中医药治疗胃癌前期病变的现状与展望

胃癌死亡率居于我国恶性肿瘤之首，有效地防治胃癌前期病变，阻断其向癌发展，是预防胃癌、减少其发病率的根本措施和手段，因此胃癌前期病变已成为学术界研究的重点。国外有文献报道‘”，浅表性胃炎中胃癌的危险性增加虽低于萎缩性胃炎，但显著高于正常胃粘膜，而且肠型和弥漫型胃癌的危险性均增高。比较而言，中、重度萎缩性胃炎肠型胃癌的危险性显著增高。萎缩性胃炎伴不完全型肠化生和（或）中、重度异型增生为真正的癌前病变已成为公认，胃粘膜发生癌变有一个演变过程即慢性胃炎～胃粘膜萎缩一肠化一异型增生一胃癌”’。目前西医对本…     

幽门螺杆菌iceA基因型与胃黏膜病变的相关性

目的:研究幽门螺杆菌(H pylori)iccA基因型与胃黏膜病变的相关性.方法:用PCR方法检测552例慢性胃炎患者胃黏膜活检标本中H pylori的iceA基因在慢性炎症、活动性炎症、腺体萎缩和肠上皮化生中的存在情况.结果:在552例样本中,iceA1和iceA2亚型菌株单独检出率分别为67.2%,21.7%,iceA1和iceA2亚型均阳性的检出率7.6%,iceA1和iceA2亚型均阴性的比率3.4%.在H pylori感染的慢性炎症、活动性炎症、腺体萎缩、肠上皮化生的重度炎症iceA1的阳性率明显高于中度炎症.两者比较差异有统计学意义(83.1% vs 10.8%,85.5% vs 10.5%,75.6% vs13.0%,75.6% vs 13.0%,均,P<0.05).腺体萎缩和肠上皮化生iceA1的阳性率明显高于其他组(P<0.05).感染iceA1亚型菌株与未感染ieeA1亚型的胃黏膜病变程度差异有显著性(P<0.05).结论:iCeA1是河南地区的优势基因亚型,iceA1阳性率随炎症程度加重逐渐升高.iceA1亚型菌株与重度炎症特别是腺体萎缩和肠上皮化生关系密切.     

唾液幽门螺杆菌抗原检测与慢性胃炎活动性及癌前病变关系的研究

目的评价唾液幽门螺杆菌(Helicobacterpylori,Hp)抗原与慢性胃炎活动性以及胃黏膜癌前病变肠上皮化生与不典型增生的相关性。方法应用酶联免疫吸附法(ELISA),对2004年6月至2005年6月浙江大学医学院附属第二医院消化内科246例接受胃镜检查患者的唾液标本进行幽门螺杆菌抗原检测,分别比较不同胃病患者唾液中Hp抗原的阳性检出率。结果慢性活动性胃炎组唾液中Hp抗原阳性检出率为74.29%(26/35),明显高于慢性非活动性胃炎组46.92%(99/211)(P<0.05)。慢性胃炎组患者唾液中Hp抗原的阳性检出率为45.98%(80/174),慢性胃炎伴轻度肠上皮化生(肠化)组唾液中Hp抗原阳性检出率为52.63%(20/38),慢性胃炎伴中重度肠化组唾液中Hp抗原阳性检出率为68.18%(15/22),慢性胃炎伴不典型增生组唾液中Hp抗原阳性检出率为83.33%(10/12),结果显示,慢性胃炎伴中重度肠化或不典型增生组与慢性胃炎组相比,差异有统计学意义(P<0.05)。结论唾液中存在高Hp检出率现象,口腔可能为Hp的重要寄居地,口腔内Hp感染程度与胃炎活动程度及部分胃黏膜癌前病变有关,慢性活动性胃炎或伴中重度肠化或不典型增生患者口腔内Hp检出率明显增高,口腔内Hp是否需行根除治疗,值得今后进一步研究探讨。     

胃粘膜肠化和异型增生作为胃癌前兆的意义

目的：探讨胃粘膜肠化和异型曾生与胃癌发生的关系及其意义。方法；对７２例胃癌５７例胃粘膜异型增生２５６例肠化生病例进行粘液组织化学，菜豆凝集素（ＰＨＡ）亲合组织化学及抗人胃癌单抗ＭＧⅡ免疫组织化学（ＡＢＣ法）研究，１５例正常胃粘膜作为对照，结果：Ⅲ型肠化在癌旁肠化及异型增生伴肠化的检出率均显著高萎缩性胃炎伴肠化（Ｐ均〈０．０１），ＰＨＡ受体及ＭＧⅡ抗原在正常胃粘膜无表达，而在胃癌高度表达。ＰＨＡ受体     

胃黏膜保护剂与慢性胃炎

慢性胃炎是由各种病因引起的胃黏膜慢性炎性反应。根据内镜及病理组织学改变，通常将慢性胃炎分为非萎缩性（浅表性）胃炎及萎缩性胃炎。前者是指胃黏膜层仅有淋巴细胞和浆细胞为主的浸润性改变，而无腺体萎缩；后者指胃黏膜腺体萎缩并常伴化生性改变（肠化或假幽门腺化生）。胃黏膜损伤和修复过程的演变，使慢性胃炎的病理组织变化多端，可表现为炎性反应、萎缩和化生，甚至异型增生。     

