中西医结合根除幽门螺杆菌对萎缩性胃炎核因子-κB表达的影响

[目的]观察以胃舒散为主的三联疗法（胃舒散、呋喃唑酮和克拉霉素）治疗幽门螺杆菌（Hp）阳性慢性萎缩性胃炎（CAG）的临床效果及其对核因子-κB（NF-κB）表达的影响。[方法]41例Hp阳性CAG患者服用胃舒散2．0g，呋喃唑酮0．1g，各3次／d，克拉霉素0．25g，2次／d，1周后再继服胃舒散4周。治疗前及治疗结束1年后行内镜及病理组织学检查，取活检观察病理组织学改变及NF-κB表达变化，采用银染色法、^14C-尿素呼气试验或快速尿素酶试验检测Hp。[结果]三联疗法结束1年后，Hp根除率为85．4％；根除Hp能显著减轻患者胃窦部慢性炎症（P〈0．05）和活动程度（P〈0．01），下调NF-κB表达（P〈0．01），但胃炎的萎缩和肠化生等病理无明显改变。[结论]以胃舒散为主的三联疗法对Hp有较高根除率。根除Hp可抑制NF-κB的表达，减轻活动性炎症，但近期观察对萎缩、肠化生等病理改变无明显作用。     

中药对萎缩性胃炎异型增生的干预治疗

胃的：探讨萎胃康对萎缩性胃炎(CAG)伴异型增生(ATP)的临床症状、CAG及ATP上皮病理改变的影响。方法：将胃镜和胃粘膜活检病理组织学确诊的172例CAG伴ATP的患者，随机分为治疗组和对照组。将萎胃康与维酶素两种药物分别制成Ⅰ、Ⅱ号胶囊，外观及大小相同，治疗组给予Ⅰ号胶囊，6粒／次，3次／d；对照组给予Ⅱ号胶囊，6粒／次，3次／d。两组均以3个月为1个疗程。观察临床症状改善情况，治疗前后1周内各做1次胃镜检查，在同一部位取材做病理组织学检查，检测血、尿、粪常规及肝、肾功能。结果：临床症状改善：治疗组总有效率88．51％(77／87)，对照组64．71％(55／85)(P＜0．01)；ATP：治疗组总有效率78．17％(68／87)，对照组为30．59％(26／85)(P＜0．01)；CAG：治疗组总有效率80．46％(70／87)，对照组为41．18％(35／85)(P＜0．01)。结论：萎胃康可以改善CAG伴ATP患者临床症状；对CAG及ATP有逆转作用，提示中药有干预CAG伴ATP进程的作用。     

中西医结合治疗慢性浅表性胃炎胃癌前病的探讨

目的选用羟氨苄青霉素、庆大霉素、铋剂（三联）根除幽门杆菌（Hp），用中药抗萎化汤，增强胃粘膜生理功能，改善胃粘膜微循环，增加血流灌注，促使已萎缩、肠化的细胞逆转，以制止胃癌前病变向胃癌发展．方法经内镜、病理细菌学检查，确诊Hp（＋）均伴肠化和部分萎缩50例胃炎患者，选用羟氨苄青霉素0．75g，3次／d，庆大霉素8万U，3次／d，丽珠得乐冲剂110g，4次／d，连服3wk，为一个疗程；中药自拟抗萎化汤（党参、黄芪、炒白芍、炒白术、蒲公英、姜半夏、九香虫、元胡、徐长卿、砂仁、马勃、白花蛇舌草），每日一剂，分二次煎服，每次250cc—300cc，连服4wk，为一个疗程，治疗结束后1mo复查．结果50例Hp（＋）伴肠化及部分（16）例萎缩性胃炎患者，完成全程治疗后复查，Hp转阴43例，肠化消失26例，其中肠化萎缩16例，萎缩消失15例．结论选用三联疗法根除Hp，中药抗萎化汤阻止胃癌前病变向胃癌发展，促使胃癌前病变逆转，从治疗50例疗效分析，HP根除率为86％，肠化消失率为52％，其肠化伴萎缩16例，萎缩消失15例治愈达94％三联疗法结合中药抗萎化汤治疗胃炎及胃癌前病变疗效确切，值得进一步探讨．     

