全景胃镜对十二指肠主乳头观察的随机对照研究

目的 探讨全景胃镜对十二指肠主乳头观察的效果和安全性。 方法 2017年3月至2017年12月在解放军总医院消化内镜中心接受无痛胃镜检查的患者按照随机化分组、自身对照原则，将符合入选标准的研究对象按就诊顺序编号，采用随机数字表法随机分为两组，分别进行普通胃镜检查（A组）或者全景胃镜检查（B组）。以十二指肠主乳头的观察情况作为主要评价指标，比较两组对十二指肠主乳头的观察率。 结果 根据入组标准共纳入100例患者，其中A组51例、B组49例。B组十二指肠主乳头全部观察率优于A组[7959%(39/49)比4118%(21/51),χ2=15366，P=0000]，而对十二指肠主乳头的总体观察率（全部、部分观察率之和）与A组比较差异无统计学意义[10000%(49/49)比9216%(47/51),χ2=2221，P=0136]。 所有患者顺利完成检查，无出血、穿孔、死亡等并发症发生。 结论 全景胃镜广阔的视野有效提高了十二指肠主乳头观察的有效性和安全性。     

Central and peripheral serotonergic influences on viscerovisceral inhibitory reflex during duodenal distension in sheep

The effects of duodenal distension on forestomach and abomasal motility were investigated in conscious sheep chronically fitted with intraparietal electrodes, a duodenal cannula, and an intracerebroventricular cannula. Duodenal distensions with a balloon inflated with 40 ml (DD40) of water reduced the frequency of forestomach and abomasal contractions by 45 and 32%, respectively, while distension with 80 ml (DD80) induced a total inhibition. Methysergide, a mixed 5HT₁-5HT₂ antagonist administered intravenously (200 g/kg) or intracerebroventricularly (20 g/kg) suppressed the DD40-induced inhibition and reduced that induced by DD80. Sprioxatrine, a selective 5HT_1A antagonist, intravenously (100 g/kg) or intracerebroventricularly (10 g/kg), suppressed the DD40 and DD80-induced inhibition, which was also attenuated by the 5HT₂ antagonist ritanserin given intravenously (200 g/kg) or intracerebroventricularly (20 g/kg). Granisetron, a 5HT₃ antagonist, injected intravenously (150 g/kg), abolished the effects of DD40 and DD80 while it had no antagonistic action on DD40 and DD80 when given intracerebroventricularly (15 g/kg). It is concluded that in sheep, duodenal distension inhibits forestomach and abomasal motility through 5HT_1A and 5HT₂ receptors at the level of the central nervous system and 5HT₃ receptors located peripherally.This work was presented in part at the First United European Gastroenterology Week, September 25–30, 1992, Athens, Greece.     

A citric acid solution is an optimal test drink in the 13C-urea breath test for the diagnosis of Helicobacter pylori infection.

BACKGROUND: The 13C-urea breath test (13C-UBT) is a simple, non-invasive and reliable test for the diagnosis of Helicobacter pylori infection. The duration of the test, the timing of breath sampling, and the accuracy of the method vary according to the test meal used. AIM: To identify the optimal test meal or drink for rapid and accurate performance of the 13C-UBT for the detection of H pylori infection. PATIENTS: Eighty patients with dyspeptic symptoms were included. Of these, 48 patients had a positive H pylori status and 32 a negative one according to the results of the rapid urease test, histological examination, and culture. METHODS: A 13C-UBT was performed after an overnight fast, on three consecutive days. On each study day a different test meal or drink was given (0.1 N citric acid solution, a standard semiliquid meal, or a semiliquid fatty meal) 10 minutes before giving 75 mg 13C-urea. Breath samples were collected at 0, 15, 30, 45, and 60 minutes, and analysed by isotype ratio mass spectrometry. Results were expressed as delta (delta) and considered as positive for H pylori if the highest delta (peak) was greater than 4.0. RESULTS: The delta peak obtained with the citric acid drink in H pylori positive subjects (24.1 (SEM 1.5)) was significantly higher than that obtained with any of the semiliquid meals (13.3 (SEM 1.1) and 17.1 (SEM 1.0) respectively, p < 0.001). Furthermore, this delta peak was obtained earlier with the citric acid drink (30 (SEM 2) minutes) than with the other two meals tests (53 (SEM 2) min and 45 (SEM 2) min, p < 0.001). The sensitivity of the 13C-UBT for the diagnosis of H pylori infection was 96-100% with all three test meals. This high sensitivity was, however, obtained from 15 minutes by giving citric acid as the test drink, from 45 minutes by giving a semiliquid fatty meal, and at 60 minutes by giving the semiliquid standard meal. The specificity was 100% for all test meals. Citric acid is inexpensive and palatable to patients. CONCLUSIONS: The 13C-UBT procedure with citric acid as the test drink is superior to the previously proposed semiliquid test meals in terms of 13CO2 recovery, time requirement, and cost. In routine clinical sampling, collection at times 0 and 30 minutes seems to be optimal and gives a high diagnostic accuracy.     

