消化性溃疡3837例流行病学研究

对象和方法１．１对象我院１９８８１０／１９９７０９内镜检查共２３０３９例，检出消化性溃疡（ＰＵ）３８３７例，男３３０３例，女５３４例．其中十二指肠溃疡（ＤＵ）２７０７例，胃溃疡（ＧＵ）９６０例，复合溃疡（ＣＵ）１７０例．表１３８３７例ＰＵ性别和年...     

北京29所医院1999年度消化性溃疡患病情况分析

目的了解北京地区消化性溃疡的发病情况及变化特点。方法回顾性分析北京地区29所医院1999年胃镜检查消化性溃疡的临床资料,并与北京地区前两次统计结果及国内部分城市统计结果相比较。结果在64874例胃镜检查中,检出消化性溃疡8832例,检出率为13.61%。其中十二指肠溃疡6179例,占69.96%;胃溃疡2058例,占23.30%;其他溃疡(包括复合溃疡和吻合口溃疡)595例,占6.74%。三级医院消化性溃疡检出率为13.16%,二级医院为19.11%(P<0.01)。城区医院消化性溃疡检出率13.23%,近郊区医院为13.55%,远郊区医院为20.59%(与前两者相比,P<0.01)。北京市市民消化性溃疡检出率为13.83%,外地来京人口为11.62%(P<0.01)。结论(1)北京地区消化性溃疡患病率呈逐渐下降趋势,特别是十二指肠溃疡,但十二指肠溃疡患者仍明显多于胃溃疡。(2)与国内其他地区相比,北京地区消化性溃疡的发病率低于南方大城市,而高于东北和西北地区;提示自北向南消化性溃疡的发病率呈逐渐升高趋势。     

消化性溃疡药物治疗进展

本文综述法莫替丁、尼扎替丁、亚砜咪唑、三钾二橼络合铋及前列腺素类似物等治疗消化性溃疡的新药的作用机理、疗效及副作用。     

前列腺素与消化性溃疡

本文综述前列腺素对胃十二指肠的生理作用,消化性溃疡病人体内的前列腺素代谢异常,以及前列腺素衍生物的临床试验及应用情况。     

消化性溃疡霉菌感染的前瞻性调查

我院１９９６１１／１９９８１２内镜下确诊消化性溃疡（ＰＵ）患者１１０例,就其是否合并霉菌感染进行了前瞻性调查．目的在于了解ＰＵ患者霉菌感染率及两者间的相互关系,从而进一步指导临床诊断治疗．１材料和方法１．１材料１１０例均为同期在我院内镜室经内镜检...     

胃蛋白酶与消化性溃疡

胃蛋白酶是胃液中最重要的蛋白分解酶,消化性溃疡的发生与其对上消化道粘膜的侵袭作用有关。胃蛋白酶由多种同工酶组成,其中同工酶1可能是致溃疡性胃蛋白酶。胃蛋白酶原是其前身,可分为Ⅰ、Ⅱ两种类型,均可在血清中检测到。测定血清胃蛋白酶原Ⅰ、Ⅱ以及两者的比率,对判断胃十二指肠疾患有一定价值。     

小儿消化性溃疡102例

目的探讨小儿消化性溃疡的特征及其与幽门螺杆菌(Hp)的关系.方法102例消化性溃疡的患儿经内镜检查胃粘膜进行快速尿素酶试验检测Hp.结果本组小儿消化性溃疡Hp检出率77.5%(79/102),其中十二指肠溃疡(DU)占74.7%(59/79),胃溃疡(GU)占18.9%(15/79),复合性溃疡占6.4%(5/79).年龄5岁～14岁,男女2.921,>6岁占92.2%,以十二指肠溃疡多见,GUDU=13.87;<6岁GUDU=11.71.十二指肠溃疡发生于球部92.3%(60/65),单发溃疡占44.6%(29/65),多发溃疡占15.4%(10/65),霜斑样溃疡占40%(26/65);胃溃疡中单发占70.4%(19/27),多发性溃疡占29.6%(8/27).溃疡复发者均伴Hp感染.结论小儿消化性溃疡好发于学龄期以上,以十二指肠溃疡为多见,十二指肠溃疡与Hp感染密切相关,复发亦与其有关.     

