胃癌及术后随访患者血清血管生成素-2含量的临床意义

目的 检测胃癌及术后随访患者血清血管生成素-2 (Ang-2)含量的变化,探讨其临床意义。方法采用ELISA法分别检测158例胃癌、31例慢性萎缩性胃炎、38例胃腺瘤息肉、28例慢性胃炎伴胃溃疡患者及30名健康对照者血清Ang-2与癌胚抗原(CEA)的含量,并检测131例行胃癌根治术患者术后2年血清Ang-2含量的变化,随访其预后。分析胃癌患者血清Ang-2含量与胃癌病理特征的关系。结果 胃癌组血清Ang-2和CEA含量分别为（331.8±64.3）μg/L和(42.6±37.3) μg/L,较正常对照组[（187.4±32.7）μg/L和（4.2±3.1）μg/L]及胃溃疡组[(197.3±35.4) μg/L和(4.5±3.2) μg/L]显著升高（P值均＜0.01）,慢性萎缩性胃炎组Ang-2含量亦明显升高(P＜0.05),而CEA含量无明显变化,胃腺瘤息肉组Ang-2与CEA含量均无明显变化。随访复发组及转移组术前血清Ang-2含量明显高于未复发组(P＜0.05)。未复发组术后1个月血清Ang-2含量降至正常范围,随访2年无明显升高。复发组术后1个月Ang-2含量亦降至正常范围,而术后6个月至2年显著高于未复发组及正常组(P＜0.01)。转移组术后2年Ang-2含量始终显著高于未复发组及正常组(P＜0.01)。未复发组2年存活率显著高于复发组和转移组。胃癌患者血清Ang-2含量变化与胃癌分化程度、TNM病理分期、有无淋巴结转移、有无远处组织转移、浸润深度和肿瘤大小均相关(P＜0.01),与组织学分型、肿瘤部位无相关性(P＞0.05)。结论血清Ang-2可作为一种新的具有一定临床价值的胃癌肿瘤标志物,有助于术后复发、转移的监测和预后评价。     

肿瘤标志物CA724、CA199、CA242、CEA联合检测在老年胃癌诊断中的应用

目的观察肿瘤标志物CA724、CA199、CA242、CEA单项及联合检测在老年胃癌诊断中的价值。方法选取老年胃癌患者50例作为观察组,同时选取慢性萎缩性胃炎伴重度不典型增生的患者50例为对照1组,选取浅表性胃炎或正常胃黏膜者50例作为对照2组。检测三组观察对象的血清,上午取空腹静脉血10 ml,用离心机分离,然后将分离血清存贮在-90℃的冷冻冰箱进行保存,最后进行肿瘤标志物CA724、CA199、CA242、CEA检测。且通过CA724、CA199、CA242、CEA单项及联合检测分析不同分化程度和不同分级的检测情况。结果观察组患者血清肿瘤标志物各项指标明显高于对照1组和对照2组(P<0.05和P<0.01);且对照1组各项指标均明显高于对照2组(P<0.05)。高、中分化组胃癌患者CA724、CA199、CA242阳性率均优于低分化组(P<0.05)。各组CEA阳性率差异不明显(P>0.05)。Ⅰ和Ⅱ期胃癌患者4种肿瘤标志物阳性水平明显低于Ⅳ期(P<0.05)。Ⅰ和Ⅱ期胃癌患者肿瘤标志物阳性率明显高于Ⅳ期(P<0.05)。结论肿瘤标志物CA724、CA199、CA242、CEA的水平异常升高或可提示有癌前病变或胃癌的发生,它可作为胃癌早期诊断的重要辅助指标。     

