CD44与大肠癌

CD44与大肠癌@田慧军$武汉大学人民医院消化内科!武汉430060~~     

Kappa 700系列起搏器的临床应用

~~Kappa 700系列起搏器的临床应用@黄新平!650021昆明$云南省第二人民医院心内科 @张荣华!650021昆明$云南省第二人民医院心内科 @洪云飞!650021昆明$云南省第二人民医院心内科 @李丹若!650021昆明$云南省第二人民医院心内科 @杨骥!650021昆明$云南省第二人民医院心内科 @陈芳!650021昆明$云南省第二人民医院心内科~~     

起搏器心室自动阈值管理功能的特殊心电图表现

~~起搏器心室自动阈值管理功能的特殊心电图表现@陈岗!200080$上海交通大学附属第一人民医院心内科 @孙宝贵!200080$上海交通大学附属第一人民医院心内科 @金炜!200080$上海交通大学附属第一人民医院心内科 @张建军!200080$上海交通大学附属第一人民医院心内科 @汪爱虎!200080$上海交通大学附属第一人民医院心内科 @汪芳!200080$上海交通大学附属第一人民医院心内科     

生长激素对肝硬化预后判断的价值及治疗意义

生长激素对肝硬化预后判断的价值及治疗意义@王旦$温州医学院附属第一医院消化内科!温州325000 @韩清锡$温州医学院附属第一医院消化内科!温州325000~~     

拉米夫定在肝移植中应用现况

拉米夫定在肝移植中应用现况@江正辉$第三军医大学西南医院消化内科!重庆400038 @王槐志$第三军医大学西南肝胆外科医院 @陈长宏$第三军医大学西南肝胆外科医院~~     

烧伤患者吸入性损伤的呼吸道护理

烧伤患者吸入性损伤的呼吸道护理@朱梅荣$临邑县人民医院!251500 @蔡秀芳$临邑县人民医院!251500     

新生儿颅内出血的观察与护理

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肺心病并呼衰的护理体会

肺心病并呼衰的护理体会@白长春$临朐县人民医院!262600 @王翠娟$临朐县人民医院!262600     

手术患者的心理护理

手术患者的心理护理@梁淑文$泰安市第一人民医院!271000 @赵会珍$泰安市第一人民医院!271000     

阻塞性睡眠呼吸暂停综合征与阵发性室上性心动过速一例

~~阻塞性睡眠呼吸暂停综合征与阵发性室上性心动过速一例@郭玉琴!123000辽宁省$阜新市第二人民医院心内科 @兰振和!123000辽宁省$阜新市第二人民医院心内科     

十二指肠溃疡患者根除幽门螺杆菌后抑酸维持治疗的疗效研究

背景：对感染幽门螺杆菌（H.pylori）的消化性溃疡患者成功根除且H.ylori后,是否应继续行抑酸治疗,目前尚存在争议。目的：探讨合并H.pylori感染的十二指肠溃疡（DU）患者根除H.pylori后抑酸维持治疗的疗效。方法：112例合并H.pylori感染的DU患者随机分为A组和B组,A组给予10d四联疗法：兰索拉唑30mg＋阿莫西林1g＋克拉霉素0．5gbid＋枸橼酸铋钾110mg qid,疗程10d。B组：在A组方案的基础上,疗程结束后再予兰索拉唑30mg,1次／d,维持4周。治疗结束4周后复查胃镜,评估H.pylori根除疗效、溃疡愈合率和腹痛缓解率。结果：109例患者完成方案。A、B两组按意向治疗（ITT）和按方案（PP）分析的H.pylori根除率（ITT：85．7％对87．5％;PP：88．9％对89．1％）和溃疡愈合率（ITT：87．5％对94．6％;PP：90．7％对96．4％）以及腹痛缓解率（95．6％对95．7％）相比差异均无统计学意义（P〉0．05）。结论：以10d四联疗法根除H.pylori后,可使多数DU患者的溃疡愈合,无需进一步行维持抑酸治疗。     

