内镜下抗反流黏膜切除术治疗质子泵依赖性胃食管反流病的短期疗效观察

2017年7月—2020年12月间,在南京鼓楼医院行内镜下抗反流黏膜切除术（anti?reflux mucosectomy,ARMS）治疗的26例质子泵抑制剂依赖性胃食管反流病连续病例纳入回顾性分析,主要比较手术前后的反流症状评分（GERD?Q评分）、生活质量评分（RQS评分）、食管动力及24 h测酸检查结果。结果发现：中位随访18.4个月（6～27个月）,23例（88.5%）临床症状得到明显缓解,15例（57.7%）停用质子泵抑制剂,平均GERD?Q评分（6.23分比13.19分,P=0.004）和平均RQS评分（26.67分比10.98分,P<0.001）均较术前明显好转,平均DeMeester评分（10.69分比53.15分,P<0.001）、平均酸反流时间百分比（3.56%比9.92%,P<0.001）、平均酸反流总次数（36.9次比139.9次,P=0.001）均明显低于术前,平均食管下括约肌静息压（25.19 mmHg比13.63 mmHg,P<0.001）和平均远端收缩积分（1 819.15 mmHg·s·cm比1 007.67 mmHg·s·cm,P<0.001）均较术前明显增加。提示ARMS治疗质子泵抑制剂依赖性胃食管反流病短期疗效显著,可有效改善患者的反流症状和生活质量,增加患者的食管下括约肌静息压和食管体部蠕动。     

抗反流黏膜切除术治疗胃食管反流病的临床疗效观察

目的 评价抗反流黏膜切除术治疗胃食管反流病的临床有效性和安全性。 方法 2015年12月至2018年7月,郑州大学第一附属医院消化内科行抗反流黏膜切除术的18例胃食管反流病病例资料纳入回顾性研究,统计治疗效果（治疗后烧心及反流症状改善情况、24 h食管pH监测结果等）以及并发症发生情况。 结果 18例均成功进行了抗反流黏膜切除术,操作成功率为100%,其中8例行ESD、10例行EMR。24 h食管pH监测结果显示,治疗后Demeester评分、pH＜4时间百分比、总反流事件、pH＜4时间长于5 min的反流次数较术前均明显降低[（20.16±9.12）分比（74.16±20.03）分、（2.70±0.88）%比（6.42±1.37）%、（43.78±19.68）次比（156.56±41.22）次、（2.89±1.68）次比（9.89±2.95）次,P均＜0.05]。无术后出血、穿孔、感染病例。随访3～34个月,烧心及反流症状改善总有效率为89%（16/18）。胃镜随访显示18例贲门均较前缩紧,收缩良好;16例反流性食管炎较前明显好转,黏膜糜烂愈合。 结论 抗反流黏膜切除术治疗胃食管反流病安全有效,且简单易行。     

多中心临床观察雷贝拉唑联合多潘立酮治疗胃食管反流病的症状缓解情况

目的 观察雷贝拉唑联合多潘立酮治疗胃食管反流病(GERD)的临床疗效.方法 采用多中心、随机、开放、观察性研究方法,将收集的130例GERD门诊患者随机分为观察组(雷贝拉唑联合多潘立酮)64例和对照组(单用雷贝拉唑)66例,以胃食管反流病诊断问卷(GERD Q量表)和一般资料调查方式进行症状评分,症状评分根据烧心、反流、上腹痛等发生的频率和程度.随访4周,比较治疗后2周末和4周末两组患者症状的改善情况.结果 治疗前观察组和对照组GERD Q评分值基线一致,治疗2周末,两组GERD症状GERD Q评分值均有明显下降,分别为8.45±2.53和9.17±2.42;治疗4周末疗效更明显,分别为6.03±1.54和6.70±1.78;治疗前后差异有统计学意义(t=16.113,t=14.149;P值均＜0.01).观察组在治疗2周和4周末GERD Q分值较对照组下降更快,差异有统计学意义(t=-1.658,P=0.050;t=-2.292,P=0.012).观察组和对照组治疗2周后GERD症状分值均明显下降(t=2.006,P=0.047),4周后反流症状分值有明显下降,差异有统计学意义(t=2.287,P=o.022).治疗2周末观察组烧心和反流症状总有效率为79.0％和73.0％,对照组为67.7％和69.7％,观察组优于对照组;但治疗4周末观察组和对照组总有效率相似.结论雷贝拉唑联合多潘立酮能更快缓解GERD烧心和反流症状.     

