幽门螺杆菌感染与胃窦炎症病理变化的关系

目的 明确幽门螺杆菌感染（H.pylori)与胃窦炎症病理变化的关系。方法 通过胃镜活检取得胃窦组织标本，在快速尿素酶试验阳性和甲苯胺蓝染色中等阳性的病人中筛检出128例患者，其中包括慢性浅表性胃炎（CG）患者68例，十二指肠球部溃疡（DU）患者30例，胃溃疡（GU）患者30例，对患者的血清进行免疫印迹试验，检测患者的细胞毒素相关蛋白A（CagA)、空泡毒素相关蛋白A（VacA)抗体的情况。结果 胃窦炎症积分在CG、DU、GU患者胃窦炎症均表现为活动性，但是没有明显差异；CagA在所有病例中具有普遍易感性。在GU中出现8例胃窦萎缩，其中4例表现为CagA和VacA均阳性。在DU中未见胃窦萎缩。结论 H pylori相关性胃病中胃窦炎症多表现为活动性，但是没有明显差异。CagA在所有病例中具有普遍易感性，胃窦萎缩多出现在GU患者中并与CagA和VacA均阳性相关。     

早期胃癌和进展期胃癌患者幽门螺杆菌感染与胃黏膜组织学特点的关系

背景幽门螺杆菌(H.pylori)感染已被确认为慢性胃炎的主要病因,由慢性非萎缩性胃炎、慢性萎缩性胃炎至肠化生,经过数十年最终可能导致胃癌发生。目的评价H.pylori感染与胃镜检查正常者、慢性胃炎、早期胃癌和进展期胃癌患者胃黏膜组织学特点的关系。方法在受检者胃窦大弯侧、胃体大弯侧和胃角处各取一块黏膜活检标本,以Giemsa染色和免疫组化染色检测H.pylori感染情况;以HE染色评价胃黏膜炎症、活动性、萎缩和肠化生情况。结果慢性胃炎、早期胃癌和进展期胃癌患者的总体H.pylori感染率均显著高于胃镜检查正常者(52.4%、52.4%和81.2%对44.9%,P<0.05),慢性胃炎与早期胃癌患者的感染率无显著差异,但均显著低于进展期胃癌患者(P<0.05)。胃镜检查正常和慢性胃炎组H.pylori感染者的胃黏膜炎症、活动性、萎缩和肠化生检出率均显著高于无感染者(P<0.05);早期胃癌和进展期胃癌组H.pylori感染者的炎症活动性检出率显著高于无感染者(P<0.05),而炎症、萎缩和肠化生检出率与无感染者无显著差异。结论由H.pylori感染引起的胃黏膜慢性炎症、萎缩和肠化生可能在胃癌的发生、发展过程中起直接或间接作用。     

南昌地区消化性溃疡的临床特点和季节变化规律

目的 了解南昌地区消化性溃疡(PU)的临床特点和季节变化规律,为PU的防治提供理论依据.方法 回顾性分析2003年10月至2008年5月经临床和胃镜检查确诊为PU的患者资料.将PU分为胃溃疡(GU)、十二指肠溃疡(DU)和复合性溃疡(CU)三种类型,其中GU病变部位按胃底贲门、胃体、胃角、胃窦、幽门管5个部位统计,DU病变部位按十二指肠球部前壁、后壁、大弯、小弯、球后5个部位统计,发病季节分为春季(3～5月),夏季(6～8月)、秋季(9～11月)和冬季(12～2月),统计不同类型PU检出率,并按性别、年龄、溃疡部位、发病季节、幽门螺杆菌(Hp)感染、并发症等情况进行分析及比较.结果 在83 888例胃镜检查者中,检出21 308例(25.4%)Pu患者,其中DU占66.33%,GU占24.88%,CU占8.79%;男女性别比为2.44 : 1,其中DU为2.53 : 1,GU为2.26 : 1,CU为2.33:1.GU患者平均年龄为48.02岁,比DU患者大6.7岁.DU发病以30～39岁年龄组最多见,GU以50～59岁组最多见.PU均以冬季发病率(30.17%)最高,夏季最低(22.54%),差异有统计学意义(P<0.01).在DU的病变部位中,依次为球部前壁57.43%、大弯18.26%、小弯13.21%、后壁7.34%;GU则依次为胃窦45.69%、胃角20.54%、胃体15.54%,幽门管9.36%、胃底和贲门8.87%.PU病例中,行Hp检查13 414例,阳性12 318例(占91.83%).Hp感染在不同类型的PU中差异无统计学意义(P0.05).PU的并发症发生率分别为出血4.94%、梗阻3.51%、慢性穿孔0.04%.结论 南昌地区的PU内镜检出率为25.4%,高于中国北方地区,PU的发生和性别,年龄、季节和溃疡部位密切相关,合并Hp感染率较高,并发症发生率低.     

