双气囊小肠镜在小肠出血中的应用价值

目的:观察双气囊小肠镜在小肠出血中的病变检出率、病因诊断率、耐受性和安全性,并探讨双气囊小肠镜对小肠出血的内镜下治疗.方法:对2006年3月至2009年11月烟台毓璜顶医院消化内科收治的可疑小肠出血102例患者双气囊小肠镜检查,首选进镜方式分为经口或经肛2种.首选方式检查后未发现病灶者,日后改换进镜方式再行检查.对活动性出血病灶行内镜下止血治疗.结果:双气囊小肠镜的病变检出率为94.12%(96/102),病因诊断率为84.31%(86/102),其中35例检查时见病变活动性出血.行内镜下止血治疗,33例止血成功,内镜止血成功率为94.30%(33/35);在耐受性方面,双气囊小肠镜的耐受性依次为:全麻下经肛进镜、全麻下经口进镜、非麻醉经肛进镜、非麻醉经口进镜.所有患者均未发生严重并发症.结论:双气囊小肠镜对小肠出血具有较高的病变检出率和病因诊断率,并且可行内镜下止血治疗,是一项安全、有效的临床诊疗方法.     

双气囊小肠镜在小肠出血中的应用价值

目的:观察双气囊小肠镜在小肠出血中的病变检出率、病因诊断率、耐受性和安全性,并探讨双气囊小肠镜对小肠出血的内镜下治疗情况.方法:对2006年3月至2009年11月烟台毓璜顶医院消化内科收治的可疑小肠出血患者102例行双气囊小肠镜检查,首选进镜方式分为经口或经肛2种,首选方式检查后未发现病灶者,日后改换进镜方式再行检查.对活动性出血病灶行内镜下止血治疗,小肠息内行息肉切除.结果:双气囊小肠镜的病变检出率为94.12%(96/102),病因诊断率为84.31%(86/102).其中35例检查时见病变活动性出血,行内镜下止血治疗,33倒止血成功,内镜止血成功率为94.30%(33/35);在耐受性方面.双气囊小肠镜的耐受性依次为:全麻下经肛进镜、全麻下经口进镜、非麻醉经肛进镜、非麻醉经口进镜.所有患者均未发生严重并发症.结论:双气囊小肠镜对小肠出血具有较高的病变检出率和病因诊断率,并且可行内镜下止血治疗,是一项安全、有效的临床诊疗方法.     

行胶囊内镜检查67 例患者临床结果分析

目的:评价胶囊内镜在小肠疾病中的诊断价值,总结胶囊内镜临床应用策略。方法:回顾性分析上海市第一人民医院胃肠镜室2009年7月-2011年4月67例行胶囊内镜检查患者的检查结果,结合其中32名患者双气囊小肠镜检查结果及手术病理,分析胶囊内镜在小肠疾病的检出率,诊断率和不良事件发生率,总结胶囊内镜检查时的注意事项。结果:1例胶囊内镜操作失败,66例受检者检出率80.3%,诊断率为66.7%,发现病变中血管病变为主要诊断,占62.1%,其次为肠道占位(息肉、肿瘤)为14.6%,克罗恩病占10.9%,所有患者均未出现严重不良事件。结论:胶囊内镜在小肠疾病检查中安全,无创,诊断率较高,临床胶囊内镜检查时建议充分肠道准备,实时监控及结合双气囊小肠镜检查。     

螺旋CT诊断急性肠梗阻的临床价值

目的探讨螺旋CT在急性肠梗阻的诊断中的作用。方法 65例明确诊断的急性肠梗阻病例,回顾性分析其CT表现。结果 65例肠梗阻,其中完全性22例,不完全性43例;绞窄性为4例;肠肿瘤22例,肠扭转16例,腹内外疝5例。CT显示梗阻点位于小肠31例,结肠23例,小肠结肠均有11例;梗阻近段肠腔扩张,而远端肠腔萎陷;扩张的肠腔内可见气液平。靶征、鸟嘴征、缆绳征等具有诊断价值。增强后梗阻段肠壁异常强化。结论螺旋CT可以判断有无急性肠梗阻、梗阻部位、梗阻病因以及是否绞窄,是诊断急性肠梗阻的最重要的方法之一。     