阻塞性黄疸与消化性溃疡

目的证实消化性溃疡与阻塞性黄疸的相关性。方法经内镜证实的溃疡患者289例，从无溃疡患者中随机挑选290例设为对照组，进行去除混杂因素的非条件的logistic回归分析。比较消化性溃疡各病种之间与阻塞性黄疸发生率的差异，消化性溃疡中的高位梗阻与低位梗阻发生率的差异，溃疡组与无溃疡组的肝功能各项指标的对比，黄疸的发生时间与消化性溃疡发生的关系，以及胃溃疡与十二指肠溃疡发生率的差异。结果溃疡组的阻塞性黄疸发病率及黄疸指数明显高于对照组（P〈0．01），低位梗阻与高位梗阻对比，低位梗阻患者的消化性溃疡发生率高（P〈0．01），十二指肠与胃溃疡发生率两组有显著差别，各病种间的溃疡发生率有明显差别，溃疡的发生率与黄疸持续的时间相关。结论本研究进一步证实了消化性溃疡与阻塞性黄疸有明显的相关性，梗阻性黄疸导致高胃酸在十二指肠溃疡形成中的重要作用。     

消化性溃疡的特点

目的为了进一步探讨消化性溃疡（PU）的特点．方法内镜检查确诊的1432例PU，从其检出率、性别、年龄、季节、分布、大小、部位、并发症等方面进行了分析．结果PU：①发病率，十二指肠明显高于胃溃疡（GU）；②年龄，GU随年龄增长而增加，60岁以后下降，十二指肠溃疡（DU）以20岁～30岁青壮年发病率高，51岁以后开始减少，平均年龄DU比GU小10岁；③性别，男性明显高于女性；④季节，GU春季发病率较低，夏秋季发病率开始上升，冬季发病率最高，DU春季和秋季发病率高，冬春季和夏季发病率相对较低；⑤大小，多为＜1．0cm；⑥部位，GU依次为胃角＞胃窦＞胃体＞胃底＞幽门管，DU下壁＞前壁＞后壁＞上壁＞球后；⑦并发症，出血较多，梗阻较少，DU多于GU．结论PU的发病与年龄、性别、季节都有一定的关系，GU与DU略有不同     

Society stress and peptic ulcer perforation

To examine the relationship between society stress and peptic ulcer perforation, time-trend analysis was performed on the annual incidence of perforated peptic ulcer per 100 000 population in Hong Kong during the years 1962–85, when Hong Kong, as a developing city, went through significant socio-economic and political changes, and the trend was correlated with specially designed and validated society stress scores estimated annually during the same period. The society stress scores were derived independently by two expert panels blinded to the purpose of the study, one selecting and categorizing negative news events for Hong Kong during this period, and the other weighing the categories and scoring the impact of the news on Hong Kong. The incidence of perforation increased significantly during the years and manifested three distinct peaks, which coincided with the worst economic recession in Hong Kong, the influx of mainlander Chinese and Vietnamese boat people, and the Sino-British negotiation on the sovereignty of Hong Kong after 1997. Both linear and autoregression analysis, the latter taking into consideration point fluctuations in rates, showed that perforation rates correlated significantly with the society stress scores (r= 0.57, P < 0.002). The peak effects and the significant correlations indicate that an association exists between society stress and peptic ulcer perforation, and suggest that chronic society stress plays an important role in the aetiology of this condition, although the relatively low r value also suggests the presence of other aetiological factors.     

Helicobacter pylori and gastric acid output in peptic ulcer disease

Helicobacter pylori is associated with peptic ulcer, and a causal relationship has been postulated. We investigated the association betweenHelicobacter pylori and gastric acid output. Two hundred forty-one patients were studied: 173 with duodenal ulcer, 51 with gastric ulcer (41 corpus, 10 prepyloric), and 17 with combined gastric and duodenal ulcer. In 194 patients (80%),Helicobacter pylori could be demonstrated histologically from gastric antral biopsies. The presence or absence ofHelicobacter pylori was not influenced by age, sex, or use of tobacco or analgesics. Patients with duodenal ulcer or combined gastric and duodenal ulcer had similar gastric acid outputs irrespective of the presence or absence ofHelicobacter pylori. However, gastric ulcer patients withHelicobacter had higher basal and maximal acid outputs when compared to patients withoutHelicobacter (mean basal output: 4.1 mmol/hr vs 2.4,P<0.05; mean maximal output 19.5 mmol/hr vs 14.4,P<0.05). AlthoughHelicobacter pylori is associated with both gastric ulcer and duodenal ulcer, its significance may be different in the two diseases.     

