养胃颗粒联合四联疗法治疗幽门螺杆菌阳性慢性萎缩性胃炎的疗效及对血清GAS、ET和PGs的影响

[目的]探讨养胃颗粒联合四联疗法治疗幽门螺杆菌(Hp)阳性慢性萎缩性胃炎(CAG)的临床疗效及对血清胃泌素(GAS)、内皮素(ET)和胃蛋白酶原(PGs)的影响。[方法]选取2016年2月~2018年1月我院收治的Hp阳性CAG患者158例,随机分为观察组和对照组各79例。对照组采用四联疗法清除Hp(1~14d)联合保护胃黏膜药物(15~90d)治疗,观察组在对照组基础上加用养胃颗粒进行治疗。观察2组患者的临床疗效、Hp根除情况,并比较2组患者治疗前后血清中GAS、ET和PGs含量的变化。[结果]观察组总有效率为91.14%,明显高于对照组的81.01%,2组对比差异有统计学意义(P0.05);观察组Hp根除率为89.87%,对照组Hp根除率为78.48%,观察组Hp根除率明显高于对照组(P0.05);2组患者治疗后血清中GAS含量明显升高(P0.01),ET含量明显降低(P0.01),观察组优于对照组(P0.01);治疗后2组患者血清中PGⅠ含量和PGⅠ/PGⅡ均明显升高(P0.01),且观察组显著高于对照组(P0.05或P0.01)。[结论]养胃颗粒联合四联疗法治疗Hp阳性的CAG疗效显著,能提高Hp根除率,促进GAS分泌,降低ET表达,提高PGⅠ/PGⅡ比值。     

疏肝解郁胶囊联合四联疗法对幽门螺旋杆菌阳性胃溃疡患者的疗效观察

目的观察疏肝解郁胶囊联合四联疗法治疗幽门螺旋杆菌(Hp)阳性胃溃疡患者的治疗效果。方法选取Hp感染阳性胃溃疡患者102例作为研究对象,按随机数字表法分为四联组(采用兰索拉唑+胶体果胶铋+克拉霉素+阿莫西林四联法治疗)和疏肝组(采用疏肝解郁胶囊+四联法治疗),各51例,治疗6周。观察两组治疗效果、胃肠道症状积分、胃泌素(GAS)和胃动素(MTL)指标以及不良反应发生率情况。结果疏肝组临床疗效优于对照组,差异具有统计学意义(P0.01)。疏肝组治疗后10 d、20 d、30 d的胃肠道症状积分、GAS和MTL指标均优于四联组,差异具有统计学意义(P0.05)。结论疏肝解郁胶囊能够提升四联法治疗Hp阳性胃溃疡的疗效,改善胃肠功能,减少GAS和MTL的分泌,安全可靠。     

小建中胶囊四联疗法根除幽门螺杆菌的疗效及相关症状的改善情况

[目的]观察小建中胶囊四联疗法根除幽门螺杆菌(Hp)的疗效及相关症状的改善情况,并与铋剂四联疗法进行比较。[方法]选取2016年1月～2016年12月在中国医科大学附属盛京医院消化内科门诊就诊并经13 C尿素呼气试验检查确诊的Hp阳性的慢性胃炎、消化性溃疡的患者102例,并记录患者根除Hp前的症状积分。随机分为A组和B组,A组予埃索美拉唑+阿莫西林+克拉霉素+枸橼酸铋钾,B组将A组中的枸橼酸铋钾替换为小建中胶囊,疗程均为14d,疗程结束后4周复查13 C尿素呼气试验评估Hp的根除情况,疗程结束后4周记录患者的症状积分。[结果]A组的Hp根除率为82.4%,B组的Hp根除率为86.3%,A、B组的Hp根除率差异无统计学意义。A、B组的治疗前症状积分差异无统计学意义,疗程结束后4周A、B组的症状积分均低于治疗前,差异有统计学意义(P0.05),疗程结束后4周B组症状积分低于A组,差异有统计学意义(P0.05)。[结论]小建中胶囊四联疗法根除Hp的疗效与铋剂四联疗法相近,对相关症状的改善率更高。     

