正丁胺基罗沙替丁乙酸脂对胃溃疡大鼠胃黏膜活性因子的影响

目的：观察BRA对乙酸烧灼型溃疡大鼠胃黏膜中活性成分的影响,探讨该药对实验性溃疡大鼠溃疡愈合的治疗作用。方法：采用冰醋酸烧灼法制备胃溃疡模型,连续药物治疗15d后取血,生化指标检测NO、MD、SOD含量。结果：BRA各剂量组均能使胃黏膜NO含量升高;并提高胃黏膜SOD的含量,降低MDA水平,与模型对照组比较,差异有统计学意义（P〈0．01）。结论：BRA通过提高胃黏膜NO、SOD含量、降低MDA含量,减少溃疡黏膜损伤,促进溃疡愈合。对实验性胃溃疡有保护性治疗作用。     

冷冻干燥羊膜移植联合板层角膜移植治疗蚕蚀性角膜溃疡

目的观察冷冻干燥羊膜移植联合板层角膜移植在蚕蚀性角膜溃疡中的临床应用及效果。方法对12例12眼蚕蚀性角膜溃疡进行板层角膜移植术及病灶临近球结膜、球筋膜切除后进行羊膜移植术。结果术后12例患者临床症状全部消失．随访一年以上，无一例复发。结论冷冻干燥羊膜移植联合板层角膜移植治疗蚕蚀性角膜溃疡，可显著降低术后病变复发率，有较好的临床效果。     

引起消化性溃疡复发的危险因素分析及预防措施

目的探讨引起消化性溃疡复发的危险因素分析及预防措施。方法对2007年1月至2008年12月间邳州市东方医院诊治的经胃镜检查确诊是消化性溃疡患者愈合后通过门诊复诊、电话随访等,将胃镜复查确诊复发者设为观察组,按照1∶2比例选择未复发者作为对照组,比较两组患者在性别构成、年龄、不良生活方式、服NSAIDs、精神因素、复发季节、溃疡愈合质量等方面的差异。结果消化性溃疡患者220例,随访(14.5±4.6)个月;复发60例占27.3%,复发危险因素:男性、存在不良生活方式、服NSAIDs、精神因素、春秋季节,溃疡S1期愈合。结论消化性溃疡的复发与多种因素有关,应通过保持良好生活方式、心理行为干预、提高溃疡愈合质量、对于需长期服用NSAIDs时宜选用选择性COX-2抑制剂,应给予PPI预防性治疗来预防或减少复发。     

奥美拉唑治疗消化性溃疡的剂量与疗程分析

目的分析研究奥美拉唑对消化性溃疡的治疗剂量与疗程和疗效。方法将90例消化性溃疡患者随机分为两组,A组45例,用奥美拉唑20mg/d,治疗十二指肠溃疡4周,胃溃疡6周;B组45例用奥美拉唑40mg/d,治疗十二指肠溃疡2周,胃溃疡3周;两组患者均同时服用甲硝唑400mg,克拉霉素250mg,均2次/d。结果十二指肠溃疡的愈合率两组分别为84%和84%,胃溃疡的愈合率两组分别为85%和85%;十二指肠溃疡的总有效率两组分别为96%和96%,胃溃疡的总有效率两组均为100%,在愈合率与总有效率方面无明显差异。说明用奥美拉唑20mg/d,治疗时间要长,用奥美拉唑40mg/d,治疗时间则短,无论采取哪种方法,该药对消化性溃疡的治疗效果都是令人满意的。结论奥关拉唑对消化性溃疡的治疗效果是显著的,该药是质子泵抑制剂,能很好地抗胃酸分泌,迅速缓解症状,促进消化性溃疡的愈合。     

