甲状腺功能减退对成年小鼠空间学习记忆及海马神经颗粒素表达的影响

目的观察甲状腺功能减退对成年雄性昆明小鼠空间学习记忆功能及海马内神经颗粒素（Ng）表达的影响。方法将成年雄性昆明小鼠随机分为对照组、丙硫氧嘧啶（PTU）组、PTU＋T4（甲状腺素）组。对照组饮用自来水，PTU和PTU＋T4组饮用含0．1％PTU水。6周后，PTU＋T4组腹腔注射T4（20μg·kg^-1·d^-1），连续2周。Morris水迷宫观察小鼠的空间学习记忆能力，免疫组化分析海马各亚区Ng蛋白的表达。结果PTU组小鼠体质量、血清B、T4显著低于对照组（P〈0．05）；水下平台的潜伏期明显长于对照组（P〈0．05）；Ng蛋白表达水平海马CA1区（6．61±1．25）和齿状回DG区（6．40±0．94）低于对照组（8．91±1．08、8．82±1．23，P〈0．05）。T4替代治疗后，上述各项检查与对照组比较，差异无统计学意义（P〉0．05）。结论甲状腺功能减退可逆性损害成年雄性小鼠空间学习记忆功能，其机制可能与CA1和DG区Ng蛋白表达减少有关。     

鳖甲煎丸对肾间质纤维化模型大鼠肾脏肾上腺髓质素及TGF—β1的影响

目的观察鳖甲煎丸对肾间质纤维化大鼠肾组织中肾上腺髓质素（ADM）、转化生长因子（TGF）-β1表达的影响。方法SD大鼠采用单侧输尿管结扎（UUO）的方法制备肾间质纤维化模型，将其随机分为鳖甲煎丸组、缬沙坦组与模型组，并设假手术组（分离输尿管后缝合腹部）。缬沙坦组、鳖甲煎丸组分别给予缬沙坦10mg·kg^-1·d^-1、鳖甲煎丸1．6g·kg^-1·d^-1灌胃，模型组和假手术组每日给予等容积的蒸馏水。所有动物于术后第14天断头处死，切取左肾，留取肾组织标本。采用免疫组化及RT-PCR方法观察梗阻侧肾脏ADM、TGF—β1在蛋白及基因水平的表达，放射免疫法测定ADM在肾组织中蛋白含量。结果模型组及各治疗组大鼠肾脏ADM蛋白含量、蛋白表达及mRNA的表达较假手术组明显降低，鳖甲煎丸组、缬沙坦组的含量均高于模型组（P〈0．05）；TGF—β1的蛋白及mRNA的表达各治疗组明显低于模型组（P〈0．05），鳖甲煎丸组、缬沙坦组两组之间比较无显著性差异。结论鳖甲煎丸能够上调肾间质纤维化大鼠肾脏ADM的蛋白及mRNA的表达，下调TGF—β1的表达，对肾脏起到保护作用。     

淫羊藿总黄酮促进去卵巢大鼠骨组织Cbfa1表达

目的 观察淫羊藿总黄酮对去卵巢大鼠骨组织核心结合因子α1（Cbfa1）表达的影响。方法 54只雌性SD大鼠分成6组：假手术组、模型组、尼尔雌醇组、淫羊藿总黄酮低、中、高剂量组。对尼尔雌醇组和淫羊藿总黄酮低、中、高剂量组分别给予尼尔雌醇（0．1mg·kg^-1·周^-1）和淫羊藿总黄酮（40，80和160mg·kg^-1·d^-1）治疗12周后，以双能X线骨密度仪测定大鼠全身的骨密度；放射免疫法测定各组大鼠血清中骨钙素及雌二醇的浓度；处死各组大鼠，直接从头盖骨中提取总RNA，采用荧光定量PCR技术检测Cbfa1mRNA的相对表达量。结果 12周后，与假手术组相比，模型组大鼠的全身骨密度和血清雌二醇水平明显降低（均P〈0．05）。淫羊藿总黄酮可以增加去卵巢大鼠的全身骨密度和血清骨钙素含量（均P〈0．05），但不增加血清雌二醇的水平（P〉0．05）。12周后，与假手术组相比，模型组大鼠骨组织中Cbfa1mRNA表达明显降低（P〈0．01）。淫羊藿总黄酮可以促进骨组织中Cbfa1mRNA的表达，以淫羊藿总黄酮高剂量最为显著（P〈0．01）。结论 淫羊藿总黄酮对去卵巢大鼠骨质疏松症具有防治作用，其部分机制可能为淫羊藿总黄酮促进骨组织Cbfa1表达，从而调节骨形成。     

