和胃胶囊对运动障碍样功能性消化不良患者胃排空的影响

目的：观察和胃胶囊对运动障碍样功能性消化不良（DFD）患者胃排空的影响。方法：随机选取DFD患者12例,设西药对照组和正常对照组,以核素法动态测定DFD患者和胃胶囊治疗前后近端胃、远端胃及全胃的排空情况,并计算近端胃、全胃的半排空时间（T1／2）。结果：DFD患者近端胃、远端胃及全胃的排空速度均较正常人明显减慢（P＜0．05－0．01）,近端胃、全胃T1／2比正常人延长（P＜0．05－0．01）;和胃胶囊治疗后,近端胃、全胃排空速度明显加快,全胃T1/2缩短,与治疗前比较差异有显著性意义（P＜0．05－0．01）,与正常人比较差异无显著性意义。结论：和胃胶囊能明显促进DFD患者的胃排空,是治疗DFD的有效药物。     

功能性消化不良腹胀与胃排空关系探讨

[目的]探讨功能性消化不良（FD）腹胀症状与胃液体排空的关系。[方法]对152例伴腹胀FD患者和56例不伴腹胀的FD患者，分别进行胃B超液体排空试验，通过测量胃窦（远端胃）和胃底体交界（近端胃）切面面积，计算胃液体排空率，从而判断液体排空情况。[结果]腹胀组152例，排空延迟130例，非腹胀组56例，排空延迟39例，2组比较差异有统计学意义（P＜0．01）；腹胀组130例胃排空延迟患者中，远端胃104例，近端胃116例，2者比较差异有统计学意义（P＜0．05）。[结论]FD患者腹胀症状与胃液体排空延迟有关；近端胃液体排空延迟较远端胃多见。     

符合罗马Ⅲ标准的功能性消化不良患者固体胃排空功能研究

背景：罗马Ⅲ标准对功能性消化不良（FD）的定义作了更新和修订，相应FD患者人群亦发生改变。目的：研究符合罗马Ⅲ标准的FD患者的固体胃排空功能，以及新的FD症状谱和分型与固体胃排空功能之间的关系。方法：对36例符合罗马Ⅲ标准的FD患者和32名健康志愿者行^99Tc固体胃排空试验。比较不同症状分型FD患者的固体胃排空功能，分析固体胃排空功能与罗马Ⅲ标准中FD症状的相关性。结果：10例（27．8％）FD患者固体胃半排空时间超过正常上限，9例（25．0％）2h残留率高于正常上限。餐后不适综合征（PDS）、上腹痛综合征（EPS）和PDS＋EPS型FD患者固体胃半排空时间分别为（150．3±40．2）min、（118．3±25．1）min和（150．5±51．2）min，三组间差异无统计学意义（P=0．126）。餐后饱胀不适症状与固体胃半排空时间和2h残留率均呈线性正相关．相关系数分别为11．5（P=0．043）和0．045（P=0．040）。结论：本组27．8％的FD患者存在固体胃排空延迟。PDS和PDS＋EPS型FD的固体胃半排空时间有长于EPS的趋势。FD患者的餐后饱胀不适症状与固体胃排空延迟有关，固体胃排空延迟是符合罗马Ⅲ标准的FD患者的病理生理机制之一。     

添加整蛋白型肠内营养粉剂对肝硬化患者营养状况及肝功能的影响

目的：探讨肠内营养对肝硬化患者营养状况及肝功能的影响。方法参照2006年欧洲肠内肠外营养学会（ESPEN）肝病肠内营养指南推荐,选取日总热量摄入低于推荐值的肝硬化患者57例,按患者意愿分成整蛋白型肠内营养粉剂支持治疗组30例,对照组（常规饮食组）27例。参照2006年 ESPEN 肝病肠内营养指南推荐给予营养支持治疗,治疗组给予添加整蛋白型肠内营养粉剂补充日热量摄入,对照组常规饮食。分别于24周和48周测定患者的上臂肌围（AMC）、检测总蛋白（TP）、白蛋白（Alb）、前白蛋白（PA）和总胆红素（TBil）;并观察随访期内两组肝硬化相关并发症的发生情况。组间比较采用独立样本 t 检验和χ2检验。结果入组前及第24周时,包括 AMC 在内的各项相关指标差异无统计学意义。第48周时,治疗组 AMC、TP、PA、Alb 均高于对照组,差异均有统计学意义 AMC 为（24．29±1．66比23．42±1．51,t＝2．05,P ＜0．05）、TP（62．76±2．26比60．25±2．61,t ＝3．87,P ＜0．05）、Alb（35．86±2．81比34．14±2．56,t＝2．41,P ＜0．05）、PA（109．72±16．71比101．62±15．92,t ＝2．09,P ＜0．05）,而48周时 TBil 在两组差异无统计学意义。随访期内治疗组肝性脑病和感染并发症发生较对照组显著减少（χ2＝4．780,P ＜0．05;χ2＝3．964,P ＜0．05）,而肝肾综合征和消化道出血两组比较差异无统计学意义。结论添加整蛋白型肠内营养粉剂能有效改善肝硬化患者营养状况及肝功能,减少部分肝硬化相关并发症的发生。     