短程三联疗法根除幽门螺杆菌的多中心临床研究

近年幽门螺杆菌（Ｈ．ｐｙｌｏｒｉ）菌株的耐药性总是日益突出,寻找有效且无耐药性的抗生素及联合治疗方案是当前十分重要的课题。本文旨在评价以奥美拉唑（Ｏ,２０ ｍｇ）或胶体次枸橼酸铋（Ｂ,２４０ ｍｇ）为基础的含呋喃唑酮（Ｆ,１００ ｍｇ）或甲唑（Ｍ,４００ ｍｇ）同时加用羟氨苄青霉素（Ａ,１ ０００ ｍｇ）或克拉霉素（Ｃ,２５０ ｍｇ）的４种短程（１周）三联疗法的Ｈ．ｐｙｌｏｒｉ根除率。方法：采用由     

Effects of killing Helicobacter pyloriquadruple therapy on peptic ulcer： A randomized double-blind clinical trial

AIM: To study the therapeutic efficacy of a Chinese and Western integrated regimen, killing Helicobacter pylori quadruple therapy on H pylori-associated peptic ulcers (PU). METHODS: With prospective and double-blind controlled method, seventy-five active PU patients with H pylori infection were randomized to receive one of the following three regimens: (1) new triple therapy (group A: lansoprazole 30 mg qd, plus clarithromycin 250 mg bid, plus amoxycillin 500 mg tid, each for 10 d); (2) killing Hp quadruple therapy(group B: the three above drugs plus killing H pylori capsule 6 capsules bid for 4 wk) and (3) placebo(group C: gastropine 3 tablets bid for 4 wk). H pylori eradication and ulcer healing quality were evaluated under an endoscope 4 wk after treatment. The patients were followed up for 5 years. RESULTS: Both the healing rate of PU and H pylori eradication rate in group B were significantly higher than those in group C (100% and 96.4% vs20% and 0%, respectively,P<0.005), but there was no significant difference compared to those in group A (88% and 92%, P>0.05). The healing quality of ulcer in group B was superior to that in groups C and A (P<0.05). The recurrence rate of PU in group B (4%) was lower than that in group A (10%) and group C (100%,P<0.01). CONCLUSION: Killing Helicobacter pylori quadruple therapy can not only promote the eradication of H pylori and healing quality of ulcer but also reduce recurrence rate of ulcer.     

Response of blood endothelin-1 and nitric oxide activity in duodenal ulcer patients undergoing Helicobacter pylori eradication

AIM: To investigate the effect of Helicobacter pylori eradication on endothelin-1 (ET-1) and nitric oxide (NO) in duodenal ulcer (DU) patients. METHODS: Sixty-six Hpylori-infected active DU patients were consecutively enrolled to receive one-week triple therapy (rabeprazole, amoxicillin and metronidazole) and then one-month rabeprazole therapy. They were asked back to determine ulcer and Hpylori status using endoscopy one month later. Thirty-seven healthy controls (H pylori +/-:17/20) were enrolled for comparison. Blood samples were collected in each visit to measure plasma ET-1 and nitrate/nitrite levels using an enzyme immunoassay kit. RESULTS: Sixty DU patients finished trial per protocol. The ulcer healing and Hpylori-eradication rates were 86.7% and 83.3%, respectively. Plasma ET-1 level in DU patients was higher than that of Hpylori-negative and positive controls (3.59±0.96 vs0.89±0.54 vs0.3±0.2 pg/mL,P<0.01), while nitrate/nitrite levels among them were also significantly different (8.55±0.71 vs5.27±0.68 vs 6.39±0.92 μmol/L, P<0.05). H pylori eradication diminished ET-1 levels (3.64±0.55 vs2.64±0.55 pg/mL, P<0.01) but elevated nitrate/ nitrite level (8.16±0.84 vs11.41±1.42 umol/L,P<0.05). CONCLUSION: Both plasma ET-1 and nitrate/nitrite levels increase in active DU patients. After an effective H pylori eradication, DU healing is associated with diminished blood ET-1 level and elevated nitrate/nitrite level.     