染料木素和17β-雌二醇对去卵巢大鼠松质骨微结构的作用

目的 观察染料木素和小剂量17β-雌二醇对去卵巢（OVX）大鼠松质骨微结构的作用。方法90只7月龄SD大鼠被随机分为基线组、OVX组、假手术（SHAM）组、小剂量17β-雌二醇干预组（10μg·kg^-1·d^-1，EST组）和染料木素干预组（5mg·kg^-1·d^-1，GEN组），分别在基线时、手术后3周和15周处死。分离左胫骨行显微CT扫描，分析距生长板远端1．6mm、层厚0．5mm骨组织的感兴趣区域松质骨结构。结果去卵巢后第3周，GEN组的组织骨密度和骨小梁厚度明显大于OVX组和EST组（均P〈0．05）；EST组的骨小梁数目显著多于GEN组（P〈0．05），骨小梁间隔则明显小于GEN组（P〈0．05）；OVX组、GEN组和EST组3组的体积骨密度和骨体积分数差异无统计学意义，但均明显小于SHAM组（均P〈0．05）。第15周时，OVX组、GEN组和EST组3组间的体积骨密度、骨体积分数、骨小梁数目和联接密度差异无统计学意义，但均小于SHAM组（均P〈0．05），结构模型指数和骨小梁间隔则大于SHAM组（均P〈0．05）。纵向观察发现，OVX组、GEN组和EST组3组的体积骨密度、骨体积分数、骨表面积分数和联接密度随时间出现下降，而组织骨密度、结构模型指数、骨小梁厚度和骨小梁间隔等参数随时间增加（均P〈0．05），其中OVX组和EST组组织骨密度和骨小梁厚度在第3周和第15周之间出现明显增长（均P〈0．05），GEN组组织骨密度增长主要发生在去卵巢后的第3周内，骨小梁厚度则在3周和15周均有增长（均P〈0．05）。SHAM组骨小梁厚度和骨小梁间隔亦随时间增加，骨表面积分数和联接密度则下降，其他参数随时间无明显变化。结论 染料木素能促进松质骨矿物质沉积和骨小梁增厚，17β-雌二醇则对抗雌激素缺乏引起的骨小梁数目减少和骨小梁间隔增大。     

β受体阻滞剂对兔心肌梗死后酪氨酸羟化酶mRNA表达及心脏电生理的影响

目的通过美托洛尔对兔心肌梗死后心肌酪氨酸羟化酶（tyrosine hydroxylase，TH）mRNA表达水平的影响来探讨β受体阻滞剂改变心脏电生理的可能机制。方法30只新西兰兔结扎冠状动脉制作兔心肌梗死模型后随机分成2组，每组15只，美托洛尔组（Metoprolol组）给予倍他乐克（10mg·kg^-1·d^-1），而对照组（MI组）给予NS（5ml·kg^-1·d^1）灌胃。再选取12只兔开胸冠状动脉穿线不结扎作为假手术组（Sham组）。8周后所有成活的兔均进行电生理试验，并采用RT—PCR检测心肌的TH mRNA表达水平。结果Sham组室性心律失常诱发率为16．7％，而MI组室性心律失常的诱发率上升至58.3％，经过美托洛尔治疗后其诱发率又降至8．3％。MI组梗死灶周及非梗死左室游离壁TH mRNA水平分别为（0．848±0．064，0．863±0．062），明显高于Sham组对应部位（0．672±0．051，0．653±0．054）；经过8周美托洛尔治疗后TH mRNA相对表达水平分别降至（0．715±0．032，0．692±0．049）。结论美托洛尔治疗可降低心肌梗死后TH mRNA表达水平，可能改善了交感神经重构，减少去甲肾上腺素的合成，改善心脏电生理异质性，降低室性心律失常发生率。     

