糖尿病并发消化性溃疡的临床特点

目的回顾性分析糖尿病并发消化性溃疡的临床特点.方法收集我院按WHO标准确诊的2型糖尿病72例,男48例,女24例,年龄34岁～75岁,平均年龄52.8岁,糖尿病病程5mo～13a,空腹血糖(FBS)8.1mmol/L～30.2mmol/L,对照组为同期随机选择的100例非糖尿病病例中检出的消化性溃疡患者,男67例,女33例,年龄28岁～75岁,平均年龄48.5岁.所有溃疡病例,均经内镜检查证实.笔者对72例糖尿病并发消化性溃疡的发病率及临床特点进行了分析.结果本文在统计学上均采用卡方检验.糖尿病组合并消化性溃疡21例(29.2%),而对照组为23例(23%),两组比较,无显著差异(P>0.05).糖尿病溃疡组十二指肠溃疡6例(28.6%)、胃溃疡11例(52.4%)、复合性溃疡4例(19.0%),对照组十二指肠溃疡13例(56.6%)、胃溃疡8例(34.8%)、复合性溃疡2例(8.7%),二组相比,糖尿病组十二指肠溃疡明显少于对照组(P>0.05),而糖尿病并发胃溃疡及复合性溃疡明显高于对照组(P>0.05).幽门螺杆菌感染,糖尿病溃疡组15例(71.4%),对照组17例(73.9%),二组无显著差异(P>0.05).糖尿病组无症状溃疡13例(61.9%),而对照组仅5例(21.7%),二组对比,糖尿病组无症状溃疡明显多于对照组(P<0.05).21例糖尿病合并消化性溃疡患者FBS≤11.2mmol/L者12例(57.1%),而FBS>11.2mmol/L者9例(42.9%),二组相比,无显著差异(P>0.05).糖尿病病程≤5a者40例,其中消化性溃疡11例(27.5%),而糖尿病病程>5a者32例,其中消化性溃疡10例(31.3%),二组比较,无显著差异(P>0.05).结论糖尿病合并消化性溃疡有以下特点一是十二指肠溃疡发病率低,胃溃疡发病率相对较高;二是无症状溃疡较多.     

幽门螺杆菌相关性消化性溃疡的细胞凋亡研究

目的：探讨幽门螺杆菌（Helicobacter pylori,HP)诱导胃上皮细胞凋亡的机制及细胞凋亡在HP相关性消化性溃疡（PU）中的作用。方法：内镜下胃粘膜活检取材,应用TUNEL法检测胃上皮细胞凋亡,免疫组化法检测凋亡调控蛋白bak、bcl-2的表达。结果：HP阳性胃溃疡（GU）和十二指肠（DU）患者细胞凋亡指数（AI）明显高于HP阴性非溃疡性消化不良（NUD）患者（P＜0．01）。根除HP后,AI在DU明显下降（P＜0．01）,在GU无明显改变（P＞0．05）。HP阳性DU溃疡活动期AI明显高于愈合期和瘢痕期（P＜0．05）,而HP阳性和GU溃疡三期AI无差异（P＞0．05）。bak蛋白表达在HP阳性PU明显高于HP阴性NUD患者（P＜0．05）。根除HP后,DU患者bak蛋白表达明显降低（P＜0．05）。GU患者虽有下降,但无统计学差异。bcl-2蛋白表达在HP阳性PU与HP阴性NUD之间无显著差异,HP根除前后亦无明显改变。结论：HP诱导胃上皮细胞凋亡在十二指肠溃疡发病中起重要的作用,HP诱导胃上皮细胞凋亡可能是通过bak路径实现的。     

消化性溃疡的中西医结合诊治方案

胃或十二指肠黏膜的局限性组织缺损，表浅者为糜烂深达肌层者为溃疡。组织缺损系由胃酸、胃蛋白酶自我消化所致，故称消化性溃疡。近年发现其发病与幽门螺杆菌（H.pylori）感染关系密切，故对H.pylori（＋）者又称H．pylori相关性溃疡。     

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.     

