能量多普勒和灰阶超声对肾脏实性肿瘤的诊断价值

目的 探讨肾脏实性肿瘤的灰阶超声特征及其能量多普勒血供模式,并评价二者联合应用的诊断价值.方法 用灰阶超声及能量多普勒超声评价98例肾脏实性肿瘤.在灰阶超声图上,观察肿块回声、均匀性、无回声边、肿瘤内无回声区及后方衰减.在能量多普勒超声上,肿块的血管分布被分成五种模式.结果 98例肾脏实性肿瘤,肾细胞癌(RCC)79例、肾血管平滑肌脂肪瘤(AML)19例.在灰阶超声上,55例(70%)RCC可见无回声边或肿瘤内无回声区;58例(73%)RCC肿块回声不均.2例AML(11%)出现声衰减.肿块回声强度不能提示病理诊断.在能量多普勒超声上,79例RCC中,模式3(边缘血流型)15例、模式4(混合性边缘及穿入血流型)64例.19例AML中,模式4血流2例,模式0(无血流信号型)11例,模式2(穿入性血流型)6例.在本组RCC及AML中均未见模式1(肿瘤内局限性血流信号型).模式0、模式2对AML有特异性.与单独灰阶超声(58%)及单独能量多普勒超声(22%)的诊断率比较,二者联合诊断率(80%)明显提高.结论 无回声边及肿瘤内无回声区提示RCC的诊断,在灰阶超声发现的基础上,能量多普勒超声血管分布为RCC及AML的鉴别诊断提供了重要的依据.     

炎症性肠病110例临床分析

目的探讨溃疡性结肠炎(UC)和克罗恩病(CD)的诊断和治疗方法。方法回顾性分析1987~2006年的110例炎症性肠病病人的临床、肠镜表现及治疗方法和效果。结果85例UC主要表现为反复发作的黏液脓血便,腹痛多位于下腹和左侧,结肠镜下主要表现为多发性浅表溃疡、弥漫性充血糜烂、假息肉。25例CD主要临床症状为糊状腹泻,腹痛多位于脐周或右下腹,结肠镜下主要表现为节段性、非对称性的黏膜炎症和阿弗他溃疡。UC结肠镜确诊率为100%,CD结肠镜确诊率为42.4%。UC内外科治疗完全缓解率32.8%,有效率81.9%;CD完全缓解率为21.8%,有效率为63.7%,UC的治疗有效率明显高于CD(p<0.05)。结论结肠镜是诊断UC的最有效方法,CD的诊断须依靠临床、结肠镜、X线及手术探查资料进行综合分析、评价。合理的内科治疗和选择性外科治疗可提高炎症性肠病的治疗效果。     

小儿炎症性肠病

炎症性肠病是指一类肠道慢性持续性炎症性疾病，与感染和饮食无关。炎症性肠病包括溃疡性结肠炎和克罗恩病。另外，白塞病、软化斑、婴儿顽固性结肠溃疡也有相似的临床表现，但未作为一类疾病。近年来，儿童溃疡性结肠炎和克罗恩病的发病有上升趋势，正逐渐被认为是儿童和青少年主要的慢性肠道疾病。     

炎症性肠病发生的影响因素

炎症性肠病(IBD)在世界各国普遍出现,而且其发病率有逐渐升高的趋势,但到目前为止本病的病因仍然不清.综述了有关文献,概括了炎症性肠病发生可能的影响因素,其中阑尾切除、膳食纤维、婴儿期母乳喂养可预防炎症性肠病;口服避孕药、糖、巧克力和可乐饮料的大量摄入、围生期感染、麻疹疫苗预防接种是炎症性肠病的危险因素;吸烟使溃疡性结肠炎发病减少,使克罗恩病发病增加.     