脂肪分存的顺序及其与胰岛素抵抗的关系

目的探讨高脂饲养SD大鼠脂肪分存的顺序及其与胰岛素抵抗的关系。方法将8周龄雄性SD大鼠随机分为2组：正常饲养组（NC，n=40）、高脂饲养组（HF，n=40）。在不同周龄测定血清、肝脏、肌肉组织中甘油三酯（TG）含量；进行正常血糖高胰岛素钳夹试验评估胰岛素的敏感性；并用定量PCR方法分析肝脏和肌肉中脂代谢调控基因mRNA表达的变化。结果（1）与NC组比较，高脂饲养4周、8周时血TG无明显变化，12周时明显增高[0．52（0．15-1．00）mmol／L vs 0．31（0．09-0．53）mmol／L，P〈0．01]，持续至20周。（2）HF组肝脏TG含量从高脂饲养4周始便明显增高[（34．38±11．12）mg／g vs（1．65±0．37）mg／g，P〈0．01]，一直持续至20周；肌肉TG在高脂饲养4、8、12周均无明显变化，高脂饲养20周时明显增高[（32．24±7．24）mg／g vs （2．77±0．76）mg／g，P〈0．01]。（3）正常血糖高胰岛素钳夹试验表明，HF组高脂饲养4周始葡萄糖输注率（GIR）呈下降趋势，高脂饲养8周时明显下降[（21．81±7．20）mg·kg^-1·min^-1 vs （8．44±1．77）mg·kg^-1·min^-1，P〈0．01]，一直持续至20周。（4）脂代谢调控基因的检测表明，高脂饲养4周时肝脏中合成基因乙酰辅酶A羧化酶（ACC1）的表达无明显增高而氧化基因肉毒碱酰基转移酶（CPT-1）的表达下降20．3％（P〈0．05），肌肉组织ACC2、CPT-1的表达均无明显变化（P〉0．05）；高脂饲养8周时肝脏中ACC1的表达增高20．6％、CPT-1的表达下降27．1％（P〈0．05），肌肉组织ACC2的表达增高18．6％、CPT-1的表达下降19．2％（P〈0．05）；高脂饲养20周时肝脏ACC1表达增高48．3％（P〈0．05）、CPT-1表达无明显变化（P〉0．05），肌肉ACC2表达增高101．1％、CPT-1的表达下降71％（P〈0．05）。结论高脂饲养SD大鼠脂肪分存过程中，肝脏早于肌肉，肝脏TG含量增加可能是胰岛素抵抗的早期标志之一。脂代谢调控基因的表达可能在其中起了重要作用。     

烟酸对高脂血症兔脂肪细胞胆固醇流出和肝X受体表达的影响

目的探讨烟酸对高脂血症兔脂肪细胞胆固醇流出和肝X受体（LXR）α、过氧化物酶体增殖物激活受体（PPAR）γmRNA表达的影响。方法选取12只健康雄性新西兰兔给予高胆固醇饲料培养8周,建立高胆固醇兔模型后,随机分为高胆固醇组（继续饲以高胆固醇饲料6周,n=6）,烟酸治疗组（在饲以高胆固醇饲料的基础上给予烟酸缓释剂0．2g·kg^-1·d^-1,共6周,n=6）,另选普通饮食14周雄性新西兰兔（n=6）作为对照组。实验结束后,取皮下脂肪行脂肪细胞培养,用液体闪烁计数器检测细胞内胆固醇流出,运用逆转录聚合酶链反应检测LXRα mRNA的表达。此外,在体外观察不同浓度的烟酸缓释剂（0．25、0．5、1、2mmol／L）对健康雄性新西兰兔脂肪细胞LXRα、PPARγ mRNA的影响。结果高胆固醇组脂肪细胞胆固醇流出率（5．94±1．26）％明显低于正常对照组（12．68±1．31）％,烟酸治疗组脂肪细胞胆固醇流出升高明显（16．39±3．32）％,3组间比较差异有统计学意义。逆转录聚合酶链反应显示烟酸治疗组较高胆固醇组LXRα mRNA表达高,与胆固醇流出率呈正相关。体外实验亦显示,烟酸缓释剂呈浓度依赖性升高脂肪细胞LXRα、PPARγ mRNA的表达。结论烟酸增加高脂血症兔脂肪细胞LXRα mRNA的表达及细胞内胆固醇流出。     