消化性溃疡的动态(下)

本文上部分主要综述了消化性溃疡的病因，下部分主要综述其治疗。内科治疗方法主要有抑制胃酸分泌、抗幽门螺杆菌，防治非类固醇类抗炎药相关溃疡，应用生长因子治疗等。对有症状而用任何药物治疗无效者或并发有生命危险的大出血者，需行外科手术治疗。     

消化性溃疡的动态(上)

本文综述消化性溃疡的病因和内科治疗现状，幽门螺杆菌、非类固醇类抗炎药、精神因素、易感因素等引致炎症和胃酸分泌过多是主要病因。     

幽门螺杆菌相关性消化性溃疡与胃肠激素的关系

幽门螺杆菌(HP)感染、胃酸分泌增加、非淄体消炎药的使用及胃、十二指肠功能减退是引起溃疡病的重要诱因。机体内多种胃肠肽类激素参与调节胃酸分泌及胃肠黏膜保护因子的水平,幽门螺杆菌感染影响某些胃肠肽类激素的释放。我们通过对根除幽门螺杆菌前后胃、十二指肠溃疡患者黏膜     

舒威、阿莫西林、痢特灵治疗幽门螺杆菌阳性消化性溃疡的疗效

目的 探索幽门螺杆菌（Hp）阳性感染的理想治疗方案。方法 随机将84例幽门螺杆菌阳性十二指肠溃疡病人分为治疗组和对照组，即舒威（枸橼酸铋雷尼替丁）、阿莫西林、痢特灵三联组（n=42），丽珠胃三联组（n=42），进行为期7d的临床治疗观察，疗程结束后1个月复查。结果 舒威三联组与丽珠胃三联组溃疡治愈率分别85．72％和88．1％，Hp根除率分别为90．4％和92.8％，统计学差异无显著性（P〉0．05）。结论 舒威三联组疗效好、费用低，是消化性溃疡最经济的治疗方案。     

消化性溃疡治疗方案的临床选择

目的 探讨治疗消化性溃疡的有效治疗方案.方法 将176例患者随机分为两组,两组均口服甲硝唑片400mg,2次/d,果胶铋片100 mg,于早、中、晚饭前30 min,睡前(服用奥美拉唑前1h)各服1次.观察组在此基础上加服奥美拉唑20mg,2次/d.对照组加服雷尼替丁150mg,2次／d.两组均以14 d为1个疗程,治疗2个疗程后统计疗效.结果 治疗组治愈率为87.50％,总有效率为96.6％；对照组治愈率为57.95％,总有效率为71.59％.两组治愈率、总有效率相比有明显差异(P＜0.05).两组治疗后Hp转阴率相比有明显差异(P＜0.05).腹痛、烧心、反胃、反酸、嗳气等症状积分治疗前两组相比无明显差异(P＞0.05)；治疗前后比较有明显差异(P＜0.05).结论 以奥美拉唑、甲硝唑片、果胶铋片为主的治疗方案治疗消化性溃疡具有临床疗效显著,可较好的改善临床症状,值得临床推广应用.     

胃康宁治疗幽门螺杆菌相关性消化性溃疡临床研究

[目的]观察胃康宁治疗幽门螺杆菌（Hp）相关性消化性溃疡临床疗效，并从中医理论和临床方面进行初步探讨。[方法]将100例Hp相关性消化性溃疡患者随机分为治疗组和对照组，分别给予胃康宁和奥抗三联治疗，疗程4周，观察主要症状的改善、溃疡愈合率、Hp根除率及不良反应。[结果]在改善主要症状方面治疗组优于对照组（P〈0．05）；在溃疡愈合率、Hp根除率方面两组差异无统计学意义。治疗组不良反应率1．7％，对照组32．5％，两组差异有统计学意义。[结论]胃康宁治疗Hp相关性消化性溃疡有较好的疗效。     

