肝静脉压梯度对食管曲张静脉出血的预测价值

目的探讨肝静脉压梯度(HVPG)对预测肝硬化食管曲张静脉出血(EVB)的临床价值。方法对26例有出血史和20例无出血史的肝硬化食管静脉曲张患者进行了HVPG测量,平均随访18个月观察HVPG值与EVB发生率之相关性。结果出血组HVPG值平均为15.13±3.57mmHg,明显高于非出血组11.07±2.21mmHg,两组相比差异显著(P<0.05);HVPG值>12mmHg者EVB或EVB再发率为73％,而HVPG值<12mmHg者EVB发生率为10％(P<0.01)。结论HVPG测定有预测首次EVB或EVB再发的价值。     

肝静脉压梯度对食管静脉曲张出血的预测价值

目的探讨肝静脉压梯度(HVPG)对预测肝硬变食管静脉曲张出血(EVB)的临床价值.方法对肝硬变并门静脉高压食管静脉曲张住院患者共36例作HVPG测定.出血组21例,男16例,女5例,平均年龄45.5岁,Child-pugh分级A级2例,B级10例,C级9例,非出血组15例,男12例,女3例,平均年龄47.3岁,Child-pugh分级A级1例,B级8例,C级6例.采取Seldinger法经右侧股静脉插5F导管肝内静脉右支,测其压力即肝静脉游离压(FHVP),将导管深插至肝静脉终末端,注造影剂见到肝实质影象,测其压力即肝静脉嵌顿压(WHVP),HVPG=WHVP-FHVP.对出血组均进行了EVL治疗,非出血组凡HVPG>12mmHg者作了EVL治疗.平均随访18mo.对两组HVPG值及出血率进行统计学处理采用t检验.结果出血组HVPG值11.7mmHg～28mmHg(平均14.48mmHg±4.49mmHg),非出血组HVPG值8mmHg～14mmHg(平均10.91mmHg±1.82mmHg).两组相比出血组HVPG值明显高于非出血组(P<0.01).出血组中HVPG>16mmHg9例有5例(88.9%)再发EVB,HVPG.5mmHg～16mmHg12例有7例(58.3%)再发EVB,两者相比再出血率差异显著(P<0.01);非出血组中HVPG>12mmHg5例有2例发生首次EVB,而HVPG<12mmHg之10例仅1例首发EVB.结论HVPG测定有预测首次EVB或EVB再发的价值.     

肝硬化食管静脉曲张出血内镜治疗后早期再出血的危险因素分析

目的探讨内镜治疗肝硬化食管静脉曲张破裂出血(EVB)后早期再出血的危险因素。 方法回顾分析2016年8月至2018年8月因肝硬化食管静脉曲张(EV)首次出血就诊于包头医学院二附院并采用内镜下治疗的患者资料,依据术后6周内是否再出血分再出血组和未出血组,对两组患者的一般资料、肝功能、血常规、凝血、门静脉血栓、门静脉异常分流等情况进行单因素分析,探讨内镜治疗EV术后早期再出血的危险因素。 结果(1)入组患者共450例,治疗后6周内出血27例,止血成功率94%;(2)单因素分析AST、GGT、TBIL、ALB、PTA、TG、肝功能、Child-Pugh分级、EV程度、门静脉血栓、门静脉异常分流在出血和未出血组之间的差异具有统计学意义;(3)多因素Logistic回归分析结果显示AST等是影响EV术后再出血的危险因素;ALB、门静脉异常分流是影响EV术后再出血的保护因素(P<0.05)。 结论AST、GGT、PTA、TG、肝功能Child-Pugh分级、EV程度、门静脉血栓是影响EV术再出血的危险因素;ALB、门静脉异常分流是影响EV术后早期再出血的保护因素。     