新生大鼠肝细胞脾内移植联合鼠肝再生增强因子治疗大鼠急性肝衰竭的疗效与免疫学机制

目的探讨新生大鼠肝细胞脾内移植联合重组鼠肝再生增强因子（rALR）治疗大鼠急性肝衰竭的疗效与免疫学机制。方法采用D-氨基半乳糖（1．2 g／kg）诱导并建立大鼠急性肝衰竭模型,36 h后随机分为6组：Ⅰ组：模型对照组;Ⅱ组：经脾脏注射等渗盐水1 ml,腹腔注射等渗盐水1 ml／d;Ⅲ组：经脾脏注射rALR 1 ml（50μg／kg）,腹腔注射rALR 1 ml（50μg·kg^-1·d^-1）;Ⅳ：经脾脏移植2×10^7同种异体新生大鼠肝细胞,腹腔注射等渗盐水1 ml／d;Ⅴ组：经脾脏移植2×10^7同种异体新生大鼠肝细胞,腹腔注射rALR 1 ml（50μg·kg^-1·d^-1）;Ⅵ组：经脾脏移植2×10^7同种异体新生大鼠肝细胞,腹腔注射环孢菌素1 ml（10 mg·kg^-1·d^-1）。观察大鼠每天存活率;术后第1、5天及2周处死大鼠以获取肝、脾组织,观察脾内移植肝细胞的组织学改变;在术前、术后第1、2、5、12天采集静脉血,采用放射免疫法测定血清IL-1β和TNFα的浓度。结果Ⅰ、Ⅱ和Ⅲ组大鼠存活时间差异无统计学意义,Ⅳ组有部分大鼠长期存活,2周存活率为33％,Ⅴ组大鼠2周存活率显著高于Ⅳ组,而与Ⅵ组大鼠2周存活率比较差异无统计学意义。Ⅳ、Ⅵ组脾内移植的肝细胞可存活5～7 d,Ⅴ组脾内移植肝细胞可存活至2周以上。术后第1天,Ⅳ组血清IL-1β水平显著高于Ⅴ组和Ⅵ组（P〈0．05）;术后第5天,Ⅳ组血清IL-1β水平仅与Ⅵ组差异有统计学意义（P〈0．05）。术后第1天,TNFα的浓度在Ⅱ组显著高于Ⅳ、Ⅴ、Ⅵ组（P〈0．05）。结论新生大鼠肝细胞脾内移植与rALR联合治疗大鼠急性肝衰竭有一定疗效,可提高D-氨基半乳糖诱导肝衰竭大鼠的存活率;移植肝细胞在脾脏可存活2周以上,其机制可能与促进肝细胞再生、预防移植肝细胞凋亡及轻微抑制细胞免疫有关。     

