurrence andincreasedcomplicationofulceration Butthemechanismisn tclear 2 HeredityPatientswithpepticulceroftenhaveafamilyhistoryofulcer AndsomestudiesshowthatbloodgroupO O型血人群 haveahighrisktodevelopingpepticulcer 3 StressHighstresscanstimulatevagusnerve 交感神经 whichcanresultinhighsecretionofacid 4 Abnormalgastroduodenallocomotion胃十二指肠功能异常DU quickgastricempty overfullacidloadfoodstorageGU movementobstruction refluxdigestiveliquid阻滞 1 Highacidsecretion2 AggravatingH pinfection3 IncreasedbadeffectofNSAID DefensiveFactors 2 MucosaBarrier 粘膜屏障 1 Mucus BicarbonateBarrier 粘液 碳酸氢盐屏障 3 MucosalBloodFlux 胃粘膜血流屏障 4 Others 1 Mucus BicarbonateBarrier Thefirstlineofdefenseismucusandbicarbonatesecretion 粘液和碳酸氢盐的分泌 ItstabilizesthepHbetweenthelumenandthesurfaceepithelialcells Mucusgel 粘液凝胶 inpatientswithH pinfectionwasfoundtobestructurallyweak 2 MucosaBarrier Thesecondlineofdefenseistheintrinsicepithelialcelldefense 上皮细胞防御 粘膜屏障 Themucosalsurfaceisabarriertoacidbackdiffusionthusmaintainingnormalintracellular 细胞内 pH 3 MucosalBloodFlux Thethirdlineofdefenseistherichmucosalbloodflow 丰富的粘膜血流屏障 Thebloodprovidesabufferforacidneutralization 中和 aswellasadequatenutritionforthemetabolic 代谢 demandtomaintainmucosalintegrity 4 Others Prostaglandin 前列腺素 canreducethesecretionofacid Feedbackregulationofgastricsecretio