Clinical and experimental research on weile jiaonang for peptic ulcer

AIM To observe the therapeutic effect of weile jiaonang (WLJN) for peptic ulcer (PU) and its toxicity toanimals, and to find out the nontoxic Chinese medicines in replacing those chemical medicines with sideeffect.METHODS Five hundred and forty patients with PU were divided into three groups, therapeutic group byWLJN, control group taking famotidine and combined group with WLJN and famotidine. One hundred andeighty patients in each group were studied. The diagnosis of 540 patients with PU is in accordance with thebasis provided by the National Scientific Congress of Digestive System Disease convened in Hangzhou, 1978.The study followed the criterion provided by this Congress.RESULTS Total effective rate in therapeutic group was 93.3%, and 93.3% in control group. Combinedgroup achieved a total effective rate of 100%. For all three groups, there was no significant differencestatistically, but the control group appeared obvious side effects. The result of acute toxic experiments onwhite mice showed that there no death and toxic side effect even the highest dosage was given, which wasequivalant to 120 times to the dosage of patients. The result of chronic toxic experiment showed there was noobvious pathologic change in three dosed groups. The tails of mice in dosed groups were more smooth delicateand cleaner than those in control group.CONCLUSION Through observation in clinic and exprimental animal, it is proved that weilejiaonang isparticularly effective and safe Chinese patent drug against PU.     

Endoscopic hemoclip treatment for bleeding peptic ulcer

AIM To evaluate the efficacy of endoscopic hemoclip in the treatment of bleeding peptic ulcer.METHODS Totally, 40 patients with F1a and F1b hemorrhagic activity of peptic ulcers were enrolled in this uncontrolled prospective study for endoscopic hemoclip treatment. We used a newly developed rotatable clip-device for the application of hemoclip (MD850) to stop bleeding. Endoscopy was repeated if there was any sign or suspicion of rebleeding, and reclipping was performed if necessary and feasible.RESULTS Initial hemostatic rate by clipping was 95%, and rebleeding rate was only 8%.Ultimate hemostatic rates were 87%, 96%, and 93% in the F1a and F1b subgroups, and total cases, respectively. In patients with shock on admission, hemoclipping achieved ultimate hemostasis of 71% and 83% in F1a and F1b subgroups, respectively. Hemostasis reached 100% in patients without shock regardless of hemorrhagic activity being F1a or F1b. The average number of clips used per case was 3.0 (range 2- 5). Spurting bleeders required more clips on average than did oozing bleeders (3.4 versus 2.8 ). We observed no obvious complications, no tissue injury, or impairment of ulcer healing related to hemoclipping.CONCLUSION Endoscopic hemoclip placement is an effective and safe method. With the improvement of the clip and application device,the procedure has become easier and much more efficient. Endoscopic hemoclipping deserves further study in the treatment of bleeding peptic ulcers.     

Esomeprazole for the treatment of peptic ulcer bleeding

Peptic ulcer bleeding is the most common cause of acute bleeding in the upper GI tract. The incidence of peptic ulcer bleeding has slowly decreased and endoscopic treatment options have improved; nevertheless, it remains a very common condition with a 7–15% mortality. Acidic environments have a negative effect on hemostasis. Therefore, acid inhibitors have been applied in the adjuvant treatment of peptic ulcer bleeding, both in preventing rebleeding and in treating the underlying cause. This requires profound acid suppressive therapy aiming for a rapid onset of effect and a persistent intragastric pH above 6. This can only be achieved by proton pump inhibitors (PPIs). Esomeprazole is the S-isomer of omeprazole, and the first PPI to consist of only the active isomer. A number of studies have compared esomeprazole with other PPIs, demonstrating a faster and more persistent increase in intragastric pH with the use of esomeprazole than with other agents. Continuous high-dose intravenous treatment with esomeprazole decreases rebleeding, surgery, transfusion rates and hospital days in peptic ulcer bleeding.     