检测血清胃蛋白酶原和胃泌素-17诊断胃癌的临床价值

目的通过测定血清胃蛋白酶原(PG)Ⅰ、PGⅡ、胃泌素-17(G-17)和H.pylori-IgG抗体来预测胃癌高危,提高胃癌早诊率。方法本研究采用观察性病例-对照研究,共310例受检者纳入研究。在作血清试验前,所有患者均在胃镜下作多处活检,并根据病理结果将受检者分为胃癌组(141例,其中早期胃癌40例、进展期胃癌101例)、正常组(77例)和萎缩性胃炎组(92例)。每一例均用酶联免疫吸附试验(ELISA)定量测定空腹血清PGⅠ、PGⅡ和G-17,定性测定H.pylori-IgG抗体。结果PGⅠ和PGR(PGⅠ/PGⅡ)水平在胃癌组(28.74±11.55μg/L,1.66±1.01)明显低于正常组(123.99±32.25μg/L,10.09±1.89)和萎缩性胃炎组(58.63±25.35μg/L,4.36±2.57)(均P<0.01),根据接受者操作特征曲线(ROC)计算PGⅠ和PGR诊断胃癌的最佳界值分别为57.15μg/L(灵敏度99.3%,特异度84.5%)和2.99(灵敏度92.5%,特异度89.0%);而G-17水平胃癌组(20.86±8.24pmol/L)明显高于正常组(10.39±9.25pmol/L)和萎缩性胃炎组(8.59±6.08pmol/L)(均P<0.01)。根据ROC曲线计算G-17的最佳界值为14.61pmol/L(灵敏度75.2%,特异度71.3%)。进展期胃癌的PGⅠ和PGR水平较早期胃癌明显降低(P<0.01),而G-17差别不明显。萎缩性胃炎组和胃癌组的H.pylori-IgG抗体阳性率均明显高于正常组(P<0.01)。结论结合G-17水平明显升高而PGⅠ、PGR水平显著低下可作胃镜进行胃癌筛查,有助于提高胃癌早诊率。     

老年胃黏膜病变患者血清胃蛋白酶原变化

目的 探讨老年胃疾病患者胃黏膜病理改变过程中,血清胃蛋白酶原(PG)Ⅰ、Ⅱ的变化规律.方法 选择我院消化内镜中心行胃镜检查老年患者276例,按病理诊断标准分为4组,非萎缩性胃炎组(对照组)34例,慢性萎缩性胃炎组(胃炎组)71例,消化性溃疡组(溃疡组)105例,胃癌组66例.用免疫放射法(IRMA)测定患者血清PGⅠ及PGⅡ,并计算PGⅠ/PGⅡ的比值(PGR).结果 对照组PG Ⅰ、PG Ⅱ和PGR分别为(149.26±62.45)/μg/L、(15.66±8.97)μg/L和10.62±3.30,慢性萎缩性胃炎组PG Ⅰ[(119.32±41.87)μg/L]、PGR(7.19±3.02)较对照组降低(P＜0.05),胃癌组PG Ⅰ[(95.39±22.80)μg/L]、PGR(5.86±3.87)较对照组明显降低(P＜0.01);溃疡组PG Ⅰ[(175.29±33.69)μg/L]、PGⅡ[(21.81±8.91)μg/L]较对照组升高(P＜0.05).结论 血清PGⅠ、PGⅡ含量的变化及PGR对癌前状态和早期胃癌的诊断具有重要的临床意义,当血清PGⅠ及PGR严重降低时,应尽早进行胃镜检查,以明确诊断.     

血清胃蛋白酶原诊断胃癌的临床价值

目的 探讨血清胃蛋白酶原（PG）诊断胃癌的临床价值.方法 选择非萎缩性胃炎患者36例（非萎缩性胃炎组）、胃溃疡患者39例（胃溃疡组）、萎缩性胃炎患者31例（萎缩性胃炎组）及胃癌患者42例（胃癌组）,采用胶乳增强免疫比浊法检测其血清PG Ⅰ、PGⅡ水平,计算PG Ⅰ/PGⅡ（PGR）.结果 非萎缩性胃炎组、胃溃疡组、萎缩性胃炎组及胃癌组的血清PG Ⅰ水平及PGR值逐渐降低,以胃癌组降低最明显,显著低于其他三组（P均＜0.01）;胃溃疡组血清PGⅡ水平显著高于其他三组（P均＜0.01）,其他三组血清PGⅡ水平比较差异无统计学意义（P均＞0.05）.以PG Ⅰ＜70 μg/L＋ PGR＜ 3.0为判断界值,其诊断胃癌的敏感性为78.6％、特异性为85.8％.结论 血清PG Ⅰ水平及PGR明显降低可作为胃癌及癌前病变的一项血清学诊断指标.     