四联疗法与序贯疗法在幽门螺杆菌根除补救治疗中的疗效比较

[目的]比较四联疗法与序贯疗法在幽门螺杆菌(Hp)根除补救治疗中的疗效及安全性,旨在寻找一种有效、安全、经济的补救治疗方案。[方法]将首次根除Hp治疗失败的90例慢性胃炎患者,随机分为四联疗法组和序贯疗法组,每组45例。四联疗法组患者治疗方案为埃索美拉唑、枸橼酸铋钾、阿莫西林、莫西沙星,疗程14d。序贯疗法组患者治疗方案为前5d给予埃索美拉唑、阿莫西林;后5d给予埃索美拉唑、克拉霉素、奥硝唑。所有患者在疗程结束停药4周后行14 C尿素呼气试验检测Hp。比较2组患者治疗前后的不良反应。[结果]四联疗法组Hp根除率(91.1%)显著高于序贯疗法组(75.6%),差异有统计学意义(P<0.05)。2组不良反应均很轻微,组间不良反应发生率比较差异无统计学意义(P>0.05)。[结论]对于Hp补救治疗,四联疗法较序贯疗法疗效更好,且不良反应小,患者依从性好,值得在临床上推广。     

清胃祛湿颗粒联合铋剂四联治疗幽门螺杆菌阳性慢性非萎缩性胃炎的临床研究

[目的]研究清胃祛湿颗粒联合铋剂四联疗法治疗脾胃湿热证型幽门螺杆菌(Hp)阳性慢性非萎缩性胃炎(CNAG)的临床疗效及安全性。[方法]将80例脾胃湿热型Hp阳性CNAG患者随机分治疗组与对照组各40例。治疗组采用清胃祛湿颗粒联合铋剂四联(艾普拉唑肠溶片+枸橼酸铋钾胶囊+阿莫西林胶囊+克拉霉素胶囊)口服,对照组予铋剂四联口服,疗程均为14 d。治疗结束4周后,观察2组患者Hp根除率、临床症状疗效、半年后Hp复发率及不良反应。[结果]Hp根除率:治疗组(95%)高于对照组(90%),但差异无统计学意义;临床总体症状疗效及主要症状单项积分,治疗组明显优于对照组,差异有统计学意义(P0.05);半年随访Hp复发率,治疗组(0)明显低于对照组(2.8%),差异有统计学意义(P0.05);治疗期间,治疗组未出现不良反应,对照组出现头晕2例、恶心2例、睡眠障碍1例。[结论]清胃祛湿颗粒联合铋剂四联用于脾胃湿热型Hp阳性CNAG临床疗效显著,安全性好,值得临床推广运用。     

大蒜素、阿莫西林、埃索美拉唑、呋喃唑酮四联疗法治疗Hp阳性十二指肠溃疡效果观察

目的 观察大蒜素、阿莫西林、埃索美拉唑、呋喃唑酮四联疗法治疗幽门螺杆菌(Hp)阳性十二指肠溃疡的效果.方法 将60例Hp阳性的十二指肠溃疡患者随机分为两组,治疗组(28例)口服阿莫西林+埃索美拉唑+呋喃唑酮+大蒜素胶囊治疗;对照组(32例)口服阿莫西林+埃索美拉唑+呋喃唑酮治疗.7d后两组继续服用埃索美拉唑3周.停药4周后复查C14尿素呼气试验,计算Hp根除率,复查胃镜观察溃疡愈合情况.结果 治疗组Hp根除率92.9％ (26/28),对照组为84.4％(27/32),治疗组根除率高于对照组(P＜0.05).治疗组痊愈20例、有效7例、无效1例,总治愈率96.4％;对照组分别为18、10、4例和87.5％,治疗组治愈率高于对照组(P＜0.05).结论 大蒜素、阿莫西林、呋喃唑酮、埃索美拉唑四联疗法治疗Hp阳性的十二指肠溃疡能有效控制Hp感染,提高Hp根除率、十二指肠溃疡治愈率.     

健脾解毒方联合西医三联疗法对幽门螺杆菌诱导的胃溃疡患者的临床疗效及幽门螺杆菌清除率的影响

[目的]探究健脾解毒方联合西医三联疗法对,幽门螺杆菌(Hp)诱导的胃溃疡患者的临床疗效及Hp清除率的影响。[方法]采集2018年1月～2018年12月我院收治的102例胃溃疡患者,按照随机数字法分为观察组和对照组各51例,对照组采用三联法治疗,观察组采用健脾解毒方联合三联法治疗,观察治疗前后临床疗效,Hp根除率,胃蛋白酶原(PG)含量,胃泌素(GAS),胃动素(MTL),胃窦溃疡直径,胃体溃疡直径和胃黏膜TFF1蛋白表达水平。[结果]治疗后观察组临床总有效率96.08%显著高于对照组80.39%,Hp根除率86.24%显著高于对照组68.63%,复发率3.92%显著低于对照组15.69%,差异有统计学意义(P0.05);治疗后2组胃窦溃疡直径、胃体溃疡直径、GAS、PG和胃黏膜TFF1蛋白表达水平均下降,且观察组低于对照组,差异有统计学意义(P0.05);2组MTL含量治疗前后、组间比较差异均无统计学意义(P0.05)。[结论]健脾解毒方联合西医三联法治疗Hp诱导胃溃疡能有效根除Hp,提高临床疗效,降低复发率,是一种切实可行的治疗方法。     