MDCT小肠造影受检者体位的优选

目的评价多层螺旋CT小肠造影最佳体位选择。方法 60例受检者口服对比剂充盈胃和小肠,随机分为2组:35例采取俯卧位,25例采取仰卧位。患者在60分钟内分4次口服总量2000ml 2.5%等渗甘露醇溶液,行256-多层螺旋CT小肠造影(MDCTE),平扫结束后行增强扫描,通过横断面及多平面重建,测量肠腔宽度、肠壁厚度,对各组测量及评价结果进行统计学分析。结果在肠腔宽度、肠壁厚度方面,者二组无明显差异;49例小肠充盈程度为满意-较满意的受检者,俯卧位明显优于仰卧位;肠管分布、显示病变等方面,俯卧位也优于仰卧位。结论小肠MDCT造影行俯卧位检查更有助于小肠疾病的临床诊断。     

吸烟对老年克罗恩病的影响

目的探讨吸烟对老年人克罗恩病的影响。方法回顾性分析1995年1月～2011年8月在我院住院的老年克罗恩病患者87例的临床资料,分为吸烟组及无烟组,比较两组并发症（肠梗阻、肠穿孔）发生率、手术治疗率及复发率。结果吸烟组并发症的发生率、手术治疗率、复发率均明显高于无烟组。结论吸烟可增加老年克罗恩病患者并发症、手术治疗及复发的风险,建议老年克罗恩病患者戒烟是必要的。     

CT仿真结肠镜与腹部增强CT 在炎症性肠病诊断中的对比分析

目的:对比CT仿真结肠镜(CTC)与腹部增强CT在炎症性肠病诊断中的价值,为临床诊疗提供依据。方法:选取2015年1月到2016年1月我院收治的炎症性肠病患者60例为研究组,另选取非炎症性肠病患者60例为对照组,两组均30例患者接受CTC检查,30例患者接受腹部增强CT检查,对影像图片进行盲法阅读,将炎症性肠病的可信度分为5个等级进行评价,对6项影像学特征进行Logistic回归分析。结果:腹部增强CT对炎症性肠病诊断的准确率、敏感性、特异性分别为68.33%,59.09%,71.39%显著低于CTC的93.33%,95.01%、89.63%,比较差异具有统计学意义(P0.05);Logistic回归分析显示:结肠粘膜呈颗粒状、不光滑;肠壁强化并增厚;结肠袋消失对炎症性肠病具有预测作用;肠壁强化及增厚对炎症性肠病诊断敏感性较高,结肠粘膜呈颗粒状、不光滑联合结肠袋消失诊断炎症性肠病的特异性较高。结论:CTC对炎症性肠病具有较高的检出率,肠壁强化及增厚对炎症性肠病诊断的敏感性较高,结肠粘膜呈颗粒状、不光滑联合结肠袋消失诊断炎症性肠病特异性较高。     

16层螺旋CT影像中漩涡征对小肠扭转的诊断价值

目的探讨16层螺旋CT影像中漩涡征对小肠扭转的诊断价值,提高多层螺旋CT诊断小肠扭转的准确率。方法对20例术前CT平扫加增强扫描出现典型漩涡征已明确诊断为肠扭转并经手术证实病例的CT资料进行分析。主要重组方法有多平面重组法(MPR)及最大密度投影法(MIP)、血管三维重建(CTA)。结果 20例肠扭转诊断均正确,主要征象有肠管的"漩涡征"(18例)和血管的"漩涡征"(19例)、"靶环征"(3例)、"鸟喙征"(4例)。结论肠系膜血管的"漩涡征"是诊断肠扭转的较为特异性征象。CTA有助于观察肠系膜血管的表现,可清楚显示小肠扭转的部位和扭转的方向;"靶环征"及肠壁强化减弱、腹水是提示绞窄性梗阻的可靠征象;多层螺旋CT扫描及三维重建对肠扭转的诊断具有重要价值。     

