胃病患者不同舌苔的细菌学及炎性细胞对比

[目的]通过对胃病患者不同舌苔的细菌学及炎性细胞变化的对比观察，探讨胃病患者黄苔的发生机制。[方法]132例胃病患者，均经胃镜及病理检查明确诊断，分为黄苔组及白苔组，各66例，经刮舌获取舌苔进行细菌培养及直接涂片查白细胞及上皮细胞。[结果]黄苔组的细菌阳性率（涂片法）为60．6％，白苔组为36．4％，两组间比较差异有统计学意义（P〈0．05）：黄苔的细菌数量、炎性细胞及上皮细胞均较白苔增多（均P〈0．05）。[结论]胃病患者出现黄苔与舌苔中的细菌数量、炎性细胞与上皮细胞增多有关。     

脾胃湿热证胃炎患者舌苔脱落细胞中微核细胞及P53表达

[目的]探讨脾胃湿热证和脾气虚证慢性浅表性胃炎患者舌苔脱落细胞微核细胞和P53表达的意义.[方法]用Feulgen法和免疫细胞化学法显示正常对照者及脾胃湿热和脾气虚患者舌苔脱落细胞中微核细胞、P53表达.[结果]脾胃湿热组和脾气虚组微核细胞的反应强度及出现频率均高于正常对照组(均P＜0.05);脾气虚组的P53阳性反应高于正常对照组,差异有统计学意义(P＜0.05).[结论]微核细胞在两患者组的舌苔脱落细胞内反应强度及出现频率较高,提示有较多的分裂畸变细胞;而P53的表达与微核细胞的出现有关,两者可能代表了证候发展不同的过程.     

幽门螺杆菌感染对胃病细胞动力学的影响

目的　观察 Ｈｐ 感染在正常粘膜演变为胃癌过程中对细胞增殖动力学的影响,以探讨 Ｈｐ 的致癌机制．方法　研究对象为正常胃粘膜的消化不良患者（ ＮＳ,ｎ ＝ １４） 及慢性浅表性胃炎（ ＣＳＧ, ｎ ＝ ５６） 、慢性萎缩性胃炎（ ＣＡＧ,ｎ ＝ ２０） 、慢性萎缩性胃炎伴肠上皮化生（ＣＡＧＩＭ ,ｎ ＝ １６） 、不典型增生（Ｄｙｓ ,ｎ ＝ １８） 、胃癌（ ＧＣ,ｎ ＝ １７） Ｈｐ 阳性与阴性患者．应用Ｋｉ６７ 免疫组化技术评价胃幽门窦上皮细胞增生,并用标记指数百分率（ＬＩ％ ） 来表示．结果　Ｈｐ 阳性患者（ ｎ ＝ ７５） 的Ｋｉ６７ ＬＩ％ 为１７ ±５ , Ｈｐ 阴性患者（ ｎ ＝ ５２ ） 的 Ｋｉ６７ ＬＩ％ 为 １３ ±６ , 差异有 显著 性（ Ｐ＜ ０－０５） ;伴有 Ｈｐ 感染的ＣＳＧ 与ＮＳ 或 Ｈｐ 阴性的ＣＳＧ 患者相比ＬＩ％ 增加（ Ｐ＜ ０－０１） ;ＣＡＧ,ＣＡＧＩＭ ,Ｄｙｓ ,ＧＣ 的 Ｈｐ 阳性与阴性患者的ＬＩ％ 相比无显著差异;五种胃病无论 Ｈｐ 阳性或阴性患者与正常者相比,ＬＩ％ 明显增加（ Ｐ＜ ０－０１） ． ＬＩ％ 与胃粘膜炎症程度无关．结论　Ｈｐ 感染促进胃上皮细胞过度增殖主要发生在胃粘膜病变的早期,并不影响在癌前病变或胃癌患者中所     

