消化系统疾病

·240·中国医学文摘·内科学1996年第17卷第3期 ,62228人胃、十二指肠粘膜55、AVP、EK和p一EP含量测定及其临床/张宏博…//第四军医大学学报一1995,16(3)一208一210 研究十二指肠溃疡(DU)24例、胃溃疡(GU)15例及慢性浅表胃炎对照组20例,结果示精氨酸加压素(AVP)、生长抑素(55)、脑啡肤(EK)和p一内啡肤(月一EP)在人胃、十二指肠皆有分布;粘膜EK、母一EP和AVP增高及55减低可能与DU发病有关;DU粘膜EK、俘一EP和AVP增高可能与55分泌减少有关。表2参6(杨直) ,62229 150例临床诊断“胃病”与胃镜诊断误差分析/场同明刀实用医学杂…     

十二指肠溃疡伴Hp~ 胃窦炎时胃窦生长抑素含量与mRNA表达

目的探讨十二指肠溃疡（DU）伴幽门螺杆菌（Hp）相关性胃窦炎时胃实生长抑素（SS）含量与mRNA表达方法采用放免法测定26例活动期DU（Hp检查均阳性）及24例非溃疡对照组（Hp检查6例阳性）胃窦粘膜组织SS含量，应用免疫组织化学方法检查D细胞的数量SSmRNA基因表达采用Northernblot和斑点杂交方法分析测量结果活动期DU26例，胃窦粘膜湿重组织SS含量为266ng／g±56ng／g±56ng／g，非溃疡对照组胃窦粘膜SS含量为335ng／g±110ng／g，两者相比差异非常显著（P＜0．01）活动期DU胃窦粘膜D细胞计数为36±13／mm2，明显少于非溃疡对照组59±42／mm2（P＜0．01）活动期DuSSmRNA水平（A）为0．52±0．11，较非溃疡对照组3．26±0．84显著降低（P＜0．01）．结论Hp感染引起中重度胃窦炎导致胃窦粘膜D细胞数量减少，同时SSmRNA基因转录及合成功能降抵，粘膜组织中SS含量减低，进一步可导致DU的发生．     

消化性溃疡患者血浆促胃液素及胃动素浓度和胃肌电节律的改变

[目的]观察胃溃疡(GU)、十二指肠球部溃疡(DU)患者胃肌电节律紊乱的发生率,及血浆促胃液素(GAS)、胃动素(MOT)在其中的临床意义。[方法]DU患者22例,GU15例,与慢性胃炎20例作对照组行餐前体表胃电图检查,并进行空腹血浆GAS、MOT检测。[结果]根据正常胃慢波百分比,DU组、GU组和对照组胃电节律异常者分别占45.5%、53.3%、20.0%,血浆GAS浓度分别为(73.84±32.25)、(80.45±27.18)及(44.94±27.56)ng/L,DU组和GU组均显著高于对照组(P<0.01),血浆MOT浓度分别为(423.47±315.92)、(610.85±331.66)(、201.19±156.23)ng/L,各组差异均有统计学意义(P<0.05)。[结论]消化性溃疡患者有胃肌电节律改变,可能由血浆GAS、MOT分泌异常所致。     

幽门螺杆菌对十二指肠球部溃疡患者生长抑素的影响

应用放免法测定23例十二指肠球部溃疡(其中17例Hp阳性,6例Hp阴性)患者血浆及胃窦组织生长抑素含量(SS),9例Hp阴性的浅表性胃炎为对照组。结果:3组血浆SS含量无明显差异(P>0.05);十二指肠球部溃疡Hp阳性组和Hp阴性组胃窦组织SS分别为7.05±1.67pg/mg湿重和8.35±3.2pg/mg湿重,与对照组(14.55±1.8pg/mg湿重)相比有显著性差异(P<0.002,P<0.05),但Hp阳性组十二指肠球部溃疡与Hp阴性组相比无明显差异。结论:胃窦生长抑素降低与十二指肠球部溃疡胃酸分泌异常有关,而Hp似与之无关联。     