环氧化物酶2及前列腺素Ⅰ2在门静脉高压性胃病发病中的作用

目的探讨环氧化物酶2(COX2)及其产物前列腺素I2(PGI2)在门静脉高压性胃病(PHG)发病中的作用. 方法 40只Wistar大鼠,随机分为手术组(32只)和对照组(8只).手术组以门静脉部分结扎复制大鼠PHG模型,分别在手术后1、2、3、4周(每周8只大鼠)测自由门静脉压力;并处死动物,肉眼和光镜观察大鼠胃黏膜病变情况;用放射免疫法测定门静脉血及胃黏膜匀浆中PGI2的稳定代谢产物6-酮-前列腺素F1α含量;用免疫组织化学染色观察各期胃组织中COX2的表达情况. 结果门静脉结扎后其压力很快升高,术后1、2、3、4周分别为(2.40±0.15)kPa、(2.38±0.17)kPa、(2.52±0.21)kPa和(2.46±0.17)kPa,与对照组(0.90±0.16)kPa比较,t值分别为19.345、17.931、17.356、18.900,P<0.05;肉眼观察见胃黏膜苍白水肿、充血、浅表糜烂及点状出血,并随门静脉结扎时间的延长而日益加重;光镜下见胃黏膜层及黏膜下层增厚,血管扩张,血管断面增加,血管周围有淋巴细胞及中性粒细胞浸润;术后1周门静脉血及胃黏膜中6-酮-前列腺素F1α含量很快升高分别为(104.52±25.11)pg/ml和(180.21±37.56)pg/ml并维持在较高水平,明显高于对照组[分别为(73.62±20.33)pg/ml 和(142.11±31.51)pg/ml],t值为2.710和2.198,P<0.05.免疫组织化学染色结果显示第1、2、3、4周各手术组COX2表达依次增强,对照组则呈阴性表达. 结论 COX2及其产物PGI2在门静脉高压时表达增加,增加的PGI2可能通过血管扩张等作用机制引起胃黏膜损害,是PHG发病中的促进因素.     

肝硬化门静脉高压患者肝静脉压力梯度的影响因素分析

目的探讨行经颈静脉肝内门体静脉分流术(TIPS)治疗的肝硬化门静脉高压患者肝静脉压力梯度(HVPG)的临床影响因素。方法选取2015年1月-2018年12月在中国人民解放军西部战区总医院接受TIPS治疗的肝硬化门静脉高压患者158例。在TIPS过程中,分别测量肝静脉楔压、肝静脉自由压及门静脉压,计算得出HVPG与门静脉压力梯度(PVPG)。计量资料2组间比较采用t检验,多组间比较采用单因素方差分析,进一步两两比较采用LSD-t检验。HVPG与PVPG相关性采用Pearson相关分析,采用多元线性逐步回归法分析影响HVPG的独立危险因素。结果 HVPG与PVPG呈正相关(r=0. 796,P 0. 001)。单因素方差分析显示年龄、病因是HVPG的影响因素(F值分别为19. 900、10. 287,P值均0. 001)。多元线性逐步回归分析显示,年龄及病因是HVPG的独立影响因素(t值分别为7. 870、-2. 178,P值均0. 001)。结论肝硬化门静脉高压患者的年龄和病因是HVPG的独立影响因素,年龄≥60岁或慢性丙型肝炎肝硬化门静脉高压患者具有更高的HVPG。     

伴自发性门静脉分流孤立性静脉曲张破裂出血患者临床特点

目的 了解伴自发性门静脉分流(SPSS)的孤立性静脉曲张(IGV-1)破裂出血患者的临床特点。方法 回顾性分析伴SPSS的IGV-1破裂出血患者,记录不同的类型的SPSS患者门静脉直径、门静脉压力梯度(HVPG)、门静脉有无血栓、Child-Pugh评分、Meld评分、治疗方式,随访3年,记录术后再出血次数及生存情况。结果 纳入IGV-1破裂出血患者37例,15例存在脾肾分流道,14例存在胃肾分流道,8例同时存在脾肾分流和胃肾分流。18例进行TIPS治疗,随访中出现再出血4例,肝性脑病4例;胃冠状静脉栓塞术联合部分脾栓塞术治疗6例,随访中再出血4例,死亡1例。内镜治疗患者9例,随访中再出血3例,肝性脑病1例,死亡1例。单因素Cox回归发现门静脉血栓(PVT)和HVPG是影响患者再出血的危险因素。结论 伴SPSS的IGV-1患者再出血、腹水和PVT发生率较高,同时PVT和HVPG是再出血的危险因素,分流形式对IGV-1治疗方案的选择有重要价值。     