Ⅲ型肠化是异型增生的一种类型

目的：探讨Ⅲ型肠化与异型增生的关系。方法：采用粘液组化技术将胃粘膜肠化标本分为Ⅰ、Ⅱ、Ⅲ型。盲法比较肠化亚型和异型增生的形态学差异；Ａｇ－ＮＯＲｓ技术定量分析肠化亚型和异型增生细胞Ａｇ－ＮＯＲｓ计数差异。结果：８６％（３７／４３）的Ⅲ型肠化符合轻度异型增生诊断标准；Ⅰ型和Ⅱ型肠化无一例符合（Ｐ＜００００１）；Ａｇ－ＮＯＲｓ计数Ⅲ型肠化（４３３±０８６）显著大于Ⅰ型（２９３±０９２）和Ⅱ型（３１３±０６９）（Ｐ＜００１），但与异型增生（４１４±１４５）差异无显著性（Ｐ＞００５）。结论：Ⅲ型肠化是异型增生的一种类型，提示Ⅲ型肠化很可能是一种癌前病变     

慢性萎缩性胃炎胃粘膜病理改变与细胞毒素相关蛋白及空泡细胞毒素的关系

目的研究慢性萎缩性胃炎时胃粘膜不同的病理变化与幽门螺杆菌(Hp)致病因子细胞毒素相关蛋白(CagA)和空泡细胞毒素(VacA)之间的关系.方法 120例Hp阳性的慢性萎缩性胃炎患者按粘膜炎症和粘膜萎缩的程度以及有无肠化生进行分组,并抽取血清,用Western blot法测定血清中特异性抗体CagA(116KD)和VacA(89KD).结果 (1)慢性萎缩性胃炎粘膜炎症的程度与CagA检出的阳性率显著相关,炎症程度严重患者的CagA抗体阳性率显著高于轻度炎症病例(85.1% vs 53.28%,P<0.005);(2)胃粘膜重度萎缩者VacA抗体阳性率显著高于胃粘膜轻度萎缩者(77.8% vs 38.7%,P<0.005);(3)慢性萎缩性胃炎患者VacA抗体阳性者多有肠化生,其肠化生的发生率显著高于VacA抗体阴性患者(84.1% vs 30.3%,P<0.005).结论 CagA的表达同慢性萎缩性胃炎的严重程度密切相关,高阳性率患者的胃粘膜炎症活动度较重,而VacA的表达则同胃粘膜的萎缩及肠化密切相关,胃粘膜重度萎缩与肠化患者VacA的表达率显著高于胃粘膜轻度萎缩与肠化的患者.     

胃脘舒冲剂加多虑平治疗慢性萎缩性胃炎65例

慢性萎缩性胃炎(CAG)是一种常见多发病,在治疗上尚无特效药物。近年来我们采用胃脘舒冲剂治疗本病55例,并与加服多虑平治疗的65例作对照,结果两组疗效均较满意,现报告如下。1　资料与方法1.1　临床资料:选择本院消化内科门诊经胃镜检查确诊的CAG患者120例,其中男69例,女51例;年龄20～69岁,平均47.2岁;病程1～10年82例,10年以上38例。随机将患者分为治疗组65例和对照组55例。诊断标准参照全国慢性胃炎座谈会纪要中制订的标准。其中符合重度CAG伴肠化和(或)异型增生20例,中度CAG伴肠化和(或)异型增生32例,轻度CAG伴肠化和(或)异型增生68…     

胃癌及癌前病变组织中PTEN蛋白的表达及意义

采用免疫组化ABC法对10例正常胃黏膜、16例胃黏膜轻度异型增生、12例中度异型增生、14例重度异型增生、16例早期胃癌及52例进展期胃癌组织中的PTEN蛋白进行了检测.结果显示,正常胃黏膜PTEN蛋白阳性表达率为90.0%,轻、中、重度异型增生胃黏膜分别为81.3%、75.0%、42.9%,早期及进展期胃癌分别为37.5%和36.5%.PTEN蛋白在轻度异型增生胃黏膜中的阳性表达率与重度异型增生、早期及进展期胃癌相比,P均<0.05;中度异型增生与早期及进展期胃癌相比,P均<0.05;肠型胃癌的阳性率(50.0%)与弥漫型胃癌(25.0%)相比,P<0.05;淋巴结转移胃癌的阳性率(14.8%)与未转移者( 51.2%)相比,P<0.05.认为PTEN蛋白在胃黏膜癌变过程中发挥了一定作用,可作为判断胃癌预后的一个有用指标.     