内镜抗反流黏膜切除术治疗难治性胃食管反流病一例

胃食管反流病(GERD)是指胃或十二指肠内容物反流至食管引起不适症状和/或并发症的一种疾病,以烧心和反流为典型表现。大多数糜烂性胃食管反流病患者的病变程度为轻度（洛杉矶分级 A 级患者占 50-90%）,因此,目前对GERD的治疗主要依靠质子泵抑制剂（PPI）。但仍有一部分患者PPI治疗疗效甚微。目前亚太的共识认为：在常规PPI剂量治疗至少 8 周反流症状仍无缓解的 GERD 可以定义难治性胃食管反流病（Refractory GERD,RGERD）。对于RGERD的治疗,最近内镜下出现了一种新的治疗方法——抗反流黏膜切除术(ARMS),初步报导可以有效地重塑贲门抗反流屏障,改善患者症状。在这篇报告中,我们将介绍国内首例通过抗反流黏膜切除术(ARMS)治疗难治性胃食管反流病的病例。     

经口内镜下贲门缩窄术治疗胃食管反流病临床研究

目的 研究经口内镜下贲门缩窄术（PECC）治疗胃食管反流病（GERD）的安全性及有效性。方法 选择2016年8月至2017年12月在内蒙古医科大学附属医院就诊、符合纳入标准的27例GERD患者作为研究对象,行PECC,比较手术前后GERD健康相关生活质量（GERD-HRQL）评分、GERD问卷量表（GERD-Q）症状评分、食管24 h pH-抗阻监测结果及临床疗效。结果 与术前比较,DeMeester评分术后3个月（Z=-6.940,P=0.001）、6个月（Z=-6.307,P=0.001）;GERD-HRQL术后3个月（t=11.499,P=0.001）、6个月（t=10.959,P=0.001）;GERD-Q术后3个月（t=30.647,P=0.001）、6个月（t=27.217,P=0.001）,3项评分均明显降低,差异有统计学意义。术后3个月、6个月基本治愈率达81.5%（22/27）和77.8%（21/27）。结论 PECC是一种治疗GERD的新方法,短期临床观察疗效显著、安全可行,具有良好的临床应用前景。     

抗反流手术治疗老年食管裂孔疝合并胃食管反流病对阻塞性睡眠呼吸暂停的影响

目的 分析老年食管裂孔疝（HH）合并胃食管反流病（GERD）患者中阻塞性睡眠呼吸暂停（OSA）的患病情况,并探索抗反流手术（腹腔镜下食管裂孔疝修补术联合胃底折叠术）治疗老年GERD合并HH对OSA的影响。 方法 根据多导睡眠监测（PSG）结果,将77例HH合并GERD患者分为OSA组,和非OSA组。对所研究指标进行差异性及相关性分析。结果 OSA组患者AHI、ODI、LAT、ESS评分、血清IL-8、TNF-α水平高于非OSA组,LSaO2低于非OSA组,差异有统计学意义（P＜0.05）;血清TNF-α水平与AHI、ODI、LAT正相关,与LSaO2负相关（r = 0.647、0.579、0.477、- 0.312,P均＜0.05）;血清IL-8水平与AHI、ODI正相关,与LSaO2负相关（r = 0.422、0.501、- 0.330,P均＜0.05）;与术前相比,术后AHI、ODI、LSaO2、LAT、ESS评分、GERD-Q评分、血清IL-8、TNF-α水平有改善,差异均有统计学意义（P＜0.05）;手术前后血清TNF-α差值与AHI、ODI、LAT差值正相关,与LSaO2差值负相关（r =0.329、0.408、0.529,- 0.312,P均＜0.05）;手术前后IL-8差值与AHI、ODI、LAT差值正相关,与LSaO2差值负相关（r =0.343、0.371、0.350,- 0.330,P均＜0.05）。结论 老年GERD合并HH患者OSA的患病率较高,男女患病比例接近,以轻中度OSA为主。通过抗反流手术治疗不仅能够改善患者反流症状,也能改善OSA的病情及相关炎症反应,术后需针对OSA进行随访和治疗。     

