克罗恩病患者199例次内镜下非干酪样肉芽肿检出分析

目的:初步探讨克罗恩病患者内镜下非干酪样肉芽肿的检出率及其影响因素,以提高克罗恩病的病理确诊率。方法:收集2016年7月至2021年4月于苏州大学附属第一医院住院,符合克罗恩病临床诊断标准且行内镜检查并行内镜下活体组织检查(以下简称活检)的患者199例次,分析克罗恩病患者总体,以及不同发病类型(初发和复发)和活检部位是...     

克罗恩病32例临床分析

克罗恩病(Crohn’s disease,CD)原因未明,其症状多样,诊断较困难。加强对克罗恩病的认识,开拓临床医师的思路,减少对该病的误诊非常重要。我们对2004年1月~2006年1月收治的32例克罗恩病患者的临床资料进行分析。对象与方法1.对象:2004年1月~2006年1月我院诊治的克罗恩病32例,均符合中华医学会消化病学分会2000年成都会议制定的克罗恩病诊断标准。男性20例,女性12例,年龄最大78岁,最小16岁,平均年龄为39岁。2.方法:对32例出院诊断为克罗恩病患者的临床特点、内镜下特点、诊断方法、确诊时间以及治疗和预后等进行总结和回顾性分析。3.统计学…     

一种小肠克罗恩病胶囊内镜诊断标准的应用价值初探

目的探讨一种小肠克罗恩病的胶囊内镜诊断标准的应用价值。方法选择2003年3月至2008年10月因临床可疑小肠克罗恩病行胶囊内镜检查患者,根据DeBona等小肠克罗恩病胶囊内镜诊断标准进行诊断并分组,对所有患者进行电话随访1～5年,评价该标准的临床应用价值。结果最终共50例患者纳入研究,分为3组。A组25例患者确诊为小肠克罗恩病,有3例接受手术治疗,病理证实为克罗恩病,其余药物治疗均好转;B组15例临床拟诊小肠克罗恩病,均按克罗恩病进行试验性治疗,2例疗效欠佳,行手术治疗,证实是小肠憩室,另外13例患者症状明显好转;C组诊断为非特异性小肠炎,给予甲硝唑及培菲康治疗至少3个月以上。以上3组患者均随访1～5年无复发。结论该种小肠克罗恩病胶囊内镜诊断标准使早期诊断小肠克罗恩病成为可能,并可指导临床早期治疗。     

胃十二指肠克罗恩病临床及超声内镜特征

目的探讨胃十二指肠克罗恩病的临床特点和超声内镜表现。方法收集1999年1月～2007年6月复旦大学附属中山医院确诊为胃十二指肠克罗恩病的相关资料并进行随访。结果 5例胃十二指肠克罗恩病患者中,1例胃克罗恩病,临床表现为中上腹胀痛和恶心,内镜表现为胃黏膜皱襞增粗僵硬伴纵行溃疡形成,超声内镜表现为胃壁黏膜及黏膜下层广泛增厚,呈均匀偏高回声。4例十二指肠球部克罗恩病,临床表现为反复上腹饱胀伴呕吐,内镜表现为十二指肠铺路石样改变、溃疡或狭窄,超声内镜表现为黏膜和黏膜下层广泛增厚。胃克罗恩病术前疑为恶性肿瘤,行全胃切除术。十二指肠球部克罗恩病经病理组织学、结肠镜检查等明确诊断,应用泼尼松等治疗缓解。结论胃镜检查病理阴性的胃十二指肠病灶应考虑克罗恩病可能,超声内镜有助于诊断的确立及与浸润性肿瘤的鉴别,结肠镜检查有助于发现回结肠病变并协助诊断克罗恩病。     

内镜结合病理检查在溃疡性结肠炎和克罗恩病鉴别诊断中的价值

目的评价内镜及病理检查在溃疡性结肠炎和克罗恩病鉴别诊断中的价值.方法回顾性分析161例溃疡性结肠炎和89例克罗恩病的临床资料,对其病变分布、内镜结果及病理检查进行了分析.结果克罗恩病好发于末段回肠、右半结肠及上消化道,而溃疡性结肠炎好发于直肠.克罗恩病的病理特征有非干酪样肉芽肿、裂隙样溃疡、淋巴细胞聚集、全层炎;溃疡性结肠炎的病理学特征有弥漫性或灶性黏膜炎症、隐窝脓肿、黏膜糜烂及溃疡.结论内镜结合病理检查在溃疡性结肠炎和克罗恩病鉴别诊断中起到决定性作用,尤其手术标本的病理检查对CD诊断价值较大.     