慢性胃炎患者采用幽门螺杆菌根除性治疗的价值及症状改善情况研究

[目的]研究慢性胃炎患者采用幽门螺杆菌(Hp)根除性治疗的价值及症状改善情况。[方法]选取我院2017年6月～2018年5月收治的88例慢性胃炎患者作为研究对象,按照信封法随机分为对照组(44例)与观察组(44例),对照组采用三联疗法治疗,观察组采用四联疗法治疗。比较2组的临床效果、Hp根除率、胃泌素、炎性因子水平、临床症状评分、胃镜评分以及不良反应发生率。[结果]观察组慢性胃炎患者的临床总有效率、Hp根除率均高于对照组,差异有统计学意义(P0.05);观察组患者治疗后的胃泌素含量、IL-6、TNF-α、CRP水平均低于对照组,差异有统计学意义(P0.05);观察组患者治疗后的临床症状评分、胃镜评分以及不良反应发生率均明显低于对照组(P0.05)。[结论]对慢性胃炎患者采用Hp根除性治疗有助于临床症状的改善,可提高Hp清除率和降低炎性因子水平,促进胃泌素水平恢复正常,安全有效,临床应用价值高。     

复方嗜酸乳杆菌在首次根除幽门螺杆菌感染胃溃疡失败补救治疗中的应用

[目的]探讨复方嗜酸乳杆菌在三联根治幽门螺杆菌(Hp)感染胃溃疡失败补救治疗中的应用效果。[方法]随机数字法将150例Hp感染胃溃疡(均经标准三联疗法根除Hp失败)患者分为观察组与对照组,各75例,观察组采取复方嗜酸乳杆菌联合四联疗法干预,对照组则行四联疗法干预,比较2组临床疗效、Hp根除率、不良反应及治疗前后血清炎症相关因子[C反应蛋白(CRP)、白细胞介素(IL)-1、IL-6]变化情况。[结果]观察组治疗总有效率、Hp根除率分别为90.67%、82.67%,均显著高于对照组的77.33%、68.00%(P0.05);与治疗前比较,2组治疗后血清CRP、IL-1、IL-6水平均显著下降(P0.05),且观察组治疗后上述指标均显著低于对照组(P0.05);观察组恶心呕吐、腹泻、便秘发生率均显著低于对照组(P0.05)。[结论]相比单纯四联疗法,加以复方嗜酸乳杆菌能有效提高首次三联疗法根除Hp失败的胃溃疡患者Hp根除率,明显减轻炎症反应及减少不良反应。     

益胃宁胶囊治疗幽门螺杆菌相关性慢性胃炎60例

[目的]观察益胃宁胶囊治疗幽门螺杆菌(Hp)相关性慢性胃炎的疗效。[方法]120例随机分为2组,治疗组60例用益胃宁胶囊治疗,对照组60例用三联疗法(枸橼酸铋钾、阿莫西林、甲硝唑)治疗,疗程均为1个月。观察治疗后2组临床综合疗效、Hp根除率、临床症状改善情况、不良反应及复发率。[结果]2组临床综合疗效及Hp根除率相近(P>0.05),治疗组临床症状改善情况优于对照组(P<0.05);且不良反应及复发率明显低于对照组(P<0.05)。[结论]益胃宁胶囊是治疗Hp相关性慢性胃炎的有效中药制剂。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Angiographic diagnosis of the degree of serosal invasion of carcinoma of the colon

Angiography using Prostaglandin El^® was performed on 38 patients with carcinoma of the colon in order to diagnose the degree of serosal cancer invasion. The findings at angiography were classified into four groups:1) AG-S3, abnormal change (irregularity and/or encasement) up to marginal vessels; 2) AG-S2, abnormality up to vasa recta; 3) AG-S1, abnormality of penetrating branches of vasa recta within the wall of the colon; and 4) AG-S0, no distinct findings of abovementioned vessels. These angiographic findings were compared with both macroscopic and microscopic serosal cancer invasion. Angiographic diagnosis is in accord with the macroscopic findings in 84.2 percent of cases. Angiographic diagnosis is in accord with the microscopic findings in 32.4 percent of cases. Macroscopic findings confirm the angiographic diagnosis precisely but the conflict with microscopic findings should not be overlooked. This may be the result of inflammatory change, adhesion, and fibrosis around carcinoma of the colon.