糖类抗原19-9联合癌胚抗原检测诊断老年胃癌的价值

目的探讨糖类抗原(CA)19-9联合癌胚抗原(CEA)检测老年胃癌的诊断价值。方法老年胃癌患者72例作为病例组,同时随机选取非胃癌患者72例作为对照组,应用电化学发光免疫分析法分析两组CA19-9及CEA水平,分别计算CA19-9、CEA单独及联合诊断胃癌的敏感性、特异性及准确性。结果胃癌组CA19-9及CEA的平均水平分别为(92.35±36.71)U/L、(17.15±7.14)μg/L,显著高于对照组〔(36.65±18.26)U/L及(3.58±2.64)μg/L〕(P0.05)。随着胃癌临床分期的加重、肿瘤分化级别的减低,CA19-9、CEA的水平进行性升高(P0.05)。CA19-9单独检测胃癌的灵敏度、特异度分别为45.8%、93.1%,而CEA单独检测的灵敏度、特异度分别为50.0%、90.3%,二者联合检测时为84.7%、86.1%,准确性为85.4%。结论血清CEA、CA199联合检测有助于提高胃癌诊断的敏感性及准确性,对胃癌的早期诊断有重要价值。     

胃病患者血清胃液胃液素、胃动素和亮-脑啡肽的变化

目的 研究胃病患者血清胃液胃液素、胃动素和亮-脑啡肽的变化及临床意义。 方法 用放射免疫法测定胃病患者(胃癌25例、胃溃疡18例和萎缩性胃炎24例)血清胃液中胃液素、胃动素和亮-脑啡肽的含量。 结果 与正常对照和胃良性疾病比较,胃癌患者血清胃液胃液素、胃动素显著升高(P<0.01),血清亮-脑啡肽含量也升高(P<0.05)。 结论 胃癌患者血清胃液胃液素、胃动素和血清亮-脑啡肽可明显升高,对胃癌诊断有一定参考价值。     

胃十二指肠疾病与血浆激素关系的初步研究

对64例胃十二指肠疾病患者(包括慢性残表性胃炎23例,萎缩性胃炎5例,胃溃疡10例,十二指肠溃疡14例及胃癌12例)的血浆生长抑索(SS)、血管活性肠肽(VIP)、胃动素(MTL)及血清胃泌素(Gas)的研究表明,血浆SS水平在胃十二指肠溃疡组及胃癌组均低于正常对照组(P<0.001);血浆VIP浓度在胃溃疡时升高最明显,与正常组及各疾病组比较均有显著性差异(P<0.01);十二指肠溃疡及胃癌组的血浆MTL含量均高于正常对照组(P<0.05);血清Gas水平在浅表性胃炎和萎缩性胃炎时均高于正常对照组(P<0.01).     

血清CA125,CA19-9,CA50含量对消化系肿瘤的诊断价值

目的评价血清CA125,CA19-9,CA50含量对消化系肿瘤的诊断价值.方法消化系肿瘤患者158例,其中肝癌38例,食管癌21例,胃癌56例,结直肠癌36例,胰腺癌7例;消化系良性疾病患者106例,其中肝硬变57例,消化性溃疡49例;正常对照者40例.全部受测对象均空腹抽静脉血,分离血清,-20℃贮存备测.采用RIA法测定血清CA125,CA19-9,CA50含量,使用国产SN-695型γ计数仪.数据均用()±s表示,以正常()±2s作为上限计算阳性率.结果肝癌、胃癌、胰腺癌、结直肠癌和食管癌血清(CA含量均以kU/L表达)CA125(分别为222±116,79±17,135±79,69±23和72±26),CA19-9(237±108,281±132,838±224,252±136和273±146)和CA50含量(25±9,20±7,18±9,18±8和17±7)显著高于正常对照组及消化道良性病变组(P＜0.01).消化道肿瘤有腹腔及远处转移者,其血清CA125,CA19-9,CA50含量升高更为明显.结论血清CA125,CA19-9,CA50均为较好的肿瘤标记物,有助于诊断消化系统肿瘤.     