双气囊小肠镜在诊断小肠克罗恩病中的价值

目的 探讨双气囊小肠镜在诊断小肠克罗恩病中的价值.方法 对65例临床怀疑小肠克罗恩病的患者进行检查,并与先前进行的插管法小肠钡灌肠和胶囊内镜检查结果进行对比分析.结果 65例患者行双气囊小肠镜检查诊断为小肠克罗恩病58例,并经病理和临床随访确诊.其中45例患者首选从肛门进镜行小肠镜检查,确认克罗恩病34例（75.6%）,另11例后从口腔进镜,发现病变者8例（72.7%）;20例首选经口进镜,检出克罗恩病11例（55%）,另9例患者日后经肛进镜检查中检出5例（55.6%）.先前进行的46例小肠钡灌肠检查中,24例诊断或疑似小肠克罗恩病,诊断率为52.2%,与小肠镜结果比较,符合小肠克罗恩病诊断例数为18例,诊断正确率为75%（18/24）.22例胶囊内镜检查者中,14例诊断或疑似小肠克罗恩病,诊断率为63.6%,最终经双气囊小肠镜确诊的病例数为11例,诊断准确率为78.6%（11/14）.结论 经口和经肛方式结合能使双气囊小肠镜完成对全小肠的检查;双气囊小肠镜是小肠克罗恩病诊断的较为理想的方法,并能对病变范围和严重程度作出正确判断,插管法小肠钡灌肠是一项决定小肠镜进镜方式选择上有价值的筛选性手段.     

回盲部溃疡228例的回顾性分析

目的探讨内镜及病理检查对回盲部溃疡的鉴别诊断价值.方法 收集我院2006年至2010年肠镜检查中检出的228例回盲部溃疡病例,就其临床特征、内镜及病理检查、治疗及随访情况进行总结分析,并比较克罗恩病及肠结核内镜下的形态特征.结果 (1)溃疡性结肠炎及回盲部肿瘤结合内镜及活检组织病理检查通常可明确诊断,回盲部的非特异性溃疡局部溃疡整齐或局限,多数经抗生素及培菲康等对症治疗后症状缓解,克罗恩病及肠结核只有少数通过内镜及病理活检确诊,多数经试验性治疗后随访明确诊断.(2)克罗恩病的溃疡多呈纵形或不规则形伴黏膜卵石征和肠腔狭窄,而肠结核溃疡多呈环形或环周分布伴息肉样变.结论 回盲部溃疡病变诊断主要依靠反复的病理检查及试验性治疗,尤其是肠结核和克罗恩病的诊断,因此寻找一种特异性血清或免疫组化的指标鉴别诊断回盲部溃疡是非常必要的.     

小肠克罗恩病的特征分析

目的通过对小肠克罗恩病患者的临床特点分析,加深对小肠克罗恩病的认识,提高早期诊断水平,减少误诊率。方法对1992年1月～2006年12月期间在我院住院病历中符合克罗恩病的116例患者的临床特点进行回顾性分析。结果小肠克罗恩病24例（20．69％）,青壮年好发,首次确诊时间比其他类型克罗恩病患者更长。其临床主要表现为腹痛20例（83．33％）,便秘8例（33．3％）,腹泻6例（25％）,便血6例（25％）,消瘦14例（58．3％）,贫血8例（33．3％）,发热7例（29．2％）,手术18例（75％）。结论小肠克罗恩病临床表现多样化,诊断困难。小肠钡灌检查可作为小肠克罗恩病的有效筛查手段。     

双气囊小肠镜鉴别诊断克罗恩病与小肠结核的价值

目的: 探讨双气囊小肠镜在克罗恩病与小肠结核鉴别诊断中的价值.方法:对38例临床怀疑小肠克罗恩病、小肠结核的患者进行小肠镜检查. 内镜诊断与病理和临床随访相结合, 评价双气囊小肠镜在两种疾病鉴别诊断中的应用价值.结果: 在38例患者中, 经病理和临床随访确诊克罗恩病18例, 小肠结核20例. 经双气囊小肠镜检查诊断为小肠克罗恩病14例, 检出率36.8%(14/38), 符合率77.8%(14/18);小肠结核为18例检出率47.4%(18/38), 符合率90.0%(18/20).结论:双气囊小肠镜是小肠克罗恩病与小肠结核鉴别诊断较为理想的方法, 并能对病变范围和严重程度作出正确的判断.     