十二指肠溃疡伴Hp相关性胃窦炎时生长抑素含量与D细胞超微结构研究

目的探讨十二指肠溃疡（DU）伴幽门螺杆菌（Hp）相关性胃窦炎时生长抑素（SS）含量与D细胞超微结构变化。方法采用放免法测定52例活动期十二指肠溃疡及60例非溃疡对照组空腹血浆及胃窦粘膜组织中SS含量，同时应用免疫组化及免疫电镜分别于光镜和透射电镜下观察了粘膜组织中D细胞的数量和超微结构。结果42例Hp阳性DU患者，胃窦粘膜病理多呈中重度炎性变化；血浆及粘膜组织中SS含量显著降低（P＜0．01），D细胞数量显著减少（P＜0．01）。粗面内质网扩张，核糖颗粒脱失。结论由于Hp相关性胃窦炎的影响，DU患者胃窦D细胞数量上减少，合成和分泌SS功能亦降低。     

幽门螺杆菌相关性十二指肠溃疡与胃肠激素的关系

目的探讨幽门螺杆菌（Hp）相关性十二指肠溃疡（DU）患者Hp根除前后胃粘膜及血中促胃液素（Gas）和生长抑素（SS）含量变化的意义．方法采用放射免疫分析法测定Hp相关性DU患者42例Hp根除前后及正常对照者20例胃粘膜及血中Gas和SS含量结果Hp相关性DU的患者胃粘膜及血中Gas的含量明显高于Hp阴性患者（粘膜：ng／g，226±65vs380±98；血清：ng／L，107±33vs50±8），而Hp根除后Gas含量则明显下降Hp阳性者SS的含量低于HP阴性患者（粘膜：ng／g，11±2us42±8；血浆：ng／L，5．6±1．2vs10．2±2．3），Hp根除后正含量显著升高．Hp感染时胃粘膜炎细胞浸润程度对Gas和SS的含量亦有一定影响结论Gas和SS与Hp相关性DU密切相关是参与DU发病的重要因素之一     

胃癌患者胃窦粘膜TNF-α含量的检测及临床意义

目的:探讨胃癌患者胃窦粘膜TNF-α含量与胃癌间关系。方法:应用放射免疫法(RIA)检查92例接受胃镜检查的患者胃窦粘膜TNF-α含量,比较胃癌与非癌性胃十二指肠患者之间的差异。其中胃粘膜正常者5例,单纯性慢性胃炎(CG)30例。十二指肠球部溃疡(DU)35例,胃癌(GCa)22例。结果:GCa患者胃窦粘膜TNF-α明显高于CG组及组织正常胃粘膜(p<0.05),但与DU组比较无明显差别(p>0.05)。结论:TNF-α含量在胃癌患者胃窦部增高,但与DU组比较无明显差别。提示TNF-α与胃癌发生、发展有关,但胃粘膜TNF-α并非胃癌的特异性标志物。     

活动期与愈合期十二指肠溃疡患者的胃十二指肠动力紊乱

酸是十二指肠溃疡(DU)形成的必要条件。然而2/3 DU患者刺激后的胃分泌仍在正常水平。有人解释为,DU是由于酸与十二指肠粘膜的接触延长所致,而不是胃泌酸量增加。本研究旨在观察活动期和愈合期DU患者在禁食和餐后胃十二指肠动力的特征,并与正常人作比较。     

胃化生对十二指肠溃疡重要?

