肝硬化并发自发性细菌性腹膜炎的临床特征及病原菌耐药分析

目的探讨肝硬化合并自发性细菌性腹膜炎(SBP)的临床特征及病原菌耐药情况。方法分析135例肝硬化合并SBP患者在抗感染治疗前后体温、腹部症状和体征、血常规、腹水白细胞及多核细胞数变化、腹水培养及药物敏感试验。结果 82.2%患者有发热,90.4%有腹部症状,88.9%有中等以上腹水7,0.4%有顽固性腹水;21.5%外周血白细胞数≥10.0×109/L,63.7%中性粒细胞0.7;45.2%腹水白细胞数0.5×109/L,57.8%多核细胞0.5;25.4%(30/118)细菌培养阳性,其中革兰氏阴性菌25例(83.3%),革兰氏阳性菌5例(16.7%),检测出的革兰氏阴性菌对大部分常用的抗菌药物耐药;治愈40例(29.63%),好转48例(35.56%),无效、恶化或自动出院47例(34.81%),其中死亡15例。结论肝硬化合并SBP的临床症状不典型,腹水培养阳性率低,以革兰阴性菌为主。除应尽早行腹水培养外,需根据临床症状、体征、血常规、腹水常规检查等综合分析,及时应用有效抗生素治疗,以提高患者的生存率。     

108例肝硬化腹水合并自发性细菌性腹膜炎患者腹水病原菌及其耐药性分析

背景：自发性细菌性腹膜炎（SBP）是肝硬化腹水患者的常见严重并发症，临床治疗效果欠佳。目的：探讨肝硬化腹水合并SBP患者腹水病原菌的分布及其耐药情况，为临床合理选用抗生素提供指导。方法：对108例次腹水细菌培养阳性肝硬化腹水合并SBP患者的临床资料以及腹水细菌培养和药物敏感试验结果进行回顾性分析。结果：108例次腹水细菌培养阳性肝硬化腹水合并SBP患者中，共分离出病原菌206株，其中革兰阴性菌占68．9％（142株）．革兰阳性菌占31．1％（64株）。分离菌株的耐药情况比较严重，治疗前单类耐药和多重耐药比例分别为50．9％和27．8％．治疗后多重耐药的比例显著高于治疗前（73．8％对27．8％，P〈0．01）。结论：对肝硬化腹水合并SBP患者．应根据药物敏感试验报告合理选用抗生素，从而达到有效抗菌目的，并抑制或延缓耐药菌株的出现。     

肝硬化合并自发性细菌性腹膜炎医院感染及社区感染病原学研究

目的 探讨肝硬化合并自发性细菌性腹膜炎(SBP)患者中医院感染与社区感染病原菌分布特点及耐药情况.方法 纳入北京地坛医院2001年1月至2008年12月腹水细菌培养阳性的肝硬化合并SBP患者226例,鉴定细菌并行药物敏感试验,数据行卡方检验和t检验.结果 医院感染的SBP患者共86例,占38.0%;社区感染的140例,占62.0%;Child-Pugh分级C级在医院感染和社区感染中各占97.7%和82.8%(x2=11.489,P=0.001),病死率分别为50.0%和30.0%(x2=9.081,P=0.003).腹水细菌培养出病原菌共232株、28种,其中医院感染SBP及社区感染SBP病原菌均以革兰阴性菌为主,分别占77.5%和76.9%,列前两位的均是大肠埃希菌和肺炎克雷伯菌,革兰阳性菌分别占19.1%和21.7%,真菌占3.4%和1.4%(P＞0.05).医院感染的SBP 32株大肠埃希菌和14株肺炎克雷伯菌中,分别有19株和5株产β-内酰胺酶(ESBL);社区感染的SBP60株大肠埃希菌和32株肺炎克雷伯菌中,只有11株大肠埃希菌产ESBL(P＜0.05).医院感染SBP革兰阴性菌对头孢菌素及喹诺酮耐药率明显高于社区感染SBP(P＜0.05),但均对亚胺培南较敏感(P＞0.05);医院感染SBP及社区感染SBP的革兰阳性菌株中,未发现对万古霉素耐药.结论 Child-Pugh C级肝硬化患者更易发生医院感染的SBP,且预后差;医院感染SBP及社区感染SBP病原菌群分布相似,以大肠埃希菌和肺炎克雷伯菌为主,但产ESBL阳性率明显升高.     

