Gastro-oesophageal reflux disease and respiratory disease

Abstract An epidemiological survey showed that respiratory symptoms with gastro-oesophageal reflux (GER) were twice as high as those without GER symptoms. In 46 cases of unknown chronic cough or asthma, 67% had positive oesophageal pH monitoring. Of 34 patients with snoring and reflux symptoms, 16 (47.1%) were confirmed as positive for obstructive sleep apnoea (OSA) and GER. Anti-reflux therapy significantly improved both GER and OSA.     

Risk of cardiovascular disease in inflammatory bowel disease

Abundant scientific evidence supporting an association between inflammatory bowel disease(IBD) and venous thromboembolic events, caused by an IBD related hypercoagulability, is acknowledged and thromboprophylactic treatment strategies are now implemented in the management of IBD patients. In contrary, the risk of arterial thromboembolic disease, as ischemic heart disease, cerebrovascular events, and mesenteric ischemia in patients with IBD remains uncertain and the magnitude of a potentially increased risk is continuously debated, with ambiguous risk estimates among studies. The evident role of inflammation in the pathogenesis of atherosclerosis forms the basis of a biological plausible link; the chronic systemic inflammation in IBD patients increases the risk of atherosclerosis and thereby the risk of thrombotic events. Further, studies have shown that the burden of traditional risk factors for atherosclerosis, such as obesity, diabetes mellitus, and dyslipidemia is lower in IBD populations, thus further strengthen the role of non-traditional risk factors, as chronic inflammation in the linking of the two disease entities. Likewise, mortality from cardiovascular disease in IBD remains questioned. The aim of the current review is to give an up-date on the existing evidence of the possible association between IBD and cardiovascular disease and to discuss traditional and non-traditional risk factors.     

先天性巨结肠类缘病的治疗探讨

目的探讨先天性巨结肠类缘病(HAD)的治疗方法。方法分析7例HAD患儿的治疗方案。术前或术中明确诊断的4例HAD患儿中,1例行根治性手术,1例行延期根治性手术,1例根治性手术后继续保守治疗,1例行肠造瘘术后等待根治术时机;3例按先天性巨结肠(HD)行根治术,术后复习病理切片才明确诊断,及时随诊,2例分别在首次术后3个月和8个月再行根治术,1例继续扩肛治疗。结果7例HAD患儿排便情况满意。结论根治手术对HAD治疗至关重要,保守治疗是HAD治疗的必要补充。     

慢性肾脏病所致心血管疾病概述

慢性肾脏病(CKD)是心血管疾病(CVD)的高危因素,CKD患者的CVD患病率很高,非常值得重视。本文将对CKD时的冠状动脉粥样硬化性心脏病、尿毒症心肌病、尿毒症心包炎、脑卒中及外周动脉病做一简介。     

Rheumatoid arthritis,periodontal disease and coronary artery disease

Rheumatoid arthritis (RA), periodontal disease (PD), and coronary artery disease (CAD) are common chronic inflammatory diseases. RA is associated with accelerated vascular risk resulting in an increased prevalence of CAD with attendant early mortality and excess morbidity. RA and PD have a common pathobiology. Accordingly, the aim of this study was to evaluate the association between RA, PD, and CAD and the influence of systemic inflammatory factors. A total of 100 active RA patients of which 50 had established CAD and 50 had no CAD were assessed for PD. All subjects underwent a clinical, cardiac, dental, laboratory, and radiological evaluation. Blood samples were obtained, and the level of high sensitivity C-reactive protein (hs-CRP), total white blood counts (WBC), erythrocyte sedimentation rate (ESR), fibrinogen and tumor necrosis factor (TNF) alpha, total cholesterol (TC), and high density lipoprotein (HDL) were assayed. The findings of this study demonstrated an association between RA, PD, and CAD. The RA patients with CAD had significantly more PD than RA patients without CAD. The inflammatory markers, hsCRP, ESR, WBC, fibrinogen, and TNF-α, were raised in all patients but were significantly higher in RA patients with CAD who also had PD. HDL levels were lower in RA patients with CAD when compared to RA patients without CAD. Evidence from this study shows an association between RA, PD, CAD, and systemic levels of the inflammatory mediators. The implication is that inflammation may be the central link between the chronic inflammatory, autoimmune disorders, and atherosclerosis. An erratum to this article can be found at     