慢性浅表性胃炎脾胃湿热证患者舌苔脱落细胞活动周期的研究

目的 :探讨脾胃湿热证慢性浅表性胃炎患者舌苔脱落细胞与细胞周期活动的关系。方法 :实验分成 4组 :正常对照组、脾气虚组、脾胃湿热组和脾胃湿热治疗组 ,用流式细胞仪检测各组舌苔脱落细胞内 DNA含量。结果 :脾胃湿热组患者 S期细胞高于正常对照组和脾气虚组 ,差异均有显著性意义 (P <0 .0 1,<0 .0 5 ) ;经过清化饮治疗 1个月后 ,脾胃湿热组患者 S期细胞数目下降 ,而 G1 和 G2 加 M期细胞增加 (P <0 .0 5 )。凋亡细胞不论脾胃湿热组还是脾气虚组均高于正常对照组 ,经过治疗后的脾胃湿热组患者 ,虽然细胞周期有改变 ,但凋亡细胞无明显变化。结论 :脾胃湿热证慢性浅表性胃炎患者的舌苔脱落细胞周期中 ,S期细胞最多 ,治疗后 S期细胞减少 ,G1 期、G2 加 M期细胞增加 ;凋亡细胞脾胃湿热组和脾气虚组均高于正常对照组。     

舌苔的研究进展

中医认为“有诸内必行于诸外”.“舌内通五脏,外系经络,有病与否,均可与舌诀之”,由此可见舌诊的重要性.舌苔是舌质上附着的苔状物.中医认为舌苔是由脾胃之气蒸化胃中食浊之气而生成.现代研究表明位于舌背面的两种乳头是形成舌苔的基础,即菌状乳头和丝状乳头,而丝状乳头在舌苔形成中最为重要.丝状乳头顶端的角质层可分化为角化树,角化细胞中含有角化物质,呈微白色.角化树的细胞及其间隙中填充的脱落角化上皮、唾液、细菌、霉菌、食物碎屑、渗出的白细胞等组成了舌苔.但有观察认为,舌苔中并不含食物碎屑[1].虽有证实舌苔中含细菌,舌苔的厚薄及苔色变化与细菌类型及数目无相关性[2].本文综述了目前有关舌苔在诊断以及判断预后的研究进展.     

CDH1基因多态性与胃腺癌患者舌苔辨证的相关性

目的:研究CDH1基因多态性与胃腺癌患者舌苔辨证的关系.方法:应用连接酶检测反应,对387例胃腺癌患者和392例健康对照的CDH1基因的4个位点进行基因分型,并且按中医舌诊辨证要求,由中医诊断学专家进行舌色、舌质的诊断.结果:胃腺癌组不按时吃饭的比例高于对照组(2=9.124,P=0.010),胃腺癌组与对照组相比饮食口味偏咸(2=74.409,P<0.001),胃腺癌组的吸烟率高于对照组(2=18.019,P<0.001),胃腺癌组经常吃豆制品的频率明显低于对照组(2=10.669,P=0.014),并且其经常吃新鲜水果的频率明显低于对照组(2=59.905,P<0.001).rs13689、rs17690554位点携带突变基因型并且苔色为黄色的个体在病例组的分布频率明显高于对照组(2=4.064,P=0.044;2=5.868,P=0.015).两组人群在各位点同一基因型的不同苔质的差异均具有统计学意义(P<0.050).结论:CDH1基因多态性与胃腺癌患者舌苔辨证有一定关联,本研究结果有助于揭示胃腺癌患者基因位点突变与舌苔形成和变化的科学内涵.     

黄苔胃病患者胃粘膜凋亡基因及相关蛋白的表达

目的:探讨胃病患者黄苔与胃粘膜组织细胞凋亡之间的关系.方法:选取黄苔胃病患者62例,采用免疫组化法与63例白苔胃病患者进行对照,采用免疫组化法检测胃粘膜增殖细胞核抗原(PCNA)、p53、bcl-2、fas凋亡基因相关蛋白.结果:黄苔患者p53、fas表达均明显高于白苔患者(均P<0.05),而PCNA、bc1-2表达则与白苔患者差异均无统计学意义(均P>0.05).结论:黄苔胃病患者伴有促凋亡基因相关蛋白的过度表达,黄苔是胃内有活动性炎症的较灵敏的指标.     