口乐药膜治疗口腔溃疡药理学实验研究和临床疗效观察

口乐药膜由黄芪、黄蜀葵花、乳香等组方,制成膜剂贴于溃疡局部。能明显减少家兔实验性口腔溃疡区的炎性细胞及坏死组织,使纤维组织明显增生,缩短愈合天数;对小白鼠二甲苯性耳廓肿胀有明显的抑制作用;能明显降低小白鼠扭体率;临床发现口乐药膜有明显的消炎止痛,促进溃疡愈合的功效。     

雷贝拉唑联合复方颠茄铋镁片治疗消化性溃疡的效果研究

目的 探讨雷贝拉唑联合复方颠茄铋镁片治疗消化性溃疡的效果.方法 将84例消化性溃疡患者随机等分为对照组和观察组,对照组给予奥美拉唑＋阿莫西林克拉维酸钾＋甲硝唑三联方案,观察组给予雷贝拉唑＋复方颠茄铋镁片＋阿莫西林克拉维酸钾＋甲硝唑四联方案,均持续治疗4周;分析两组治疗后的总体症状改善情况,停药4周后的Hp根治及溃疡愈合情况并记录治疗期间不良反应.结果 观察组的总体症状改善总有效率（95.24% vs 80.00%,P 〈 0.05）、溃疡愈合总有效率（97.62% vs 88.10%,P 〈 0.01）和痊愈率（52.38% vs 30.95%,P 〈 0.05）均高于对照组;Hp根治率高于对照组（80.95% vs 59.52%,P 〈 0.01）;两组的不良反应差异无统计学意义（P 〉 0.05）.结论 雷贝拉唑联合复方颠茄铋镁片治疗消化性溃疡的效果较好,提高总体症状改善、溃疡愈合总有效率及Hp根治率.     

Stimulation of gastric ulcer healing by heat shock protein 70

It is important in treatment of gastric ulcers to not only prevent further ulcer formation but also enhance ulcer healing. When cells are exposed to gastric irritants, expression of heat shock proteins (HSPs) is induced, making the cells resistant to the irritants. We recently reported direct evidence that HSPs, especially HSP70, are preventive against irritant-induced gastric ulcer formation. Gastric ulcer healing is a process involving cell proliferation and migration at the gastric ulcer margin and angiogenesis in granulation tissue. In this study, we have examined the role of HSP70 in gastric ulcer healing. Gastric ulcers were produced by focal and serosal application of acetic acid. Expression of HSP70 was induced in both the gastric ulcer margin and granulation tissue. Compared with wild-type mice, gastric ulcer healing was accelerated in transgenic mice expressing HSP70, and both cell proliferation at the gastric ulcer margin and angiogenesis in granulation tissue were enhanced. Oral administration of geranylgeranylacetone, an inducer of HSPs, to wild-type mice, either prior to or after ulcer formation, not only induced expression of HSP70 in the stomach but also accelerated gastric ulcer healing. On the other hand, oral administration of purified recombinant HSP70 prior to the ulcer formation, but not after formation, stimulated gastric ulcer healing. This study provides the first evidence that HSP70 accelerates gastric ulcer healing. The results also suggest that both the HSP70 produced prior to ulcer formation and released from damaged cells, and the HSP70 produced after ulcer formation are involved in this accelerated healing process.     

维生素C片剂局部治疗复发性口腔溃疡的疗效观察

目的评价维生素C片剂压敷治疗复发性口腔溃疡的疗效。方法将2010年1月至2012年1月门诊收治的复发性口腔溃疡患者142例分为2组,分别使用维生素C片剂压敷和西瓜霜喷剂进行局部治疗,采用χ2检验比较两组治疗有效率。结果两组治疗总有效率差异有统计学意义(P<0.05);治疗后溃疡愈合时间明显缩短(P<0.05),疼痛缓解率显著高于对照组(P<0.05)。结论维生素C片剂压敷治疗复发性口腔溃疡病损部位有立刻缓解疼痛、促进愈合作用,溃疡期明显缩短,效果显著,优于国内外研究报告的对复发性口腔溃疡病治疗的任何方法,值得临床推广。     

