儿童和青少年期肥胖症与血脂的关系

目的探讨儿童和青少年期肥胖症与m脂的关系。方法采用整群抽样横断面调查与追踪调查的流行病学方法观察北京市193名(386人次)学生,每一观察对象在儿童期(7～12岁)和9年后其青少年期(16～21岁)测量身高、体质量,检测血清总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)和三酰甘油(TG)水平。结果儿童和青少年期男孩的超重和肥胖发牛率均明显高于女孩(儿童期:16.3%比11.9%,15.2%比10.9%;青少年期:23.9%比7.9%,8.7%比3.0%,均为P0.05),儿童期总的肥胖率高于青少年期(12.9%比5.7%,P0.05),青少年期的超重率略高于儿童期(15.5%比14.0%,P0.05)。儿童期肥胖组的平均TG水平较体质量正常组高[(1.22±0.84)mmol/L比(0.82±0.54)mmol/L,P0.01];青少年期肥胖组平均TC和LDL-C水平均高于体质量正常组(均为P0.05);儿童期肥胖组在青少年期时平均TC和LDL-C水平高于体质量正常组(均为P0.01)。结论儿童和青少年期肥胖症是影响血脂的重要因素。     

腹腔镜Roux-en-Y胃旁路术规范化手术操作指南（2019版）

目前中国肥胖症和2型糖尿病（T2DM）的患病人数已居全球首位,大量的循证医学证据表明腹腔镜Roux-en-Y胃旁路手术（LRYGB）可显著减轻病态肥胖症患者体重,并有效改善T2DM等一系列肥胖相关合并症。尽管LRYGB手术在国内已有超过14年历史,然而仍缺少规范化的手术操作指南,因此,中国医师协会外科医师分会肥胖和糖尿病外科医师委员会（CSMBS）发起编写首版《腹腔镜Roux-en-Y胃旁路术规范化手术操作指南》,旨在推荐标准化的LRYGB手术操作,为肥胖与代谢病外科领域的临床医生提供规范化手术操作的参考。     

儿童肥胖症的干预治疗

儿童肥胖症患病率逐渐升高 ,它严重影响了儿童的健康成长。目前对儿童肥胖的治疗方法主要是以家庭疗法为基础 ,加以饮食控制、运动训练以及认知行为治疗在内的综合治疗 ,而不主张采用药物或手术干预。     

减重与代谢外科加速康复外科原则中国专家共识（2021版）

目的近年加速康复外科（ERAS）在外科领域得以广泛应用,减重与代谢外科有其特殊性,建立适合中国国情的减重与代谢外科ERAS原则专家共识十分必要。 方法参照改良Delphi方法建立《减重与代谢外科加速康复外科原则中国专家共识（2021版）》。由20位从事减重与代谢外科的专家组成专家组,提出、审核EARS原则条目,由专家组邀请56位有经验的减重与代谢外科医师,共76位专家对42项ERAS原则条目进行投票,经两轮投票赞成率≥70%的条目为达成共识。 结果经第一轮投票,42项ERAS原则条目中,14项赞成率<80%;经第二轮投票,最终36项ERAS原则条目达成共识,6项条目未达成共识。 结论结合文献证据及中国减重与代谢外科具体情况,建立《减重与代谢外科加速康复原则中国专家共识（2021版）》,供减重与代谢外科医师临床实践中参考。     

中国儿童消化道异物管理指南（2021）

消化道异物是消化科常见的危急症之一,在儿童中最为常见。因误吞异物的种类繁多,导致处理方式多样,潜在的风险及并发症不断升级,若处理不及时或者处理不当会产生严重后果。目前,中国尚无针对儿童的消化道异物指南,因而在结合我国临床实践基础上制订符合国际标准的儿童消化道异物循证指南,对有效指导和促进儿童消化道异物管理具有重要意义。本指南按照规范的制订流程,联合多学科专家,基于现有证据,结合临床实践,制订符合我国国情的儿童消化道异物管理指南,以期为各级各类接诊儿童消化道异物的临床医师提供指导与决策依据。     

腹腔镜袖状胃切除术操作指南（2018版）

中国肥胖症患病率逐年增加,越来越多的临床证据表明"腹腔镜袖状胃切除术"能明显减轻单纯性肥胖症患者的体重,并缓解肥胖相关代谢性疾病。对于腹腔镜袖状胃切除术,我国仍缺少相应的规范手术操作指南。因此,"中国医师协会外科医师分会肥胖和糖尿病外科医师委员会"组织编写首版《腹腔镜袖状胃切除术操作指南》,旨在对国内减重代谢领域的腹腔镜袖状胃切除术操作进行规范化和标准化,为该领域的临床外科医生们提供标准规范手术操作步骤。     