不同温度试餐对健康人近端胃舒张功能的影响

目的探讨应用B超测定近端胃舒张功能的可行性,研究不同温度试餐对健康人近端胃舒张功能的影响.方法选择健康志愿者20名,采用实时B超测定每位受试者进食液体试餐后60分钟内的近端胃容积,并计算排空分数.每位受试者分别采用37℃试餐和4℃试餐,对试餐前后行上腹部症状及胃底气体对超声影像的干扰进行评分.结果在试餐后所有8个时间点4℃试餐时近端胃容积较37℃试餐时小（P＜0.01）.餐后20分钟和30分钟,4℃试餐时近端胃排空分数较37℃试餐大（P＜0.05）.4℃试餐后症状积分较37℃试餐后高（P＜0.05）.结论B超测定近端胃容积是一种可行的方法.低温刺激使健康人近端胃舒张功能下降而液体排空加快.     

慢性胃脘痛患者中医证型与核素胃排空功能关系的初步探讨

采用国际上先进的放射核素标记试餐法，测定45例典型中医分型的慢性胃脘痛患者的液体胃排空功能，并与18例正常对照组进行比较，旨在探讨慢性胃脘痛中医证型与胃排空功能紊乱的关系。结果显示脾胃虚弱组胃半排空时间较正常对照组明显缩短（P＜0．01），说明脾胃虚弱者液体胃排空加快；肝胃不和组和肝胃郁热组的胃排空时间较脾胃虚弱组明显延长（P＜0．01），而脾虚肝郁组不论与正常对照组或脾胃虚弱组比较均无显著差异（P＞0．05）。提示中医慢性胃脘痛虚、实证型的排空状态截然不同，并可能各自有着不同的病理生理基础。     

系统性硬化病患者的食物胃排空和胃内分布

为探讨无消化道症状的系统性硬化病（ＳＳ）患者的胃排空功能，以双核素标记试餐及单光子发射计算机断层摄影（ＳＰＥＣＴ）技术检测了１１例无消化道症状的ＳＳ患者之液体与固体食物的胃排空和胃内分布，对照组为１７例健康志愿者。结果：ＳＳ组液体和固体食物的近端胃排空和全胃排空均慢于对照组（Ｐ值＜０．０５）；液体和固体食物的近端胃半排空时间均与它们的全胃半排空时间之间存在正相关（Ｐ值分别＜０．０２和０．０１）。９例患者固体半排空时间延迟，其中８例伴液体排空障碍。在食物的排空过程中，远端胃内的活性变化与对照组的差异无显著性。结果提示：尽管缺乏胃轻瘫的主观症状，但该组患者也存在明显的胃排空障碍，这可能与其神经功能紊乱所致的近端胃的紧张性收缩障碍有关。     

