遗传性出血性毛细血管扩张症相关性上消化道出血1例报告

正遗传性出血性毛细血管扩张症(Hereditary Hemorrhagic Telangiectasia,HHT)是一种罕见的常染色体显性遗传病,以毛细血管扩张和出血为主要临床表现,发病率1/5000~1/10000[1]。该病基本病理变化表现为毛细血管或小动脉管壁变薄、弹力纤维缺乏、平滑肌缺乏,甚至毛细血管壁和小动脉壁仅由一层内皮细胞组成,导致毛细血管扩张、动静     

以伪膜性肠炎为表现的结肠克罗恩病1例

正1临床资料患者男性,75岁,主因左下腹痛伴腹泻1周、粘液脓血便1 d入院。病史一周,表现为持续性腹痛,伴腹泻,大便不成形,伴少量黏液,10余次/d,同时伴里急后重。入院前1 d开始排黏液脓血便,量少,但无发热。入院前曾在外院予抗生素治疗1次(具体不详)。既往高血压病、脑梗塞、冠心病、冠脉搭桥术后。入院后反复查便常规示:红白细胞     

小建中胶囊联合拉呋替丁治疗胃溃疡的临床研究

目的 探讨小建中胶囊联合拉呋替丁治疗胃溃疡的临床研究.方法 选取2019年6月—2021年6月在天津市北辰医院中医科诊治的126例胃溃疡患者,随机分为对照组和治疗组,每组各63例.对照组餐后口服拉呋替丁片,10 mg/次,2次/d.治疗组在对照组基础上口服小建中胶囊,3粒/次,3次/d.两组患者连续用药7 d.观察两组患者临床疗效,比较治疗前后两组临床症状缓解时间,胃动素(MTL)、胃泌素(GAS)和胆囊收缩素(CCK)水平,血清白细胞介素-6(IL-6)、白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)和C反应蛋白(CRP)水平,及不良反应情况.结果 治疗后,治疗组患者临床总有效率明显高于对照组(98.41％vs 84.13％,P<0.05).治疗后,治疗组患者临床症状缓解时间明显短于对照组(P<0.05).治疗后,两组患者MTL水平明显升高,而GAS和CCK水平明显下降(P<0.05),且治疗组MTL、GAS和CCK水平明显好于对照组(P<0.05).治疗后,两组患者血清IL-6、TNF-α和CRP水平明显降低,而IL-1β水平明显升高(P<0.05),且治疗组患者血清水平明显好于对照组(P<0.05).治疗期间,治疗组药物不良反应发生率明显低于对照组(4.76％vs 11.21％,P<0.05).结论 小建中胶囊联合拉呋替丁治疗胃溃疡疗效显著,可有效缓解临床症状,并能降低炎症反应,加快溃疡面愈合,具有一定临床推广应用价值.     

160例胰腺外分泌功能不足患者的临床观察及其中医分型

目的:探讨胰腺外分泌不足(PEI)患者的临床特点、病因构成及中医分型。方法:回顾性研究C~(13)呼气试验检测证实的PEI病例160例,比较患者性别、年龄、相关病因构成、临床表现、合并疾病;并对每例患者进行中医辨证分型。结果:PEI患者41~60岁为发病高峰期,其中饮酒者占总人数44.2%,吸烟及胆道疾病分别42.8%及20.2%。腹痛为最主要症状,占总人数80%,其次为腹泻,占50%,腹胀占47%,食欲减退占41%,消瘦占33%。患者中合并肠道菌群失调者占总人数66%,慢性胃炎占76%,胆汁淤积占40%;中医辨证分型显示,脾胃虚弱型占总人数93%,并将脾虚量表评分与C~(13)-胰腺外分泌Cum值进行正态性检验。结论:PEI患者致病因子中,饮酒居第一位,吸烟及胆道疾病其次;临床表现腹痛最常见,其次分别为腹泻、腹胀等,有超过半数合并慢性胃炎及肠道菌群失调。对患者进行脾虚症状评分,与C~(13)-胰腺外分泌Cum值呈线性负相关。     

成人先天性胆管扩张症68例临床研究

目的 探讨先天性胆管扩张症的临床特点,了解胆总管扩张的分型及其并发症的发生.方法 回顾性研究2000年1月至2009年12月在天津南开医院确诊的成人先天性胆管扩张病例68例,采用Alonso分类法分型,比较各型的临床表现、合并疾病、病情进展.结果 共收集先天性胆管扩张病例68例.其中Ⅰ型占47.1%,Ⅳa型占35.3%,Ⅳb型17.6%,未见Ⅱ、Ⅲ、Ⅴ型.67.6%患者合并胆囊炎,70.6%患者合并胆道结石,胆管狭窄占26.5%,胆囊萎缩占17.6%,胰腺炎占8.8%,胆汁性肝硬变占5.9%,脂肪肝占11.8%,胆囊息肉占17.6%,脾轻度肿大14.7%,肝囊肿8.8%,肾囊肿2.9%.癌变占23.5%.结论 先天性胆管扩张症Ⅰ型最多见,其次为Ⅳa型,未见Ⅱ、Ⅲ、Ⅴ型.常见并发症为慢性胆囊炎、胆道结石,约1/4发生癌变.

Abstract：

Objective To investigate the clinical characteristics of congenital cholangiectasis,the classification of choledochectasia and its complications. Methods Sixty-eight patients with congenital cholangiectasis admitted to Nankai hospital of Tianjin from Jan. 2000 to Dec. 2009 were retrospectively studied. The patients were classified using Todani method. The clinical presentation,complications and development were compared among patients with different types. Results In 68patients, type Ⅰ , Ⅳa and Ⅳb were accounted for 47. 1%, 35.3%, 17.6%,respectively. Wheraes type Ⅱ , Ⅲ and Ⅴ were not found. The complications included cholecystitis (67.6%) and bile duct stone (70. 6%). Biliary stricture and gallbladder atrophy were accounted for 26.5% and 17.6%,respectively. Pancreatitis was found in 8.8% patients, biliary cirrhosis in 5.9% patients,carcinogenesis in 23.5 % patients, fatty liver steatosis in 11.8 % patients, cholecystic polyps in 17.6 %patients, slight spleen enlargement in 14.7% patients, hepatic cyst in 8. 8% patients, renal cyst in 2.9% patients. Conclusions Tyep Ⅰ is commonly found in congenital cholangiectasis, and the next is the type of Ⅳa, but no type of Ⅱ , Ⅲ or Ⅴ is found. The common complications are cholecystitis and bile duct stone. Carcinogenesis is found in 25 % patients.