脑卒中高危人群氧化应激指标与颈动脉粥样硬化危险因素分析

目的调查贵州省福泉县脑卒中高危人群氧化应激指标与颈动脉粥样硬化(CAS)关系,分析CAS相关危险因素。方法采用随机整群抽样法对福泉县6个镇、4个乡常住居民9500例进行健康问卷调查、体格检查、实验室检查、心电图检查及颈动脉彩色超声检查。共筛选出脑卒中高危人群1032例,随机选取高危人群360例,再根据颈部血管彩色超声筛查结果分为颈动脉正常组78例、颈动脉内膜中层厚度(IMT)增厚组131例及CAS组151例,检测氧化应激指标氧化型低密度脂蛋白(ox-LDL)及超氧化物歧化酶(SOD)变化,采用单因素和多因素logistic回归分析CAS的危险因素。结果 CAS组ox-LDL明显高于颈动脉正常组和IMT增厚组[(564.7±70.6)μg/L vs(434.5±46.3)μg/L,(488.1±51.2)μg/L,P<0.05],SOD明显低于颈动脉正常组和IMT增厚组[(41.0±18.1)kU/L vs(67.4±9.5)kU/L,(58.6±10.3)kU/L,P<0.05]。logistic回归分析显示,年龄、吸烟、高血压、脑卒中史或家族史、空腹血糖、LDL-C、ox-LDL升高是导致CAS的独立危险因素。结论加强脑卒中高危人群管理,积极指导控制各项危险因素,调控患者氧化应激反应,可延缓CAS,降低脑卒中发生。     

Substance P,vasoactive intestinal peptide,and leu-enkephalin in plasma and gastric juice of patients with precancerous lesions and gastric cancer

AIM: To investigate the changes of the brain-gut-peptide concentrations in the plasma and gastric juice and their relations to gastric diseases. METHODS: A total of 83 subjects were part of the study. Of those, 28 had chronic atrophic gastritis with precancerous lesions, 22 had gastric cancer in an advanced stage, and 33 were healthy subjects for a control group. Samples of fasting blood and gastric juice were collected. Levels of substance P (SP), vasoactive intestinal peptide (VIP) and leu-enkephalin (LEK) in plasma and gastric juice were measured with radioimmunoassay kits expressed as ng/L. RESULTS: In patients with gastric cancer, the SP levels (83.7 ± 11.0 vs 39.6 ± 4.5, P < 0.01; 24.0 ± 1.6 vs 17.8 ± 1.5, P < 0.05) and LEK in plasma and gastric juice (226.2 ± 15.4 vs 180.3 ± 13.1, P < 0.01; 55.0 ± 3.4 vs 30.7 ± 2.4, P < 0.05), and VIP of gastric juice (80.5 ± 2.9 vs 64.3 ± 4.1, P < 0.05) were higher than those in the controls. The SP and LEK levels of plasma correlated with those of gastric juice (r = 0.432 and 0.516, P < 0.05). In the post-surgical gastric cancer, plasma levels of SP and gastric juice LEK were lower than the pre-surgical levels (P < 0.05). In the precancerous lesions, plasma and gastric juice LEK levels and gastric juice VIP levels were increased (P < 0.05), and the plasma LEK level correlated with the gastric juice LEK level (r = 0.398, P < 0.05). CONCLUSION: Measurement of concentrations of SP, VIP, and LEK in plasma and gastric juice is of clinical significance in detecting certain stomach diseases.     

Antifibrotic effects of ambrisentan,an endothelin-A receptor antagonist,in a non-alcoholic steatohepatitis mouse model

AIM: To examine the effects of the endothelin type A receptor antagonist ambrisentan on hepatic steatosis and fibrosis in a steatohepatitis mouse model.METHODS: Fatty liver shionogi(FLS) FLS-ob/ob mice(male, 12 wk old) received ambrisentan(2.5 mg/kg orally per day; n = 8) or water as a control(n = 5) for 4 wk. Factors were compared between the two groups, including steatosis, fibrosis, inflammation, and endothelin-related gene expression in the liver.RESULTS: In the ambrisentan group, hepatic hydroxyproline content was significantly lower than in the control group(18.0 μg/g ± 6.1 μg/g vs 33.9 μg/g ± 13.5 μg/g liver, respectively, P = 0.014). Hepatic fibrosis estimated by Sirius red staining and areas positive for α-smooth muscle actin, indicative of activated hepatic stellate cells, were also significantly lower in the ambrisentan group(0.46% ± 0.18% vs 1.11% ± 0.28%, respectively, P = 0.0003; and 0.12% ± 0.08% vs 0.25% ± 0.11%, respectively, P = 0.047). Moreover, hepatic RNA expression levels of procollagen-1 and tissue inhibitor of metalloproteinase-1(TIMP-1) were significantly lower by 60% and 45%, respectively, in the ambrisentan group. Inflammation, steatosis, and endothelin-related m RNA expression in the liver were not significantly different between the groups.CONCLUSION: Ambrisentan attenuated the progression of hepatic fibrosis by inhibiting hepatic stellate cell activation and reducing procollagen-1 and TIMP-1 gene expression. Ambrisentan did not affect inflammation or steatosis.     