生长激素在老年心血管手术围术期的应用

目的研究在老年心血管手术围术期应用重组人生长激素（rhGH）对患者术后恢复的影响。方法老年患者40例，治疗组及对照组各20例。治疗组从手术后第1天开始皮下注射rhGH 0．01 U·kg^-1·d^-1（注射时用生理盐水1ml稀释），共7d。对照组同法皮下注射安慰剂（生理盐水1ml）。所有病人于术前、术后第1、3、5、8天抽取静脉血，检测白蛋白、前白蛋白（PA）、血糖、血清胰岛样生长因子（IGF）-1。所有病人分别于术前和第8天对疲劳计分（Christensen计分）进行评估。术后第10天，测定6min行走距离，并进行超声心动图心功能检测。结果术前及术后第1、3天两组患者血浆白蛋白、PA水平无明显差异（P〉0．05）。术后第5天治疗组血浆PA明显高于对照组（P〈0．05）。术后第8天，治疗组白蛋白明显高于对照组（P〈0．05）；血浆PA水平明显高于对照组（P〈0．01）；血糖在各观测时间两组差异不显著（P〉0．05）；IGF-1在术后第3天起治疗组显著高于对照组，至术后第8天仍然差异显著（P〈0．01）。术后第8天治疗组病人疲劳程度明显轻于对照组（6．0±1．6 vs 8．2±1．8，P〈0．05）。术前及术后第10天心脏超声检测心功能，两组比较无明显差异。6min行走距离，治疗组明显高于对照组[（164±75）m vs （65±34）m，P〈0．05]。治疗组无过敏反应及其他严重不适反应。结论与对照组相比，心脏术后应用rhGH的治疗组术后营养状态明显改善，术后疲劳明显减轻，体力增强，未发现明显严重不良反应；rhGH用于促进心脏术后患者的恢复，安全有效。     

男性慢性心力衰竭患者雄激素水平与心功能和运动耐量的关系

目的探讨男性慢性心衰患者雄激素水平与心功能和运动耐量的关系。方法用酶联免疫吸附方法测定90例男性慢性心衰患者（心衰组）和80例健康对照组血清总睾酮（TT）、游离睾酮（FT）水平，心衰患者心功能按NYHA心功能分级，运动耐量以6min步行试验评价。结果与对照组相比，心衰组患者TT、FT明显降低（（9．63±3．22 vs 20．45±8．92，P〈0．01；0．054±0．036 vs 0．422±0．328，P〈0．01）；心衰组TT、FT水平与左室射血分数（LVEF）呈显著正相关（r=0．270，P〈0．01；r=0．257，P〈0．05）；心衰组TT、FT水平与6min步行试验距离成正相关（r=0．247，P〈0．05；r=0．330，P〈0.01）。结论男性慢性心衰患者雄激素水平降低，其雄激素水平的测定对心脏功能评估具有重要临床意义。     

A Call to Action to Enhance Filovirus Disease Outbreak Preparedness and Response

The frequency and magnitude of recognized and declared filovirus-disease outbreaks have increased in recent years, while pathogenic filoviruses are potentially ubiquitous throughout sub-Saharan Africa. Meanwhile, the efficiency and effectiveness of filovirus-disease outbreak preparedness and response efforts are currently limited by inherent challenges and persistent shortcomings. This paper delineates some of these challenges and shortcomings and provides a proposal for enhancing future filovirus-disease outbreak preparedness and response. The proposal serves as a call for prompt action by the organizations that comprise filovirus-disease outbreak response teams, namely, Ministries of Health of outbreak-prone countries, the World Health Organization, Médecins Sans Frontières, the Centers for Disease Control and Prevention—Atlanta, and others.     

Control of intraabdominal hemorrhage and shock: a comparison of fluid resuscitation, MAST, and balloon occlusion

Our study examined the efficacy of four treatment modalities in controlling hemorrhage and achieving hemodynamic stabilization in hemorrhagic shock: intravenous fluid replacement (IV); military antishock trousers used concomitantly with fluids (MAST); balloon occlusion at the level of the diaphragm with concomitant fluid replacement (balloon); and a combination of MAST inflation, balloon occlusion, and fluid resuscitation (MAST and balloon). Twenty-eight mongrel dogs were anesthetized, and the spleen was exposed and completely crushed. The abdomen was closed, and treatment was initiated and continued for four hours or until the dog died. For all conditions the hematocrit dropped during the course of the experiment; balloon occlusion was effective at slowing this drop (P less than .0001), but MAST had no statistically significant effect. Animals with balloons bled more slowly into the abdominal cavity than did animals in the other two groups (P less than .0001). MAST also were effective at slowing the bleeding (P less than .05). Of the balloon and the MAST and balloon dogs, all except one survived the entire four hours; this difference between balloon and nonballoon dogs is significant (P = .002). MAST did not have a statistically significant effect on survival. Perfusion pressure (PP) declined during the course of the experiment, and the balloon was effective at slowing this decline (P less than .0001); none of the other comparisons was statistically significant.     