310例消化性溃疡胃镜追踪观察

作者通过胃镜及活组织检查,对1974年5月到1986年3月期间,首次胃镜活检无癌变的310例消化性溃疡患者追踪观察3.5～10年,发现患病年龄、胃窦部幽门螺旋杆菌(HP)及溃疡边缘粘膜的病理学类型,与消化性溃疡愈合与再发的关系非常密切(P<0.01)。还发现十二指肠溃疡也可癌变(0.7%),随着溃疡部位的上移,癌变率明显升高(P<0.01),到食管溃疡癌变率最高(14.7%)。     

Relation of hypoxia-inducible factor-1alpha to vascular endothelial growth factor and vasoactive factors during healing of gastric ulcers

We studied the relation of hypoxia-inducible factor-1alpha (HIF-1alpha) to vascular endothelial growth factor and vasoactive factors during the healing of gastric ulcers. The gastric ulcers were divided into three stages (active stage, healing stage and scar stage). The expression of HIF-1alpha, endothelin-1, inducible nitric oxide synthase, and vascular endothelial growth factor mRNA was highest during the active stage of ulcer healing, and endothelin-1, vascular endothelial growth factor protein levels and nitric oxide were higher during the healing stage. Thus, levels of HIF-1alpha mRNA tend to increase during the active stage of gastric ulcer healing, suggesting that this factor participates in the induction of endothelin-1, inducible nitric oxide synthase, and vascular endothelial growth factor. Also, the HIF-1alpha mRNA level did not differ significantly among the various stages of ulcer healing, and detectable levels of HIF-1alpha protein were not found during any stage. This suggests that these angiogenic factors and vasoactive substances may be induced by HIF-1alpha. During the active stage on endoscopic examination, considered the initial phase of ulcer healing, the process of ulcer healing has begun, and the tissue at the ulcer margin has already been reoxygenated.     

Platelets accelerate gastric ulcer healing through presentation of vascular endothelial growth factor

1. Platelets contain an array of growth factors that can modulate healing processes, including both pro- (e.g., vascular endothelial growth factor (VEGF)) and antiangiogenic (e.g., endostatin) factors. Previous studies have shown that circulating platelets contribute significantly to gastric ulcer healing, acting as a delivery system for these growth factors to the site of injury. In this study, we examined the effects of orally administered human platelets on the healing of gastric ulcers in rats, and determined the contribution of VEGF and endostatin to healing in this model. 2. Twice-daily administration of human platelets significantly accelerated ulcer healing, but platelet-poor plasma (PPP), lysed platelets and serum failed to produce this effect. There was no correlation between ulcer healing and the levels of VEGF or endostatin in serum, PPP or platelet-rich plasma (PRP). 3. Accelerated ulcer healing could not be produced by oral administration of the angiogenic factors themselves, at concentrations matching those in PRP. 4. The accelerated healing induced by platelets could be reversed by immuno-neutralization of VEGF. In contrast, immuno-neutralization of endostatin did not affect PRP-induced ulcer healing. 5. These studies indicate that VEGF released from platelets accounts for the accelerated healing of gastric ulcers. However, as intact (rather than lysed) platelets were required for the accelerated healing, the presentation of VEGF by the platelet at the site of injury appears to be crucial for enhancement of the healing process.     

Systematic review and meta‐analysis: is 1‐week proton pump inhibitor‐based triple therapy sufficient to heal peptic ulcer?