胃癌自然过程中的胃上皮异型增生:多中心前瞻性随访研究

胃癌有两种类型:即肠型和弥漫型,两者的流行病学、临床、病理及生物学特点均不相同;它们的癌前病变也可能不同:肠型胃癌的癌前病变比较明确,为Ⅰ型(或腺瘤型)异型增生,而弥漫型胃癌的不太明确,可能为Ⅱ型起源于非肠化腺体的异型增生。良好的内镜活检及常规的HE染色迄今仍为主要的和最有效的诊断异型增生的措施。胃上皮异型增生(GED)常在浅表型或进展期胃癌的附近发现,在临床实践中,     

The history of the (Young) AEMI(E) and the EFIM

The European Federation of Internal Medicine (EFIM) was formed in 1996 through a merger between the Association Européenne de Médicine Interne (d' Ensemble) (AEMI(E)) and the Forum of Presidents of National Societies of Internal Medicine (IM). It arose as a result of ideas from Carcassi (Rome/Cagliari) and Merino (Alicante) to transform the largely French-speaking and rather elitist AEMI into a more easily accessible and English-speaking federation of national societies. The founding meeting of the General Assembly of the EFIM took place in May 1996 in Paris. Since then, the EFIM has initiated many activities, some of them originating from the time of the AEMI(E).     

Central bisectionectomy (bisegmentectomy) of the liver (with video)

Surgical techniques and indications for central bisectionectomy (bisegmentectomy) of the liver, i.e., resection of Couinaud's segments 4, 5 and 8, are described. Parenchymal dissection between the left medial and lateral sections is performed by dividing Glisson's branches arising from the right side of the umbilical portion towards the confluence between the middle and left hepatic veins. Parenchymal dissection between the right anterior and posterior sections is performed along the demarcation line created by obliterating the Glisson's pedicle of the right anterior section (Couinaud's segments 5 and 8), and then along the left side of the right hepatic vein. The root of the middle hepatic vein is divided at the bottom of the right and left plane of the parenchymal division. The indications for central bisectionectomy include benign and malignant tumors occupying both the left medial and right anterior sections, i.e., Couinaud's segments 4, 5 and 8, while sparing the left lateral and right posterior sections, i.e., Couinaud's segments 2, 3, 6 and 7. This technique is advocated especially for liver tumors arising in chronic liver diseases such as hepatocellular carcinoma complicating viral hepatitis and metastatic liver tumor with concomitant steatosis of the non-cancerous liver parenchyma, for which right or left trisectionectomy could result in less than optimal remnant liver volume and function.     

Diffusivity of Methane in a Mixture of CCl(4) and c-C(6)F(11)C(2)F(5) of the Critical Composition in the Region above the Temperature of Separation

The diffusivity of CH₄ in a mixture of CCl₄ and c-C₆F₁₁C₂F₅ of the critical composition in the region of temperature close to that of unmixing, decreases as in a homogeneous liquid from 36° to about 32°. It then passes through a minimum of 10⁵D ≈ 4.15 cm²/sec at about 27.5°, then rises to 10⁵D = 4.61 at 25.00°, then steeply to 6.36 cm²/sec in the further drop of only 0.3° to 24.71°.     

Human immunodeficiency virus (HIV) antigenemia (p24) in the acquired immunodeficiency syndrome (AIDS) and the effect of treatment with zidovudine (AZT)

Infection with human immunodeficiency virus (HIV) may cause viral antigenemia, detected primarily as p24 viral core protein. Among 16 patients with the acquired immunodeficiency syndrome (AIDS) or AIDS-related complex studied serially, 12 had or developed antigenemia ranging from 16 to 3006 pg/mL in plasma. The level could be categorized as high (greater than 100 pg/mL) or low (15 to 65 pg/mL). Three patients with anti-p24 antibody had no antigenemia. Zidovudine (AZT), 200 or 250 mg every 4 hours, reduced antigenemia by about 90%; other regimens were less effective. Leukocyte cultures were positive for HIV from patients with antigenemia, and in one third of samples in the absence of antigenemia. High levels of antigenemia correlated with symptoms, CD4 cell count, and prognosis. Drug toxicity requiring a lower dose was followed by increased antigenemia, recurrent symptoms, and decreased CD4 cells, suggesting lymphocyte toxicity. Monitoring antigenemia can be useful in evaluating patients with HIV infection and in evaluating the effect of antiviral chemotherapy.     

Variations of the pre-coronary times (1973-1977) (author's transl)

A comparison has been made between the pre-coronary times of IMA patients in the UCIC of the S. Camillo Hospital in Rome between 1973 and 1977, and the pre-coronary times of patients in another UCIC in the same city, in order to record possible modifications. From 1973 to 1977 there has been a decrease in the pre-coronary times: this is the result of a better hospitalization policy and more frequent admission directly to the UCIC. The mortality rate according to the data in question, has also decreased from 21% in 1973 to 10% in 1977, with a marked reduction for patients with a pre-coronary time superior to 12 hours. This is also connected to the fact that there is a considerable reduction in the number of patients, generally suffering from serious complications, transferred to UCIC from other wards. From an analysis of the data we infer that there has been an improvement in the policy governing the admission of patients to UCIC, a policy which could be improved further by a more adequate training both for doctors and the population in general.