Interplay between interferon-mediated innate immunity and porcine reproductive and respiratory syndrome virus

Innate immunity is the first line of defense against viral infection, and in turn, viruses have evolved to evade host immune surveillance. As a result, viruses may persist in host and develop chronic infections. Type I interferons (IFN-α/β) are among the most potent antiviral cytokines triggered by viral infections. Porcine reproductive and respiratory syndrome (PRRS) is a disease of pigs that is characterized by negligible induction of type I IFNs and viral persistence for an extended period. For IFN production, RIG-I/MDA5 and JAK-STAT pathways are two major signaling pathways, and recent studies indicate that PRRS virus is armed to modulate type I IFN responses during infection. This review describes the viral strategies for modulation of type I IFN responses. At least three non-structural proteins (Nsp1, Nsp2, and Nsp11) and a structural protein (N nucleocapsid protein) have been identified and characterized to play roles in the IFN suppression and NF-κB pathways. Nsp's are early proteins while N is a late protein, suggesting that additional signaling pathways may be involved in addition to the IFN pathway. The understanding of molecular bases for virus-mediated modulation of host innate immune signaling will help us design new generation vaccines and control PRRS.     

Disease Pandemics and Major Epidemics Arising From New Encounters between Indigenous Viruses and Introduced Crops

Virus disease pandemics and epidemics that occur in the world’s staple food crops pose a major threat to global food security, especially in developing countries with tropical or subtropical climates. Moreover, this threat is escalating rapidly due to increasing difficulties in controlling virus diseases as climate change accelerates and the need to feed the burgeoning global population escalates. One of the main causes of these pandemics and epidemics is the introduction to a new continent of food crops domesticated elsewhere, and their subsequent invasion by damaging virus diseases they never encountered before. This review focusses on providing historical and up-to-date information about pandemics and major epidemics initiated by spillover of indigenous viruses from infected alternative hosts into introduced crops. This spillover requires new encounters at the managed and natural vegetation interface. The principal virus disease pandemic examples described are two (cassava mosaic, cassava brown streak) that threaten food security in sub-Saharan Africa (SSA), and one (tomato yellow leaf curl) doing so globally. A further example describes a virus disease pandemic threatening a major plantation crop producing a vital food export for West Africa (cacao swollen shoot). Also described are two examples of major virus disease epidemics that threaten SSA’s food security (rice yellow mottle, groundnut rosette). In addition, brief accounts are provided of two major maize virus disease epidemics (maize streak in SSA, maize rough dwarf in Mediterranean and Middle Eastern regions), a major rice disease epidemic (rice hoja blanca in the Americas), and damaging tomato tospovirus and begomovirus disease epidemics of tomato that impair food security in different world regions. For each pandemic or major epidemic, the factors involved in driving its initial emergence, and its subsequent increase in importance and geographical distribution, are explained. Finally, clarification is provided over what needs to be done globally to achieve effective management of severe virus disease pandemics and epidemics initiated by spillover events.     