克罗恩病19例误诊原因分析

目的探讨克罗恩病临床表现特点,分析误诊原因,为建立正确的克罗恩病诊断思路提供借鉴。方法对2013~2018年曾误诊的19例克罗恩病病例的临床资料进行回顾性分析,总结其临床特点及诊治过程,分析误诊原因。结果 19例克罗恩病临床表现不典型,曾误诊慢性肠炎、急性阑尾炎、溃疡性结肠炎、结肠癌、肝硬化等疾病。结论克罗恩病临床表现多样,需结合患者临床表现、内镜检查、病理结果以及密切随访疾病进展,才能减少误诊,提高确诊率。     

四种代谢综合征诊断标准在初发2型糖尿病人群中应用的比较

目的 比较WHO(1999年)、国际糖尿病联盟(IDF,2005年)、美国国家胆固醇教育计划成人治疗组(NCEP-ATPⅢ,2001年)的代谢综合征(MS)诊断标准和中华医学会糖尿病学分会(CDS,2004年)制定的MS诊断标准在我国初发老年2型糖尿病人群中应用的异同.方法 对初诊2型糖尿病患者1399例进行MS诊断相关指标测定,按年龄分为老年组259例和非老年组1140例,计算不同标准的MS诊断率,比较两组结果的异同.结果 (1)MS患病率以WHO诊断标准检出率最高(68.0%),NCEP-ATPⅢ标准次之(54.8%),CDS标准(47.9%)与IDF标准(46.7%)相近,NCEP-ATPUI标准、WHO诊断标准、IDF标准与CDS标准诊断率比较,差异均有统计学意义(P＜0.01);(2)NCEP-ATPⅢ标准与CDS标准诊断符合率较高,WHO、IDF标准稍差.结论 对初诊2型糖尿病患者,应用WHO标准诊断MS阳性率最高,NCEP标准与CDS标准一致性最高,WHO诊断标准可能更适合本组初发老年2型糖尿病患者.     

乙型肝炎病毒相关早期肝细胞癌影像学检查与诊断标准共识

早期肝细胞癌(eHCC)病理诊断标准已建立并于2009年更新,但目前国内外均未确定eHCC影像学诊断标准。中华医学会放射学分会传染病学组联合中国医师协会放射医师分会感染影像专业委员会、中国研究型医院学会感染与炎症放射学专业委员会、中国性病艾滋病防治协会感染(传染病)影像工作委员会、中国医院协会传染病分会传染病影像学组和北京影像诊疗技术创新联盟组织国内10余省市40多名专家共同努力形成本共识,旨在为相关专业医生诊断eHCC提供帮助。     

Comparison of the current WHO and new ADA criteria for the diagnosis of diabetes mellitus in three ethnic groups in the UK

The American Diabetes Association have recommended that the fasting plasma glucose level for the diagnosis of diabetes is lowered and that this becomes the main diagnostic test. We have used population-based data from three ethnic groups in Newcastle upon Tyne to examine the implications of this change. Data were available on 824 European (25–74 years), 375 Chinese (25–64 years), and 680 South Asian (25–74 years) subjects. All subjects apart from those reporting a prior diagnosis of diabetes underwent a standard 75 g oral glucose tolerance test (WHO criteria) which included the measurement of fasting glucose. The prevalence of diabetes was higher in all three ethnic groups using the new ADA criteria compared to the WHO criteria: 7.1 % vs 4.8 % in Europeans; 6.2 % vs 4.7 % in Chinese; and 21.4 % vs 20.1 % in South Asians. There was much variation in individuals categorized by the ADA and WHO criteria. Agreement between the two for the diagnosis of previously unknown diabetes was only moderate (kappa statistics 0.42 to 0.59). Thus in the populations studied the new criteria would increase the prevalence of diabetes in addition to classifying some individuals diabetic by current criteria as non-diabetic. It should be stressed however that diagnosis of the individual should not be based on a single test.     