胆汁反流、胃酸和幽门螺杆菌感染共同作用对胃黏膜损伤程度和分布的影响

背景:胆汁反流、胃酸和幽门螺杆菌（H.pylori）感染均是胃黏膜损伤的独立致病因素。然而,它们共同存在时有无协同致病作用尚不清楚。目的:探讨胆汁反流、胃酸和H.pylori感染共同作用对胃黏膜损伤程度和分布的影响。方法:37例胃镜检查疑有十二指肠胃反流者均经24h胃内胆汁监测证实,同时行胃内PH监测。胃体和胃窦黏膜有或无活动性炎症、萎缩、肠化和不典型增生分别记2分或1分。分别以胃体和胃窦黏膜的各项病理学改变为应变量,以胃内胆红素吸收值>0.14的时间百分比、pH<4的时间百分比和H.pylori感染状态指标为自变量进行多变量逐步Logistic回归分析。结果:37例患者胃内胆红素吸收值>0.14的时间百分比为34.49％±22.69％,pH<4的时问百分比为78.68％土 9.91％,H.pylori阳性率为29.73％。胆汁反流出现在以胃体和胃窦黏膜肠化以及胃体黏膜活动性炎症为应变量的Logistic回归模型中,H.pylori出现在以胃体黏膜活动性炎症为应变量的回归模型中。结论:胆汁反流是胃黏膜肠化的危险因素;胃内有胆汁反流存在时,H.pylori感染是导致胃体新膜炎症的重要病因。     

根除幽门螺杆菌对胃黏膜炎症变化的人群随访研究

目的 观察胃癌高发区中幽门螺杆菌(Hp)阳性者根除Hp5年后胃黏膜组织的炎症变化,以探讨。Hp感染与胃黏膜组织炎症及胃癌的关系。方法 对胃癌高发区山东省烟台市成年人群随机抽样1006例,做内镜、快速尿素酶试验及胃窦、胃体部黏膜组织学检查,将Hp阳性者随机分为治疗组(奥美拉唑20mg、克拉霉素500mg、阿莫西林1000mg)及对照组,2组入选者分别于1年后、5年后进行内镜复检,本研究是将5年后复查胃镜及相同部位胃黏膜组织病理检查与5年前结果进行比较并做χ^2检验。结果 552例Hp阳性者随机分为治疗组及对照组各276例,5年后Hp持续阴性者161例,持续阳性者198例。2组结果统计显示：(1)入选前2组胃窦部炎症及活动度发生率与体部相比差异无显著性,P值分别为0．105及0．084,但萎缩及肠化生发生率明显高于体部,P值均为0．000;(2)根除Hp 5年后胃窦、胃体部炎症及活动度均明显减轻,P值均为0．000;(3)根除Hp5年后胃窦部肠化生减轻或未进展,而Hp持续阳性组肠化生发生率明显增加,P=0．032;(4)根除Hp 5年后窦、体部萎缩改善差异无显著性,两组比较P值分别为0．223及0．402。结论 根除Hp可使胃慢性炎症及活动度明显减轻,窦部肠化生得到显著控制,溃疡病发病明显减少;持续Hp感染可使萎缩及肠化生呈进行性加重。     