消化性溃疡患者粘膜生长抑素和精氨酸加压素分布和意义

回的:为了研究消化性溃疡患者粘膜生长抑素(SS)和精氨酸加压素(AVP)的分布及其在溃疡发病中的作用。方法:应用放射免疫分析法对39例消化性溃疡患者胃、十二指肠粘膜SS和AVP含量进行了测定,并以20例慢性浅表性胃炎(CSG)作对照。结果:十二指肠溃疡(DU)胃(体、窦分别为177.1±115.6,330.9±92.6Pg/mg)十二指肠粘膜SS含量(153.5±106.5Pg/mg)显著低于CSG(分别为288.8±181.1,559.9±381.5和252.7±152.9Pg/mg,P<0.05),而DU球部粘膜AVP含量(52.3±29.7Pg/mg)显著高于CSG(37.7±19.2Pg/mg)。GU与CSG组比较均无显著性。结论:①胃、十二指肠存在AVP样物质;②DU发生与粘膜SS、AVP分泌失调有关。     

Perforated peptic ulcer in Hong Kong and New South Wales

Direct comparisons of ulcer perforation rates and trends between countries have not been made in the past. Data on hospital admissions for perforated peptic ulcer during 1 January 1979 to 31 December 1985 were collected in Hong Kong (5868 perforations) and New South Wales, Australia (1669 perforations). Age and sex specific rates per 100,000 population were calculated. In Hong Kong, annual duodenal ulcer and gastric ulcer perforation rates were 13-16 and under two per 100,000 population respectively. In New South Wales, the corresponding rates were between three and four and under two per 100,000 population, respectively. The male:female ratios for duodenal ulcer perforation were consistently about 5:1 in Hong Kong and 2:1 in New South Wales, and for gastric ulcer perforation about 2:1 and 1:1, respectively. The incidence of perforation increased with age, and there was a statistically significant rise, over time, in duodenal but not gastric ulcer perforation rates in persons aged over 60 years in New South Wales; similar trends were seen in Hong Kong. Thus duodenal ulcer perforation occurs five times more commonly in Hong Kong than in New South Wales and this is largely accountable for by the higher rates of duodenal ulcer perforation in Chinese than in Australian males. Such geographical differences can best be explained by the occurrence of multiple aetiological mechanisms in ulcer perforation. Furthermore, there appears to be an increased susceptibility and an appreciable rising trend for duodenal ulcer perforation to occur in the elderly.     

Observations on peptic ulcer in Shan Dong, China

The study consisted of 10 994 inpatients with peptic ulcer in Shan Dong province. The ratio of duodenal to gastric ulcer was 1.59 : 1. The ratio of males to females was 6.8 : 1 for duodenal ulcer and 4.6 : 1 for gastric ulcer. The highest incidence was in adolescence and young adults and the presentation occurred more commonly in winter. A study of blood groups revealed that there was no relationship between blood group and duodenal or gastric ulcer. The majority (71.9%) of patients with peptic ulcer had complications of upper gastrointestinal bleeding, perforation or gastric outlet obstruction. Bleeding and obstruction were equally common in gastric and duodenal ulcer, but perforation was more common in gastric ulcer.     

Clinical significance of gastric juice viscosity in peptic ulcer patients

We developed a simple method of determining gastric juice viscosity using a cone plate viscometer and tested its clinical application in the staging of peptic ulcers. We found a significant positive correlation between viscosity and macromolecular glycoprotein concentration of gastric juice P<0.001).Gastric juice viscosity in active and healing gastric ulcer patients was significantly lower than that in the scarring stage or hospital control patients P<0.05 and P<0.01, respectively). In duodenal ulcer patients, a significant difference was found between the active and healing stages and hospital controls P<0.01). However, the difference between the active and healing stages and the scarring stage was not significant. Gastric juice viscosity is a simple, reliable, clinically useful measure.     