消化性溃疡出血相关因素的分析

目的 探讨幽门螺旋杆菌及其他因素同消化性溃疡出血的相关性。方法 胃镜确诊的消化性溃疡92例,分为两组:单纯消化性溃疡组和出血组,系统收集临床资料,并进行如下检测:胃黏膜快速尿素酶检测、病理HE染色检查、13C呼气试验检测和血清Helicobacter pylori抗体和CagA抗体的检测。结果NSAIDs药物同出血相关,OR值为7.61(P<0.05)。出血组和非出血组之间H.pylori感染率分别为68.1％和60.6％,两组之间无显著性差异,但出血组血清CagA抗体阳性率高于非出血组(分别为61.2％和37.5％),OR值为2.63,范围为1.05～6.59,P<0.05。结论 服用NSAIDs药物和CagA抗体阳性与出血密切相关,出血组和非出血组之间H.pylori感染率无显著性差异。     

幽门螺杆菌阴性消化性溃疡与出血关系的多中心对照研究

目的明确中国大陆地区幽门螺杆菌（Hp）阴性消化性溃疡与出血的关系。方法拟定于2006年4月至2007年3月期间在国内14个研究中心中进行,每个中心预期调查30例经急诊内镜诊断为胃溃疡和（或）十二指肠溃疡合并出血的患者（PUB组）,同时调查30例不伴出血的胃溃疡和（或）十二指肠溃疡患者作为对照（PU组）。共拟人选840例患者,消化性溃疡合并及不合并出血组各420例。在内镜检查中采用快速尿素酶试验和病理检测却感染,并对初次检查却阴性者于1个月后进行尿素呼气试验复查。结果共617例患者纳入分析,其中PUB组263例、PU组354例,2组在性别比、平均年龄等一般状况方面差异无统计学意义（P均〉0．05）。PUB组却阳性率61．2％（161／263）显著低于PU组的87．9％（311／354）（P〈0．001）;PUB组跏阳性的溃疡出血发生复合溃疡的比例7．5％（12／161）显著高于Hp阴性溃疡出血者1．0％（1／102）（P=0．018）,但两者在平均发病年龄、性别比、呕血发生率、十二指肠球部溃疡发生率、胃溃疡发生率及溃疡平均直径方面差异无统计学意义（P均〉0．05）。对于初次tip阴性的溃疡出血患者,1个月后的呼气试验复查未发现阳性病例。结论目前中国大陆缉,阴性溃疡在消化性溃疡出血中的比例较高,坳阴性溃疡可能更容易并发消化道出血,需要引起消化专科医生的重视。     

Influence ofHelicobacter pylori on tryptase and cathepsin D in peptic ulcer

We here ascertain whether tryptase (a serine endoprotease released by mast cells) and cathepsin D (CD, a lysosomal hydrolase that seems able to derange the extracellular matrix) play a part in peptic ulcer disease and whether they are linked toHelicobacter pylori (Hp) infection. We studied 13 controls, 25 patients with gastric ulcer, 47 with duodenal ulcer, and 11 with duodenitis. Tryptase and CD were measured in mucosal biopsies (body and antrum of the stomach and duodenum) using IRMA methods. Hp infection was histologically evaluated (Giemsa). Tryptase and CD levels were higher (25%) in patients with active peptic ulcer, whether gastric or duodenal. In Hp-positive patients the CD mucosal content was higher while tryptase mucosal levels were lower than in Hp-negative patients. Tryptase was correlated with gastrin content. CD seems to be mainly related to the phlogistic reaction of the mucosa to Hp infection; tryptase may reflect an indirect link between Hp infection, gastrin release, and the function of mast cells.     