十二指肠球部和末端回肠黏膜菌群多样性分析

目的分析十二指肠球部与末端回肠正常状态下黏膜菌群多样性,比较不同部位菌群组成情况。方法选择胃镜及肠镜检查的健康体检者各15例,分别钳取十二指肠球部和末端回肠黏膜组织,使用16S rRNA测序法对球部和末端回肠黏膜组织进行生物信息分析。另外又选取8例球炎患者和15例末端回肠炎患者进行对比分析。结果球部黏膜菌群测得个28个门,397个属。末端回肠黏膜测得25个门,344个属。两个部位在门水平上均以梭杆菌门、变形菌门、厚壁菌门、拟杆菌门、放线菌门为主要菌群,球部优势菌群所占比例依次为49.43%、25.93%、8.68%、5.19%、5.76%;末端回肠优势菌群比例依次为38.30%、29.61%、17.56%、8.15%、3.70%。属水平球部黏膜以鲸甘菌属、气单胞菌属、贪铜菌属、不动杆菌属、梭菌属为主要菌群,比例依次为49.38%、6.42%、5.62%、4.78%、3.84%;末端回肠黏膜以鲸甘菌属、贪铜菌属、气单胞菌属、拟杆菌属、不动杆菌属为主要菌群,比例依次为37.56%、12.83%、4.2%、3.84%、2.74%。球部正常黏膜与炎症状态菌群组成差异有统计学意义（P＜0.05）。末端回肠正常黏膜与炎症状态菌群差异无统计学意义（P>0.05）。结论不同部位的肠道黏膜菌群分布存在差异,球部黏膜菌群比末端回肠黏膜菌群更多样。球部黏膜菌群失调参与炎症发生;末端回肠黏膜菌群在炎症状态下有轻微改变。     

甘草酸铋散联合泮托拉唑治疗十二指肠溃疡的临床研究

目的探讨甘草酸铋散联合泮托拉唑钠肠溶片治疗十二指肠溃疡的临床疗效。方法选取2018年2月—2019年2月在天津市西青医院治疗的十二指肠溃疡患者88例,按照治疗方法的差别分为对照组(44例)和治疗组(44例)。对照组口服泮托拉唑钠肠溶片,40 mg/次,1次/d;治疗组在对照组基础上口服甘草酸铋散,1 g/次,3次/d。两组患者经4周治疗。观察两组患者临床疗效,同时比较治疗前后两组患者症候积分、血清白细胞介素-1β(IL-1β)、白细胞介素-18(IL-18)、白细胞介素-23(IL-23)、血管内皮生长因子(VEGF)、高迁移率族蛋白1(HMGB1)、前列腺素E2(PGE2)、肾上腺髓质素(AM)、胃泌素(GAS)、生长抑素(SS)和降钙素基因相关肽水平(CGRP)水平,及GQOL-74量表评分。结果治疗后,对照组和治疗组临床有效率分别为81.82%和97.73%,两组比较差异有统计学意义(P0.05)。治疗后,两组患者症候积分显著下降(P0.05),且治疗组患者这些症候积分明显低于对照组(P0.05)。治疗后,两组患者血清AM、GAS、IL-1β、IL-8、IL-23和HMGB1水平水平均明显下降(P0.05),而CGRP、SS、VEGF和PGE2水平均明显升高(P0.05),且治疗组患者这些细胞因子水平明显好于对照组(P0.05)。治疗后,两组患者GQOL-74量表评分均明显升高(P0.05),且治疗组患者GQOL-74量表评分明显高于对照组(P0.05)。结论甘草酸铋散联合泮托拉唑钠肠溶片治疗十二指肠溃疡可有效改善患者临床症状,降低机体炎症反应,促进溃疡愈合。     

