血清胃蛋白酶原检测在萎缩性胃炎和胃癌诊断中的临床意义

目的 探讨血清学胃蛋白酶原（pepsinogen,PG）检测对慢性胃炎、胃癌诊断的临床意义。方法 回顾性分析2018年6月至2019年5月就诊于大连医科大学附属第二医院,行胃蛋白酶原Ⅰ（PGⅠ）、胃蛋白酶原Ⅱ（PGⅡ）检测,符合纳入标准的患者230例。根据胃镜及病理检查结果分为胃炎组208例,胃癌组22例,再将其中胃炎组分为非萎缩性胃炎组105例、萎缩性胃炎组103例,通过比较各组间PGⅠ、PGⅡ、PGⅠ/PGⅡ（PGR）值的变化,探讨PG水平对萎缩性胃炎、胃癌诊断的临床意义,通过单因素分析和多因素分析,分析胃癌的危险因素。结果 与胃炎组相比,胃癌组PG Ⅱ水平升高,PGR水平降低,差异有统计学意义（P<0.05）。进一步对非萎缩性胃炎组、萎缩性胃炎组、胃癌组三组间分析显示,与非萎缩性胃炎组相比,萎缩性胃炎组PGR下降（P<0.001）,胃癌组PG Ⅱ水平升高（P<0.001）,PGR下降（P<0.01）;与萎缩性胃炎组相比,胃癌组PG Ⅱ升高（P<0.05）。单因素分析结果显示性别、年龄、PG Ⅰ、PG Ⅱ是与胃癌相关的危险因素,进一步行多因素Logistic回归分析,提示性别、年龄、PG Ⅱ是与胃癌相关的独立危险因素。结论 血清PGⅠ、PGⅡ、PGⅠ/PGⅡ检测对萎缩性胃炎、胃癌诊断具有一定的临床意义,PGR水平降低、PGⅡ水平升高提示存在萎缩或病情进展,胃癌风险增高。     

胃复春片联合复方丙谷胺西咪替丁慢性萎缩性胃炎的临床研究

目的观察胃复春片联合复方丙谷胺西咪替丁片治疗慢性萎缩性胃炎的临床疗效。方法选取2017年4月—2018年10月在三峡大学第二人民医院进行治疗的慢性萎缩性胃炎患者98例作为研究对象,将所有患者采用数字表法随机分为对照组和治疗组,每组各49例。对照组患者口服复方丙谷胺西咪替丁片,2片/次,3次/d。治疗组在对照组治疗的基础上口服胃复春片,4片/次,3次/d。所有患者均治疗4个月。观察两组患者的临床疗效,比较两组治疗前后的临床症状积分和血清学指标。结果治疗后,对照组和治疗组的总有效率分别为81.63%、93.88%,两组比较差异具有统计学意义(P0.05)。治疗后,两组胃刺痛、口干口苦、胃脘胀满、倦怠乏力和嗳气反酸评分均显著降低,同组治疗前后比较差异具有统计学意义(P0.05、0.01);且治疗后治疗组临床症状积分显著低于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者胃泌素(GAS)明显下降,降钙素基因相关肽(CGRP)、血管内皮生长因子(VEGF)和一氧化氮(NO)水平均显著上升,同组治疗前后比较差异具有统计学意义(P0.05、0.01);且治疗后治疗组血清学指标显著优于对照组,两组比较差异具有统计学意义(P0.05)。结论胃复春片联合复方丙谷胺西咪替丁片治疗慢性萎缩性胃炎具有较好的临床疗效,可明显改善患者临床症状和血清学指标,具有一定的临床推广应用价值。     

Significant association of deficiency of hemoglobin, iron and vitamin B12, high homocysteine level, and gastric parietal cell antibody positivity with atrophic glossitis