英夫利昔单抗联合酪酸梭菌对克罗恩病炎症及肠屏障的影响

目的观察英夫利昔单抗(IFX)联合酪酸梭菌对克罗恩病(CD)患者炎症及肠屏障功能的影响。方法共纳入44例轻至中度CD患者随机分组,剔除3例,剩余观察组21例及对照组20例。对照组给予IFX治疗(第0,2, 6,14 , 22 和30周,5 mg/kg,注射一次),观察组在此基础上口服酪酸梭菌(40 mg,一天三次),疗程30周。评估治疗后两组患者肠屏障功能、炎症活动指数及肠道菌群的差异。结果治疗后两组克罗恩病炎症活动指数(CDAI)、C反应蛋白(CRP)、血沉(ERP)及血内毒素水平、尿乳果糖/甘露醇(L/M)比值均比治疗前明显下降(P<0.05),且观察组炎症指数显著低于对照组(P<0.05),观察组内毒素及尿L/M比值的下降较对照组明显(P<0.05)。治疗后观察组的菌群Shannon指数和Simpson指数均明显高于对照组(P<0.05)。在门水平,与对照组比较,观察组变形菌门(Proteobacteria)的丰度明显降低,拟杆菌门(Bacteroidetes)丰度明显升高(P<0.05);在属水平,观察组埃希菌属/志贺菌属(Escherichia/Shigella)丰度明显降低(P<0.05),阿利斯特杆菌属(Dialister)、相位弧菌属(Phascolarctobacterium)、粪杆菌属(Faecalibacterium)等丰度升高(P<0.05)。通过LEfSe分析发现观察组特征性菌群为梭菌纲(c_Clostridia)、梭菌目(o_Clostridiales)、瘤胃球菌科(f_Ruminococcaceae)、g_Erysipelotrichaceae incertae sedis、纺锤链杆属(g_Fusicatenibacter)、柯林斯菌(g_Collinsella)、摩根氏菌属(g_Morganella)、红蝽杆菌目(o_Coriobacteriales)、红蝽菌科(f_Coriobacteriaceae)、丹毒丝菌纲(c_Erysipelotrichia)、韦荣球菌科(f_Erysipelotrichaceae)和丹毒丝菌目(o_Erysipelotrichales),对照组为颗粒链菌属(g_Granulicatella)、肉杆菌科(f_Carnobacteriaceae)。结论IFX联合酪酸梭菌可有效改善轻中度CD患者的菌群及肠黏膜屏障功能,并且可降低克罗恩病患者的炎症活动指数。     

改良单层胰肠吻合术在胰十二指肠切除术带蒂大网膜包埋中的应用

目的:探讨带蒂大网膜包埋的改良单层胰肠吻合法重建消化道的胰十二指肠术的临床疗效。方法:回顾性分析2012年9月-2014年12月在我院行胰十二指肠切除术带蒂大网膜包埋改良单层胰肠吻合术的34例患者的临床资料。统计患者的手术时间、胰肠吻合时间、术后出血量、住院时间以及并发症的发生情况。结果:(1)手术平均时间(2.9±1.4)h,胰肠吻合平均时间(14±2.1)min,术后平均出血量(380±60)m L。所有患者经治疗后均治愈出院,住院时间平均(13.0±2.4)天。(2)术后并发症发生率为8例(23.5%),其中胰瘘2例(5.8%),为A级胰瘘;腹部感染3例(8.8%);腹腔出血2例(5.8%);胃排空延迟1例(2.9%)。无手术死亡者,无因严重并发症需要再次手术者。术后病理学诊断胰头癌18例,胆总管下癌8例,壶腹部癌5例,十二指肠乳头癌3例。结论:带蒂大网膜包埋的改良单层胰肠吻合能够减少术后胰瘘、出血、感染等并发症,提高手术成功率,值得临床进一步推广。     

IDO1 and IDO2 Non-Synonymous Gene Variants: Correlation with Crohn's Disease Risk and Clinical Phenotype