本文探讨胃化生(GM)和幽门螺旋菌(HP)在印度病人十二指肠溃疡(DU)发生中的作用。材料取自100例病人的十二指肠粘膜,其中活动性DU46例,已愈合DU14例,无症状十二指肠正常者40例作对照。十二指肠粘膜GM分为:“浅表性”和“泌酸性”GM两种:前者是指异位的产胃粘液的上皮细胞,而后者是指含有主细胞和壁细胞的发育完全的胃组织。十二指肠     

胆汁返流性胃炎患者胃、十二指肠粘膜胃肠激素含量及其意义研究

为了探讨胆汁返流(BR)的发生机理,本文研究了BR性胃炎患者胃、十二指肠(D)粘膜胃肠激素(GH)的含量及其意义。结果表明,胃粘膜生长抑素(SS)(P<0.025),血管活性肠肽(VIP)(P<0.001)含量明显减少,胃动素(MT)、血管加压素(AVP)含量亦降低;脑啡呔(ME)(P<0.025)、β—内啡呔(β—EP)(P<0.001)含量显著增加。D粘膜SS(P<0.005)、(β—EP)(P<0.001)、VIP(P<0.001)含量著减少;MT(P<0.05)、AVP(P<0.025)显著增加。胃粘膜病变程度与ME(P<0.05)和VIP(P<0.025)含量呈正相关,与β—EP及MT呈负相关。提示粘膜GH参与胃、幽门和D运动的调节及BR的发生。     

延边地区消化性溃疡4 348例胃镜分析

目的探讨少数民族地区消化性溃疡的发病学特点.方法分析1990年至1998年间延边地区的28547例内镜检查患者.结果在所有被检查患者中检出消化性溃疡4348例(15.23%),其中十二指肠溃疡2097例(48.22%),胃溃疡1921例(44.18%),复合性溃疡330例(7.59%).消化性溃疡中,男2974例(19.05%),女1374例(10.62%).男女检出率差异显著(P＜0.01);朝鲜族占2727例,汉族占1621例,检出率分别为13.96%和17.98%,但检出率差异显著(P＜0.01).结论延边地区消化性溃疡中汉族检出率高于朝鲜族,男性高于女性.     

Perforated peptic ulcer in Hong Kong and New South Wales

Direct comparisons of ulcer perforation rates and trends between countries have not been made in the past. Data on hospital admissions for perforated peptic ulcer during 1 January 1979 to 31 December 1985 were collected in Hong Kong (5868 perforations) and New South Wales, Australia (1669 perforations). Age and sex specific rates per 100,000 population were calculated. In Hong Kong, annual duodenal ulcer and gastric ulcer perforation rates were 13-16 and under two per 100,000 population respectively. In New South Wales, the corresponding rates were between three and four and under two per 100,000 population, respectively. The male:female ratios for duodenal ulcer perforation were consistently about 5:1 in Hong Kong and 2:1 in New South Wales, and for gastric ulcer perforation about 2:1 and 1:1, respectively. The incidence of perforation increased with age, and there was a statistically significant rise, over time, in duodenal but not gastric ulcer perforation rates in persons aged over 60 years in New South Wales; similar trends were seen in Hong Kong. Thus duodenal ulcer perforation occurs five times more commonly in Hong Kong than in New South Wales and this is largely accountable for by the higher rates of duodenal ulcer perforation in Chinese than in Australian males. Such geographical differences can best be explained by the occurrence of multiple aetiological mechanisms in ulcer perforation. Furthermore, there appears to be an increased susceptibility and an appreciable rising trend for duodenal ulcer perforation to occur in the elderly.     