炎症性肠病的营养支持治疗

炎症性肠道疾病(IBD)主要指溃疡性结肠炎(UC)和克罗恩病(CD),其病因不明。近年来,该病的患病率迅速上升。近5年,我科每年收治的CD病人数均超过100例,并逐年增加,2010年达407例。由于IBD是消化系疾病,且常并发感染,不但     

儿童炎症性肠病病原菌分析

摘要:目的　分析某院炎症性肠病（Inflammatory Bbowel Disease,IBD）儿童患者粪便中的菌群分布,并与正常对照进行比较,探讨儿童IBD的发生与肠道菌群的关系。方法　选取2011年5月-2014年8月在该院确诊的IBD患儿共101例作为调查对象;同时选取该院同一时间段进行健康体检的健康儿童50例作为对照。收集调查样本新鲜粪便,通过荧光定量PCR检测肠道优势菌群的数量情况,比较溃疡性结肠炎（UC）患儿、克罗恩病（CD）患儿与正常对照组各优势菌种的数量差异。结果　根据菌群定量检测结果发现,拟杆菌属在3组人群中数量差异无统计学意义（F＝3.148,P＞0.05）,UC组及CD组双歧杆菌、缠绕杆菌、乳酸菌、脆弱杆菌、梭状芽胞杆菌比对照组显著减少（F值分别为15.331、17.453、21.479、18.521,27.658,P值均＜0.05）,UC组及CD组肠球菌比正常对照组明显增多（F＝23.457,P＜0.05）。结论　儿童肠道优势菌群与IBD的发生具有关联性,但优势菌群分布与IBD发生的因果关系还需要今后进行进一步的研究证实。     

炎症性肠病122例临床分析

目的 探讨炎症性肠病（IBD）患者的临床治疗现状.方法 调查122例IBD患者的临床特点及诊疗特征.结果 122例IBD患者中,54例为溃疡性结肠炎（UC）,病变范围以广泛结肠为主,就诊医院中位数3家,使用氨基水杨酸制剂、糖皮质激素、免疫抑制剂、生物制剂和抗生素分别为100.0％（54/54）,55.6％（30/54）,24.1％（13/54）,7.4％ （4/54）,75.9％（41/54）;68例为克罗恩病（CD）,病变范围以空回肠＋结肠为主,就诊医院中位数4家,使用过氨基水杨酸制剂、糖皮质激素、免疫抑制剂、生物制剂和抗生素分别为95.6％（65/68）,58.8％（40/68）,47.1％（32/68）,11.8％ （8/68）,79.4％（54/68）.CD患者使用免疫抑制剂、喹诺酮类抗生素均高于UC患者,使用中草药治疗的低于UC患者,差异有统计学意义（P＜0.05）.结论 目前治疗IBD的主要药物有氨基水杨酸制剂、糖皮质激素、免疫抑制剂、生物制剂.     

添加益生菌的低脂高蛋白肠内营养制剂在炎症性肠病中的疗效观察

目的:观察添加益生菌的低脂高蛋白肠内营养(EN)制剂对炎症性肠病(IBD)病人的治疗效果。方法:总结104例IBD病人的临床资料,按照使用EN不同,分为试验组(n=48)和对照组(n=56)。试验组病人使用添加益生菌的低脂高蛋白EN制剂,对照组使用常规EN制剂。所有病人在入院时和营养支持第14天分别测定营养指标和免疫指标等。结果:试验组病人前清蛋白、血小板计数、淋巴细胞明显高于对照组(P﹤0.05),同时达到目标营养液供给量的时间和腹泻发生率亦明显低于对照组(P﹤0.05)。结论:添加益生菌的低脂高蛋白EN比普通EN更能改善IBD病人的营养状况和改善肠道功能。     

炎症性肠病

背景 炎症性肠病（inflammatory bowel disease，IBD）包括克罗恩病（Crohn’s disease，CD）和溃疡性结肠炎（ulcerative colitis，UC）。营养不良在IBD患者，尤其是CD患者中多见。根据疾病严重程度不同，65％-78％的CD患者和18％-62％的UC患者有体重下降。25％-80％的CD患者和26％-50％的UC患者存在低蛋白血症。半数CD患者存在贫血，可能继发于营养不良，而80％的UC患者存在贫血，主要原因为血液丢失。腹泻所致电解质丢失在CD和UC中均常见。     

炎症性肠病的发病率、患病率与环境因素的影响

综合相关文献描述了炎症性肠病在不同地区、不同年龄及性别的发生差异,并引用移民流行病学资料,分析了不同地区移民与本土居民及原住居民的发病差异,从而说明炎症性肠病的发生与生活方式、环境因素密切相关.     