肝硬化并发自发性细菌性腹膜炎52例临床分析

目的探讨肝硬化患者并发自发性细菌性腹膜炎(SBP)的临床特点,以提高诊断率,改善患者生命质量。方法对52例肝硬化并发SBP患者的临床资料进行回顾性分析。结果本组患者发热26例(50.0%),腹胀46例(88.5%),腹痛24例(46.2%),腹部压痛、反跳痛32例(61.5%),腹肌紧张9例(17.3%),短期腹水增多且利尿剂治疗效果差40例(82.7%);发生肝肾综合征10例(19.2%),上消化道出血9例(17.3%),肝性脑病8例(15.4%),感染性休克1例(3.8%);血常规示白细胞总数达10×109/L以上者12例(23.1%),多形核白细胞比值达70%以上者40例(76.9%);在42例患者行腹水细菌培养,结果细菌阳性者10例(19.2%),其中大肠埃希菌7例,肺炎克雷伯杆菌2例,表皮葡萄球菌1例。30例行血培养,细菌阳性4例(7.7%),其中3例与腹水细菌培养一致,均为大肠埃希菌,另1例为肺炎克雷伯杆菌;在52例患者中,临床治愈20例(38.5%),好转12例(23.1%),Child-Pugh C级患者死亡20例(41.7%)。结论自发性细菌性腹膜炎患者临床表现不典型,诊断需要依靠腹水中多形核白细胞计数和细菌培养,早期诊断及积极治疗是提高SBP临床治愈的关键。     

肝硬化合并自发性细菌性腹膜炎112例临床分析

目的：探讨肝硬化合并自发性细菌性腹膜炎（SBP）的临床特点。方法：回顾性分析112例确诊为肝硬化合并SBP患者的临床资料。结果：112例患者均为不同程度发热、腹痛、腹部压痛、反跳痛，从轻微症状到典型腹膜炎表现。其中93例（83．0％）腹水多形核白细胞（PMN）比值≥0．50；57例腹水细菌培养阳性（50．9％），病原菌以革兰氏阴性杆菌为主，其中大肠埃希菌为主要致病菌；药物敏感试验对第三代头孢菌素和第三代氟喹诺酮类药物敏感。结论：肝硬化合并SBP临床表现大多数不典型，腹水PMN比值是诊断SBP重要而可靠的指标；病原菌以大肠埃希菌为主，抗感染治疗首选第三代头孢菌素和第三代氟喹诺酮类药物。     

肝硬化合并自发性细菌性腹膜炎病原学特征分析

目的分析自发性细菌性腹膜炎(SBP)的病原学及耐药特点、实验室特征指标,为早期预警、快速诊断和及时治疗提供客观依据。方法对解放军第三○二医院2011年1月至2013年12月诊断为SBP的1340例住院患者的临床资料及实验室指标进行回顾性分析,对比不同种类病原菌的SBP的分布特点和实验室特征,明确不同种类病原菌的耐药特点。药敏结果采用WHONET5软件进行分析,统计学分析采用CHISS统计软件,计量资料采用t检验,计数资料采用χ2检验。结果 1340例肝硬化合并SBP患者中,感染革兰阴性杆菌(G-b)591例(44.10%),革兰阳性球菌(G+C)746例(55.67%),真菌1例(0.07%)、革兰阳性杆菌(G+b)2例(0.15%)。G-b合并其他部位感染、血中性粒细胞、腹水白细胞数(WBC)、多形核白细胞(PMN)、ALT、AST、TBil、外源性凝血酶原活动度(PTA)、血肌酐(Cr)等实验室指标的异常率,明显高于G+C感染(P0.05)。大肠杆菌和肺炎克雷伯菌产生超广谱β-内酰胺酶(ESBL)阳性率分别为40.00%和36.03%。鲍曼不动杆菌对阿米卡星、磺胺甲恶唑/甲氧苄啶、亚胺培南耐药率为42.42%、57.57%、57.58%;铜绿假单胞菌对头孢哌酮和替卡西林/克拉维酸耐药率分别为45.45%、36.36%。甲氧西林耐药金黄色葡萄球菌构成比43.33%,甲氧西林耐药凝固酶阴性葡萄球菌构成比78.09%,对万古霉素和替考拉宁的敏感率为100%。结论 SBP的病原菌以G+C和G-b为主,耐药严重,辅助诊断血中性粒细胞、腹水WBC、腹水PMN、ALT、AST、TBil、PTA、Cr可预测G-b感染,治疗应依据感染病原的类型和药敏及患者病情选择抗生素。     