原发性病理性十二指肠胃反流致病的因素分析

目的 探讨原发性病理性十二指肠胃反流(DGR)胃黏膜病变、幽门螺杆菌(Hp)感染、胆汁反流之间的关系.方法 应用便携式胆汁监测仪监测86例原发性病理性DGR患者胃内24 h胆汁反流情况;另取胃黏膜组织活检,分别行快速尿素酶试验、改良Giemsa染色和HE染色,判断有无Hp感染,并观察胃黏膜慢性炎症、活动性、萎缩、肠化等组织学特征.结果 ①将患者根据有无Hp感染分为Hp阳性组和Hp阴性组,Hp阳性组胃窦部黏膜病理积分、胆红素吸收值≥0.25的时间百分比均显著低于Hp阴性组(P均＜0.05);两组胆红素吸收值≥0.25的时间百分比和胃窦、胃角部黏膜病理积分均呈显著正相关(P均＜0.05).②将患者根据胆汁反流程度分为高反流组和低反流组,高反流组Hp阳性率显著低于低反流组(P＜0.05),胃窦和胃角部黏膜肠上皮化生的检出率、胃窦部黏膜病理积分均显著高于低反流组(P均＜0.05).结论 原发性病理性DGR导致胃窦黏膜损伤的主要因素可能为胆汁反流,随胆汁反流程度加重,胃窦黏膜损伤程度加重;胆汁反流可能抑制Hp在胃窦部定植,Hp感染可能与胆汁反流协同作用导致胃体部黏膜损伤.     

质子泵抑制剂治疗对胃食管反流病患者胃黏膜组织学变化的影响

背景:长期质子泵抑制剂(PPI)治疗对胃食管反流病(GERD)胃黏膜组织病理学特征(如萎缩、肠化生,甚至异型增生等)的影响少见针对性研究。目的:观察长期PPI治疗对不同幽门螺杆菌(Hp)感染状态GERD患者胃黏膜损伤和病理改变的影响。方法:采用前瞻性、随机和对照设计,纳入100例胃镜检查诊断为反流性食管炎(RE)的患者。给予埃索美拉唑20 mg bid初始治疗8周,之后按需维持治疗10个月。评估Hp感染的状态,治疗前后分别行GERDQ评分、胃镜检查以及胃黏膜组织学检查。结果:PPI治疗后,GERDQ评分较治疗前显著降低(P=0.000),食管炎愈合率为81.0%。Hp阳性组食管炎愈合率与Hp阴性组无明显差异(P=0.323)。胃体、胃窦黏膜慢性炎症较治疗前明显减轻(P0.05),活动性炎症基本消失,萎缩、肠化生均无加重,异型增生无增加趋势。Hp阳性组PPI治疗后胃窦黏膜活动性炎症(P=0.021)、异型增生(P=0.028)与Hp阴性组相比差异均有统计学意义。Hp阳性组胃窦慢性炎症的改善幅度低于胃体(P=0.041)。结论:长期大剂量PPI治疗可有效缓解GERD患者的临床症状,促进食管黏膜愈合,明显减轻患者胃体、胃窦的炎症。     

胃癌患者胃窦粘膜TNF-α含量的检测及临床意义

目的:探讨胃癌患者胃窦粘膜TNF-α含量与胃癌间关系。方法:应用放射免疫法(RIA)检查92例接受胃镜检查的患者胃窦粘膜TNF-α含量,比较胃癌与非癌性胃十二指肠患者之间的差异。其中胃粘膜正常者5例,单纯性慢性胃炎(CG)30例。十二指肠球部溃疡(DU)35例,胃癌(GCa)22例。结果:GCa患者胃窦粘膜TNF-α明显高于CG组及组织正常胃粘膜(p<0.05),但与DU组比较无明显差别(p>0.05)。结论:TNF-α含量在胃癌患者胃窦部增高,但与DU组比较无明显差别。提示TNF-α与胃癌发生、发展有关,但胃粘膜TNF-α并非胃癌的特异性标志物。     