实验性急性肺栓塞后炎性细胞的超微结构改变

目的探讨急性肺栓塞后在栓塞肺动脉局部炎性细胞的超微改变和临床意义。方法 建立急性肺栓塞动物模型,取材栓塞3h、8h和24h的栓塞部位和正常肺动脉,固定液固定后送检。结果正常肺动脉内皮细胞完整,内皮下无水肿。内弹力层波浪状,未见异常。内皮下无淋巴细胞浸润。肺栓塞后3h可见内皮细胞大片脱落,内弹力层断裂。内皮下水肿,液压增高,且可见淋巴细胞浸润、活化。肥大细胞胞浆颗粒显著,部分颗粒核心溶解,并见肥大细胞毗邻淋巴细胞,个别肥大细胞颗粒排空呈空囊,核固缩凝集。结论急性血栓性肺栓塞后激活了栓塞肺动脉的炎性反应,该反应对局部血栓的溶解起着一定作用。     

外源性过敏性肺泡炎患者肺部炎性细胞的凋亡信号受体表达

Ｆａｓ受体 (ＦａｓＲ)和肿瘤坏死因子 (ＴＮＦ)受体 1(ＴＮＦＲ 1)同属于ＴＮＦ表面受体家族 ,因二者都含有一个传导细胞凋亡信号必需的胞浆死亡决定簇 ,所以又被称为凋亡信号受体[1] 。机体的多种细胞都可表达ＦａｓＲ和ＴＮＦＲ 1,它们的异常表达与一些疾病的发生有关[2 ,3 ] 。我们的研究旨在观察外源性过敏性肺泡炎 (ＥＡＡ)时ＦａｓＲ和ＴＮＦＲ 1在肺泡巨噬细胞 (ＡＭ)和淋巴细胞 (Ｌ)的表达及可能的作用。对象与方法　ＥＡＡ患者 11例 ,女 6例 ,男 5例 ,年龄(5 5± 8)岁和对照组 12名女 5名 ,男 7名 ,年龄 (48± 12 )岁按常规对两组…     

10216例胃病患者消化内镜与舌诊观察

“舌为脾胃之外候”、“苔乃胃气之所蒸熏”,舌象与脾胃的关系极为密切。脾胃病在舌象的反映上迅速而灵敏 ,而胃镜的观察是中医望诊的延伸。既往虽然有不少舌诊与胃镜关系的研究 ,但例数均较少 [1,2 ] 。本文旨在通过大样本的内镜直视观察 ,探讨胃粘膜病变与舌诊的关系。1　资料与方法1 .1　临床资料 :1 0 2 1 6例均为 1 987～ 2 0 0 1年我科门诊或住院患者 ,经消化内镜检查后 ,符合以下条件 :1有慢性胃病史 ;2经消化内镜或胃粘膜活检病理明确诊断 ;3常规检查十二指肠球部 ;4不伴有热性病 ,肝胆疾病 ;5除外染苔。 1 0 2 1 6例中 ,男 81 5 8…     

Inflammation-Related Erythrocyte Aggregation in Patients with Inflammatory Bowel Disease

Chronic inflammation is associated with increased erythrocyte adhesiveness/aggregation. This might have deleterious effects on the microcirculatory flow and tissue oxygenation. We aimed to determine the degree of erythrocyte adhesiveness/aggregation in the peripheral blood of individuals with inflammatory bowel disease (IBD). Fifty-two patients (24 women and 28 men) with ulcerative colitis (UC) at a mean age of 44.0 ± 16.8 years and 96 patients (44 women and 52 men) with Crohns disease (CD) at a mean age of 38.0 ± 15.5 years, with various degrees of disease activity, were matched to normal controls. A simple slide test and image analysis were used to determine the degree of erythrocyte adhesiveness/aggregation. CD activity index (CDAI) was determined in patients with CD, while clinical colitis activity index was applied for patients with UC. A significant (P < 0.0005) increment in the degree of erythrocyte adhesiveness/aggregation was noted in both groups of IBD patients compared with matched control groups. This increment was evident even in individuals with a low index of disease activity and during remission. The highly significant correlation with the concentrations of fibrinogen suggests that the degree of erythrocyte adhesiveness/aggregation is an inflammation-related phenomenon. An enhanced state of erythrocyte adhesiveness/aggregation was noted in the peripheral blood of patients with IBD. This might have a deleterious effect on intestinal microcirculatory flow and tissue oxygenation.     