AIMS: To systematically review the efficacy on ulcer healing of 1-week combination of a proton pump inhibitor plus two antibiotics and to perform a meta-analysis of randomized clinical trials to evaluate whether 7 days of proton pump inhibitor-based triple therapy is sufficient to heal peptic ulcer. METHODS: Studies where 1-week proton pump inhibitor-based triple therapy was administered to heal peptic ulcer were included. Randomized clinical trials comparing the efficacy on ulcer healing of 7-day proton pump inhibitor-based triple therapy versus this same regimen but prolonging the proton pump inhibitor for several more weeks were included in the meta-analysis. Electronic and manual bibliographical searches were conducted. Meta-analysis was performed combining the odds ratios of the individual studies. RESULTS: Twenty-four studies (2342 patients) assessed ulcer healing with 1-week proton pump inhibitor-based triple therapy. Mean healing rate was 86%, and 95% in Helicobacter pylori-eradicated patients. Six studies (862 patients), were included in the meta-analysis. Mean ulcer healing rate with a 7-day treatment was 91% versus 92% when proton pump inhibitor was prolonged for 2-4 more weeks (odds ratio = 1.11; 95% confidence interval = 0.71-1.74). CONCLUSION: In patients with peptic ulcer and H. pylori infection, prolonging therapy with proton pump inhibitor after a triple therapy for 7 days with a proton pump inhibitor and two antibiotics is not necessary to induce ulcer healing.     

Topical amiloride solution accelerates healing of mechanical skin ulcers in albino rats

The present investigation was undertaken to explore the ulcer healing properties of three dosage schedules of various concentrations of topically administered amiloride solution in mechanically produced skin ulcers in albino rats. Four skin ulcers (two on either side of the midline) were made 2.5 cm apart on the preshaved back of each anesthetized rat with a round body skin biopsy punch (7 mm diameter) through the dermis to the depth of subcutaneous tissue. The animals were randomly divided into groups of 5 rats each. Ulcers on one side of the midline were treated with normal saline and served as control, whereas those on the other side were treated with amiloride solutions. Each ulcer was observed for its size, slough formation and any sign of irritation on alternate days until healing was complete. Healing of ulcers was significantly accelerated with all the strengths of amiloride (0.01, 0.02 and 0.04%) in all the dosage schedules (o.d., b.i.d. and q.i.d.) in terms of days required for complete healing, ulcer size and area under the size-time curve. This acceleration was dose-dependent with maximum effect at b.i.d. administration of 0.04% solution. No irritation or suppression of immunity was noticeable. Thus topical amiloride may prove to be an inexpensive and better ulcer healing agent with no apparent side effects. Inhibition of u-PA by amiloride seems to be responsible for this effect.     

Low-dose antacids versus ranitidine in the short-term treatment of patients with duodenal ulcer. Endoscopic and histologic placebo-controlled study.

In this double-blind randomized placebo-controlled trial we compared the efficiency of two Polish antacids (Alugastrin, dihydroxyaluminium sodium carbonate and Alumag, aluminium hydroxide with magnesium hydroxide; buffering capacity 189 and 224 mmol) with ranitidine in the healing of duodenal ulcer. We also examined the effect of drugs on the frequency and severity of gastritis and selected morphometric parameters of the fundic mucosa. The study showed that low-dose antacids effectively promote the healing of duodenal ulcer during four week therapy, similarly to ranitidine (72%, 76% and 80%, respectively) and significantly better than placebo (46%). Both antacids and ranitidine were without effects on the chronic gastritis and did not cause any trophic changes of the gastric mucosa.     

Studies on the healing promoting action of Z-103 in chronic gastric ulcer models of rats]

We studied the healing promoting action of Z-103 on the chronic gastric ulcer induced by acetic acid (AAU) or Fe-ascorbic acid (FAU) in rats. The area of the gastric ulcers, hydroxyproline (Hyp) and DNA contents in the ulcer region were measured as an index of ulcer healing. The area of gastric ulcers was the largest on day 4 and thereafter gradually decreased, but the ulcers still remained at the 14th day. Hyp contents in the ulcer region decreased until the 7th day in both models, and then this level increased. Significant decrease in DNA contents in the ulcer region was observed on the 7th day only in FAU. In AAU and FAU, administration of Z-103 (3 mg/kg/day x 2, p.o.) resulted in a significant decrease in the area of gastric ulcers on the 14th day and a significant increase in Hyp contents in the ulcer region on the 7th day as compared with the control group. Z-103 increased the DNA contents in the ulcer region on the 4th day in AAU and on the 7th day in FAU. These results suggest that tissue destruction surrounding the ulcer region in AAU and FAU models might occur until the 4th or 7th day after operation, and that the acceleration of ulcer healing by Z-103 on these models may be facilitated by the wound healing action of this drug.     