Effects of electro-needling at Zusanli on stress gastric ulcer in rats: Changes in nitric oxide and catecholamine

AIM: To investigate the effects of electro-needling at Zusanli (ST36) on changes of nitric oxide (NO), dopamine (DA) and norepinephrine (NE) in rats with stress gastric ulcer. METHODS: By biochemical methods the changes in contents of NO, DA and NE in gastric antral mucosa, corporal ventriculi mucosa and in blood after electro-needling (EN) were analysed. For observation all animals were randomly divided into four groups: stress group, EP after stress group, stress after EP group and control group. RESULTS: NO content in serum of stress gastric ulcer rats (5.78 ± 1.49 μmol/L) was significantly decreased, as compared with the control group (13.30 ± 2.75 μmol/L; P < 0.01). DA content in gastric antral mucosa was markedly decreased (3.31 ± 0.67 ng/mg vs 6.78 ± 4.65 ng/mg, P < 0.05). DA in corporal ventriculi mucosa showed a tendency to increase. EN at Zusanli made NO level recover in stress gastric ulcer rats (7.91 ± 1.11 μmol/L), as compared with the stress group (P < 0.01). EN regulated DA and NE contents in antrum and corpora ventriculi mucosa bi-directionally, i.e., the contents were decreased when they formerly rose, and increased when formerly fell, respectively, as compared with the stress group (P < 0.01). CONCLUSION: EN has a protective effect on the gastric mucosa. EN bi-directionally regulates DA and NE, and the vascular relaxation partially brought about by NO regulates the gastric mucosal blood flow, and strengthens the defensive function of the gastric mucosa.     

Comparison of Pentax HiLine and Olympus Lucera systems at screening colonoscopy

AIM:To compare the performance characteristics of Pentax HiLine(PHL)(with i-scan) and Olympus Lucera(OL) systems in a screening population.METHODS:Screening colonoscopies in asymptomatic guaiac faecal occult blood test-positive patients with PHL(n = 58) and OL(n = 425) colonoscopes were analysed.All procedures were performed by a single colonoscopist.PHL used white-light endoscopy(WLE) on scope insertion and contrast/surface enhancement(i-scan 1) on withdrawal,and OL utilised WLE both on insertion and withdrawal.Patient age,sex,instrument insertion and withdrawal times,nurse assessed patient comfort scores,midazolam and fentanyl doses,procedure completion and rates of lesion detection were recorded separately for each group.Comparisons between the groups were made using either Fisher’s exact test(for dichotomous variables) or Mann-Whitney U test(for ordinal and continuous variables).RESULTS:Colonoscopy completion rates were similar in both groups:413/425(97.2%) for OL and 55/58(94.9%) for PHL(P = 0.24).For complete colonoscopies,the two groups were well matched for age,sex,colonoscope insertion times(mean 11.1 min in OL vs 11.6 min in PHL,P = 0.93) and normal colonoscopy withdrawal times(mean 15.6 min in OL vs 14.7 min in PHL,P = 0.2).Patients in the PHL group experienced a small increase in discomfort(mean patient comfort scores were 0.49 in the OL and 0.95 in the PHL group,P < 0.0001).While Fentanyl doses required were similar between groups(mean 57.5 μg in OL vs 61.4 μg in PHL,P = 0.13),slightly more Midazolam was required in the PHL group(mean 2.1 mg in OL vs 2.4 mg in PHL,P = 0.035).There was no difference in polyp(58% in OL vs 67% in PHL) or adenoma(49% in OL vs 56% in PHL) detection rates between the groups.Neither the total number of polyps and adenomas,nor the characteristics of these(including size,location or presence of advanced features) were different between the two systems.CONCLUSION:This study suggests that there is no advantage of either colonoscope system in lesion detection.     