BackgroundCrohn''s disease (CD) is a chronic inflammatory disease of the gastrointestinal tract. Genetic polymorphisms can confer CD risk and influence disease phenotype. Indoleamine 2,3 dioxygenase-1 (IDO1) is one of the most over-expressed genes in CD and mediates potent anti-inflammatory effects via tryptophan metabolism along the kynurenine pathway. We aimed to determine whether non-synonymous polymorphisms in IDO1 or IDO2 (a gene paralog) are important either as CD risk alleles or as modifiers of CD phenotype.MethodsUtilizing a prospectively collected database, clinically phenotyped CD patients (n = 734) and non-IBD controls (n = 354) were genotyped for established IDO1 and IDO2 non-synonymous single nucleotide polymorphisms (SNPs) and novel genetic variants elucidated in the literature. Allelic frequencies between CD and non-IBD controls were compared. Genotype-phenotype analysis was conducted. IDO1 enzyme activity was assessed by calculating the serum kynurenine to tryptophan ratio (K/T).ResultsIDO1 SNPs were rare (1.7% non-IBD vs 1.1% CD; p = NS) and not linked to Crohn''s disease diagnosis in this population. IDO1 SNPs did however associate with a severe clinical course, presence of perianal disease, extraintestinal manifestations and a reduced serum K/T ratio during active disease suggesting lower IDO1 function. IDO2 minor allele variants were common and one of them, rs45003083, associated with reduced risk of Crohn''s disease (p = 0.025). No IDO2 SNPs associated with a particular Crohn''s disease clinical phenotype.ConclusionsThis work highlights the functional importance of IDO enzymes in human Crohn''s disease and establishes relative rates of IDO genetic variants in a US population.     

头颈部木村病的CT、MRI影像学表现

目的:探讨头颈部木村病的CT、MRI的影像学表现。方法:对6例经手术或活检病理证实的头颈部木村病的CT及MRI影像学表现进行回顾性分析。结果:本组6例以中青年男性患者多见,病灶位于耳周2例、颊面部1例、颌下区1例,腮腺区1例、头皮下1例,均表现为无痛性肿块。3例CT表现为单侧或双侧、单发或多发等或略高密度软组织肿块,密度均或不均,边缘清楚或局部欠清,伴邻近皮下组织受累;增强扫描病灶表现为不同程度强化。3例MRI表现为对比邻近肌肉信号,病灶在T1WI上为等、稍高信号,在T2WI上为高信号,大部分病灶中等至明显强化。本组6例病变均伴有周围多发淋巴结肿大及实验室检查外周血嗜酸性粒细胞增多,可伴病侧局部皮下脂肪层萎缩。结论:头颈部木村病的CT、MRI影像表现有一定特征性,结合临床病史及实验室检查,可提高木村病的诊断准确率。     

超声引导下动静脉内瘘球囊扩张术疗效及通畅率影响因素分析

摘要 目的：观察超声引导下动静脉内瘘球囊扩张术疗效及通畅率的影响因素。方法：选择2018年6月-2020年12月在安徽医科大学第二附属医院行超声引导下自体动静脉内瘘球囊扩张患者230例作为研究对象,根据患者术前血镁水平将患者为低镁血症组87例、正常及高镁血症组143例。分析患者一般人口学资料、术前实验室检查及超声记录指标,随访预后疗效。结果：手术技术成功率98.12 %,平均随访443±100天。两组术后3个月的血管内径与透析血流量高于术前,正常及高镁血症组高于低镁血症组（P<0.05）。术后3个月正常及高镁血症组的总有效率高于低镁血症组（P<0.05）。正常及高镁血症组术后3个月、6个月与1年的血管通畅率分别为90.9 %、77.62 %、67.83 %,明显高于低镁血症组的80.46 %、64.37 %、51.72 %（P<0.05）。COX多因素分析影响随访血管1年通畅率的因素主要为镁、血管内径、肱动脉血流量、年龄等（P<0.05）。结论：超声引导下动静脉内瘘球囊扩张术对自体动静脉内瘘狭窄或血栓具有很好的效果,低镁血症、血管内径、肱动脉血流量是影响血管通畅率的重要因素。     

Detection of inflammatory bowel disease in adults and children: evaluation of a new isotopic technique.