2012至2018年某院肝硬化并自发性细菌性腹膜炎的病原学及耐药性分析

目的分析肝硬化并发自发性细菌性腹膜炎(SBP)患者的腹水病原菌分布及其耐药性。方法抽取2012年1月至2018年12月某院收治的肝硬化并SBP患者的腹水做病原学鉴定及药敏试验。结果817例患者中,141例腹水培养的病原菌阳性(阳性率为17.26%),共检出病原菌151株,除2例患者为三种细菌重叠感染、6例为两种细菌重叠感染,余133例均为单一细菌感染(占94.32%,133/141);包括革兰阳性菌88株(占58.28%,88/151)、革兰阴性菌54株(占35.76%,54/151)和真菌9株(占5.96%,9/151);产超广谱β-内酰胺酶(ESBL)病原菌共12株(占7.95%,12/151)。革兰阳性菌以科氏葡萄球菌(17.05%)、溶血葡萄球菌(14.77%)、粪肠球菌(13.64%)及表皮葡萄球菌(11.36%)为主;对青霉素G、红霉素、苯唑西林及克林霉素的耐药率较高,对万古霉素和替考拉宁均无耐药。革兰阴性杆菌以大肠埃希菌(51.85%)和肺炎克雷伯菌(25.93%)为主;对氨苄西林耐药率较高,对亚胺培南和美罗培南均无耐药。结论肝硬化患者并发自发性细菌性腹膜炎的病原菌以大肠埃希菌、科氏葡萄球菌、肺炎克雷伯菌和溶血葡萄球菌为主,部分细菌对常用的抗菌药物有一定耐药性,临床医生需根据药敏试验选择抗菌药物。     

肝硬化并发自发性细菌性腹膜炎患者腹水病原菌鉴定及耐药性分析

目的：观察肝硬化并发自发性细菌性腹膜炎（SBP）患者腹水病原菌的分布特点,并分析其耐药性状况。方法回顾性分析87例肝硬化合并 SBP 患者的临床资料,分析腹水细菌培养和药物敏感试验结果。结果在87例患者腹水中共分离出92株病原菌,其中革兰氏阴性菌64株（69.6%）,革兰氏阳性菌24株（26.1%）,真菌4例（4.3%）;产超广谱β-内酰胺酶（ESBLs）大肠埃希菌菌株7例（23.3%）,产 ESBLs 肺炎克雷伯菌菌株2例（16.7%）;对革兰氏阴性菌耐药性较高的抗生素为头孢类（23.3%～41.7%）及喹诺酮类抗生素（55.0%）,对革兰氏阳性菌耐药性较高的是氨苄西林（72.7%）和哌拉西林（63.6%）。结论肝硬化合并SBP 患者往往存在革兰氏阴性菌感染,且耐药现象比较明显。应根据药物敏感试验报告合理选用抗生素治疗。     

肝硬化腹水并发自发性腹膜炎50例临床分析

目的探讨肝硬化并发自发性细菌性腹膜炎（SBP）的特点,为科学治疗提供临床指导。方法回顾性分析50例肝硬化并发SBP患者的临床资料。结果50例患者中。发热37例（74．0％）,腹胀41例（82．0％）,腹痛30例（60．0％）,腹水多形核白细胞（PMN）比值〉0．50者43例（86．0％）,腹水细菌培养阳性27例（54．0％）。结论肝硬化并发SBP临床表现不典型．腹水PMN比值是诊断SBP的敏感指标之一。大肠杆菌为该疾病主要病原菌,对头孢噻肟和第三代喹诺酮类药敏感,可作为首选药物。     

慢性重型肝炎和肝硬化并发自发性细菌性腹膜炎168例临床分析

目的　探讨慢性重型肝炎和肝硬化并发自发性细菌性腹膜炎 (SBP)菌株种类、临床特点和预后。方法　对 16 8例住院慢性重型肝炎和肝硬化并发SBP临床资料进行回顾性分析。结果　 14 2例 (85 71% )患者多核细胞 (PMN)相对值≥ 0 5 0。 32例腹水细菌培养阳性 ,共分离细菌 4 2株 ,大肠埃希菌占 4 2 % ,腹水蛋白≤ 10g/L并发SBP发生率高于腹水蛋白 >10g/L患者。两者差异显著 (P <0 0 5 )。结论　慢性重型肝炎和肝硬化并发SBP临床症状大多不典型 ,腹水PMN比值是诊断SBP比较可靠的参数。病原菌以大肠杆菌为主。腹水蛋白 <10g患者应警惕SBP发生 ,应及早做腹水常规检查     

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。     

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。     

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。     

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.     

Angiographic diagnosis of the degree of serosal invasion of carcinoma of the colon

Angiography using Prostaglandin El^® was performed on 38 patients with carcinoma of the colon in order to diagnose the degree of serosal cancer invasion. The findings at angiography were classified into four groups:1) AG-S3, abnormal change (irregularity and/or encasement) up to marginal vessels; 2) AG-S2, abnormality up to vasa recta; 3) AG-S1, abnormality of penetrating branches of vasa recta within the wall of the colon; and 4) AG-S0, no distinct findings of abovementioned vessels. These angiographic findings were compared with both macroscopic and microscopic serosal cancer invasion. Angiographic diagnosis is in accord with the macroscopic findings in 84.2 percent of cases. Angiographic diagnosis is in accord with the microscopic findings in 32.4 percent of cases. Macroscopic findings confirm the angiographic diagnosis precisely but the conflict with microscopic findings should not be overlooked. This may be the result of inflammatory change, adhesion, and fibrosis around carcinoma of the colon.