门静脉高压性胃病的研究进展

门静脉高压性胃病(PHG)是一种内镜下胃黏膜呈特征性马赛克样改变的疾病,其组织学上无明显炎性改变。PHG是上消化道出血的重要因素之一,超过65%的肝硬化门静脉高压症患者会发展为PHG。目前PHG的发病机制尚未完全清楚。PHG临床主要表现为消化道出血等症状,其诊断主要依靠内镜和组织学,治疗主要针对降低门静脉压力。     

门脉高压症所致门脉高压性胃病119例分析

门脉高压患者由于全身和内脏的循环动力学增高，门静脉血流量增加，而且出现门脉压力增高并可引起整个消化道粘膜病变。而门脉高压性胃病(PHG)是门脉高压症患者上消化道出血的常见原因之一。本文就内镜确诊的119例PHG患者进行了临床及内镜分析，现报告如下。     

门脉高压性胃病的研究

肝硬化患者发生上消化道出血，常常被认为是食管胃底静脉曲张破裂出血所致。随着急诊内镜的广泛开展应用，发现部分患者的出血是由于胃黏膜严重糜烂坏死出血所致。此病又称为门脉高压性胃黏膜病变（PHG）。门脉高压性胃病是指门脉高压症伴发的胃黏膜病变，主要发生于肝硬化门脉高压症患者，是肝硬化门脉高压症的常见并发症。1984年Sarfeh等提出PHG与非PHG在形态、功能、治疗上都有不同，因其病理组织学上炎性改变依据不足，可称其为门脉高压性胃病，逐渐引起人们重视。PHG常与食管静脉曲张同时存在，而PHG出血可占门脉高压消化道出血的10％-60％”。     

肝硬化门脉高压性胃病临床分析

正门静脉高压性胃病(portal hypertension gastropa-thy,PHG)是指由门脉高压引起的胃黏膜非炎性病变,是门静脉高压症患者除食管胃底静脉曲张破裂外另一重要出血因素[1]。为了探讨肝硬化PHG与食管胃底静脉曲张程度、上消化道出血、门静脉宽度及肝功能Child-Pugh分级的关系,我们于2008年1~6月回顾性分析了我院126例肝硬化患者的胃镜及临床资料,报告如下。对象与方法1.一般资料:本     

门静脉高压性胃病的研究进展

门静脉高压性胃病(PHG)是一种内镜下胃粘膜呈特征性马赛克(mosaic)样改变的疾病,其组织学上无明显炎症性改变,即或有炎症也很轻,和粘膜损害的程度不符合,在疾病概念上与急性胃炎(出血性或糜烂性)不同.目前,PHG的发病机制尚未完全清楚,临床上多表现为慢性隐匿性出血,出血量与PHG的持续时间及病变范围和严重程度有关,在肝硬化上消化道出血病因中,PHG仅次于食管-胃底静脉曲张破裂,而在重度肝功能不全患者及重度PHG患者中,则上升为第一位出血因素,故PHG越来越引起人们的重视.本文将重点对PHG的研究进展作一综述.     

门静脉高压性胃病与幽门螺杆菌感染的关系

目的 探讨门静脉高压性胃病(portal hypertensive gastropathy,PHG)的致病因素,尤其是与幽门螺杆菌(helicobacter pylori,HP)感染的关系.方法 对已确诊的101例住院肝硬化患者均进行胃镜和彩色多普勒超声(彩超)检查,同时进行HP检查,分析PHG与食管胃底静脉曲张程度、肝硬化病因、HP感染的关系.结果 PHG的发生率为37.6%,PHG的发生率及其严重程度与食管胃底静脉曲张程度有关,在肝功能Child-PughA、B、C级之间,不同病因肝硬化之间,是否感染HP之间,PHG的发生率差异均无统计学意义(均为P＞0.05).肝硬化病人的慢性活动性胃炎与HP阳性有关(P＜0.01),而与门静脉高压关系不大.结论 PHG的发生与肝硬化的病因、肝功能分级和HP感染关系不明显,与食管静脉曲张程度有关.肝硬化病人的慢性活动性胃炎可能与HP感染有关.     

门静脉高压性胃病诊断及治疗策略

目的探讨门静脉高压性胃病(PHG)的临床特点，为其诊断及治疗提供理论依据。方法对40例门静脉高压性胃病患者临床资料进行回顾性分析。结果PHG的程度与食管静脉曲张程度及肝功能损害程度间存在一定的依从关系。PHG合并出血的治疗以降低门静脉压力为主。结论门静脉高压、肝功能受损与PHG形成有关。首选降低门静脉压力的药物防治PHG出血。     

130例肝硬化门脉高压症患者胃镜检查结果分析

目的分析各种原因引起的门脉高压症患者胃粘膜特点。方法130例研究对象共分为3组:A组47例,为乙肝肝硬化;B组42例,为酒精性肝硬化;C组41例,为脂肪性肝硬化。所有研究对象于入院后3天内行电子胃镜检查,观察门静脉高压性胃病(PHG)及急性胃粘膜病变(AGML)的检出情况。结果A组、B组、C组3组患者PHG、AGML检出例数分别为36例(76.60%)、14例(29.79%),30例(71.43%)、35例(83.33%),32例(78.05%)、13例(31.71%);3组患者其PHG检出例数之间差异均无显著性(P>0.05),但无论A组或是C组其AGML检出例数与B组相比,差异均有高度显著性(P<0.01)。结论肝硬化门脉高压患者易合并PHG及AGML,PHG及AGML可能与慢性肝病基础有关,但酒精性肝硬化以AGML病变为多见,其余两种均以PHG为多见。     

肝硬化门静脉高压性胃病临床分析

目的 进一步了解肝硬化门静脉高压性胃病的临床特点.方法 对396例肝硬化患者进行常规胃镜检查,并对其中并发门静脉高压性胃病(PHG)患者的临床资料进行回顾性分析.结果 396例肝硬化患者中有343例(86.7%)出现不同程度的食管静脉曲张,160例出现PHG(40.4%),随肝功能Child-Pugh分级级别增加,PHG发病率及严重程度呈上升趋势(P＜0.01);而随着食管静脉曲张严重程度上升,PHG发病率亦有上升(P＜0.01).结论 随着患者肝功能损害程度以及食管静脉曲张程度的加重,PHG发病率增高并加重.     

肝硬化门静脉高压症患者内镜检查前渥太华肠道准备评分量表评分现况及影响因素

目的 分析肝硬化门静脉高压症患者内镜检查前渥太华肠道准备评分量表(OBPQS)评分现况及影响因素.方法 选取2020年5月至2021年7月永城市人民医院收治的116例肝硬化门静脉高压症患者作为调查对象.患者均接受内镜检查.分析OBPQS评分现状与影响因素.结果 OBPQS评分(10.52±1.12)分,合格率达61.2...     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.