幽门螺杆菌相关性胃炎内镜随访研究

为了解Ｈｐ长期感染是否促进胃粘膜萎缩、肠上皮化生和异型增生的形成与发展，对首次胃镜检查诊断为慢性胃炎而不伴有肠化生和异型增生的１２０例Ｈｐ阳性患者和８７例Ｈｐ阴性患者进行内镜随访。随访时间３～８年，平均４．８年，随访次数２－１０次，活检组织进行Ｈｐ检查、病理学检查和ＡｇＮＯＲｓ，银染及ＰＣＮＡ免疫组化染色。结果Ｈｐ阳性患者其慢性萎缩性胃炎、肠化生、Ⅲ型肠化生和异型增生的发生率显著高于Ｈｐ阴性患者，Ｈｐ阳性胃粘膜ＰＣＨＡ标记指教和ＡｇＮＯＲｓ数也显著高于Ｈｐ阴性胃粘膜。表明Ｈｐ感染可能通过刺激胃粘膜细胞的过度增殖、更新加快，促进萎缩性胃炎和肠化生的形成与发展，从而增加患胃癌的危险性。     

幽门螺杆菌感染者胃粘膜癌前病变与Fas抗原表达的关系

目的 研究幽门螺杆菌(Hp)感染后胃粘膜癌前病变中Fas抗原表达的情况，了解Hp在胃癌发生过程中的作用．方法 采用免疫组织化学等方法捡测83例经病理证实为慢性胃炎病人胃粘膜上皮细胞中Fas抗原的表达情况。结果 在浅表性胃炎、萎缩性胃炎、肠化生及异型增生中，Fas抗原表达率分刷为20．00%、36．36％、73．33％、43．75%，Fas抗原在肠化生中的表达率显高于浅表性胃炎，萎缩性胃炎及异型增生(P<0．01及P相似文献   

幽门螺杆菌相关性胃炎内镜随访研究

为了解Ｈｐ长期感染是否促进胃粘膜萎缩、肠上皮化生和异型增生的形成与发展，对首次胃镜检查诊断为慢性胃炎而不伴有肠化生和异型增生的１２０例Ｈｐ阳性患者和８７例Ｈｐ阴性患者进行内镜随访。随访时间３～８年，平均４．８年，随访次数２～１０次，活检组织进行Ｈｐ检查、病理学检查和ＡｇＮＯＲｓ，银染及ＰＣＮＡ免疫组化染色。结果Ｈｐ阳性患者其慢性萎缩性胃炎、肠化生、Ⅲ型肠化生和异型增生的发生率显著高于Ｈｐ阴性患者，Ｈｐ阳性胃粘膜ＰＣＮＡ标记指数和ＡｇＮＯＲｓ数也显著高于Ｈｐ阴性胃粘膜。表明Ｈｐ感染可能通过刺激胃粘膜细胞的过度增殖、更新加快，促进萎缩性胃炎和肠化生的形成与发展，从而增加患胃癌的危险性。     

胃癌及其癌前病变中转化生长因子β1，细胞周期蛋白A表达与细胞凋亡关系的研究

目的：探讨转化生长因子（TGF）－β1,细胞周期蛋白（cyclin)A表达与细胞凋亡的关系及其在正常胃粘膜,非萎缩性胃炎,萎缩性胃炎,不典型增生及胃癌演化列中的规律和可能作用,方法：用免疫组化法检测TGF－β1和cylclin A的表达,用DNA原位末端标记法（TUNEL（检测细胞凋亡。结果：正常胃粘膜,非萎缩性胃炎,萎缩性胃炎,不典型增生和胃癌组织的细胞凋亡指数分别为1．7&;#177;1．6％,4．7％&;#177;5．0％,5．2％&;#177;4．7％,3．0％&;#177;3．5％和1．＝6％&;#177;2．5％,非萎缩性胃炎,萎缩性胃炎和不典型增生组织的凋亡指数明显高于胃癌（P＜0．05）,TGF－β1的阳性表达率分别为10．0％（1／10）,25．0％（4／16）,25．0％（11／44）,60．7％（17／28）和59．5％（25／42）,正常胃粘膜,非萎缩性胃炎和萎缩性胃炎组织的阳性率与不典型增生和胃癌组织相比有显著差异（P＜0．05）,cyclin A 的阳性表达率分别为0,6．2％,（1／16）,20．5％（9／44）,46．4％（13／28）和85．7％（36／42）,不典型增生和胃癌组织的阳性率有显著差异,但两者均显著高于正常胃粘膜,非萎缩性胃炎和萎缩性胃炎（P＜0．05）,结论：在胃癌演化过程中,从正常胃粘膜到萎缩性胃炎,凋亡指数逐渐上升,从不典型增生期开始,凋亡指数逐渐下降,在胃癌和不典型增生组织中,TGF－β1和cyclinA的阳性表达率均显著高于正常胃粘膜,非萎缩性胃炎和萎缩性胃炎,提示TGF－β1和cyclin A的表达可能与细胞凋亡有关并在胃癌的发生,发展中具有重要作用。     