不同静脉灌注量对门静脉高压失血性休克犬血流动力学的影响

目的 研究门静脉高压犬失血性休克时不同静脉灌注量对血流动力学的影响。方法 行缩窄门静脉主干1/2加丝线慢性栓塞术建立犬肝前性门静脉高压症模型,2周后股动脉快速放血制失血性休克模型,分大剂量、小剂量组静脉灌注复苏休克,观察不同静脉灌注量对门静脉高压失血性休克犬血流动力学的影响。结果 肝前性门静脉高压犬在失血性休克期血流动力学发生一系列改变,加重门静脉高压症时存在的血流动力学紊乱。快速静脉灌注复苏休克后,平均动脉压（MAP）、下腔静脉压（IVCP）、门静脉压（PVP）、门静脉压力梯度（PVPG）、门静脉血流量（PVBF）、肝动脉血流量（HABF）及肝血流量（HBF）均迅速上升,大剂量静脉灌注组升高幅度均较小剂量静脉灌注组大。PVR、SVR、HAR均显著降低。大剂量静脉灌注复苏休克,PVP、PVPG、PVBF、HABF、HBF出现反跳式升高,超过基线水平PVA达（3.28±0.34）kPa。而小剂量静脉灌注复苏休克时PVPG、PVP、PVBF、HABF、HBF与MAP、IVCP改变大致平行,无此反跳式升高,PVP至（2.34±0.26）kPa。大剂量静脉灌往组PVPG较PVP升高更早,更显著,并且超过基础值的 13％,达（2.58±0.37）kPa,故其发生再出血的危险性大为增加。小剂量静脉灌柱组PVPG一直低于基线水平,而且较基础值降低22％以上,至（1.67±0.27）     

探讨肝硬化合并食管和胃静脉曲张之分型与临床症状或合并症之关系

本所对近5年来经内镜检查的肝硬化门静脉高压病人275例(其中58例合并肝癌)就其食管静脉曲张(EV)和胃静脉曲张(GV)进行分型,分为以EV为主型组(177例)和以GV为主型组(98例),就两组临床症状或合并症进行对比。EV、GV出血率:EV组出血率高(80.2％),GV组低(26.85％);肝性脑病发生率:EV组低(15.25％),GV组高(55.2％);child分级两组对比:EV为主型C级占23％,GV组占43％,EV组肝功好于GV组,两组相比差异显著。EV和/或OV与门静脉造影相比:EV组主要由胃左静脉供血为主,而GV组以胃后或胃短静脉供血为主。分型对选择治疗方案与预后估价十分重要     

先天性心脏病介入治疗与外科治疗临床比较

目的:对房间隔缺损(ASD)、室间隔缺损(VSD)的介入治疗(Amplatzer封堵器)和外科手术治疗的临床疗效进行比较。方法:2004年5月至12月住院患儿,符合单一左向右分流畸形ASD或VSD,根据治疗方法不同分为介入组和手术组;比较2组在疗效、费用、并发症、输血量及住院时间等方面的异同;通过放免法测定2组治疗前后的心钠素(ANP)水平。结果:2组手术成功率均为100%;介入组均未输血,手术组均输血治疗(P<0·01);术后住院时间介入组少于手术组(P<0·01);治疗费用介入组高于手术组(P<0·01);ANP水平、外科手术及介入治疗后均较治疗前降低。结论:单一ASD、VSD的介入治疗与手术治疗临床效果相同;介入组不需输血,术后住院时间短,但治疗费用较昂贵。     

肝静脉压力梯度预测内镜下食管静脉曲张套扎术后早期再出血的临床应用

目的 探讨肝静脉压力梯度(HVPG)预测内镜下食管静脉曲张套扎术(EVL)后早期再出血的应用价值.方法 研究有肝硬化食管静脉曲张出血史、EVL前行HVPG测定患者105例.收集其住院期间HVPG值、内镜下表现及EVL术后2周内是否出血及其他严重并发症等.应用x2检验、秩和检验、logiStic回归模型的假设检验及受试者工作特征曲线(ROC)分析进行统计学处理. 结果 经统计学分析,只有HVPG是EVL术后早期再出血的独立危险因素.对HVPG关于EVL术后早期再出血行ROC分析,得出曲线下面积(AUC)为0.866,当HVPG≥16 mmHg时,AUC为0.838,有一定准确性,其敏感性为90.9％,特异性为76.6％.结论 HVPG是影响EVL术后早期再出血的独立危险因素.HVPG≥16 mmHg作为预测EVL术后早期再出血的阈值,具有一定准确性、敏感性及特异性.     

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.