Low-dose amitriptyline combined with proton pump inhibitor for functional chest pain

AIM:To investigate the efficacy of amitriptyline with proton pump inhibitor(PPI)for the treatment of functional chest pain(FCP).METHODS:This was a randomized,open-label trial investigating the addition of low dose amitriptyline(10 mg at bedtime)to a conventional dose of rabeprazole(20 mg/d)(group A,n = 20)vs a double-dose of rabeprazole(20 mg twice daily)(group B,n = 20)for patients with FCP whose symptoms were refractory to PPI.The primary efficacy endpoints were assessed by global symptom score assessment and the total number of individuals with > 50% improvement in their symptom score.RESULTS:The between-group difference in global symptom scores was statistically significant during the last week of treatment(overall mean difference;3.75 ± 0.31 vs 4.35 ± 0.29,the between-group difference;P < 0.001).Furthermore,70.6% of patients in group A had their symptoms improve by > 50%,whereas only 26.3% of patients in group B had a similar treatment response(70.6% vs 26.3%,P = 0.008).Specifically,patients in group A had a significantly greater improvement in the domains of body pain and general health perception than did patients in group B(52.37 ± 17.00 vs 41.32 ± 12.34,P = 0.031 and 47.95 ± 18.58 vs 31.84 ± 16.84,P = 0.01,respectively).CONCLUSION:Adding amitriptyline to a PPI was more effective than a double-dose of PPI in patients with FCP refractory to a conventional dose of PPI.     

Gardenia jasminoides attenuates hepatocellular injury and fibrosis in bile duct-ligated rats and human hepatic stellate cells

AIM:To investigate the anti-hepatofibrotic effects of Gardenia jasminoides in liver fibrosis.METHODS:Male Sprague-Dawley rats underwent common bile duct ligation(BDL) for 14 d and were treated with Gardenia jasminoides by gavage.The ef-fects of Gardenia jasminoides on liver fibrosis and the detailed molecular mechanisms were also assessed in human hepatic stellate cells(LX-2) in vitro.RESULTS:Treatment with Gardenia jasminoides decreased serum alanine aminotransferase(BDL vs BDL + 100 mg/kg Gardenia jasminoides,146.6 ± 15 U/L vs 77 ± 6.5 U/L,P = 0.0007) and aspartate aminotransferase(BDL vs BDL + 100 mg/kg Gardenia jasminoides,188 ± 35.2 U/L vs 128 ± 19 U/L,P = 0.005) as well as hydroxyproline(BDL vs BDL + 100 mg/kg Gardenia jasminoides,438 ± 40.2 μg/g vs 228 ± 10.3 μg/g liver tissue,P = 0.004) after BDL.Furthermore,Gardenia jasminoides significantly reduced liver mRNA and/or protein expression of transforming growth factor β1(TGF-β1),collagen type?Ⅰ?(Col?Ⅰ) and α-smooth muscle actin(α-SMA).Gardenia jasminoides significantly suppressed the upregulation of TGF-β1,Col?Ⅰand α-SMA in LX-2 exposed to recombinant TGF-β1.Moreover,Gardenia jasminoides inhibited TGF-β1-induced Smad2 phosphorylation in LX-2 cells.CONCLUSION:Gardenia jasminoides exerts antifibrotic effects in the liver fibrosis and may represent a novel antifibrotic agent.     