远端收缩积分和无效食管动力与胃食管反流的关系

目的探讨食管高分辨率测压（HRM）下远端收缩积分（DCI）和无效食管动力（IEM）与GERD 患者反流情况的关系。方法共纳入69例 GERD 患者，均完成食管 HRM、24 h pH 联合阻抗监测检查。应用 Pearson 相关分析研究 DCI、无效吞咽次数和 DeMeester 评分的相关性。根据10次5 mL液体吞咽试验发生无效吞咽的次数分成3组，5～10次无效吞咽为 IEM 组（21例），1～4次无效吞咽为动力异常组（19例），0次无效吞咽为动力正常组（29例），采用 t 检验比较3组平均 DCI、残余的有效吞咽 DCI 平均值、DeMeester 评分、酸反流时间、食团暴露时间、近端反流次数的差异。结果69例 GERD患者中，其10次5 mL 液体吞咽平均 DCI 和 DeMeester 评分呈负相关（r＝－0．363，P ＝0．003），无效吞咽次数和 DeMeester 评分呈正相关（r＝0．374，P ＝0．002）。动力正常组、动力异常组和 IEM 组10次5 mL液体吞咽平均 DCI 分别为（1458．96±545．10）、（986．48±577．50）和（288．50±167．25）mmHg·s·cm， IEM 组低于动力正常组和动力异常组（t＝－11．42、－2．12，P 均＜0．05）。动力正常组、动力异常组和IEM 组残余的有效吞咽 DCI 平均值分别为（1458．96±545．10）、（1187．90±669．40）和（450．78±350．73）mmHg·s·cm，IEM 组低于动力正常组和动力异常组（t＝－8．05、－5．27，P 均＜0．01）。IEM组的 DeMeester 评分为（15．42±8．79）分，高于动力正常组的（6．34±3．45）分，差异有统计学意义（t ＝2．43，P ＜0．05）。IEM 组的酸反流时间、食团暴露时间分别为（54．93±37．07）min、（0．64±0．49）％，分别长于动力异常组的（37．37±22．66）min、（0．52±0．24）％，动力正常组的（21．22±13．98）min、（0．39±0．14）％，差异均有统计学意义（t＝2．36、2．17，2．60、2．54，P 均＜0．05）。IEM 组和动力异常组的总反流次数分别为（67．10±32．94）、（57．26±38．90）次，均多于动力正常组的（44．61±23．84）次，差异均有统计学意义（t＝2．48、2．17，P 均＜0．05）。结论DCI 和无效吞咽次数在一定程度上可预测GERD 患者发生反流的情况，IEM 组食管体部收缩力度最弱，食管对反流物的廓清能力最差。     

消化性溃疡患者的胃排空功能与胃肠激素变化

目的：研究消化性溃疡患者治疗前后的胃排空功能与血浆基础胃肠激素水平变化。方法：以15例健康志愿者为正常对照组,应用公认的“金标准”放射性核素法观察经内镜检查证实的15例活动期十二指肠溃疡和10例活动期胃溃疡患者治疗前后的胃排空功能,并深入分析其全胃、近端胃和远端胃排空情况;同时应用放射免疫法检测对照者和患者治疗前后的血浆基础胃泌素（GAS）、胃动素（MOT）、胰高血糖素（Glu)、血管活性肠肽（VP）和降钙素基因相关肽（CGRP）水平。结果：治疗前后,十二指肠溃疡和胃溃疡患者在进食45min后均存在胃排空延迟（P＜0．05）,近端胃排空始终与学对照者无显著差异,远端胃排空分别在进食30min和20min后显著延迟（P＜0．05）。消化性溃疡患者治疗前后的血浆GAS、Glu和VIP水平与正常对照者无显著差异;MOT水平在治疗前显著增高（P＜0．05）,治疗后恢复正常;CGRP水平在治疗前后均显著减低（P＜0．05）。结论：消化性溃疡患者存在远端胃排空障碍,可能参与了溃疡的发生机制,而与血浆GAS、MOT、Glu、VIP和CGRP水平无关。治疗前MOT水平增高可能系反馈性升高;CGRP水平减低可能是溃疡发生的又一致病因素。     

莫沙必利分散片治疗餐后不适综合征的近期疗效观察

背景：餐后不适综合征（PDS）是临床常见的功能性胃肠病,胃肠动力障碍为其重要病理生理机制之一。莫沙必利是一种胃肠促动力药．已用于胃肠动力障碍的治疗。目的：观察莫沙必利分散片治疗PDS的近期疗效。方法：60例符合罗马mPDS诊断标准的患者随机分成M组（接受铝碳酸镁1000mg加莫沙必利分散片5mg tid治疗）和P组（接受铝碳酸镁1000mg加安慰剂tid治疗）。疗程均为2周。于治疗前后行患者总体PDS症状评分并检测胃排空功能。结果：两组治疗后总体PDS症状评分较治疗前均显著降低（P〈0．001）,其中M组评分又显著低于P组（P〈0．01）。M组治疗有效率为83．3％,显著高于P组（40．0％）（P〈0．001）。两组治疗前胃3h排空钡条数无明显差异,均显著少于正常对照组（P〈0．001）。M组治疗后胃排空钡条数较治疗前和P组治疗后显著增多（P〈0．001）,P组治疗后与治疗前相比则无明显差异。结论：莫沙必利分散片能明显改善PDS患者的胃排空功能,对缓解餐后饱胀和早饱症状近期疗效满意。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.