Bleeding peptic ulcer occurring in hospitalized patients

We reviewed 84 consecutive cases of peptic ulcer hemorrhage, which occurred, in an area of 270,000 people, from 1986 to 1988, in patients already hospitalized for other diseases (in-bleeders). These subjects were compared with a prospective series of 386 patients who initially bled as out-patients and were then admitted (out-bleeders). Of 84 hemorrhages in hospitalized patients, 41 followed major surgery, while 43 were associated with other severe conditions. Bleeding site was duodenal in two thirds. Mean age was 67 ± 15 years versus 59 ± 15 among out-bleeders. Fifty percent of in-bleeders had recently received nonsteroidal antiinflammatory drugs (NSAIDs), and one third were on anticoagulants and 10% on corticosteroids; in 39 (46%) bleeding was shown to be persistent or recurrent, 5 (5.9%) underwent endoscopic and 18 (21%) surgical therapy; 29 died (34%). The corresponding figures among out-bleeders were: further bleeding 80 (20.7%), endoscopic therapy 12 (3.1%), surgery 25 (6.5%), deaths 17 (4.4%). As regards in-bleeders, only active bleeding and endoscopic stigmata emerged as statistically significant risk factors for further bleeding. The latter was shown to be significantly related to mortality. The most relevant finding was, however, that NSAIDs and anticoagulants, in association with stress and aging, are very frequently involved in peptic ulcer bleeding of hospitalized patients. The fatal outcome of one third, despite all available treatments, highlights the importance of prevention against drug- and stress-related mucosal damage in in-patients suffering from severe diseases.     

溃疡病的流行病学研究：北京地区358 644例胃镜分析

北京地区２３所医院自１９８４年１９９３年胃镜检查３５８６４４例，共检出消化性溃疡（ＰＵ）５７５２２例，检出率为１６．０４％。其中十二指肠溃疡（ＤＵ）４３５２９例（上中７５．６５％），胃溃疡（ＧＵ）１３２９７例（占２３。１１％），二者之比为３．２７：１。ＰＵ中男４４３４７例（７７．０８％），女１３１８５例（２２．９１％），男女之比为３．３６：１。ＤＵ中，男３３６２７例（７７．２５％），女９９０２例（     

梗阻性黄疸与消化性溃疡

研究234例梗阻性黄疸和209例非黄疸病人的消化性溃疡发病情况.结果黄疸组42例(17.9%),而对照组仅5例(2.4%)发现胃或十二指肠溃疡.十二指肠溃疡发病率两组有显著差别,而胃溃疡则两组发生率无明显差别.黄疸持续的时间对溃疡的发生无明显影响.胆总管阻塞者溃疡发生率高,而胆总管以上部位阻塞者溃疡发生率与对照组无明显差异.本研究进一步证实了胃酸在十二指肠溃疡形成中的重要作用.     

Observations on peptic ulcer in Shan Dong, China

The study consisted of 10 994 inpatients with peptic ulcer in Shan Dong province. The ratio of duodenal to gastric ulcer was 1.59 : 1. The ratio of males to females was 6.8 : 1 for duodenal ulcer and 4.6 : 1 for gastric ulcer. The highest incidence was in adolescence and young adults and the presentation occurred more commonly in winter. A study of blood groups revealed that there was no relationship between blood group and duodenal or gastric ulcer. The majority (71.9%) of patients with peptic ulcer had complications of upper gastrointestinal bleeding, perforation or gastric outlet obstruction. Bleeding and obstruction were equally common in gastric and duodenal ulcer, but perforation was more common in gastric ulcer.     

