特利加压素联合生长抑素治疗肝硬化食管胃底静脉曲张破裂出血疗效观察

目的 观察特利加压素联合生长抑素治疗肝硬化并发食管胃底静脉曲张破裂出血（EGVB）患者的临床疗效及不良反应。方法 67例肝硬化并发EGVB患者被随机分为两组,32例对照组在对症支持治疗的基础上加用生长抑素治疗,35例观察组在对照组治疗基础上加用特利加压素联合生长抑素治疗。结果 观察组患者28例（80.0%）止血,3例（8.6%）再出血,4例（11.4%）,对照组则分别为21例（65.6%）、7例（21.9%）和8例（25.0%,P<0.05）;观察组输血量为（3.8±2.2） U,对照组则为（5.9±2.7） U。结论 特利加压素联合生长抑素治疗肝硬化并发EGVB患者疗效优于单用生长抑素,且具有较好的安全性。     

肝硬化消化道出血及出血后并发症治疗的临床研究

目的通过比较特利加压素联合急诊内镜及生长抑素联合急诊内镜治疗上消化道出血及出血后并发症的疗效,探讨肝硬化消化道出血及出血后并发症治疗的方法,分析可能的机制。方法纳入因肝硬化上消化道大出血急诊入住上海市公共卫生临床中心患者共128例,分为特利加压素联合急诊内镜组(60例)和生长抑素联合内镜组(68例)。入院后完善相关检查,给予基础治疗,及时行内镜下食管胃底静脉曲张套扎及"三明治"治疗,分别在内镜治疗前后给予特利加压素或生长抑素。观察治疗后患者的再出血情况、血压、24h尿量、肝肾功能及药物不良反应等。整理资料并进行统计学分析,计量资料组间比较采用t检验,计数资料组间比较采用χ2检验。结果两组患者经急诊内镜和药物治疗后均成功止血(100%),术后3d内均未出现再出血,止血效果相比较差异无统计学意义(P0.05)。特利加压素和生长抑素都能在一定程度上改善肝硬化出血后患者的血压(治疗前血压分别为72.70±18.00mmHg和75.00±17.50mmHg,治疗后分别为98.90±10.40 mmHg和88.80±9.60 mmHg;治疗前后比较P0.05)、增加尿量(治疗前尿量分别为270.0±115.0mL/24h和278.0±130.0mL/24h,治疗后分别为1 200.0±450.0mL/24h和730.0±310.0mL/24h;治疗前后比较P0.05)、改善肝肾功能(治疗前ALT分别为85.68±47.64U/L和93.14±50.12U/L,治疗后分别为57.52±27.21U/L和70.21±31.33U/L;治疗前后比较P0.05)、减少胸腹水(治疗前后腹水减少患者比例分别为46.9%和17.1%;差异有统计学意义,P0.05);两组间比较,特利加压素维持血压、改善肝肾功能、增加尿量、减轻胸腹水疗效优于生长抑素。特利加压素相较于生长抑素更容易使患者发生腹泻(两组腹泻发生率分别为16.6%和4.4%,差异有统计学意义),但通过减慢滴速或减少用量能够缓解,并未发生危重的不良反应。结论特利加压素联合急诊内镜与生长抑素联合急诊内镜治疗消化道出血效果相同,多环套扎治疗食管静脉曲张出血的良好疗效可重复。在内镜治疗成功的基础上,两种药物对于出血后伴发的多种并发症均有一定的疗效,但特利加压素带来的益处更大,能达到改善肝硬化患者多种并发症的作用。     

肝硬化食管胃静脉曲张破裂出血的临床处理动向

治疗肝硬化食管胃静脉曲张破裂出血的首选措施是药物治疗,可选用特利加压素、生长抑素类似物等;硝酸酯类药物、分流术或硬化疗法均不建议用于一级预防;非选择性β受体阻滞剂联合内镜下曲张静脉套扎术是目前二级预防中的首选措施。     

特利加压素联合生长抑素治疗肝硬化食管胃静脉曲张出血的效果分析

目的探析特利加压素联合生长抑素治疗肝硬化食管胃静脉曲张出血(EVB)患者的效果。方法回顾性分析2017年9月-2019年2月在首都医科大学附属北京佑安医院肝病消化中心住院治疗的73例肝硬化EVB患者的临床资料。在抑酸对症治疗的基础上,加用生长抑素治疗的患者43例,加用特利加压素治疗的8例,加用特利加压素联合生长抑素治疗的22例。比较3组患者24 h止血成功率、止血时间、早期再出血率、迟发性再出血率、并发急性肾损伤(AKI)治疗改善率及半年累积生存率情况。符合正态分布的计量资料3组间比较采用单因素方差分析;非正态分布的计量资料3组间比较采用Kruskal-Wallis H秩和检验。计数资料3组间比较采用χ~2检验。采用累积风险函数(CIF)描述病死率,采用竞争风险模型(Gray's Test)检验3组生存率的差异。结果联合治疗组、生长抑素组、特利加压素组24 h内止血成功率分别为54. 5%、41. 9%、37. 5%,止血时间分别为1. 00(1. 00～3. 00)d、2. 00(1. 00～3. 00) d、2. 00(1. 00～3. 00) d,早期再出血率分别为25%、27. 5%、16. 7%,迟发性再出血率分别为16. 7%,27. 3%、40%,以上指标3组间差异均无统计学意义(P值均 0. 05);联合治疗组与生长抑素组并发AKI患者的治疗改善率分别为100%、50%,差异无统计学意义(P=0. 429); 3组患者的半年累积生存率差异无统计学意义(部分分布风险比=1. 40,95%CI:0. 60～3.27,P=0. 436)。结论特利加压素联合生长抑素与单用生长抑素、单用特利加压素均可有效控制肝硬化EVB,3种治疗方案治疗效果无明显差异;与单用生长抑素相比,联合应用特利加压素对改善AKI方面具有潜在优势。     

