胃食管反流病与功能性肠道疾病的重叠及其相关因素

目的: 探讨胃食管反流病(gastro-oesophageal reflux disease, GERD)与功能性肠道疾病的重叠情况及其相关因素.方法: 2008-07/2008-12我院消化科门诊收治具有反酸、反食、烧心、胸骨后疼痛等症状的患者232例, 对其进行反流性疾病问卷调查(reflux disease questionnaire, RDQ), 以症状积分(S c)≥12为症状性胃食管反流标准. 将患者分为GERD组(Sc≥12)和对照组(Sc<12)2组, 记录患者的身高、体质量、吸烟史、饮酒史. 按照罗马Ⅲ诊断标准筛选功能性肠道疾病患者, 包括肠易激综合征(irritable bowel syndrome, IBS)、功能性腹泻(functional diarrhea, FD)、功能性便秘(functiona constipation, FC)、功能性腹胀(functional bloating, FB)等. 采用t检验、χ2检验、Logistic回归分析重叠率及其相关因素.结果: GERD与IBS, FD, FC, FB的重叠率分别为29.1%, 15.2%, 10.6%, 2.0%, 均高于对照组(11.1%, 3.7%, 9.9%, 1.2%). GERD组与对照组相比IBS重叠率有显著统计学差异( P<0.05), 2组间FD, FC, FB的重叠率无显著统计学差异.GERD症状积分与发生功能性肠道疾病的重叠有相关性( P<0.01), 年龄、性别、体质量指数、吸烟史、饮酒史与发生功能性肠道疾病的重叠无相关性.结论: GERD与IBS、FD、FC、FB均有一定的重叠, 但与IBS的重叠率最高且明显高于一般人群. GERD患者的症状积分越高, 与功能性肠道疾病发生重叠的几率越大.     

功能性胃肠病与胃食管反流病重叠发病的研究

目的 调查功能性胃肠病(FGIDs)患者重叠胃食管反流病(GERD)的发病率.方法 收集2006年8～10月解放军总医院消化科门诊FGIDs患者492例,调查其重叠GERD的情况.包括功能性消化不良(FD)、肠易激综合征(IBS)、慢性功能性便秘(CC)、功能性腹泻(F-D)、功能性腹胀(FB)和功能性嗳气(BD).FGIDs的诊断参照罗马Ⅲ标准;GERD的诊断按照耐信(RDQ)量表,以烧心、胸骨后疼痛感、反酸和反食症状的程度和频度积分≥12分作为判断标准.结果 492例FGIDs患者重叠GERD者达73例,重叠率为14.84%.重叠GERD组和无重叠组相比.患者的性别、年龄、病程、居住地、吸烟史及饮酒史差异无统计学意义(P>0.05).重叠率最高的3种FGIDs依次为FD、CC和IBS.FD患者重叠GERD者21.32%;CC患者重叠GERD者19.35%;12.55%的IBS患者重叠GERD.重叠率最低的FGIDs为BD,重叠率7.69%.302例单一FGIDs患者,重叠GERD者37例,重叠率为12.25%;190例重叠FGIDs患者,重叠GERD者36例,重叠率为18.95%.两组GERD重叠率比较差异有统计学意义(P<0.05).重叠GERD最多的单一FGIDs为FD,重叠率21.62%;其次为F-D和BD,单一FB未见重叠GERD患者.结论 按照罗马Ⅲ诊断标准,FGIDs患者重叠GERD常见.重叠率最高的3种FGIDs依次为FD、CC和IBS,重叠率最低的FGIDs为BD.重叠GERD最多的单一FGIDs为FD,其次为F-D和BD,单一FB未见重叠GERD患者.重叠FGIDs组GERD的重叠率明显高于单一FGIDs组.     

反流性疾病问卷对咽喉炎为主症的胃食管反流病的筛查功效研究

目的 探讨反流性疾病问卷(RDQ问卷)对以食管外症状-咽喉炎为主要表现的胃食管反流病(GERD)病例的筛查功效.方法 对26例食管外症状-咽喉炎为主要症状的,确诊为GERD病例,分别对KDQ问卷筛查阳性及阴性病例的平均积分进行比较分析,并对RDQ问卷对该类病例诊断敏感性、特异性、阳性符合率进行统计.结果 ①26例确诊为GERD病人中,19例RDQ问卷筛查阳性,症状平均积分为(14.32±5.12);7例RDQ问卷筛查阴性,症状平均积分(8.14±5.04),两组症状积分差异有显著性.②RDQ问卷对有食管外症状-咽喉炎的胃食管反流病确诊病例的功效为诊断敏感性73.07%、特异性53.33%、阳性符合率40.42%.结论 RDQ问卷对以食管外症状-咽喉炎为主要症状胃食管反流病病例的诊断筛查功效明显降低.     