青少年肥胖症代谢手术后3年效应观察与分析

目的探究青少年肥胖症病人接受减重代谢手术后中期效益及影响。 方法回顾性分析2014年11月至2015年10月于长春嘉和外科医院接受减重代谢手术的16例青少年肥胖症患者（13~21岁）的临床资料,对他们术前及术后3年间的体重、体质量指数（BMI）、甘油三酯（TC）、高密度脂蛋白（HDL）及低密度脂蛋白（LDL）进行统计分析。 结果16名入组患者的平均体重、BMI、空腹TC、LDL在术后3年均有不同幅度下降,平均空腹HDL有所升高,数据分析均有统计学意义（P<0.05）。 结论减重代谢手术可以明确并且持续性地减轻青少年肥胖症病人的体重,同时改善血脂异常问题。青少年一旦达到肥胖II级应当尽早手术。     

中国结直肠癌县域医师诊疗指南-外科部分（2019版草案）

我国县域级医院发展不平衡,因设备、人员、科室、资金配置相对落后,无法严格按照国际的结直肠癌诊疗指南进行诊治。而县域级医院服务人群基数大,为多数结直肠癌患者的初诊单位,因此制定适合于县域级医院的结直肠癌诊疗指南显得极为重要。本指南以2017年国家卫计委发布的《中国结直肠癌诊疗规范》为参照,通过问卷调查的形式调研了覆盖我国东、中、西部地区共计71所县域级医院的结直肠癌手术开展、诊断设备、科室配套、诊疗过程障碍等方面情况,汇总后进行归纳分析,结合现有诊疗新进展,根据我国县域级医院现有状况,在原有指南基础上做出适应于县域级医院诊疗的改动。希望该版指南可规范、提高我国基层医院结直肠癌诊治水平。     

儿童及青少年肥胖的干预

近20年来,儿童及青少年肥胖的发生率在世界范围内均明显升高,肥胖相关的危害更为引人瞩目.目前公认的儿童及青少年肥胖干预方法主要通过调整生活方式,包括饮食控制、增加运动、心理认知行为干预等.大量的证据表明,上述措施有确切的短期减重效果,然而长期效果尚未明确.即使彻底调整生活方式,仍有一部分人群减重效果不理想,因此,学者们致力于开辟有效安全的新途径,包括药物、手术,以及肥胖疫苗,以期控制儿童、青少年肥胖及其相关疾病的发生.     

儿童和青少年Graves病的治疗现状

与成年人相比,儿童和青少年Ｇｒａｖｅｓ病（ＧＤ）患者治疗上有其特殊性,治疗效果直接影响患儿的长期生活质量。目前常用的３种治疗方法（抗甲状腺药物治疗、放射性＾１３１碘治疗和手术）各有利弊。为重视和提高该年龄组ＧＤ患者的治疗效果,简要综述国内外治疗现状（包括近期开展的介入栓塞治疗）,并对治疗方案的选择进行探讨。     

School-based interventions for childhood and adolescent obesity

The purpose of this article was to review population-based interventions for preventing childhood obesity carried out in school settings published between 1999 and 2004. A total of 11 such interventions were found from USA and UK. The grade of the interventions was from kindergarten, primary grades, middle school to high school. Most of these interventions targeted both physical activity and nutrition behaviours although there were some interventions that focused on only one dimension such as TV watching or restricting drinking of carbonated drinks or increasing physical education time in the school. Most of the interventions were based on some behavioural theory and the most popular theory was social cognitive theory. Most of the interventions focused on individual level behaviour change approaches. Most of the interventions focused on short-term changes right after the intervention. On the whole, interventions resulted in modest changes in behaviours and mixed results with indicators of obesity. TV watching seems to be most modifiable behaviour, followed by physical activity and nutrition behaviours. The outcome measures such as lowered BMI (body mass index), triceps skin-fold thickness and waist circumference have not been measured by all studies. Recommendations for enhancing the effectiveness of school-based childhood obesity interventions are presented.     

《2019年美国胃肠病学院临床实践指南:遗传性血色素沉着症》摘译

遗传性血色素沉着症(hereditary hemochromatosis,HH)是北欧人群最常见的遗传疾病之一。最近HH在诊断、管理及治疗方面有了新的进展。大部分HH患者已通过分子诊断检测得以诊断。一些基因型-表型相关性的研究证实C282Y纯合基因型和其他HFE突变模式的患者之间的临床特征存在差异。越来越多的非侵入性检查(如MRIT2*)使肝脏铁沉积的定量测定更简便,并降低了患者肝活组织的检查率。诊断时血清铁蛋白(SF)<1000 ng/ml仍然是鉴别晚期肝纤维化低风险患者的重要诊断试验,应常规作为初步诊断评估的一部分。对其他类型的HH进行基因检测是可行的,但价格昂贵,通常不适用于大多数临床实际情况。血清SF在非酒精性脂肪性肝病(NAFLD)和酒精性肝病患者中可能会升高,在非C282Y纯合子或C282Y/H63D复合杂合子且血清SF升高的HH患者中,更为常见。在疑似铁超载的非C282Y纯合子患者中,应排除肝脏疾病的继发原因。静脉切开术仍然是主要的治疗方法,但新兴的新型治疗方法,如新的螯合剂可能对一些特定患者有一定的治疗作用。     