Castleman's病合并糖尿病Graves病1例

1病历资料患者女,53岁。主因Castleman s病6年,糖尿病5年,烦热伴消瘦明显6个月,咳嗽伴发热2 d入院。患者自     

合并还是模拟:当Castleman病与结缔组织病共存时

目的探讨Castleman病与CTD共存时的关系,减少误诊误治。方法回顾性分析2001年1月至2017年5月北京协和医院收治的疑诊CTD最终诊断Castleman病患者的临床及实验室资料。结果①Castleman病合并或模拟CTD 11例,占同期Castleman病患者的5.7%(11/194),发病平均年龄(51±17)岁,男性6例,女性5例;②常见的临床表现依次为多发浅表淋巴结肿大(10/11)、发热(8/11)、浆膜腔积液(6/11)、关节肿痛(5/11)、脱发(2/11)、雷诺现象(1/11)、光过敏(1/11);③实验室检查表现为ESR增快(11/11)、低白蛋白血症(11/11)、hs-CRP升高(10/11)、IgG升高(7/11)、蛋白尿(5/11)、镜下血尿(5/11)、ANA阳性(5/11);④疑诊的CTD包括SLE 5例,IgG4相关性疾病2例,成人Still病2例;合并SS 2例;⑤11例均由活检病理明确诊断为多中心型Castleman病,浆细胞型10例,混合型1例。结论Castleman病可出现发热、多浆膜腔积液、关节肿痛、蛋白尿等合并或模拟CTD的表现,诊断和治疗需谨慎,必要时行淋巴结或肿物活检,减少误诊误治。     

Anorectal Crohn's disease

A group of 86 patients with anorectal Crohn's disease were followed up from ten to 40 years to determine the course of the disease and the number of patients who later required proctectomy. The overall cumulative probability of avoiding proctectomy was 91.6 percent at ten years and 82.5 percent at 20 years. Resection of all proximal Crohn's disease did not ameliorate the anorectal disease, except in patients who had all proximal disease removed and had no recurrence. Read at the meeting of the American Society of Colon and Rectal Surgeons, San Diego, California, May 5 to 10, 1985.     

脂肪性肝病与胃食管反流病的相关性研究

目的评估脂肪性肝病(FLD)与胃食管反流病GERD之间的关系。方法选取2 000例受试者,采用较简便的胃食管反流病问卷(GerdQ)作为初筛GERD诊断标准,对入选者均进行腹部超声波等检查,分析FLD与GERD关系。结果对2 000例患者利用GerdQ评估GERD诊断情况,有176例(8.8%)诊断为GERD,女68人(38.64%),男108人(61.36%);脂肪肝患者760例,患病率38.0%,在脂肪肝组中,男女性GERD症状的GerdQ阳性率分别为13.77%和12.24%,两者无明显差异(P>0.05)。脂肪肝人群发生GERD症状的患病率与对照组存在统计学差异(P<0.05)。结论脂肪肝与GERD显著相关,控制脂肪肝发展可以降低GERD发病率。     

Nonalcoholic fatty liver disease and cardiovascular disease

Nonalcoholic fatty liver disease (NAFLD) and cardiovascular disease (CVD) are two diseases that are common in the general population. To date, many studies have been conducted and demonstrate a direct link between NAFLD and CVD, but the exact mechanisms for this complex relationship are not well established. A systematic search of the PubMed database revealed that several common mechanisms are involved in many of the local and systemic manifestations of NAFLD and lead to an increased cardiovascular risk. The possible mechanisms linking NAFLD and CVD include inflammation, oxidative stress, insulin resistance, ectopic adipose tissue distribution, dyslipidemia, endothelial dysfunction, and adiponectin, among others. The clinical implication is that patients with NAFLD are at an increased risk of CVD and should undergo periodic cardiovascular risk assessment.     