The distribution of radioactivity after the oral administration of sucralfate labelled with technetium-99m was studied in 33 patients with Crohn''s disease (13 adults, 20 children), 10 with ulcerative colitis (four adults), and 29 controls (23 with upper intestinal disease, four irritable bowel, one hypolactasia, and one malrotation of the gut). Positive scans were obtained in all patients with ulcerative colitis and 29 of 31 with active Crohn''s disease. The scans of two patients with inactive Crohn''s disease were negative. There were two false negative scans in patients with Crohn''s colitis and one false positive scan. Overall, sensitivity was 95% and specificity 97%. Comparison with radiology in 39 patients showed similar distribution of disease in 24 and more extensive disease in 12. The scan was inexpensive, simple to perform, well tolerated, allowed small and large bowel to be visualised simultaneously, and used a lower dose of radiation than barium studies. It may prove useful as a screening test for inflammatory bowel disease and in the serial assessment of disease activity.     

Apport de la TEP/TDM au FDG en cancérologie de l’intestin grêle

This article focuses on the indication for FDG PET/CT in case of tumours of the small intestine, neuro-endocrine tumours excluded. The adenocarcinomas, lymphomas and sarcomas (including stromal tumours or GIST) are studied. There is no specific recommendation for FDG PET/CT in adenocarcinomas, extremely rare in comparison with colorectal adenocarcinomas. However, the utility of FDG PET/CT has been reported in clinical cases for detection and staging, especially in patients with high risk of developing the disease (Crohn's disease being the most important risk factor). The primary lymphomas of the small gut are also very rare, corresponding in all cases to non-Hodgkin lymphomas, for which the role of FDG PET/CT is recognised in follicular lymphoma, large B-cell lymphoma and Burkitt lymphoma. The stromal tumours correspond to the most frequent sarcomas. Stromal tumours in the small intestine are less frequent in the small intestine than in the stomach. The role of FDG PET/CT is well established in stromal tumours for the staging of the disease and for determining the efficacy of therapy with tyrosine kinase inhibitor. FDG PET is especially effective to evaluate the response since the radiologic criteria are difficult to assess, based not on the decrease of size of the lesions but on the decrease of density and of contrast enhance.     

Association of IRGM Gene Mutations with Inflammatory Bowel Disease in the Indian Population

Background

Mutations in the IRGM gene have been associated with Crohn''s disease in several populations but have not been explored in Indian patients with this disease. This study examined the association of IRGM mutations with ulcerative colitis and Crohn''s disease in Indian patients with inflammatory bowel disease.

Methods

The IRGM gene was amplified in four segments and Sanger-sequenced in 101 participants (42 Crohn''s disease, 39 ulcerative colitis, and 20 healthy controls). Ten single nucleotide polymorphisms (SNP) were genotyped in 1200 participants (352 Crohn''s disease, 400 ulcerative colitis, and 448 healthy controls) using Sequenom MassARRAY iPLEX. Disease associations were evaluated for each of the ten SNPs.

Results

Thirty one mutations were identified in the IRGM gene, of which two had not hitherto been reported (150226250- ss947429272 & 150227858- ss947429273). Ten SNPs (6 from the above and 4 from the literature) were evaluated. Significant associations with Crohn''s disease were noted with the T allele of rs1000113 (OR 1.46, 95% CI 1.12–1.90), T allele of rs9637876 (OR 1.25, 95% CI 1.005–1.561) and C allele of rs 13361189 (OR 1.33, 95% CI 1.07–1.669). Two SNPs – rs11747270 and rs180802994 – did not exhibit Hardy-Weinberg equilibrium but were associated with both Crohn''s disease and ulcerative colitis in this population. The remaining SNPs did not show significant associations with either Crohn''s disease or ulcerative colitis.

Conclusions

Association of IRGM gene SNPs with Crohn''s disease is reported for the first time in Indian patients. We also report, for the first time, an association of rs 9637876 in the IRGM gene with Crohn''s disease.     