《2019年欧洲肝病学会临床实践指南:职业性肝病》摘译

1概述许多化学物质(包括化学试剂、杀虫剂、金属等)均与职业性肝病(occupational liver disease,OLD)有关,工作场所的暴露几乎涉及所有急、慢性肝病,但OLD的发病率及流行病学相关数据目前仍非常有限。OLD可缘于偶发事件或低剂量长期暴露,前者虽易于识别但发病率低,而后者虽相对常见,但因其发病隐匿、无明显症状及常见临床指标多正常,同时存在较多的混杂因素而易被忽略。     

Immersion treatment of childhood and adolescent obesity: the first review of a promising intervention

Obese children have attended weight loss camps and residential programmes for more than 40 years. This paper provides the first systematic review of the effects of those programmes. Twenty‐two studies met inclusion criteria (targeted and assessed change in weight status, minimal stay of 10 days and nights). Similar components across programmes included controlled diet, activities, nutrition education, and therapy and/or education regarding behaviour change. Participants lost substantial amounts of weight in all 22 studies, as measured by reductions in per cent‐overweight during intervention. Eleven programmes included long‐term follow‐up evaluations. Compared with results highlighted in a recent meta‐analysis of out‐patient treatments, these immersion programmes produced an average of 191% greater reductions in per cent‐overweight at post‐treatment and 130% greater reduction at follow‐up. Furthermore, mean attrition rates were much lower when compared with standard out‐patient treatment. Inclusion of a cognitive–behavioural therapy (CBT) component seemed especially promising; follow‐up evaluations showed decreased per cent‐overweight at follow‐up by an average of 30% for CBT immersion programmes vs. 9% for programmes without CBT. Explanations for the potentially greater impact of immersion relative to out‐patient treatments are presented, including possibly differential effects on self‐efficacy for both children and their parents.     

The role of parents in pre‐adolescent and adolescent overweight and obesity treatment: a systematic review of clinical recommendations

The study aims to describe clinical recommendations (i) on the role of parents in both pre‐adolescent and adolescent overweight and obesity treatment; (ii) to health professionals on how to involve parents in paediatric overweight and obesity treatment and (iii) to identify deficiencies in the associated literature. A systematic literature review was conducted in March 2010 to identify clinical practice guidelines, position or consensus statements on clinical management of paediatric overweight or obesity, developed by a national or international health professional association or government agency, and endorsed for current use. Relevant clinical recommendations in these documents were identified via a screen for the words ‘parent’, ‘family’ and synonyms. Twenty documents were included. Most documents emphasized the importance of involving parents or the family in paediatric overweight and obesity treatment with approximately a third of documents providing separate recommendations on the role of parents/family for pre‐adolescents and adolescents. The documents varied markedly with regard to the presence of recommendations on parent/family involvement in the various components of lifestyle interventions or bariatric surgery. Almost half of the documents contained recommendations to health professionals regarding interactions with parents. High‐quality research is needed on age‐specific techniques to optimize the involvement of parents and family members in paediatric overweight and obesity treatment.     

Prevention and treatment of childhood obesity

Obesity has reached epidemic proportions among children and youth in the United States. Surveys indicate that the number of overweight children aged 6 to 17 years has doubled within three decades. In the decade between the late 1970s and the late 1980s, the prevalence of overweight increased from 7.6% to 10.9% for children aged 6 to 11 years, and from 5.7% to 10.8% for adolescents aged 12 to 19 years. Data for 1999 indicates that the epidemic is continuing to increase, so that 13% of 6- to 11-year-old children and 14% of 12- to 19-year- old children are currently overweight (body mass index ≥95th percentile for age/gender). This article reviews newer concepts related to etiologic factors, comorbidities, and strategies for prevention and treatment.     

中国结直肠癌肝转移诊断和综合治疗指南(V 2020)

肝脏是结直肠癌血行转移最主要的靶器官,结直肠癌肝转移是结直肠癌治疗的重点和难点之一.为了提高我国结直肠癌肝转移的诊断和综合治疗水平,自2008年开始编写《中国结直肠癌肝转移诊断和综合治疗指南》并后续进行了多次修订,以期指导对结直肠癌肝转移患者进行全面评估,个性化地制定治疗目标,开展相应的综合治疗,达到预防结直肠癌肝转移...     

中国消化不良的诊治指南(2007,大连)

一、定义 消化不良(dyspepsia)是指一组表现为上腹部疼痛或烧灼感、餐后上腹饱胀和早饱感的症候群,可伴食欲不振、嗳气、恶心或呕吐等[1-3].消化不良症状的产生与消化系统器官疾病有关,从病因上可分为器质性消化不良(organic dyspepsia,OD)和功能性消化不良(functional dyspepsia,FD).