Complementary Alternative Medicine in Patients with Inflammatory Bowel Disease: Use and Attitudes

Background: A widespread increase in the use of complementary alternative medicine (CAM) by patients with inflammatory bowel disease (IBD) has been recognized. The aim of our study was to evaluate both the extent and the determinants of CAM use by outpatients with IBD. Methods: Outpatients of the IBD centre at the University Hospital of Berne and patients of two gastroenterology private practices in Olten (Switzerland) completed a mailed self-administrated questionnaire regarding alternative medicine. The questionnaire addressed the following topics: demographic variables; disease-related data; the use of 16 types of complementary medicine; comparison between attitudes towards alternative versus conventional medicine and out-of pocket expenses. Results: Alternative medicine has been used by 47% of the patients. Diagnosis, duration and activity of disease, gender, age, previous surgery were not predictive for the use of CAM. The most commonly used CAM methods were: homeopathy, acupuncture and traditional Chinese medicine. Reasons cited for the use of CAM were: lack of satisfaction with and side effects of conventional therapy and the perceived safety of CAM. Sixty-one percent of patients noted that their IBD had improved with the use of CAM. By contrast, 16% noted a flare during CAM therapies. Forty-seven percent of patients paid more than €400 per year for CAM. Conclusions: Complementary medicine use is common in patients with IBD. Frequently cited reasons for the use of complementary therapies were safety of CAM; dissatisfaction with conventional therapies, including their side effects; and that CAM can be used in addition to conventional therapy.     

Clinical Features and Outcomes of Coronavirus Disease 2019 in Patients with Inflammatory Bowel Disease and Spondyloarthropathies

Background:We aimed to determine the clinical features, predictive factors associated with severe disease, and outcomes of coronavirus disease 2019 in patients with immune-mediated inflammatory diseases and report data on the comparison of coronavirus disease 2019 between patients with inflammatory bowel disease and spondyloarthropathies.Methods:A total of 101 patients with inflammatory bowel disease and spondyloarthropathies who had confirmed diagnosis of coronavirus disease 2019 were retrospectively analyzed. Demographics, comorbidities, immunosuppressive treatments, and the impact of immunosuppression on negative outcomes were assessed.Results:The median age of the patients was 47 (38-57) years. The most common rheumatologic diagnosis was ankylosing spondylitis (n = 24), psoriatic arthritis (n = 17), and reactive arthritis (n = 1). In the inflammatory bowel disease group, 47 patients had ulcerative colitis, 11 Crohn’s disease, and 1 unclassified. The most commonly used treatments were biologics (55%) in the spondyloarthropathies group and aminosalicylates (66.1%) in the inflammatory bowel disease group. Overall, 18.8% of the patients required hospitalization, 5% developed severe complications, and 2% died. There were no significant differences in coronavirus disease 2019-related negative outcomes between spondyloarthropathies and inflammatory bowel disease patients. The median age was higher in the patients who required hospitalization [57 (46-66) vs 47 (38-57) years, P = .008]. Bilateral opacities on chest radiographs were more common in the patients who required hospitalization in the spondyloarthropathies group [88.9% vs 14.3%, P = .016]. Comorbidity was significantly associated with hospitalization in the inflammatory bowel disease group (P ≤ .05). Baseline therapy with biologics or immunosuppressives was not associated with severe coronavirus disease 2019 outcomes.Conclusion:Older age, comorbidities, and bilateral ground-glass opacities were associated with adverse outcomes, whereas specific immune-mediated inflammatory disease diagnoses or immunosuppressive treatments were not.     

炎症性肠病患者树突状细胞的免疫功能研究

研究炎症性肠病（ＩＢＤ）患者外周血树突状细胞（ＤＣ）的免疫功能,探讨ＤＣ免疫功能变化在ＩＢＤ发生中的作用。方法：以健康成人（ｎ＝１０）作为对照,自ＩＢＤ患者（ｎ＝１１）外周血中分离和纯化ＤＣ及Ｔ细胞,按间接免疫荧光法通过流式细胞仪检测ＤＣ表面ＨＬＡ－ＤＲ及Ｂ７－１的表达水平,检测ＤＣ诱导自体混合Ｔ淋巴细胞增殖反应的能力。结果：ＩＢＤ患者 ＤＣ表面 ＨＬＡ－ＤＲ、 Ｂ７－１的表达水平及 ＤＣ诱导自体混合 Ｔ淋巴细胞增殖的能力（１９．６ＶＯＦ±１．３ＶＯＦ,１８．７ＶＯＦ±１．６ＶＯＦ,１２３１０ｃｐｍ±１４６ｃｐｍ）明显高于对照组（１３．６ＶＯＦ±１．２ＶＯＦ,１２．８ＶＯＦ±１．４ＶＯＦ,Ｐ＜０．０５,８６６０ｃｐｍ±１２０ｃｐｍ,Ｐ＜０．０１）。结论： ＩＢＤ患者ＤＣ免疫功能亢进。提示ＤＣ免疫功能亢进可能与ＩＢＤ的发生及发展相关。     