Practice guidelines for the pathological diagnosis of primary liver cancer: 2015 update

In 2010, a panel of Chinese pathologists reported the first expert consensus for the pathological diagnosis of primary liver cancers to address the many contradictions and inconsistencies in the pathological characteristics and diagnostic criteria for PLC. Since then considerable clinicopathological studies have been conducted globally, prompting us to update the practice guidelines for the pathological diagnosis of PLC. In April 18, 2014, a Guideline Committee consisting of 40 specialists from seven Chinese Societies(including Chinese Society of Liver Cancer, Chinese Anti-Cancer Association; Liver Cancer Study Group, Chinese Society of Hepatology, Chinese Medical Association; Chinese Society of Pathology, Chinese Anti-Cancer Association; Digestive Disease Group, Chinese Society of Pathology, Chinese Medical Association; Chinese Society of Surgery, Chinese Medical Association; Chinese Society of Clinical Oncology, Chinese Anti-Cancer Association; Pathological Group of Hepatobiliary Tumor and Liver Transplantation, Chinese Society of Pathology, Chinese Medical Association) was created for the formulation of the first guidelines for the standardization of the pathological diagnosis of PLC, mainly focusing on the following topics: gross specimen sampling, concepts and diagnostic criteria of small hepatocellular carcinoma(SHCC), microvascular invasion(MVI), satellite nodules,and immunohistochemical and molecular diagnosis. The present updated guidelines are reflective of current clinicopathological studies, and include a novel 7-point baseline sampling protocol, which stipulate that at least four tissue specimens should be sampled at the junction of the tumor and adjacent liver tissues in a 1:1 ratio at the 12, 3, 6 and 9 o'clock reference positions. For the purposes of molecular pathological examination, at least one specimen should be sampled at the intratumoral zone, but more specimens should be sampled for tumors harboring different textures or colors. Specimens should be sampled at both adjacent and distant peritumoral liver tissues or the tumor margin in order to observe MVI, satellite nodules and dysplastic foci/nodules distributed throughout the background liver tissues. Complete sampling of whole SHCC ≤ 3 cm should be performed to assess its biological behavior, and in clinical practice, therapeutic borders should be also preserved, even in SHCC. The diagnostic criteria of MVI and satellite nodules, immunohistochemical panels, as well as molecular diagnostic principles, such as clonal typing, for recurrent HCC and multinodule HCC were also proposed and recommended. The standardized process of pathological examination is aimed at ensuring the accuracy of pathological PLC diagnoses as well as providing a valuable frame of reference for the clinical assessment of tumor invasive potential, the risk of postoperative recurrence, long-term survival, and the development of individualized treatment regimens. The updated guidelines could ensure the accuracy of pathological diagnoses of PLC, and provide a valuable frame of reference for its clinical assessment.     

Value and significance of new diagnostic criteria of diabetes mellitus in older people

In 1998, the World Health Organization (WHO) accepted the diagnostic criteria proposed in 1997 by the American Diabetes Association (ADA) and confirmed that, independent of age, the fasting plasma glucose (FPG) level from and above 126mg/dl in the morning should be considered as diabetic, while subjects with FPG 110-125mg/dl have an impaired fasting glucose (IFG), compared with the normal fasting glucose (NFG) level (up to 110mg/dl). In a pool of 4492 elderly people (65-84 years), we assessed the significance and meaning of these new diagnostic criteria of diabetes. A 5-year follow-up was carried out, during which out of 4492 elderly subjects, 2750 were re-examined. As regards the diagnosis, we applied both the criteria of WHO (1985, 1998). At our first observation (1992), 13.1% were diabetic in the elderly group, if applying the WHO (1985) criteria, and 15.1% applying the ADA-WHO definitions. When re-analyzing the subjects with FPG of 126-139mg/dl after 5 years, it became evident that the diagnosis of diabetes is not stable in this group, because 50.7% of them displayed FPG<126mg/dl (14.5% IFG; 36.2% even NFG). It means that the significance of FPG and the conditions of diabetes are different in the elderly, as compared with the younger adults. Furthermore, the oral glucose tolerance test (OGTT) of 60 elderly subjects in the age range of 71-80 years, admitted in our day hospital, were considered. Among the subjects with an FPG 126-140mg/dl, the OGTT was of diabetic type in 90%, while among IFG and NFG subjects, it was in 50 and 10%, respectively. In conclusion, in elderly subjects with FPG of 126-140mg/dl, the diagnosis of diabetes is not stable and requires further confirmation.     