13C-尿素呼气试验定量值与胃黏膜病变程度的相关性

目的:探讨13C-尿素呼气试验定量检测值与胃黏膜病变程度的关系.方法:74例患者于1wk内分别测定13C-尿素呼气试验定量检测和行胃镜检查取胃黏膜,进行组织病理学检查,黏膜按标准予以评分.将13C-尿素呼气试验定量值和胃黏膜病理病变评分做相关性分析.结果:13C-尿素呼气试验定量值与胃窦黏膜慢性炎症(r=0.9958,P=0.0001)、萎缩(r=0.2498,P=0.0318)、肠化(r=0.2784,P=0.02)病变程度呈正相关,与其活动性炎症(r=0.1979,P=0.09)病变程度不相关;13C-尿素呼气试验定量值与胃角黏膜活动性炎症(r=0.6223,P=0.0001)、慢性炎症(r=0.5480,P=0.0001)、萎缩(r=0.6014,P=0.0001)病变程度呈正相关,与其肠化(r=0.1308,P=0.27)病变程度不相关;13C-尿素呼气试验定量值与胃体黏膜活动性炎症(r=0.2039,P=0.08)、慢性炎症(r=0.0966,P=0.41)、萎缩(r=0.1369,P=0.24)、肠化(r=0.1837,P=0.12)程度均不相关;13C-尿素呼气试验定量值与全胃黏膜活动性炎症(r=0.9958,P=0.0001)、慢性炎症(r=0.9843,P=0.0001)、萎缩(r=0.9921,P=0.0001)、肠化(r=0.9934,P=0.0001)病变程度均呈正相关.结论:13C-尿素呼气试验定量值与胃黏膜病理病变程度呈正相关,临床上可以根据13C-尿素呼气试验定量值高低考虑黏膜病理病变程度,进而更好地指导临床诊断、用药及预后.     

慢性萎缩性胃炎的相关因素及内镜与病理诊断比较的临床意义

目的 探究慢性萎缩性胃炎(CAG)的临床相关因素并比较临床中胃镜诊断与病理诊断结果的差别。方法通过在我院进行胃镜及病理检查的994例病人的临床相关因素资料、胃镜及病理检查结果的分析和差异的比较，了解慢性萎缩性胃炎的相关因素以及胃镜诊断与病理诊断结果差异的原因。结果慢性萎缩性胃炎和慢性非萎缩性胃炎在平均年龄、吸烟史、酗酒、既往有胃或十二指肠病史上有显著差异；肠上皮化生和活动性炎症伴随CAG的比例分别为91．2％、76．7％，明显比不伴CAG的比例(分别为8．8％、23．3％)高，两者有高度相关性。CAG在不同部位的萎缩程度有差别：胃窦部CAG以轻中度萎缩为主，重度萎缩很少。而在胃体部cAG和胃窦兼胃体部cAG病人中，重度萎缩占有相当的比例。正常胃黏膜与CAG内镜下诊断以及不同部位间的CAG内镜下诊断为正常胃黏膜、胃窦部CAG、胃窦兼胃体部CAG和胃体部CAG与病理诊断比较的符合率分别为52．5％、37．5％、8％、25％。结论慢性萎缩性胃炎与多方面因素有关，以胃窦部多见，在病理诊断上与胃黏膜的活动性炎症及肠上皮化生有关。胃镜诊断与病理诊断的符合率不高，要提高CAG诊断的正确率，必须在提高胃镜检查技术的同时结合黏膜病理活检。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.