特利加压素与生长抑素治疗肝源性腹泻的疗效比较

目的:观察Child-Pugh分级与肝源性腹泻患者腹泻次数的关系,评价特利加压素与生长抑素治疗肝源性腹泻患者的临床疗效.方法:入选52例肝源性腹泻患者,根据用药不同分为2组,特利加压素治疗组22例以1mgq8h静脉滴注;生长抑素治疗组30例以250mg/h微量泵入,2组治疗疗程均为7 d.评估治疗前后患者每天腹泻的次数及治疗前Child-Pugh分级、门静脉宽度.结果:Child-Pugh分级越高的肝源性腹泻患者,门静脉宽度越大,每天腹泻次数越多.治疗肝源性腹泻,特利加压素组有效20例,有效率为91%,生长抑素组有效20例,有效率为67%.2组有效率差异有统计学意义(91%vs 67%,P0.05).结论:特利加压素能更有效持久地降低门静脉高压,治疗肝源性腹泻效果优于生长抑素.     

特利加压素在肝硬化食管胃静脉曲张出血中的应用

食管胃静脉曲张破裂出血(EVB)是继发于肝硬化门静脉高压的一种常见致死性的并发症。特利加压素可以收缩内脏血管、降低门静脉压力、增加肾脏灌注,主要用于治疗EVB。总结了特利加压素治疗肝硬化EVB的作用机制、疗效等,认为特利加压素可有效控制EVB,且在条件允许的情况下,应优先选择特利加压素联合内镜下曲张静脉套扎术治疗EVB。     

特利加压素联合血浆治疗肝硬化失代偿期肝肾综合征疗效观察

目的 观察特利加压素联合血浆治疗对肝硬化失代偿期肝肾综合征的疗效.方法 将肝硬化失代偿期合并有肝肾综合征的56例患者分为A、B、C3组,在内科综合治疗基础上,A组患者给予多巴胺治疗,B组患者给予特利加压素治疗,C组患者给予特利加压素联合血浆治疗,观察3组患者治疗期间临床症状、尿量、血肌酐、尿素氮、凝血酶原活动度及腹水的变化.结果 B、C组患者临床症状改善较A组明显,尿量显著增加,血肌酐、尿素氮明显下降,C组患者的肾功能改善较B组更明显,A组患者尿量、血肌酐和尿素氮下降均不明显.结论 在常规治疗的基础上,特利加压素联合血浆治疗肝硬化失代偿期肝肾综合征比单纯加用多巴胺或特利加压素的疗效更加显著.     

特利加压素消化道出血中的临床应用观察

目的探讨特利加压素在消化道出血的临床应用观察。方法选取我院2015~2016年收治的患有肝硬化及上消化道出血的患者60例,将这60例患者随机分为A组和B组,A组患者给予兰索拉唑、白眉蛇毒血凝酶、生长抑素进行治疗,B组在A组患者治疗的基础上给予特利加压素进行治疗,观察两组患者在临床上的效果以及消化道的止血情况。结果经过3天治疗后,A组患者的总效率为83.33%,B组患者的总效率为96.67%,B组总效率明显高于A组,差异具有统计学意义(P0.05)。A组患者治疗后不良反应的发生率为16.67%,B组患者治疗后不良反应的发生率为3.33%,B组明显优于A组,差异具有统计学意义(P0.05)。结论对于患有肝硬化及上消化道出血的患者,给予兰索拉唑、白眉蛇毒血凝酶、生长抑素和特利加压素进行治疗,能够得到显著的疗效,且治疗后不良反应的发生率大大地降低,值得临床上应用。     

联合应用特利加压素和内镜套扎治疗食管静脉曲张破裂出血

目的:观察评价特利加压素、内镜套扎和联合上述两种方法治疗食管静脉曲张破裂出血的疗效.方法:56例患者分为三组,其中特利加压素组19例,内镜套扎组20例,联合治疗组17例.结果:72小时止血率在三组分别为68.4%,80%和94.l%;一周内再出血率为30.8%,12.5%和6.3%;急诊手术率为26.3%,21.1% 和5.9%.联合治疗组的72小时止血率明显高于其他两组(P<0.05),一周再出血率和急诊手术率低于其他两组(P<0.05) .特利加压素组和内镜套扎组的72小时止血率则没有差别(P>0.05 ).结论:食管静脉曲张破裂出血时联合应用特利加压素和内镜套扎治疗可以提高止血率、降低近期再出血率和急诊外科手术率.     

特利加压素与加倍剂量奥曲肽对肝硬化静脉曲张患者HVPG的影响

<正>目前临床上肝硬化患者的主要死因是由于门静脉压力过高导致食管胃静脉急性破裂出血,该病最主要的治疗手段就是如何快速、有效的降低门静脉压力以控制曲张静脉出血。加压素类似物特利加压素和生长抑素类似物奥曲肽是临床上最常用的降低门静脉压力的药物。本文为探讨加倍剂量奥曲肽和特利加压素的治疗效果进行了相关研究,现报道如下。资料和方法一、一般资料回顾性分析我院消化内科自2014年1月到2015年12月     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.