Combining desloratadine and pseudoephedrine in the treatment of seasonal allergic rhinitis

Nonsedating antihistamines are a first-line therapy in the management of allergic rhinitis. They relieve the majority of the histamine-mediated symptoms of the condition, including rhinorrhea, sneezing, and pruritus. The nonsedating antihistamine desloratadine is effective in alleviating the symptoms of both seasonal and perennial allergic rhinitis. It may also have some decongestant properties, and thus help to alleviate nasal congestion. Administering desloratadine in combination with the decongestant pseudoephedrine may offer allergic rhinitis patients with moderate-to-severe nasal congestion the benefits of desloratadine’s effectiveness for alleviating histamine-mediated symptoms plus pseudoephedrine’s relief from nasal congestion. This drug profile reviews a combination therapy containing desloratadine and pseudoephedrine, approved in the USA for the relief of the symptoms of seasonal allergic rhinitis, including nasal congestion.     

憩室切除术治疗十二指肠乳头旁憩室的疗效

十二指肠憩室是一种常见疾病,好发于十二指肠降部.60％ ～ 70％的十二指肠憩室发生于十二指肠降部乳头周围2～3 cm处,称为十二指肠乳头旁憩室.本研究回顾性分析2006年5月至2010年10月我中心采用憩室切除术治疗3例十二指肠乳头旁憩室患者的临床资料,探讨该手术方式的适应证和疗效.     

消化道疾病患儿血清抗组织谷氨酰胺转移酶抗体阳性病例分析

目的 对消化道疾病住院儿童中的抗组织谷氨酰胺转移酶(tTG)抗体阳性病例进行分析,探索适合我国儿童乳糜泻疾病诊疗的血清学检测.方法 采用ELISA方法检测患儿血清中tTG抗体IgA和IgG,采用间接免疫荧光法检测患儿血清中的抗肌内膜抗体(EMA)和麦胶蛋白抗体(AGA) IgA和IgG.收集所有患儿临床资料,包括小肠黏膜病理分析等.结果 162例患儿中,11例血清IgA-tTG和IgG-AGA阳性.11例中,2例tTG、EMA和AGA全部阳性,3例伴有IgMIgG-EMA和IgA-AGA阳性,1例伴有IgG-EMA可疑阳性、IgA-EMA和IgA-AGA阳性,4伴有IgA-EMA和IgA-AGA阳性,1例伴有IgG-tTG可疑阳性.以上11例IgA-tTG和IgG-AGA阳性患儿十二指肠黏膜都有中重度以上程度损害,8例并发心肌损害、肝功能损害、营养不良、生长发育迟缓等.其中7例临床诊断为乳糜泻、且无麸质饮食试验治疗有效.结论 11例IgA-tTG阳性患儿3种血清抗体检测结果与十二指肠黏膜病理活检相符.血清抗体,特别是tTG检测可以更快更早地帮助临床诊断乳糜泻.     

36例新生儿环状胰腺的诊治分析

目的 总结小儿环状胰腺的产前诊断、围产期管理、早期手术的系统化诊疗.方法 选取2007年9月至2015年3月我院收治的36例产前诊断为环状胰腺患儿的病例资料,对其产前诊断、围产期管理、影像学检查、手术治疗及预后等资料进行回顾性分析.结果 同期收治产前超声诊断为十二指肠梗阻的52例患儿中,36例手术证实为环状胰腺.产前超声检查显示“双泡征”30例,“羊水过多”24例.其中30例分娩后当日即转运至我院,行十二指肠一十二指肠菱形吻合术治疗,均痊愈出院.结论 产前诊断、生后按计划转诊、早期手术治疗逐渐成为环状胰腺的主流管理模式.新生儿腔镜技术的发展应用进一步提高了本病疗效.