酸反流与胆汁反流在胃食管反流病中的作用

目的探讨酸反流与胆汁反流在胃食管反流病(GERD)中的作用及相互关系.方法46例GERD患者(反流性食管炎组30例,胃镜阴性组16例)及26例健康对照者在完成食管测压后,应用便携式食管pH监测仪及Bilitec2000胆汁反流监测仪,同时进行24h食管内酸及胆汁反流的动态连续监测.结果GERD患者酸反流及胆汁反流各指标均明显高于健康对照者,且与食管炎严重程度一致.pH＜4总时间百分比与胆红素光吸收值(Abs)＞0.14,总时间百分比存在线性相关关系(r=0.34,P＜0.01).酸反流和胆汁反流共存的双重反流在GERD患者中最为常见,且较单纯反流更易引起严重食管炎.结论GERD患者中较为常见的双重反流对食管粘膜的损伤作用强于单纯酸或胆汁的不完全反流,酸反流与胆汁反流间可能有正性协同作用;联合应用胃镜检查及食管内酸和胆汁反流监测将为GERD的诊治提供可靠的客观依据.     

胃食管反流病Q评分与电子胃镜在胃食管反流病诊断中的应用比较

[目的]探讨胃食管反流病（GERD）Q评分在GERD诊断中的临床应用价值.[方法]将因烧心、反酸等症状就诊于消化科门诊的120例患者随机分为GERDQ评分组和胃镜组,每组60例,分别接受GERDQ问卷评分、电子胃镜,比较分析各种方法对GERD的检出情况.[结果]GERDQ评分组与胃镜组比较差异无统计学意义（P＞0.05）,但GERDQ评分组检出率较胃镜组高.[结论]GERDQ量表是诊断GERD简单、易行、有效且零成本的方法,值得推广.     

胃食管反流病患者酸反流与食管运动功能障碍的关系

背景：异常酸反流和食管运动功能障碍与胃食管反流病（GERD）密切相关。目的：研究GERD患者的食管运动和酸反流与食管黏膜损害的关系，以及两者之间的相关性。方法：选取有反酸、烧心、胸痛等典型胃食管反流症状的患者72例行上消化道内镜检查、食管测压和24hpH监测。根据pH〈4总时间百分比〈4．5％且DeMeester计分〈14．7的标准。将食管炎患者分为生理性酸反流组（pH^-组）和病理性酸反流组（pH^＋组）。结果：内镜下食管炎组24hpH监测各项指标较无食管炎组显著增高（P〈0．05），病理性酸反流的发生率显著高于无食管炎组（P〈0．01）。两组食管测压各项指标无显著差异，食管炎组pH^＋者的食管下括约肌压力（LESP）较pH^-者显著降低，食管体部蠕动波传导速度减慢，湿咽成功率减少（P〈0．05）。结论：GERD患者食管炎的发生与酸反流密切相关，有病理性酸反流的GERD患者易见食管运动功能障碍。     

抗反流黏膜切除术治疗食管裂孔疝伴重度胃食管反流病的临床探究

目的 探究抗反流黏膜切除术（ARMS）治疗食管裂孔疝伴胃食管反流病的疗效。方法 回顾性分析19例2017年9月至2018年6月于宁夏回族自治区人民医院消化内科行ARMS治疗食管裂孔疝伴重度胃食管反流病患者的病例资料。结果 19例患者术后均未发生出血、穿孔、感染等并发症。术后第3~4天,1例患者出现胸痛,2例患者感反酸、烧心,1例患者出现进食哽噎感,该4例患者经常规治疗3 d后症状自行好转。结论 ARMS治疗食管裂孔疝伴重度胃食管反流病的安全有效,术后恢复快。     

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.