根除老年人消化性溃疡合并幽门螺旋杆菌感染的治疗策略

目的对质子泵抑制剂（PPI）或铋剂三联疗法作为初治方案以及序贯疗法或四联疗法作为补救方案根除老年人消化性溃疡（PUA）合并幽门螺旋杆菌（Hp）感染的疗效进行比较。方法2009年7月至2010年7月间261例胃镜下尿素酶法诊断的PUA合并Hp感染患者,随机采用PPI三联疗法、铋剂三联1周疗法进行根除,观察治疗过程中不良反应发生率。PUA患者经上述抗Hp治疗后继续4周抗溃疡治疗,停药1月后复查胃镜并比较两种方法对Hp根除率及溃疡愈合率的疗效差异。对于首次三联疗法根除Hp失败者,随机应用10日序贯疗法和PPI、铋剂四联1周疗法再次行Hp根除。观察疗程中不良反应发生率,停药1个月后采用”C呼气试验观察Hp根除率。统计分析采用符合方案（PP）群组分析和意向治疗（ITT）群组分析。结果相比于铋剂三联疗法,PPI三联疗法Hp根除率（ITT：77．7％vs62．6％;PP：79．5％v564．1％;P〈0．05）及溃疡愈合率（ITT：78．5％vs64．9％;PP：80．3％vs66．4％;P〈0．05）高,不良反应发生率无明显差异（1TT：10．8％vs16．8％：PP：11．0％vs17．2％;P〉0．05）。对于首次三联疗法失败者以10日序贯疗法补救,Hp根除率较高（ITT：84．6％vJ61．5％;PP：86．8％v563．2％;P〈0．05）,且不良反应发生率较四联疗法低（ITT：12．8％VS35．9％;PP：13．2％VS36．8％;P〈0．05）。结论PPI三联1周疗法进行Hp感染根除可作为PUA患者首选,有较高的溃疡愈合率和Hp根除率;首次根除失败者可优先改用10日序贯疗法进行补救。     

The therapeutic strategy for peptic ulcer disease

Abstract Therapy of acid/peptic disease has evolved since the 1970s with development of: (i) more accurate endoscopes which permit precise examination and documentation of upper gastrointestinal lesions; and (ii) the histamine H₂-receptor antagonists. As well, refined standards for clinical investigation have contributed to the clinical study of acid/peptic diseases. Initially, ulcer diseases were considered to be principally secondary to increased 'aggressive' factors (acid, pepsin) and the therapeutic focus was directed at antacids, the progressive evolution of additional histamine H₂-receptor antagonists and recently the H⁺/K⁺-ATPase inhibitors. Later studies indicated efficacy of sucralfate, low dose antacids and prostaglandin analogues, drugs with either no or only modest antisecretory effect. This led to studies on the role of gastroduodenal mucosal defensive factors (mucus and bicarbonate secretion, blood flow, leucocyte adherence, cytokines, reactive oxygen radicals). The prominent role played by aspirin and other non-steroidal anti-inflammatory drugs (NSAID) in initiating and causing recurrence of peptic ulcer disease has been increasingly realized. Recognition of those most at risk for NSAID-induced complication has led to newer approaches to treatment and prevention. Since 1983, Helicobacter pylori has been incriminated as a major factor in the pathogenesis of ulcer disease, particularly ulcer recurrences. Treatment of such ulcers now includes antibiotics and bismuth compounds in order to eradicate H. pylori. This therapeutic regimen is in a state of flux ('triple therapy' vs a H⁺/K⁺-ATPase inhibitor plus antibiotic) as is the question of how to work up and treat patients initially presenting with ulcer symptoms.     

Bleeding peptic ulcer: An evolving role for surgical intervention

Abstract Early surgical intervention was previously advocated in patients > 60 years with bleeding peptic ulcer presenting with haemodynamic instability or ongoing transfusion requirements. It is, however, well recognized that emergency surgical intervention with its inherent risks must be reserved for highly selected patients in whom endoscopy initially fails to control exsanquinating haemorrhage or in whom life-threatening bleeding recurs. Therapeutic endoscopy for bleeding ulcer has led to a remarkable decline in rebleeding rates, the need for emergency surgery and mortality. Octogenarians are at risk, particularly when ulcer size exceeds 2 cm. Poor surgical candidates make up two-thirds of patients with major ulcer bleeding and operation is to be avoided if at all possible. Medical therapy with proton pump inhibitor and subsequent eradication of Helicobacter pylori following endoscopic treatment has been shown to be beneficial to outcomes. Should surgery be deemed necessary, it is likely that laparoscopic techniques to control bleeding, with or without the addition of an acid-reducing procedure, will find a role in haemodynamically stable patients undergoing operation on an early elective basis.