J Oral Pathol Med (2012) 41 : 500–504 Background: Atrophic glossitis (AG) is considered to be a marker of nutritional deficiency. In this study, we evaluated whether there was an intimate association of the deficiency of hemoglobin, iron, vitamin B12 or folic acid, high blood homocysteine level, and serum gastric parietal cell antibody (GPCA) positivity with AG. Methods: The blood hemoglobin, iron, vitamin B12, folic acid, and homocysteine concentrations and the serum GPCA level in 176 AG patients were measured and compared with the corresponding levels in 176 age‐ and sex‐matched healthy control subjects. Results: We found that 39 (22.2%), 47 (26.7%), 13 (7.4%), and 3 (1.7%) AG patients had deficiencies of Hb (men < 13 g/dl, women < 12 g/dl), iron (<60 μg/dl), vitamin B12 (<200 pg/ml), and folic acid (<4 ng/ml), respectively. Moreover, 38 (21.6%) AG patients had abnormally high blood homocysteine level, and 47 (26.7%) AG patients had serum GPCA positivity. AG patients had a significantly higher frequency of Hb, iron, or vitamin B12 deficiency, of abnormally elevated blood homocysteine level, or of serum GPCA positivity than healthy control subjects (all P‐values = 0.000). However, no significant difference in frequency of folic acid deficiency was found between AG patients and healthy control subjects. Conclusion: We conclude that there is a significant association of deficiency of hemoglobin, iron and vitamin B12, abnormally high blood homocysteine level, and serum GPCA positivity with AG.     

应用数码显微镜评价重组牛碱性成纤维细胞生长因子辅助治疗萎缩性舌炎的临床效果

目的：应用数码显微镜观察重组牛碱性成纤维细胞生长因子（recombinantbovinebasicfibroblastgrowthfactor,rb-bFGF）辅助治疗萎缩性舌炎的疗效。方法：39例维生素B12缺乏的萎缩性舌炎患者,随机进入治疗组（21例）和对照组（18例）。采用数码显微镜,检测患者初次就诊及第7、14d复诊时舌乳头形态,同时记录舌痛、味觉改变的程度。比较两组患者在初诊及两次复诊时上述3项指标的改善情况。结果：第7d复诊,治疗组患者总体舌黏膜萎缩的改善程度高于对照组（P〈0．05）,其舌痛存在时间短于对照组护（P〈0．05）;第14d复诊,两组治疗效果趋于一致。结论：rbFGF能够减轻炎症反应、促进舌乳头生长并缩短疼痛时间。     

Hashimoto’s thyroiditis: TGAb,TPOAb, TRAb and recovery from hypothyroidism

Hashimoto described four patients with goiter. The histology of the goiter was characterized by diffuse lymphocytic infiltration, fibrosis and epithelial cell destruction. Thyroglobulin antibody (TGAb) and thyroid peroxidase antibody (TPOAb) have been used to diagnose Hashimoto’s thyroiditis. Patients with positive TGAb and/or TPOAb have been assumed to have Hashimoto’s thyroiditis. Approximately 10% of those with positive TGAb and/or TPOAb have hypothyroidism. There are two types of autoimmune thyroiditis: goitrous Hashimoto’s thyroiditis and atrophic thyroiditis. The latter patients have blocking antibody (thyroid-stimulating hormone [TSH]-stimulation blocking antibody [TSBAb]). TSBAb is a TSH-receptor antibody (TRAb). TSBAb causes thyroid atrophy and hypothyroidism. TGAb and/or TPOAb do not necessarily cause hypothyroidism. Hypothyroid patients with Hashimoto’s thyroiditis usually receive life-long l-thyroxine therapy. However, spontaneous recovery from hypothyroidism has been reported. Patients who had Hashimoto’s hypothyroidism and then Graves’ hyperthyroidism (and vice versa), have also been reported. Hashimoto’s hypothyroidism and Graves’ hyperthyroidism could be the opposite spectrums of one disease.     