中西医结合治疗复发性口腔溃疡115例临床分析

目的探讨中西医结合治疗复发性口腔溃疡的方法及临床疗效。方法将230例复发性口腔溃疡患者随机分为观察组和对照组各115例,对照组采用西药治疗,观察组在对照组的基础上加用中药治疗。结果观察组总有效率为93.91%,对照组总有效率63.48%,两组比较有显著性差异(P<0.05)。结论中西医结合治疗复发性口腔溃疗效可靠,能促进溃疡面愈合,减少溃疡的复发程度和次数,且无明显不良反应,值得临床推广。     

消化性溃疡愈合质量的临床观察

目的：本研究通过对消化性溃疡患者巩固治疗后随访半年,观察消化性溃疡愈合质量与溃疡愈合率、瘢痕（S2）形成率的关系。方法：选取消化性溃疡患者30例,正规抗溃疡治疗1个疗程（胃溃疡6周;十二指肠溃疡4周）,随访半年,于1个疗程结束后（即1个月或1.5个月）、第3个月末、第6个月末复查胃镜及病理组织学检查。结果：30例患者消化性溃疡巩固治疗1个疗程后疼痛缓解率为84.6%,第3个月末为92.3%,第6个月末为80.8%,部分患者症状复发。疗程结束后复查胃镜,溃疡愈合率为73.3%,S2形成率为36.4%,3个月末和6个月末时S2的形成率均为54.5%,3例镜下复发。结论：消化性溃疡愈合质量的高低是决定溃疡复发与否的重要因素,再生黏膜的组织成熟程度越高,溃疡愈合质量越高,复发率越低。     

Gastric secretion, proinflammatory cytokines and epidermal growth factor (EGF) in the delayed healing of lingual and gastric ulcerations by testosterone

Hormonal fluctuations are known to predispose ulceration of the upper gastrointestinal tract, but to date no comparative study of their effects on the healing of pre-existing ulcers in the oral cavity and stomach has been made. We studied the effects of depletion of testosterone and of EGF on the healing of acetic acid-induced ulcers using rats having undergone bilateral orchidectomy and/or salivectomy respectively. We measured alterations in gastric acid secretion and blood flow at ulcer margins, as well as plasma levels of testosterone, gastrin and the proinflammatory cytokines IL-1β and TNF-α. Testosterone (0.01–10 mg/kg/day i. m.) dose-dependently delayed oral and gastric ulcer healing. When applied in an optimal dose of 1 mg/kg/day, this hormone significantly raised gastric acid secretion and plasma IL-1β and TNF-α levels. Attenuation of plasma testosterone levels via bilateral orchidectomy inhibited gastric acid secretion and accelerated the healing of oral and gastric ulcers, while increasing plasma gastrin levels and these effects were reversed by testosterone. Salivectomy raised plasma testosterone levels, and delayed oral and gastric ulcer healing. Treatment of salivectomised animals with testosterone further inhibited ulcer healing, and this effect was counteracted by EGF. We propose that testosterone delays ulcer healing via a fall in blood flow at the ulcer margin, a rise in plasma levels of IL-1β and TNF-α and, in the case of gastric ulcers, an increase in gastric acid secretion. EGF released from the salivary glands plays an important role in limitation of the deleterious effects of testosterone on ulcer healing. Received 17 October 2006; revised 2 July 2007; accepted 5 July 2007