上海市900例老年住院结核病患者营养状况调查分析

目的 分析上海市老年结核病住院患者营养状况及其风险因素,为早期营养干预老年结核病住院患者提供依据。方法 连续性收集2018年8月1日至2019年8月1日同济大学附属上海市肺科医院结核病区住院超过24 h且确诊为结核病的1100例≥65岁老年患者,剔除无体质量记录、严重糖尿病、严重高血压、肝肾功能不全,以及神志不清者,最终纳入900例。对纳入患者的临床相关资料[包括患者性别、年龄、临床诊断、并发症、治疗次数、出入院日期、营养风险筛查量表(NRS 2002)分值]及营养相关指标[血红蛋白(Hb)、血清总蛋白(TP)、血清白蛋白(ALB)、血清前白蛋白(PAB)、视黄醇结合蛋白(RBP)、预后营养指数(PNI)、中性粒细胞/淋巴细胞比值(NLR)等因素]进行统计,分析影响老年结核病患者营养风险发生的危险因素。900例老年结核病患者中,443例(49.22%)NRS 2002≥3分者纳入有营养风险组,457例(50.78%)NRS 2002<3分者纳入无营养风险组。结果 因素分析显示,有营养风险组患者在75~和80~90岁组[18.28%(81/443)和18.51%(82/443)]、BMI<18.5[40.41%(179/443)]、治疗2次及以上[25.51%(113/443)]、结核性胸膜炎[21.67%(96/443)]方面的分布均明显高于无营养风险组[分别为9.19%(42/457)和8.75%(40/457)、0.00%(0/457)、17.51%(80/457)、13.13%(60/457)](χ²=51.350,299.500, 8.818, 16.280;P=0.000,0.000,0.012,0.000)。营养相关临床指标检测结果显示,有营养风险组患者的TP[(64.88±0.34)g/L]、ALB[(34.15±0.23)g/L]、PAB[(138.60±3.26)g/L]、Hb[(113.60±0.84)g/L]、RBP[(26.32±0.50)g/L]、PNI[(39.61±0.35)]均低于无营养风险组患者[分别为(67.30±0.28)g/L、(38.18±0.16)g/L、(194.10±3.22)g/L、(126.70±0.79)g/L、(34.32±0.22)g/L、(45.51±0.26)][F=19.496, 79.334, 34.030, 22.808,21.326, 72.464;P值均=0.000];而NLR(5.44±0.32)和住院时间[(6.61±0.17)d]明显高于无营养风险组患者[分别为(3.29±0.14),(5.53±0.13)d][F=6.335, P=0.012;F=5.994,P=0.015]。结论 老年结核病患者营养风险发生率较高,且与年龄、治疗次数呈正相关、与BMI呈负相关,并表现为有营养风险组患者的TP、ALB、PAB、Hb、RBP、PNI均明显低于无营养风险组患者,严重影响临床治疗效果、延长住院时间。     

Desferrioxamine in warm reperfusion media decreases liver injury aggravated by cold storage

AIM:To evaluate whether desferrioxamine decreases ischemia and perfusion injury aggravated by cold storage(CS)in a rat liver perfusion model. METHODS:Isolated rat livers were kept in CS in University of Wisconsin Solution for 20 h at 4℃,then exposed to 25 min of warm ischemia(WI)at 37℃ followed by 2 h of warm perfusion(WP)at 37℃with oxygenated(95%oxygen and 5%carbon dioxide) Krebs-Henseleit buffer.Desferrioxamine(DFO),an iron chelator,was added at different stages of storage,ischemia and perfusion:in CS only,in WI only,in WP only, in WI and perfusion,or in all stages.Effluent samples were collected after CS and after WI.Perfusate samples and bile were collected every 30 min(0,0.5,1,1.5 and 2 h)during liver perfusion.Cellular injury was assessed by the determination of lactate dehydrogenase(LDH) and aspartate aminotransferase(AST)in the effluent and perfusate samples.Total iron was analysed in the perfusate samples.After WP,the liver was collected for the determination of liver swelling(wet to dry ratio) and liver morphological examination(hematoxylin and eosin staining). RESULTS:Increased CS time caused increased liver dysfunction during WP.After 2 h of WP,liver injury was indicated by increased release of AST(0.5 h CS:9.4± 2.2 U/g liver vs 20 h CS:45.9±10.8 U/g liver,P<0.05) and LDH(0.5 h CS:59±14 U/g liver vs 20 h CS:297 ±71 U/g liver,P<0.05).There was an associated increase in iron release into the perfusate(0.5 h CS:0.11 ±0.03μmoL/g liver vs 20 h CS:0.58±0.10μmoL/g liver,P<0.05)and reduction in bile flow(0.5 h CS: 194±12μL/g vs 20 h CS:71±8μL/g liver,P<0.05). When DFO was added during WI and WP following 20 h of CS,release of iron into the perfusate was de- creased(DFO absent 0.58±0.10μmoL/g liver vs DFO present 0.31±0.06μmoL/g liver,P<0.05),and liver function substantially improved with decreased release of AST(DFO absent 45.9±10.8 U/g liver vs DFO present 8.1±0.9 U/g liver,P<0.05)and LDH(DFO absent 297±71 U/g liver vs DFO present 56±7 U/g liver,P<0.05),and inc     