胃舒散联合呋喃唑酮和阿莫西林根除幽门螺杆菌阳性十二指肠溃疡及抗复发疗效观察

目的 :观察胃舒散、呋喃唑酮和阿莫西林对幽门螺杆菌 (Hp)阳性十二指肠溃疡 (DU)的疗效及根除Hp对溃疡复发的影响。方法 :73例 Hp阳性 DU患者随机分为两组 :三联组 4 1例 ,服用胃舒散 2 .0 g,呋喃唑酮 0 .1g,阿莫西林 0 .5 g,各 3次 /d ,2周后再继服胃舒散 4周。雷尼替丁组 32例 ,服用雷尼替丁 0 .15 g,3次 /d,共 6周。治疗前后均记录胃痛症状 ,内镜观察溃疡情况 ,并进行 2年随访。Hp检测采用 Warthin- Starry银染色法 ,1 4C-尿素呼气试验或快速尿素酶试验 ,2项阳性为 Hp感染 ,阴性为 Hp根除。结果 :6周治疗结束后 ,两组溃疡愈合率均为10 0 %。三联组临床症状缓解率、副反应发生率为 97.6 %和 18.8% ,雷尼替丁组为 93.8%和 9.4 % (均 P >0 .0 5 )。三联组 Hp根除率 (92 .7% )显著高于雷尼替丁组 (0 % ,P <0 .0 1)。 Hp根除的 38例中 ,1年及 2年溃疡复发率为(5 .3% ,10 .5 % )均显著低于 Hp持续感染者 (2 8.1% ,4 6 .9% ,P <0 .0 1)。结论 :以胃舒散为主的三联疗法具有疗效高、副作用少、溃疡复发率低的优点 ,是一种根除 Hp的较好方案。     

Smoking Does Not Contribute to Duodenal Ulcer Relapse after Helicobacter pylori Eradication

Cigarette smoking is believed to be one of the major factors influencing duodenal ulcer (DU) recurrence. However, the influence of cigarette smoking on DU recurrence after the eradication of Helicobacter pylori has not been separately addressed. The aim of this study was to investigate DU relapse rate in smokers and nonsmokers, both with confirmed eradication of H. pylori. Patients with H. pylori eradication, demonstrated at endoscopy 4 wk post-treatment, were included in the study. Smoking history was obtained with a standard questionnaire, and patients were followed endoscopically, both yearly and at symptomatic recurrence, to detect anatomical DU recurrence. Of the 197 (121M:76F) patients enrolled in the study and followed for 1-6 yr, 80 (41%) were smokers, smoking 5-40 cigarettes/day. The 117 (59%) nonsmokers included 31 (26%) patients who had ceased smoking 4-20 yr ago. Another seven (9%) smokers ceased smoking during the follow-up period. In the 197 patients with eradicated H. pylori and cured DU, there has been no recurrence of ulcer, regardless of smoking status. We conclude that in patients with DU in whom H. pylori infection is eradicated, ulcer disease does not recur, as observed for up to 6 yr. Furthermore, cigarette smoking is not a risk factor for DU recurrence, provided H. pylori is eradicated.     

根除幽门螺杆菌对出血性十二指肠溃疡自然病程影响的3年随访研究

目的：探讨根除幽门螺杆菌（Ｈｐ）对出血性十二指肠溃疡自然病程的影响。方法：选择胃镜证实的出血性十二指肠溃疡病人１３６例，均有Ｈｐ感染（胃粘膜Ｇｉｅｍｓａ染色和１４Ｃ尿素呼吸试验二项均阳性）。予奥米拉唑２０ｍｇ，每日２次；羟氨苄青霉素７５０ｍｇ，每日２次；甲硝唑４００ｍｇ，每日３次，疗程２周。疗程结束后４周复查胃镜和Ｈｐ，溃疡愈合者分Ａ组（Ｈｐ根除）和Ｂ组（Ｈｐ未根除）进入随访阶段，随访观察３年。结果：溃疡愈合１２４例（９１２％），Ｈｐ根除１１１例（８１６％）；Ｈｐ根除的溃疡愈合率为９９１％（１１０／１１１），显著高于Ｈｐ未根除的５６％（１４／２５，Ｐ＜０００５）；Ｂ组１年内溃疡复发率达１００％，显著高于Ａ组８３％（Ｐ＜００５）；Ｂ组３年累积再出血率１００％，显著高于同期Ａ组的９０％（Ｐ＜００５）。结论：根除Ｈｐ可提高十二指肠溃疡愈合率和减少溃疡复发率，尤可显著减少溃疡再出血率，提示根除Ｈｐ很可能改变出血性十二指肠溃疡的自然病程。     

Five-Day Bismuth-Free Triple Therapy for the Eradication of Helicobacter pylori and Reduction of Duodenal Ulcer Relapse