The uncertain primary diagnosis of inflammatory bowel diseases

BACKGROUND: The purpose of this study is to re-evaluate our series of patients affected by a colonic non-neoplastic disease, in order to measure the percentage in whom we were unable to make a correct diagnosis after the first clinical and histological approach and to single-out the reasons for our inability to reach the correct diagnosis. METHODS: During the period 1985-1999 we observed 1228 patients affected by chronic inflammatory colonic diseases. RESULTS: In 859 patients (69.9%) an ulcerative colitis was diagnosed for the first time, and 248 patients (20.1%) were affected by Crohn's colitis. One hundred and twenty-one patients (9.8%) were defined as being affected by an undetermined colitis. Forty-three patients of these had a definite diagnosis, afterwards: 27 patients were affected by ulcerative colitis and 16 by Crohn's colitis. Differential diagnosis between inflammatory large bowel diseases (ILBD) and other forms of colitis was set out as follows: 62 cases out of 1228 were consequent on a bacterial infection or parasitosis; in 28 patients a colitis pseudomembranosus was diagnosed. Eighteen cases of ischemic colitis are reported and 14 patients were affected by NSAID-related colitis. In another 6 patients we diagnosed a postradiation colitis. In 22 cases mimicking a Crohn's colitis we ascertained 9 patients affected by intestinal lymphoma, 11 mycobacterium tuberculosis related intestinal infections and 2 cytomegalovirus related colitis. CONCLUSIONS: Despite progress in scientific acquisitions and in diagnostic methods, correct initial diagnosis of ILBD is still difficult, even though it will be defined with time.     

HE4联合CA125及彩色多普勒超声在上皮性卵巢癌诊断中的价值

目的探讨新型血清肿瘤标记物人附睾蛋白(HE4)联合CA125及彩色多普勒超声在诊断上皮性卵巢癌中的临床价值。方法选取在2013年1月-2016年1月在该院妇科接受手术治疗并根据术后常规病理检查结果确诊为卵巢上皮性肿瘤的患者为研究对象,其中恶性肿瘤组73例,良性肿瘤组93例,另收集上皮性交界性肿瘤为交界性组41例。对术前常规检测的肿瘤标记物及彩色多普勒超声检查结果进行回顾性分析,探讨各项检查在卵巢上皮性癌诊断中的价值。结果 HE4、CA125及彩色多普勒超声阳性率在观察组与对照组间比较,差异有统计学意义(χ~2_(HE4)=80.38,P0.005;χ~2_(CA125)=93.02,P0.005;χ~2_(超声)=31.48,P0.005);HE4、CA125及彩色多普勒超声检查单独诊断上皮性卵巢癌的灵敏度、特异度、准确度、阳性预测值、阴性预测值分别是75.34%、92.47%、84.94%、88.71%、82.69%;90.41%、84.95%、87.35%、82.50%、91.86%及73.97%、69.89%、71.69%、65.85%、77.38%。3者联合诊断上皮性卵巢癌的灵敏度、特异度、准确度、阳性预测值、阴性预测值分别是98.63%、54.84%、74.10%、63.16%、98.08%。结论 HE4联合CA125及彩色多普勒超声检查可显著提高卵巢上皮性癌诊断的灵敏度及阴性预测值,减少漏误诊率,对早期诊断和治疗卵巢癌、改善预后有着重要的临床价值。     

彩色多普勒超声对急性阑尾炎的诊断价值

目的:结合急性阑尾炎的病理分型,分析声像图特征,以提高对其诊断准确率。方法:对127例急性阑尾炎病例,应用彩色多普勒技术及凸阵、线阵探头并结合临床资料综合分析,总结不同病理分型的声像图表现。结果:127例急性阑尾炎患者中,超声诊断为急性阑尾炎的113例,漏诊14例。声像图主要表现为阑尾自身和阑尾周围不同程度的改变。所有病例均经手术或随访证实。结论:彩色多普勒超声对急性阑尾炎的诊断有较高的准确率并可初步提示阑尾炎的分型,可作为协助临床对急性阑尾炎的诊断及选择治疗方案的首选影像诊断方法。     