岳阳市城区小学生血吸虫病防治健康教育现状调查

目的 调查湖南省岳阳市城区小学生血吸虫病防治知识、行为现状及健康教育需求情况,为制定科学有效的小学生血吸虫病健康教育方案提供参考依据。方法 采用分层整群抽样方法,抽取岳阳市城区洞庭湖湖畔学校和中心城区学校各2所,每所再从五、六年级分别抽取2个班的学生,通过调查问卷了解小学生血吸虫病相关知识、预防行为及健康教育需求,并进行统计分析。结果 共调查湖畔小学353人、中心城区小学363人,两组学校小学生年龄、性别、年级构成差异无统计学意义（t=-0.494,χ²_性别=1.615,χ²_年级=2.152;P均>0.05）。学生血吸虫病防治知识总知晓率为42.60%（305/716）,其中,湖畔学校小学生血防知识知晓率（52.97%）高于中心城区（32.51%）,差异有统计学意义（χ²=30.661,P<0.05）;学生行为正确率为76.68%（549/716）,血防知识知晓组行为正确率（81.31%）高于不知晓组（71.24%）,差异有统计学意义（χ²=6.384,P<0.05）。学生血防知识主要来源于老师（47.49%）;91.90%的学生愿意了解更多的血防知识,最喜欢的血防知识学习方式是参加课外活动（50.42%）。结论 岳阳市城区小学生的血防知识知晓率及行为正确率偏低,对血吸虫病防治健康教育需求较高。建议针对学生开展形式多样的血防健康教育,以增强学生的血吸虫病防护意识,提高自我防护能力。     

Barrett's Esophagus: Where Do We Stand?

Barrett''s esophagus (BE) is a precursor for esophageal adenocarcinoma, which has an increased incidence rate over the last few decades. Its importance stems from the poor five-year survival of esophageal adenocarcinoma and current data that suggest a survival benefit when surveillance programs are implemented. In this review, we will cover the pathophysiology and natural history of BE and the different endoscopic findings. The prevalence of BE in different geographic areas and the incidence of high-grade dysplasia and adenocarcinoma in this patient population is reviewed. Recent recommendation for screening and surveillance of BE has been covered in this review as well as the efficacy of nonconventional imaging modalities and endoscopic ablation therapies.     

Routine diagnosis of intestinal tuberculosis and Crohn’s disease in Southern India

AIM:To investigate whether routinely measured clinical variables could aid in differentiating intestinal tuberculosis(ITB)from Crohn’s disease(CD).METHODS:ITB and CD patients were prospectively included at four South Indian medical centres from October 2009 to July 2012.Routine investigations included case history,physical examination,blood biochemistry,ileocolonoscopy and histopathological examination of biopsies.Patients were followed-up after 2 and 6 mo of treatment.The diagnosis of ITB or CD was re-evaluated after 2 mo of antituberculous chemotherapy or immune suppressive therapy respectively,based on improvement in signs,symptoms and laboratory variables.This study was considered to be an exploratory analysis.Clinical,endoscopic and histopathological features recorded at the time of inclusion were subject to univariate analyses.Disease variables with sufficient number of recordings and P<0.05 were entered into logistic regression models,adjusted for known confounders.Finally,we calculated the odds ratios with respective confidence intervals for variables associated with either ITB or CD.RESULTS:This study included 38 ITB and 37 CD patients.Overall,ITB patients had the lowest body mass index(19.6 vs 22.7,P=0.01)and more commonly reported weight loss(73%vs 38%,P<0.01),watery diarrhoea(64%vs 33%,P=0.01)and rural domicile(58%vs 35%,P<0.05).Endoscopy typically showed mucosal nodularity(17/31 vs 2/37,P<0.01)and histopathology more frequently showed granulomas(10/30vs 2/35,P<0.01).The CD patients more frequently reported malaise(87%vs 64%,P=0.03),nausea(84%vs 56%,P=0.01),pain in the right lower abdominal quadrant on examination(90%vs 54%,P<0.01)and urban domicile(65%vs 42%,P<0.05).In CD,endoscopy typically showed involvement of multiple intestinal segments(27/37 vs 9/31,P<0.01).Using logistic regression analysis we found weight loss and nodularity of the mucosa were independently associated with ITB,with adjusted odds ratios of 8.6(95%CI:2.1-35.6)and 18.9(95%CI:3.5-102.8)respectively.Right lower abdominal quadrant pain on examination and involvement of≥3 intestinal segments were independently associated with CD with adjusted odds ratios of 10.1(95%CI:2.0-51.3)and 5.9(95%CI:1.7-20.6),respectively.CONCLUSION:Weight loss and mucosal nodularity were associated with ITB.Abdominal pain and excessive intestinal involvement were associated with CD.ITB and CD were equally common.