REVIEW: Concerns of Patients with Inflammatory Bowel Disease

Idiopathic, chronic inflammatory bowel disease (IBD) refers to two diseases—ulcerative colitis (UC) and Crohn's disease (CD). Despite an abundant literature discussing the pathophysiology and treatment of these diseases, little if any empirical studies have focused on patients' subjective experiences with their diseases. The purpose of this paper was to identify and discuss the concerns of individuals with IBD and to suggest that the integration of concerns in clinical management is necessary for a comprehensive understanding of these chronic and debilitating diseases. In addition, case studies were included to highlight the concerns of people with IBD. Our review of the literature identified eight categories of concerns for individuals with IBD. They included loss of energy, loss of control, body image, isolation and fear, not reaching full potential, feeling dirty, and lack of information from the medical community. In conclusion, we argue that the efficacy of treatment for IBD would be greatly improved if psychosocial issues were to be integrated into treatment protocols.     

Free Protein S Deficiency in Patients with Chronic Inflammatory Bowel Disease

Free protein S, protein C, and C4b-binding protein (C4b-BP) were measured in randomly selected outpatients: 22 with Crohn's disease (CD) and 16 with ulcerative colitis (UC). Active disease was recorded in 10 patients with CD and 4 with UC. Fourteen patients (63.6%) with CD and 4 (25%) with UC had free protein S values below the normal range, with mean values of 62% and 78% of that found in healthy control subjects (p > 0.01). The C4b-BP level was 127% in patients with CD as compared with 89% in both healthy subjects and UC patients (p > 0.01). The protein C levels were similar in the three groups. The present results add to the factors already known favouring thromboembolic complications in inflammatory bowel disease and which might play a major role both for the pathogenesis and for the increased tendency to venous thromboembolism in these diseases.     

Reduced Free Protein S Levels in Patients with Inflammatory Bowel Disease

We evaluated free plasma levels of protein S, a natural anticoagulant factor, the prevalence of anti-protein S antibodies, a possible cause of protein S deficiency, and their correlation with anti-phospholipid antibodies in 53 patients with inflammatory bowel disease (IBD) and 53 age- and sex-matched controls. Mean free plasma protein S levels (± sd) were significantly lower in IBD patients (0.98 ± 0.32 IU/ml) than in controls (1.06 ± 0.28 IU/ml) (P < 0.05); only one patient showed protein S deficiency. Specific antibodies to protein S were found in four IBD patients (7.5%) and in one control (1.9%) (P = NS). Five IBD patients (9.4%) and none of the controls showed anti-phospholipid antibodies (P < 0.06). No correlation was found between free protein S levels and anti-protein S antibodies or between anti-protein S and anti-phospholipid antibodies. In conclusion, free plasma protein S levels are slightly but significantly decreased in IBD patients. The prevalence of anti-protein S and anti-phospholipid antibodies is increased in IBD patients. Anti-protein S antibodies do not appear to determine low protein S levels or to overlap with or belong to anti-phospholipid antibodies.     

Longitudinal Study of Cortical Bone Loss in Patients with Inflammatory Bowel Disease

Bone mineral density of the radius was measured by single-photon absorptiometry in 50 patients with inflammatory bowel disease. Thirty-three had Crohn's disease and 17 ulcerative colitis; 25 were women. The mean age was 45 years (range, 18–70 years). Measurements were repeated in 39 of them after a mean follow-up period of 7.9 years (range, 7.1–8.2 years). In female patients the mean (95% confidence interval) annual change in radial bone mineral density was -0.74% (-1.34% to -0.14%) (P = 0.022), the greatest bone loss occurring in postmenopausal women (mean, -1.16% (-2.01% to -0.30%)). In male patients the mean annual rate of bone loss was -0.07% (-0.41% to 0.28%) (P = NS). Patients with abnormally low values at the first measurement remained osteopenic at the second measurement, whilst some others with normal values initially showed increased rates of bone loss and had a subnormal bone mineral density after the follow-up period. These results show increased rates of cortical bone loss in some patients with inflammatory bowel disease and emphasize the need to monitor bone mass in these patients so that prophylactic measures can be instituted.