二维超声及彩色多普勒超声对艾滋病感染合并腹部结核的诊断价值

目的探讨二维超声及彩色多普勒超声对艾滋病感染合并腹部结核患者的诊断价值及其临床意义。方法选择武汉市皮肤病防治院初治艾滋病患者225例为研究对象,其中有26例患者合并腹部结核。所有患者均结合二维超声及彩色多普勒超声进行检查,观察分析艾滋病以及艾滋病合并腹部结核时病变形态、边界、内部后方回声、钙化灶、包膜、血流分级、阻力指数等特征。以穿刺或者手术病理检查结果为金标准,计算二维超声及彩色多普勒超声对于艾滋病及合并腹部结核病变诊断的敏感度、特异性。结果 26例艾滋病合并腹部结核患者中,15例患者合并肝脏结核,13例表现为肝脏肿大,而6例表现为肝脏局部病变,呈大小、密度均匀的高/低回声小结节,彩色多普勒超声内部与周边可见血流信号。17例患者合并脾脏结核,14例患者表现为脾脏肿大,7例表现为脾脏局部病变,呈均匀散在的低回声结节,1例病变表现为弥漫性,彩色多普勒超声没有明显的血流信号。3例患者合并肠道结核,1例合并胰腺结核,1例合并有泌尿道结核,6例患者合并腹腔积液,部分病灶无回声区域可见细小密集高回声。合并有腹部结核患者,在3～6个月抗结核治疗后,再次接受超声检查发现病变明显缩小或者消失。二维超声与彩色多普勒超声诊断艾滋病合并腹部结核的敏感度为73.07%,特异度为96.98%。结论超声可以动态分析艾滋病合并腹部结核患者病变的特点与变化,病变多呈现为无回声液化区,内少有钙化,并且肿大的淋巴结与腹腔积液以结核性为著,在临床定性上具有一定的指导意义。     

Osteoporosis associated with inflammatory bowel diseases

Inflammatory bowel diseases, most frequently Crohn's disease, are frequently accompanied by decreased bone mineral content (30-70%). The osteopenia is not explained by the side effects of treatment or the secondary malabsorption. There must be a common pathological pathway in the background. The mineral content of bones is most easily measured by dual-ray absorptiometry. The measurement should be performed at the time of the diagnosis of bowel disease. It is useful to perform some routine laboratory examinations (serum calcium and phosphate, urinary calcium excretion level, etc.) and some special tests (serum osteocalcin and crosslaps) to exclude some other pathological pathways as well as to plan the anti-osteoporotic therapy. Appropriate calcium and vitamin-D supplementation is essential in prevention and therapy as well. Several drug-classes have proven useful in the therapy of severe osteoporosis associated with inflammatory bowel diseases such as bisphosphonates, hormone replacement therapy, selective estrogen receptor modulators and calcitonin. The authors provide an algorithm for the therapy of metabolic bone disease in inflammatory bowel disease.     

Prebiotics in inflammatory bowel diseases

In genetically susceptible individuals, an altered mucosal immune response against some commensal bacteria of the gut ecosystem appears to be the principal mechanism leading to intestinal lesions in inflammatory bowel disease (IBD). The information currently available does not provide an exact explanation about the origin of this important dysfunction of the interaction between host and commensal bacteria, but an altered microbial composition has been detected in the gut ecosystem of patients with Crohn's disease or ulcerative colitis. Prebiotics are food ingredients not digested nor absorbed in the upper intestinal tract that are fermented by intestinal bacteria in a selective way promoting changes in the gut ecosystem. Experimental and human studies have shown that inulin and oligofructose stimulate saccharolysis in the colonic lumen and favour the growth of indigenous lactobacilli and bifidobacteria. These effects are associated with reduced mucosal inflammation in animal models of IBD. Strong experimental evidence supports the hypothesis that inulin and oligofructose can offer an opportunity to prevent or mitigate intestinal inflammatory lesions in human Crohn's disease, ulcerative colitis, and pouchitis. Encouraging results have been obtained in preliminary clinical trials.     

超声诊断在肛周感染性疾病治疗中的价值分析

目的分析探讨超声诊断在肛周感染性疾病治疗过程中的价值。方法对医院2009年11月-2010年11月收治的67例肛周感染性疾病患者的诊治资料进行回顾性分析,将超声诊断结果与手术所见进行比较,分析二者的符合率,评价超声诊断在肛周感染性疾病治疗方法选择及治疗效果核实方面的价值。结果超声诊断与手术所见符合率分别为单纯肛周脓肿97.1%、肛瘘100.0%、复合型肛周脓肿90.0%。结论超声诊断在肛周感染性疾病的诊断中有独特的优势,可结合病变发生的解剖部位对肛周感染性疾病进行准确分型,并对脓肿发生的大小、范围、程度提供信息,为临床治疗提供依据。     