Omeprazole versus placebo in duodenal ulcer healing

The study objective was to study the ulcer healing effects and safety of the proton pump inhibitor, omeprazole, given in a dose of 20 mg once daily before breakfast. The study design was a randomized, double-blind, multicenter comparison of omeprazole and placebo using endoscopy to assess ulcer healing after two or four weeks of therapy. One hundred fifty-three patients with endoscopically documented active duodenal ulcer were studied. One hundred two patients received omeprazole and 51 received placebo. Patients in both groups were similar with regard to age, sex, duration of disease, initial ulcer size, smoking history, and alcohol use. A per protocol analysis of healing rates showed a significant advantage for omeprazole (P<0.01) at both week 2 (41% vs 13%) and week 4 (75% vs 27%). Concomitant factors (including smoking and ulcer size) did not alter the significance of the differences in healing rates between omeprazole and placebo. Complete relief of day and night pain was more often achieved (P<0.01) in the omeprazole group. All-patients treated analyses for healing and pain relief gave results similar to the respective per protocol analyses. Omeprazole was well tolerated; fewer patients had clinical and laboratory adverse experiences in the omeprazole group than in the placebo group. Fasting serum gastrin levels increased with omeprazole therapy (mean 34.9 to 73.5 pg/ml) but exceeded the normal range (>150 pg/ml) in only 12.3% of patients. Two weeks after therapy was stopped, serum gastrin levels showed a decrease toward baseline but had not yet completely returned to pretreatment levels (mean 49.7 pg/ml). Observations from Europe and Australia of >90% healing of duodenal ulcers after four weeks of omeprazole therapy were not confirmed in this study. No single factor explains this difference. Considerable variation in the degree of suppression of acid secretion has been demonstrated with the 20-mg daily dose of omeprazole; it is possible that, in US populations, a greater degree of antisecretory effect may be required to achieve the healing rates observed in Europe and Australia. In conclusion, omeprazole was more effective than placebo in the treatment of active duodenal ulcer, as determined by ulcer healing and relief of pain, and was well tolerated in the short-term treatment of patients with duodenal ulcer.     

Antibody to herpes simplex virus type 1 in peptic ulcer patients

It has been postulated that herpes simplex virus type 1 may be a causative factor of duodenal ulcer. Serum antibody titres to herpes simplex virus type 1 in duodenal and gastric ulcer patients were compared with race-, sex- and age-matched controls. No differences in antibody titres could be demonstrated between duodenal ulcer and gastric ulcer patients and their respective controls, between gastric ulcer and duodenal ulcer patients or between acute and convalescent sera in either gastric or duodenal ulcer. Although Chinese are more susceptible to ulcer disease than Malays and Indians, antibody titres were comparable between subjects of different races. The results of this study do not support a causal role for herpes simplex virus in peptic ulcer disease.     

Helicobacter pylori and gastric acid output in peptic ulcer disease

Helicobacter pylori is associated with peptic ulcer, and a causal relationship has been postulated. We investigated the association betweenHelicobacter pylori and gastric acid output. Two hundred forty-one patients were studied: 173 with duodenal ulcer, 51 with gastric ulcer (41 corpus, 10 prepyloric), and 17 with combined gastric and duodenal ulcer. In 194 patients (80%),Helicobacter pylori could be demonstrated histologically from gastric antral biopsies. The presence or absence ofHelicobacter pylori was not influenced by age, sex, or use of tobacco or analgesics. Patients with duodenal ulcer or combined gastric and duodenal ulcer had similar gastric acid outputs irrespective of the presence or absence ofHelicobacter pylori. However, gastric ulcer patients withHelicobacter had higher basal and maximal acid outputs when compared to patients withoutHelicobacter (mean basal output: 4.1 mmol/hr vs 2.4,P<0.05; mean maximal output 19.5 mmol/hr vs 14.4,P<0.05). AlthoughHelicobacter pylori is associated with both gastric ulcer and duodenal ulcer, its significance may be different in the two diseases.     

胃溃疡与十二指肠溃疡胃电图变化的探讨

目的分析胃溃疡与十二指肠溃疡患者胃肌电活动特点,探讨消化性溃疡病患者节律性疼痛、腹胀、反酸等临床症状与胃动力的关系,为消化性溃疡病临床治疗提供客观依据和指导。方法对44例胃溃疡和十二指肠溃疡患者及20例健康志愿者进行胃电图监测,记录主频率,主功比,各频段胃电所占百分比等指标。结果胃溃疡患者多存在胃电失常,以混合节律失常和胃动过缓节律失常为主;而十二指肠溃疡以混合节律及胃动过速失常为主。结论消化性溃疡患者大多有胃动力障碍。胃电图检查结果对其治疗具有一定的指导意义。