血清Visfatin、PRDX1水平与克罗恩病患者活动度指标和肠道菌群的相关性分析

摘要 目的：分析血清内脂素（Visfatin）、过氧化物还原蛋白1（PRDX1）水平与克罗恩病（CD）患者活动度指标和肠道菌群的相关性。方法：选取2019年4月~2022年12月期间联勤保障部队第九一〇医院收治的146例CD患者，根据简化克罗恩病疾病活动指数（CDAI）将所有CD患者分为中重度活动组（n=36）、轻度活动组（n=49）、缓解期组（n=61）。对比三组血清Visfatin、PRDX1、C反应蛋白（CRP）水平、血沉（ESR）、肠道菌群数量。采用Pearson相关性分析血清Visfatin、PRDX1与 CDAI、 CRP、ESR和肠道菌群数量的相关性。结果：中重度活动组、轻度活动组的血清Visfatin、PRDX1水平高于缓解期组，且中重度活动组血清Visfatin、PRDX1水平高于轻度活动组（P<0.05）。中重度活动组、轻度活动组的CRP、ESR高于缓解期组，且中重度活动组CRP、ESR高于轻度活动组（P<0.05）。中重度活动组、轻度活动组的肠球菌、大肠杆菌高于缓解期组，且中重度活动组的肠球菌、大肠杆菌高于轻度活动组（P<0.05），中重度活动组、轻度活动组的双歧杆菌、类杆菌低于缓解期组，且中重度活动组的双歧杆菌、类杆菌低于轻度活动组（P<0.05）。Pearson相关性分析显示，血清Visfatin、PRDX1、 CRP水平与 肠球菌、大肠杆菌菌群数量、CDAI、ESR呈正相关，而与双歧杆菌、类杆菌菌群数量呈负相关（P<0.05）。结论：CD患者的血清Visfatin、PRDX1升高，可导致疾病进展，肠道菌群紊乱加重。     

帕罗西汀治疗阿尔兹海默症合并抑郁对血清NE以及5-HT表达的影响

摘要 目的：探讨帕罗西汀治疗阿尔兹海默症合并抑郁对血清去甲肾上腺素(Noradrenaline,NE)以及5-羟色胺(5-hydroxytryptamine,5-HT)表达的影响。方法：2017年9月到2019年8月选择在本院诊治的98例阿兹尔海默症合并抑郁患者,根据治疗方法的不同分为帕罗西汀组50例与多奈哌齐组48例。多奈哌齐组给予多奈哌齐治疗,帕罗西汀组在多奈哌齐组治疗的基础上给予帕罗西汀治疗,两组治疗观察3个月,记录血清NE、5-HT表达变化情况。结果：帕罗西汀组的总有效率是96.0 % (48/50),显著高于多奈哌齐组的79.2 % (38/48) (P<0.05)。两组治疗前的MMSE评分对差异比无统计学意义(P<0.05),两组治疗后的MMSE评分显著高于治疗前(P<0.05),且帕罗西汀组也显著高于多奈哌齐组(P<0.05)。帕罗西汀组治疗期间的便秘、嗜睡、头晕、心动过速、肝功能异常等不良反应发生率为40.0 % (20/50),多奈哌齐组为31.3 % (15/48),两组对比差异无统计学意义(P>0.05)。两组治疗前血清NE、5-HT含量对比差异无统计学意义(P>0.05);两组治疗后的血清NE、5-HT含量显著高于治疗前(P<0.05),且帕罗西汀组也显著高于多奈哌齐组(P<0.05)。结论：帕罗西汀治疗阿尔兹海默症合并抑郁能促进血清NE、5-HT的释放,改善患者的认知功能,提高治疗效果确切,且不会增加不良反应。     

Cook双球囊联合改良B-Lynch缝合术对产后出血的治疗效果观察

目的:探讨Cook双球囊联合改良B-Lynch缝合术对产后出血的治疗效果。方法:选取2015年6月～2018年6月在我院经剖宫产术分娩并发生产后出血的产妇81例进行回顾性分析。根据术中止血方法的不同分为两组,对照组40例采用Cook双球囊进行止血,观察组41例在对照组的基础上应用改良B-Lynch缝合术进行止血。对两组患者的手术相关指标、止血成功率、子宫切除率、术后恢复情况和并发症发生情况进行比较。结果:观察组的术中出血量、术后24 h出血量和输血量显著低于对照组(P0.05),止血时间显著短于对照组(P0.05);观察组患者的止血成功率显著高于对照组(P0.05),子宫切除率和切口恢复时间显著低于对照组(P0.05),两组患者的住院时间和并发症发生率比较无统计学差异(P0.05)。结论:Cook双球囊联合改良B-Lynch缝合术对剖宫产产后出血患者的临床效果显著优于单用Cook双球囊,且安全性较高。