Quantitative ultrastructure analysis of neuroendocrine cells of gastric mucosa in normal and pathological conditions

AIM: To study the quantitative ultrastructure of neuroendocrine cells of the gastric mucosa in normal and pathological conditions, including the duodenal ulcer (DU) and Zollinger-Ellison syndrome (ZES). METHODS: The neuroendocrine cells of the gastric mucosa of eight normal subjects, six patients with DU, and five patients with ZES were quantitatively investigated with by electron microscopy and ultrastructure image analysis. RESULTS: The volume density of neuroendocrine (NE) cells in the DU was 1.3% and 0.8% (vs 1.6% and 0.9%, P < 0.05) in gastric antrum and corpus, respectively. In the antrum, G cells were 65% (P < 0.05), D cells decreased in cell density (3% vs 9.5%) and in number per unit area (P < 0.01). In the corpus, the cell density of enterochromaffin-like (ECL) cells increased (49% vs 30%, P < 0.05); D cells and enterochromaffin (EC) cells decreased (2%, P < 0.01 and 4%, P < 0.05, respectively), and the number of D cells per unit area markedly decreased. In ZES, D cells in the corpus decreased in cell density (4% vs 22%, P < 0.01), and P cells also decreased (11% vs 24%, P < 0.05). The density of ECL cells increased (65% vs 30%, P < 0.01). CONCLUSION: In DU and ZES, both the number and type of NE cells presented some changes. Increased gastrin in DU and ZES patients may be caused by the decrease of D cells and somatostatin secretion.     

氨甲环酸静脉及局部应用在腰椎结核围手术期中的效果评价

目的: 探讨氨甲环酸静脉及局部应用在腰椎结核围手术期中的临床价值。 方法: 采用前瞻性研究的方法,搜集2019年1月至2022年1月青岛市胸科医院收治的腰椎结核患者92例,随机分为观察组(46例)和对照组(46例),观察组术前静脉滴注氨甲环酸0.5g(5ml),术后12h内给药1次,每次0.5g,术中每腔内喷洒氨甲环酸 0.5g(包括腰椎后路小切口、腰椎斜前方切口及髂骨取骨区切口)。对照组术前静脉滴注氨甲环酸0.5g,术后12h内静脉给药1次,每次0.5g。两组均进行腰椎斜前方入路病椎清除植髂骨融合手术,比较两组术中出血量、手术时间、术后24h引流量、术后72h引流量,术后3d红细胞比容,术后3d血红蛋白下降值,术后1周血D-二聚体(D-D)水平、凝血功能(凝血酶原时间、活化部分凝血活酶时间)等相关指标。 结果: 92例患者均顺利完成手术,术后经下肢静脉彩色超声检查,均无深静脉血栓形成。观察组手术时间[(149.0±23.8)min]、术中出血量[(344.0±120.0)ml]与对照组[分别为(145.0±26.3)min和(360.0±134.0)ml)]相比,差异均无统计学意义(t=0.765,P=0.443; t=0.603,P=0.402)。观察组术后24h引流量、术后72h引流量、术后3d血红蛋白下降值分别为(64.0±23.3)ml、(159.0±25.2)ml、(28.2±8.1)g/L,均低于对照组[分别为(77.0±33.1)ml、(174.0±27.2)ml、(32.5±9.6)g/L)],差异均有统计学意义(t=2.178,P=0.042;t=2.743,P=0.032;t=2.324,P=0.037)。观察组术后3d红细胞比容为(32.1±8.3)%,高于对照组[(28.2±10.2)%],差异有统计学意义(t=2.014,P=0.048)。观察组胃肠道反应发生率、术后3d凝血酶原时间、活化部分凝血酶原时间、术后1周血D-D水平分别为8.7%(4/46)、(13.1±3.2)s、(36.1±6.1)s、(0.9±0.2)mg/L,对照组分别为10.9%(5/46)、(12.6±2.9)s、(34.6±5.6)s、(0.9±0.3)mg/L,差异均无统计学意义(χ²=0.123,P=0.212;t=0.835,P=0.517;t=1.229,P=0.224;t=0.366,P=0.712)。 结论: 静脉及局部应用氨甲环酸能有效减少腰椎结核病灶清除植骨内固定手术的渗血量,明显减少术后的出血量,不增加术后血栓形成风险,可使患者达到快速康复的目的。