肺心病合并冠心病心电图分析

目的探讨肺心病合并冠心病心电图的特点。方法回顾我院住院病例选择肺心病和肺心病合并冠心病各120例均行同步十二导联心电图检查,必要时进行24 h动态心电图检查对比心电图的变化。结果肺心病合并冠心病组(合并组)比肺心病组心电图改变明显,两者有显著差异结论心电图及动态心电图的某些特殊改变能提示肺心病合并冠心病。     

类癌性心脏病

类癌是一种主要发生于胃肠道,但也可位于胃肠外器官的能产生小分子多肽类或肽类激素的肿瘤。类癌综合征是由类癌细胞分泌、释放一些生物活性物质所引起的一组具有多种复杂症状、体征的症候群。类癌性心脏病是指类癌综合征累及心脏,引起的以右侧心脏瓣膜和心内膜病变为主的心脏病,多发生于类癌晚期出现肝脏转移的患者。由于生长抑素类似物的应用以及针对转移性肿瘤的治疗,类癌患者存活延长,应该考虑瓣膜外科治疗减轻心脏症状。     

非酒精性脂肪肝和心血管疾病

非酒精性脂肪肝(NAFLD)是临床慢性肝脏疾病,包括单纯的肝细胞脂肪变、脂肪性肝炎(NASH)、肝脏纤维化甚至肝硬化等,是临床隐原性肝硬化最常见的病因。胰岛素抵抗(IR)和中央性肥胖是NAFLD的重要发病机制。同时由中央性肥胖、2型糖尿病、胰岛素抵抗、高血压及血脂异常等组成的代谢综合征(MS)是心血管疾病(CVD)的高危险因素。现在,越来越多的研究认为NAFLD是MS在肝脏系统的表现,NAFLD的出现可能不仅仅是CVD发生的标志,甚至是CVD的早期中间状态。     

慢性阻塞性肺病与胃食管反流病

目的：了解慢性阻塞性肺病(COPD)患者中胃食管反流病(GERD)的发生率及探讨GERD与COPD的关系。方法：从医院门诊收集89例COPD患者[第1秒用力呼气量(FEV_1)=1．37±0．53],同时选取88例非COPD患者为对照组,所有病例完成反流性疾病诊断问卷、慢性黏液高分泌症(CMH)问卷和肺功能检查。结果：COPD组中GERD发生率为18%,对照组为16%。气道阻塞严重(根据肺功能判断)的COPD患者没有更高的GERD发生率,各不同严重程度的COPD患者的GERD发生率分别为11%(轻度)、24%(中度)、11%(重度)和19%(极重度)。气促程度严重的COPD患者中GERD发生率较气促程度轻者升高(29%比15%,P=0．19)。有CMH的患者中27%表现GERD,而无CMH患者中仅8%表现GERD(P＜0．05)。结论：本研究发现COPD患者中GERD的发生率没有明显增高,但气促症状严重的患者表现较高的GERD发病率。CMH与GERD有显著的相关性,提示CMH的潜在作用及在治疗有CMH的COPD患者时需考虑GERD影响。     