Previous studies have demonstrated that the eradication of Helicobacter pylori ( H. pytori ) is associated with a significant reduction of the rate of duodenal ulcer (DU) relapse. The aim of this study was to assess the long-term effect of a bismuth-free triple therapy on the eradication of H. pylori and reduction of DU relapse. After informed consent, 61 patients with endoscopically proven DU and H. pylori infection detected on ¹⁴C-urea breath test (BT) were included in the study. All patients received a combination of furazolidone, amoxicillin, and metronidazole, three times a day, for 5 days, in addition to eventual classical antiulcer agents prescribed by their attending physicians. BT was repeated after an interval of at least 60 days to evaluate H. pylori eradication. Endoscopy and another BT were performed again at 6.5 months after therapy to detect possible recurrences. Forty-eight patients completed the trial: 26 (54%) patients were negative for H. pylori at 6.5 months after the end of treatment, and 22 (46%) persisted H. pylori positive. Ninety-two percent of the patients in whom the bacteria were eradicated showed endoscopically healed ulcers and were asymptomatic, and two that were sympatomatic presented only occasional pain not requiring therapy. Among the 22 patients who persisted H. pylori positive, six (27%) showed endoscopically active ulcers ( p = 0.012) and eight (36%) patients continued to be symptomatic ( p < 0.01), and were still using antiulcer drugs ( p < 0.002) 6.5 months after treatment. It is concluded that combined treatment with furazolidone, amoxicillin, and metronidazole for 5 days represents a well-tolerated, inexpensive, and effective therapeutic regime for the eradication of H. pylori and abolition of DU relapse in more than 50% of the patients during a follow-up period of 6.5 months.     

Eradication rates of helicobacter pylori infection with second-line treatment: non-ulcer dyspepsia compared to peptic ulcer disease

BACKGROUND/AIMS: Initial proton pump inhibitor (PPI)-based triple therapy for Helicobacter pylori (H. pylori) infection is less effective in patients with nonulcer dyspepsia (NUD) than those with peptic ulcer disease (PUD). To date, there have been no studies on the difference in eradication rates in NUD compared to PUD with regard to second-line therapy. Therefore, we retrospectively analyzed the difference in eradication rates of a second-line quadruple therapy for NUD and PUD patients. METHODOLOGY: Between June 2003 and December 2005, patients who failed to respond to initial PPI-based triple therapy, received 7 days of quadruple therapy (PPI b.i.d., bismuth 300mg q.i.d., metronidazole 500mg t.i.d., tetracycline 500mg q.i.d.) as a second-line treatment regimen. Four weeks after the completion of the course of medication, a 13C-urea breath test was performed for detection of H. pylori. RESULTS: A total of 87 patients received second-line quadruple therapy. Of these, 43 patients had NUD and 44 patients had PUD (19 gastric ulcers, 23 duodenal ulcers, 2 both ulcers). The eradication rates were 76.7% (33/43) in the NUD group and 90.9% (40/44) in the PUD group by per-protocol analysis. Therefore, the eradication rates in the NUD group were significantly lower than those in the PUD group (p = 0.034). CONCLUSIONS: A 7-day bismuth-based second-line quadruple therapy for H. pylori infection was less effective in patients with NUD than those with PUD. Therefore, a more potent second-line treatment regimen or extension of treatment duration of quadruple therapy should be considered for the eradication of H. pylori in patients with NUD.     

Duodenal ulcer and eradication of Helicobacter pylori in a developing country. An 18-month follow-up study.

Forty-eight patients with endoscopically proven duodenal ulcer (DU) and Helicobacter pylori infection detected by 14C-urea breath test (BT) were assigned to 5 days of treatment with furazolidone, metronidazole, and amoxicillin in addition to eventual classical anti-ulcer agents if necessary. Clinical evaluation and BT were repeated at 2, 6, and 18 months after therapy to determine H. pylori eradication or reinfection. Endoscopy was also repeated at 6 and 18 months after treatment to detect DU relapse. In 29 (60%) patients H. pylori had been eradicated at 2 months after therapy, and in 19 (40%) infection persisted. After successful eradication, 6 of 29 (20.7%) were reinfected. All 24 patients who were negative at the 18-month evaluation were asymptomatic, free of anti-ulcer drugs, and with healed ulcers, whereas among the 19 positive patients followed up, 11 (57%) continued to be symptomatic and still using anti-ulcer agents (p less than 0.010), and 10 (53%) showed active ulcers at endoscopy (p less than 0.010). H. pylori eradication is clearly followed by long-term remission of DU. Reinfection may be an additional problem in treating DU patients in developing countries.