胃镜下激光固有荧光光谱技术对胃恶性病变诊断价值的初探

背景：胃镜的广泛开展和应用使胃癌的检出率日益提高，但对于一些较难识别的早期胃癌和微小肿瘤病灶．仍存存一定的诊断难度。激光诱导的固有荧光光谱技术（laser—induced fluorescence spectroscopy，LIFS）可在特定波长处区分正常组织和肿瘤组织。目的：初步探讨在胃镜下应用LIFS检测胃恶性病变的诊断价值。方法：2005年10月～2006年5月期间在上海交通大学医学院附属瑞金医院消化内科接受胃镜检查和LIFS检查的患者共37例．其中男20例，女17例，检查结果与手术病理检查结果进行比较。结果：33例LIFS检查结果为异常，与胃镜检查和手术后病理学检查结果相一致．敏感性为89．2％（33／37），无假阳性。结论：LIFS对于诊断胃黏膜恶性病变具有一定的临床应用价值。     

糖尿病筛查与诊断方法的争议

及时筛查、正确诊断是糖尿病治疗的关键环节,近年来,不同国际组织美国糖尿病协会（ADA）,WHO以及日本糖尿病协会（JDS）等在糖尿病诊断和筛查方面如糖尿病及糖尿病前期诊断切点的设立,糖化血红蛋白（HbA1C）在筛查与诊断中的应用价值等都存在争议。根据糖尿病发展的病理生理机制和基于血糖范围和糖尿病并发症危险的大规模的流行病学研究结果,设置适合各国人群的糖尿病诊断和筛查标准是当前亟待解决的问题。     

Proposed diagnostic criteria for acute‐on‐chronic liver failure in Japan

To establish diagnostic criteria for acute‐on‐chronic liver failure (ACLF) in Japan, the Intractable Hepato‐Biliary Disease Study Group of Japan undertook a multicenter pilot survey for patients fulfilling the Asian Pacific Association for the Study of the Liver (APASL), Association for the Study of the Liver–Chronic Liver Failure (EASL‐Clif) Consortium, or Chinese Medical Association (CMA) diagnostic criteria for ACLF. The APASL criteria were suitable for screening Japanese patients with ACLF when patients whose conditions were triggered by gastrointestinal bleeding were included within the disease entity, and the EASL‐Clif Consortium criteria were useful for classifying the severity of the patients’ conditions. Based on these observations, the Study Group proposed the following diagnostic criteria for ACLF in Japan: patients with cirrhosis and a Child–Pugh score of 5–9 should be diagnosed as having ACLF when a deterioration of liver function (serum bilirubin level ≥5.0 mg/dL and prothrombin time value ≤40% of the standardized values and/or international normalization rate ≥1.5) caused by severe liver damage develops within 28 days after acute insults, such as alcohol abuse, bacterial infection, gastrointestinal bleeding, or the exacerbation of underlying liver diseases. The severities of the patients can be classified into four grades depending on the extent of the deterioration in organ functions, including kidney, cerebral, blood coagulation, circulatory and respiratory functions, as well as liver function. The usefulness of these novel criteria should be validated prospectively in a large‐scale cohort in the future.     

原发性十二指肠肿瘤49例回顾分析

目的：探讨原发性十二指肠肿瘤的临床特点,诊断方法,预后,为早期诊,治该病提供依据,方法：对２０年来４９例原发性十二指肠肿瘤住院病人进行回顾性分析。     

低分子肝素早期干预对慢性阻塞性肺疾病急性加重期临床疗效的影响

目的探讨早期应用低分子肝素对慢性阻塞性肺疾病急性加重期（AECOPD）临床疗效的影响。方法根据中华医学会呼吸病学分会慢性阻塞性肺疾病学组制订的COPD诊断标准,纳入哈尔滨医科大学附属第四医院呼吸内科2009年8月-2012年10月明确诊断AECOPD的连续病例140例,随机分为对照组（70例）和抗凝组（70例）。对照组患者均采用常规治疗;抗凝组除常规治疗,同时腹部皮下注射低分子肝素,1次／d,10d为一个疗程。所有患者在治疗前后均进行动脉血气分析、D-二聚体、肺功能检测,并统计住院天数。结果AECOPD患者早期低分子肝素与常规治疗联合应用较常规治疗,明显纠正凝血功能,改善肺功能,纠正低氧和二氧化碳潴留,缩短住院天数。结论AECOPD早期低分子肝素与常规治疗联合应用可明显提高临床疗效。