HLA-DQ: Celiac disease vs inflammatory bowel disease

AIM To determine the genetic predisposition to celiacdisease(Ce D) in inflammatory bowel disease(IBD) patients by quantifying the frequency of Ce D-related human leucocyte antigen(HLA)(HLA-Ce D: HLA-DQ2 and-DQ8) in IBD patients globally, by type of IBD and gender, and by calculating the protective/risk contribution of these haplotypes in the development of the IBD disease.METHODS We conducted a prospective study with IBD patients from our Unit. Clinical information was gathered and blood was tested for HLA-CeD. The control group was made up of unrelated Valencian organ donors.RESULTS1034 subjects were analyzed: 457 IBD [207 ulcerative coliti(UC) and 250 Crohn's disease(CD)] patients and 577 healthy controls. 39% of the controls and 34% of the patients had HLA-Ce D(P = 0.0852). HLA-DQ2 was less frequent in UC patients(P = 0.0287), and HLA-DQ8 in CD(P = 0.0217). In women with UC, the frequency of DQ2.5 cis(DQB1*02:01-DQA1*05:01) was reduced ≥ 50% [P = 0.0344; preventive fraction(PF) = 13%]. PFs(7%-14%) were obtained with all HLACe D haplotypes. HLA DQB1*02:02-DQA1*02:01(HLADQ2.2) was more frequent in CD patients with respect to controls(P = 0.001) and UC patients(etiological fraction = 15%).CONCLUSION HLA-CeD is not more frequent in IBD patients, with an even lower frequency of HLA-DQ2 and-DQ8 in UC and CD respectively. HLA-DQ2.5 confers protection from the development of UC, especially in women, and HLADQ8 does so for the appearance of CD. HLA-DQ2.2 is present in 34% of the CD patients and may constitute a genetic risk factor for CD development.     

非酒精性脂肪性肝病相关心血管疾病的发病机制

非酒精性脂肪性肝病也称为代谢相关脂肪性肝病,是全球最为常见的慢性肝病。研究发现非酒精性脂肪性肝病与心血管疾病的风险增加有关,并且非酒精性脂肪性肝病本身是心血管疾病的独立危险因素。鉴于非酒精性脂肪性肝病与心血管疾病的密切关联,文章综述了连接非酒精性脂肪性肝病与心血管疾病的病理生理机制,为临床非酒精性脂肪性肝病患者心血管疾病的诊治提供了思路。     

Report: Association of coronary artery disease and valvular heart disease in chile

This study analyzes the prevalence of coronary artery disease (CAD) among patients with rheumatic valvular heart disease (VHD) in Chile. Coronary angiography was performed in all patients referred to cardiac catheterization with VHD who were over age 50 years and who had angina or ECG signs of ischemia. A total of 100 patients entered the study. Significant CAD (greater than 50% obstruction) was found in 14% of the cases: 7% in patients with mitral valve disease (MVD), 18% in aortic valve disease (AVD), and 21% in combined mitral and aortic valve disease (MAVD). Angina was present in 14% of the patients with MVD, 63% with AVD, and 53% with MAVD. Only 57% of patients with CAD had angina pectoris; 20% with angina had CAD. Hemodynamic parameters and left ventricular ejection fraction were not correlated with the presence or absence of CAD. We conclude that in patients with valvular heart disease, the incidence of CAD is lower in Chile than previously reported in the English literature. We confirmed the fact that angina is often not associated with CAD, and that CAD is often present in the absence of angina.     

Increased incidence of Parkinson disease among relatives of patients with Gaucher disease

In a previous study of 99 Ashkenazi Jewish patients with Parkinson disease from Israel who were tested for the six most common mutations for Gaucher disease, 31.3% had at least one Gaucher disease mutation, implying that carrier status per se my be a risk for Parkinson disease. The purpose of this survey was to ascertain the presence of Parkinson disease among Ashkenazi Jewish obligate carriers of Gaucher disease relative to its incidence in a comparable cohort of Ashkenazi Jews who are putatively non-carriers. There was no statistically significant difference in gender or age between the groups (n>100). Among patients, 27.3% reported having a relative with Parkinson disease while among the controls there was a reported 12.3% which was statistically significant (P=0.05). While based completely on subjective reports in a paper-base questionnaire, the results of this survey implicate a high rate of Parkinson disease among individuals with Gaucher disease mutations.     

瓣膜病变合并冠状动脉病变的手术治疗

目的 总结分析瓣膜病变并发冠状动脉病变的同期手术治疗.方法 分析48例瓣膜置换术同期冠状动脉旁路移植术患者的临床资料.结果 5例发生低心排综合征,其中死亡2例.生存病例随访6～60个月,无心绞痛发作,无出血或血栓形成事件.结论 瓣膜置换术同期冠状动脉旁路移植术效果良好.良好的瓣膜病变矫治、心肌再血管化和心肌保护是手术成功的关键因素.