Bone Graft Healing in Reconstruction of Maxillary Atrophy

Purpose: Evaluate correlations between volume change for iliac crest bone grafts in maxillary reconstruction (graft volume change [GVC]) and bone mineral density (BMD), bone volume fraction (BVF), hematologic bone metabolic factors (I), and identify indicators of implant failure (II). Material and Methods: Forty‐six consecutive patients had their edentulous atrophic maxilla reconstructed with free autogenous bone grafts from anterior iliac crest. Endosteal implants were placed 6 months after graft healing. Computer tomography was performed after 3 weeks and 6 months after grafting. Bone biopsies were taken from the internal table of donor site for calculation (BVF), and blood samples were collected. Implant stability was measured at placement with resonance frequency analysis and expressed as implant stability quotient (ISQ). Implant failure was registered. Results: GVC in onlay bone graft was 37%. The BVF in iliac crest biopsies was 32%. Serum‐IGFBP3 differed with 79% of the samples over normal range. Fifteen patients had one or more implant failures prior to loading (early failures). Forty‐two patients were followed for a minimum of 3 years after implant loading and, in addition, 6/42 patients had one or more implants removed during the follow‐up (late failures). GVC correlated to decreased BMD of lumbar vertebrae L2‐L4 (Kruskal–Wallis test, p = .017). No correlation was found between GVC and hematologic factors (Pearson correlation test) or between GVC and BVF (Kruskal–Wallis test). No correlation was found between ISQ and GVC (Pearson correlation test, p = .865). The association between implant failures and the described factors were evaluated, and no significant correlations were found (unconditional logistic regression). Conclusion: Onlay bone grafts decrease 37% during initial healing period, which correlate to BMD of lumbar vertebrae L2‐L4. No other evaluated parameters could explain GVC. The evaluated factors could not explain implant failure.     

胃康宁颗粒与胃复春片治疗慢性萎缩性胃炎癌前病变的临床对照研究

目的 探讨胃康宁颗粒与胃复春片治疗慢性萎缩性胃炎（CAG）癌前病变的临床效果。方法 将安阳市第三人民医院自2012年1月-2016年12月收治的CAG癌前病变患者85例作为研究对象,随机分为对照组41例和研究组44例,对照组给予胃复春片治疗,研究组给予胃康宁颗粒治疗,比较两组治疗前后的病理积分及临床疗效。结果 两组治疗后炎症、萎缩、肠化生积分均明显较治疗前减小,同组治疗前后比较差异有统计学意义（P<0.05）;研究组炎症、肠化生积分明显小于对照组,差异有统计学意义（P<0.05）。研究组临床总有效率为90.91%,明显高于对照组的75.61%,差异有统计学意义（P<0.05）。结论 胃康宁颗粒治疗CAG癌前病变效果显著,尤其对炎症、肠化生等组织学变化有明显的改善作用,临床应用价值高。     

胃复春片联合莫沙必利治疗慢性萎缩性胃炎的临床研究

目的探讨胃复春片联合枸橼酸莫沙必利片治疗慢性萎缩性胃炎的临床疗效。方法选取2015年7月—2017年7月在上海市浦东新区人民医院进行治疗的慢性萎缩性胃炎患者212例为研究对象,入选者根据用药的差别分为对照组和治疗组,每组各106例。对照组口服枸橼酸莫沙必利片,5 mg/次,3次/d。治疗组在对照组治疗基础上口服胃复春片,4片/次,3次/d。两组均连续治疗2周。观察两组的临床疗效,比较两组的临床症状评分和血清学指标。结果治疗后,对照组和治疗组的总有效率分别为83.96%、98.11%,两组比较差异有统计学意义(P0.05)。治疗后,两组胃脘疼痛、胃中嘈杂、嗳气泛酸和口苦口干评分均显著降低,同组治疗前后比较差异有统计学意义(P0.05);且治疗组这些观察指标明显低于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组血清白细胞介素-1β(IL-1β)、人可溶性白介素-2受体(s IL-2R)、胃泌素(GAS)、胃动素(MTL)水平明显降低,胃泌素-17(G-17)水平明显增高(P0.05),同组治疗前后比较差异有统计学意义(P0.05);且治疗组这些观察指标的改善程度明显优于对照组,两组比较差异具有统计学意义(P0.05)。结论胃复春片联合枸橼酸莫沙必利片治疗慢性萎缩性胃炎具有较好的临床疗效,可改善临床症状,降低机体炎症反应,调节胃肠激素水平,具有一定的临床推广应用价值。