胃食管反流病与功能性肠病关系的研究

目的探讨胃食管反流病与功能性肠病的关系。方法随机选取2004年北京大学人民医院消化科门诊有上腹症状的病人168例,填写反流性疾病诊断问卷(耐信量表),以Sc≥12为症状性胃食管反流标准,将病人分为两组,Sc≥12组及Sc<12组,记录病人身高、体重、计算体重指数、吸烟史、饮酒史、手术史、用药史,按照功能性肠病罗马Ⅱ诊断标准筛选功能性肠病病人,包括肠易激综合征(IBS)、功能性便秘、功能性腹胀、功能性腹泻等病人。结果按照罗马Ⅱ标准,两组患IBS及患功能性便秘差异无显著统计学意义,但两组发生功能性腹泻的差异有显著统计学意义,经logistic回归分析,发现体重指数与发生和胃食管反流病程相伴的下消化道功能异常有一定关系。结论胃食管反流可以合并不同程度下消化道功能异常,但具体机制尚有待进一步研究。     

慢性阻塞性肺疾病稳定期、急性加重期胃食管反流情况观察

为探讨慢性阻塞性肺疾病(慢阻肺)患者与胃食管反流病(GERD)的情况,我们对84例慢阻肺患者进行24小时食管pH监测以及胃食管反流症状评分,发现慢阻肺患者存在合并胃食管反流病,其严重程度与临床分期相关。     

老年胃食管反流病患者临床症状、心理状况和生活质量调查

背景:近年来,胃食管反流病(GERD)的患病率呈增高趋势,且其患病率随年龄的增长而增加。目的:分析GERD患者,尤其是老年GERD患者的胃食管反流症状、食管外症状、精神心理和生活质量状况,为GERD的诊治提供依据。方法:于2007年1月～2009年7月连续纳入GERD患者296例(老年组160例,非老年组136例),同期纳入正常对照者60例。以反流性疾病问卷(RDQ)和食管外症状调查问卷评价患者的胃食管反流症状和食管外症状,Zung焦虑自评量表(SAS)和Zung抑郁自评量表(SDS)调查患者的精神心理状况,SF-36健康凋查量表评价患者的生活质量情况。结果:GERD患者的胃食管反流症状和食管外症状较正常对照组更常见且更严重,SAS评分和SDS评分明显高于正常对照组,SF-36评分明显低于正常对照组,差异均有统计学意义(P0.05)。GERD组老年患者与非老年患者间的胃食管反流症状差异无统计学意义;老年GERD患者的食管外症状发生率较高,SAS和SDS评分明显高于非老年患者,SF-36评分明显低于非老年患者,差异均有统计学意义(P0.05)。结论:GERD患者常伴有精神心理异常和生活质量下降。老年人更易罹患GERD,老年GERD患者食管外症状较常见,心理健康水平更易受到影响,生活质量下降更为明显。     

反流性疾病问卷在胃食管反流病诊断中的价值

目的 探讨以反流症状为主的问卷调查(RDQ)在诊断胃食管反流病(GERD)中的价值。方法 上海、北京等10家医院多中心研究，对128例有烧心、胸骨后疼痛、反酸、反食等四种消化道症状的患者，按症状程度与发作频率为记分标准(5级记分制)，最高分可达40分，取症状6分以上为人选患者，以内镜检查有否反流性食管炎(RE)及24h食管pH检测为诊断(3ERE)的金标准，并与RDQ分值进行比较，计算出诊断GERD的临界值。结果 RDQ分值与RE严重程度呈正相关，食管pH检测异常组DeMeester积分显著高于正常组(20．18／16．84)。以RDQ分值12为临界值，Youden指数最大，ROC曲线下面积(Az)为0．71，对GERD诊断阳性符合率达88．07％，阴性符合率为68．42％，敏感度为94．12％，特异度为50．00％。结论 RDQ调查是诊断GERD的一个良好的筛选试验。     

胃食管反流病与下消化道功能异常关系的研究

国外有研究显示，胃食管反流与肠易激综合征（IBS）可合并存在，确诊为胃食管反流病（GERD）的患者中，符合IBS罗马Ⅱ诊断标准者高达70％，本研究旨在观察国人GERD与下消化道功能异常的关系。     

联合食管多通道腔内阻抗-pH监测在诊断胃食管反流病中的价值

目的 了解联合食管多通道腔内阻抗pH(MII-pH)监测诊断胃食管反流病(GERD)的价值.方法 纳入具有烧心症状且食管黏膜无损伤患者44例,首先行MII-pH监测,然后行14 d的雷贝拉唑试验(试验结束时烧心症状完全消失定义为雷贝拉唑试验阳性).70名健康志愿者行MII-pH监测的结果作为正常值进行参照.结果 根据食管pH监测存在异常食管酸暴露或酸反流症状指数(SI)阳性者20例(45.4%).MII-pH监测提示弱酸反流SI阳性者2例,据此检查诊断烧心患者GERD的比例增至50%(22/44).雷贝拉唑试验阳性4例,据此则将烧心患者诊断为GERD的比例增至54.5%(24/44).结论 联合食管MII-pH监测可增加GERD检出率.     

联合食管多通道腔内阻抗-pH监测在诊断胃食管反流病中的价值

目的 了解联合食管多通道腔内阻抗pH(MII-pH)监测诊断胃食管反流病(GERD)的价值.方法 纳入具有烧心症状且食管黏膜无损伤患者44例,首先行MII-pH监测,然后行14 d的雷贝拉唑试验(试验结束时烧心症状完全消失定义为雷贝拉唑试验阳性).70名健康志愿者行MII-pH监测的结果作为正常值进行参照.结果 根据食管pH监测存在异常食管酸暴露或酸反流症状指数(SI)阳性者20例(45.4%).MII-pH监测提示弱酸反流SI阳性者2例,据此检查诊断烧心患者GERD的比例增至50%(22/44).雷贝拉唑试验阳性4例,据此则将烧心患者诊断为GERD的比例增至54.5%(24/44).结论 联合食管MII-pH监测可增加GERD检出率.     

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.