Antibody to herpes simplex virus type 1 in peptic ulcer patients

It has been postulated that herpes simplex virus type 1 may be a causative factor of duodenal ulcer. Serum antibody titres to herpes simplex virus type 1 in duodenal and gastric ulcer patients were compared with race-, sex- and age-matched controls. No differences in antibody titres could be demonstrated between duodenal ulcer and gastric ulcer patients and their respective controls, between gastric ulcer and duodenal ulcer patients or between acute and convalescent sera in either gastric or duodenal ulcer. Although Chinese are more susceptible to ulcer disease than Malays and Indians, antibody titres were comparable between subjects of different races. The results of this study do not support a causal role for herpes simplex virus in peptic ulcer disease.     

胃舒胶囊治疗消化性溃疡236例

目的观察胃舒胶囊治疗消化性溃疡（ＰＵ）的临床疗效．方法用胃舒胶囊（６粒，ｐｏ，３次／ｄ×２ｗｋ×２）治疗ＰＵ２３６例（男１９２例，女４４例；年龄１８岁～７４岁，平均３２岁±７岁；病程１ａ～１５ａ，平均４９ａ±３５ａ；ＤＵ１０６例，ＧＵ８３例，ＣＵ４７例），用纤维内镜观察不同证型ＰＵ患者的治疗效果．结果用胃舒胶囊两个疗程，对消化道症状改善率达９１２％～１００％，溃疡愈合率达９２８％，对肝胃气滞、寒邪犯胃、脾胃虚寒、胃热炽盛和瘀血阻络各型的治愈率分别为９２８％，９３５％，９４２％，８００％和８５７％．治疗组的疗效明显优于西咪替丁加胃必治组（Ｐ＜００１）．结论胃舒胶囊治疗ＰＵ具有显著疗效，其治疗作用可能与保护胃粘膜，中和胃酸和杀灭Ｈｐ等有关．     

Thickness of Brunner’s glands and its clinical significance in peptic ulcer diseases

The thickness of Brunner’s glands was measured using an ocular micrometer in 297 cases of surgically resected peptic ulcer and in 120 autopsy cases (control group). The mean maximum thickness of Brunner’s glands in the control group was 1.55±0.37mm (mean±SD) and no difference in thickness was noted for each decade of age. The mean maximum thickness of Brunner’s glands in patients with gastric ulcer, duodenal ulcer and gastroduodenal ulcer was 2.34±1.06, 3.18±1.07 and 3.24±1.05mm, respectively. When an ulcer is within the duodenum, Brunner’s glands near the ulcer were thicker than those contralateral to it. In patients with gastric ulcer, Brunner’s glands were the thickest in the pyloric ulcer group and negative correlation was noted between the thickness of Brunner’s glands and the distance to the ulcer from the pyloric ring. Since gastric acidity is supposed to be lower when an ulcer is located more proximally, these results suggest that Brunner’s glands become hyperplastic not only with the presence of an ulcer in the duodenum but also by acid hypersecretion of the stomach.     

幽门螺杆菌相关性十二指肠溃疡与胃肠激素的关系

目的探讨幽门螺杆菌（Hp）相关性十二指肠溃疡（DU）患者Hp根除前后胃粘膜及血中促胃液素（Gas）和生长抑素（SS）含量变化的意义．方法采用放射免疫分析法测定Hp相关性DU患者42例Hp根除前后及正常对照者20例胃粘膜及血中Gas和SS含量结果Hp相关性DU的患者胃粘膜及血中Gas的含量明显高于Hp阴性患者（粘膜：ng／g，226±65vs380±98；血清：ng／L，107±33vs50±8），而Hp根除后Gas含量则明显下降Hp阳性者SS的含量低于HP阴性患者（粘膜：ng／g，11±2us42±8；血浆：ng／L，5．6±1．2vs10．2±2．3），Hp根除后正含量显著升高．Hp感染时胃粘膜炎细胞浸润程度对Gas和SS的含量亦有一定影响结论Gas和SS与Hp相关性DU密切相关是参与DU发病的重要因素之一