中医治疗慢性萎缩性胃炎的探讨

对于慢性萎缩性胃炎从整体出发进行辩证论治，结合微观胃粘膜病理特点对有关几个问题进行讨论．1辨证施治将慢性萎缩性胃炎分为脾胃虚弱、脾胃虚寒、肝胃不和、脾胃湿热、胃阴虚等型．慢性萎缩性胃炎有癌变可能，学术界把胃癌前病变作为胃粘膜研究的重点，运用中药治疗可以使胃粘膜腺体萎缩得到逆转，“重建”．2中医治疗慢性萎缩性胃炎有关几点①辨症和辨病相结合：由于慢性萎缩性胃炎有时缺少特异症状，因此，尚须在辨证的基础上与辨病内镜及病理切片相结合．②慢性萎缩性胃炎病理检查常出现肠腺化生和不典型增生，中医认为均有瘀滞表现，宜用活血化瘀的药物，通过改善微循环使病变的粘膜和腺体得到充分灌注，加快损伤的修复③关于幽门螺杆菌（Hp）：中草药如黄连、黄芩、大黄等Hp有抑制与杀灭作用．④关于慢性萎缩性胃炎伴胆汁反流：胆汁反流中医认为与脾气虚，肝气郁结有关，所以采用健脾和胃，疏肝降逆药物治疗．⑤临床用药的注意点：胃弱者不胜重药忌重投大苦大寒，滋腻壅中，香燥破气之品．     

环氧化酶-2在胃癌和胃炎中的表达及其与幽门螺杆菌感染的关系

目的探讨环氧化酶-2（Cyclooxygense-2，COX-2）在胃癌和胃炎中的表达及其与幽门螺杆菌（Helicobacter pylori，Hp）感染的关系，为胃癌的预防和治疗提供有价值的实验和理论依据。方法采用免疫组化技术检测COX-2、Hp在胃癌以及各型胃炎中的表达。结果胃癌和萎缩性胃炎伴不典型增生组织中COX-2的表达率明显高于浅表性胃炎（P〈0.05），COX-2在Hp感染阳性萎缩性胃炎伴不典型增生病人中的表达率明显高于Hp感染阴性组（P〈0．05），高、中分化胃癌COX-2表达率高于低分化胃癌（P〈0．05）。结论COX-2在胃癌组织中存在过表达，Hp感染可使萎缩性胃炎伴不典型增生组织中COX-2表达增强，COX-2表达与胃癌分化程度有关。     

胃粘膜肥大细胞及其脱颗粒与Hp致病关系的探讨

目的：探讨胃粘膜肥大细胞（MC）及其脱颗粒与幽门螺杆菌（Hp）致病性的关系。方法：采用改良甲苯胺蓝染色法检测120例患者胃粘膜中MC计数及脱颗粒细胞所占比例。结果：1．Hp阳性患者胃粘膜MC计数及脱颗粒比显著高于Hp阴性患者（P＜0．01）;2．不同Hp感染胃病患者之间胃粘膜MC计数及脱颗粒比也有差异,消化性溃疡（PU）和慢性浅表性胃炎（CSG）患者胃粘膜MC计数及脱颗粒比显著高于慢性萎缩性胃炎（CAG）患者（P＜0．01）。结论：胃粘膜肥大细胞及其脱颗粒参与了Hp致病而导致胃粘膜受损。     

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.     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.