Haptoglobin polymorphism in patients with inflammatory bowel diseases

BACKGROUND: Since functional differences were found among three major haptoglobin phenotypes, haptoglobin polymorphism was reported to be associated with the risk and clinical course of different inflammatory diseases. The aim of the study was to investigate the Hp polymorphism distribution in Hungarian Crohn's disease patients. METHODS: 511 Hungarian IBD patients were investigated (Crohn's disease patients: 468, m/f ratio: 233/235, duration 8.2 +/- 6.7 ys, and ulcerative colitis patients: 43, m/f: 22/21, duration: 9.5 +/- 10.6 ys) and 384 healthy subjects served as controls. Hp phenotypes were determined by sodium dodecyl sulphate-polyacrylamide gel electrophoresis of sera followed by immunoblotting. Clinical data were come by the questionnaires prepared by the physicians. RESULTS: The frequency of haptoglobin-1 allele was significantly higher in Crohn's disease (0.395) compared to the controls (0.345; OR: 1.24, 95%CI: 1.02-1.52, p = 0.03), but the phenotype distribution showed no such differences. Haptoglobin phenotype was associated to disease behavior in Crohn's disease (B1 and B2, in haptoglobin 1-1 and 2-2: 36.6%-34.3% and 32.4%-32.5% vs. in 2-1: 44.9% and 20.3%; ORB1Hp2-1 vs. others: 2.06, 95%CI: 1.29-3.28). Furthermore, an increased frequency of primary sclerosing cholangitis was observed in haptoglobin 2-2, compared to the 1-1 (6.5% vs. 0.0%, p = 0.039). No associations were found in ulcerative colitis. CONCLUSIONS: haptoglobin-1 allele was associated with Crohn's disease, whereas the phenotypes with the disease behavior and frequency of primary sclerosing cholangitis, exhibiting a disease-modifying effect.     

彩色多普勒超声联合X线钼靶在乳腺癌诊断中的价值

目的分析彩色多普勒超声（CDU）与x线钼靶联合应用于乳腺癌诊断的价值。方法对98例乳腺肿瘤患者的CDU与x线钼靶摄片的诊断及鉴别诊断结果进行回顾性分析和比较。结果98例患者中71例病理证实乳腺癌。联合诊断的符合率与单独应用CDU、X线钼靶相比,差异均有统计学意义（X^2值分别为5．87和13．14,均P〈0．05）。联合诊断乳腺癌的准确率为91．5％,高于单独应用X线钼靶、CDU诊断乳腺癌的准确率分别为76．1％和77．5％,差异有统计学意义（X^2值分别为6．27和5．38,均P〈0．05）。直径〈1．0cm的肿块,联合诊断的准确率高于单用CDU、X线钼靶（X^2值分别为3．11和5．60,均P〈0．05）,结论CUD检查和x线钼靶摄片检查各具优势,联合应用能明显提高乳腺癌的检出率。     

Etiopathogenesis of inflammatory bowel diseases

The pathogenesis of IBD is only partly understood; various environmental and host (e.g. genetic-, epithelial-, immune and non-immune) factors are involved. It is a multifactorial polygenic disease with probable genetic heterogeneity, some genes are associated with IBD itself, while others increase the risk of ulcerative colitis (UC) or Crohn's disease (CD) or are associated with disease location and/or behaviour. The role of environmental factors, in particular, enteric antigens, smoking and non-steroid anti-inflammatory drug use has been well established. However uptil now no proof of a role of any unique pathogenic bacteria or special dietary and/or psychosocial factor has been identified. In this hypothesis, the disease may develop in a genetically predisposed host as a consequence of disregulated immune response to environmental, in particular, enteric antigens, resulting in a continuous immune-mediated inflammation (in CD predominantly Th-1, in UC a modified Th-2 mechanisms are involved) and not in tolerance. As a consequence, the permeability of mucosa and the antigen challenge increases, in contrast, the disregulated immune response is unable to downregulate the inflammatory process. This will result in a continuous inflammation and tissue damage. The pathogenesis of CD is thought to be mainly an antigen driven, T-lymphocyte dependent process, while in UC the role of epithelial factors and activated granulocytes are essential.