荆花胃康胶丸对功能性消化不良疗效的观察

背景:功能性消化不良(FD)的发病机制还不十分清楚,目前尚缺乏令人满意的治疗方法。目的:评价荆花胃康胶丸对FD的治疗效果。方法:采用开放、随机、对照试验,60例FD患者随机分为两组,每组30例,分别予口服荆花胃康胶丸160mg,3次/d和多潘立酮10mg,3次/d。根据治疗前后胃排空试验结果和消化不良症状(上腹不适、餐后饱胀、早饱、上腹痛、烧心、反酸、嗳气、食欲不振)积分的比较,评估荆花胃康胶丸的疗效和安全性。结果:治疗后两组患者餐后2h胃排空率均有所提高,治疗前后胃排空率差异有统计学意义(荆花胃康胶丸组,P<0.05;多潘立酮组,P<0.01)。两组比较,多潘立酮组治疗后胃排空率较荆花胃康胶丸组显著提高,差异有统计学意义(P<0.05)。治疗后两组患者的症状总积分均较治疗前显著下降(P<0.01)。通过两组差值的比较,荆花胃康胶丸组餐后饱胀、上腹痛、嗳气的改善程度尤其优于多潘立酮组(P<0.01)。结论:荆花胃康胶丸治疗FD具有一定的疗效,在改善消化不良症状方面优于多潘立酮,并具有良好的安全性。     

荆花胃康胶丸联合三联疗法治疗老年幽门螺杆菌感染慢性胃炎的疗效

目的了解荆花胃康胶丸联合三联疗法治疗老年幽门螺杆菌(Hp)感染慢性胃炎的临床效果。方法选取2010年2月至2013年1月160例老年慢性胃炎患者,采用随机数字表分为对照组和荆花胃康胶丸治疗组,每组80例;对照组采用兰索拉唑、阿莫西林与克拉霉素联合治疗,荆花胃康胶丸治疗组在对照组的治疗基础上加用荆花胃康胶丸,治疗4 w后观察两组患者Hp的根除率、临床症状缓解情况及不良反应的发生情况。结果对照组患者中59例(73.8%)Hp得到根除,67例(83.8%)慢性胃炎症状得到缓解,7例患者在治疗期间发生不良反应;荆花胃康胶丸治疗组77例(96.3%)Hp得到根除,71例(88.8%)慢性胃炎症状得到缓解,3例患者治疗期间出现不良反应,荆花胃康胶丸治疗组的Hp根除率与临床症状缓解率高于对照组(P<0.05),不良反应发生率低于对照组(P<0.05)。结论荆花胃康胶丸联合三联疗法能够提高Hp根除率和降低不良反应发生率,对老年Hp感染慢性胃炎的临床效果显著。     

荆花胃康胶丸联合PPI三联疗法治疗Hp相关性慢性胃炎52例临床观察

[目的]观察荆花胃康胶丸联合PPI三联疗法对幽门螺杆菌(Hp)相关性慢性胃炎的治疗效果。[方法]将104例患者随机分为治疗组和对照组,治疗组给予兰索拉唑30mg bid+阿莫西林1 000mg bid+克拉霉素500mg bid+荆花胃康胶丸160mg tid,治疗10d后,再单独服用荆花胃康胶丸2周;对照组给予兰索拉唑30mg bid+阿莫西林1 000mg bid+克拉霉素500mg bid+枸橼酸铋钾220mg bid,治疗10d。比较2组治疗后的症状改善情况,以及停药28d后Hp的根除效果。[结果]在Hp根除方面,2组的根除率分别为84.4%、88.9%,差异无统计学意义;在症状改善方面,2组较前均有明显改善(P<0.05),其中荆花胃康胶丸组在改善上腹胀、嗳气、上腹痛方面优于含铋剂四联组(P<0.05)。[结论]2组根除Hp效果相当,但荆花胃康胶丸组在改善症状方面的效果更为明显。     

荆花胃康胶丸四联疗法治疗慢性胃炎及根除幽门螺杆菌的疗效观察

目的:评价荆花胃康胶丸、奥美拉唑、克拉霉素、替硝唑四联疗法对慢性胃炎及根除幽门螺杆菌(HP)的疗效。方法:将120例慢性胃肠炎及HP阳性的患者随机分为2组:观察组60例,口服荆花胃康胶丸、奥美拉唑、克拉霉素、替硝唑;对照组60例,给予奥美拉唑、克拉霉素、替硝唑,15 d为1个疗程。比较2组Hp清除率、慢性胃炎愈合率、研究对象对治疗的满意度。结果:观察组Hp清除率、慢性胃炎治愈率、对治疗满意度均明显优于对照组(均P0.05)。结论:采用荆花胃康胶丸、奥美拉唑、克拉霉素、替硝唑四联疗法治疗慢性胃炎及根除HP效果可靠,患者依从性及满意度高,值得推广和进一步探讨。     

荆花胃康胶丸治疗HP相关性慢性胃炎的临床、病理研究

目的 观察荆花胃康胶丸治疗HP相关性胃炎的临床疗效。方法选取HP相关性慢性胃炎120例，随机分成荆花胃康胶丸治疗组和雷尼替丁胶囊对照组，对两组的临床症状、组织学改善情况，HP转阴率进行比较。结果荆花胃康胶丸治疗HP相关性慢性胃炎有较好的疗效。患者自觉症状减轻，组织学改善明显，部分患者HP转阴。结论荆花胃康胶丸是治疗HP相关性慢性胃炎的有效药物。     

荆花胃康胶丸联合盐酸伊托必利分散片治疗功能性消化不良的临床效果评价

[目的]探讨荆花胃康胶丸联合盐酸伊托比利分散片治疗功能性消化不良的临床效果分析。[方法]选取2011年12月～2013年12月我院收治的功能性消化不良患者120例,随机分为实验组和对照组,各60例。实验组采用荆花胃康胶丸联合盐酸依托必利分散片治疗,对照组采用单纯荆花胃康胶丸进行治疗。[结果]实验组治疗效果明显高于对照组30.0%,差异有统计学意义（P〈0.05）。[结论]采用荆花胃康胶丸联合盐酸依托必利分散片治疗功能性消化不良临床效果较好,患者能够在短时间内改善消化不良的症状,且具有良好的安全性,值得在临床上大力推广。     

荆花胃康胶丸联合埃索美拉唑治疗消化性溃疡50例

[目的]观察荆花胃康胶丸联合埃索美拉唑治疗消化性溃疡（PU）的疗效。[方法]采用开放、随机、对照试验,将经胃镜检查确诊的97例PU患者随机分为2组,治疗组50例,口服荆花胃康胶丸160mg／次,3次／d,埃索美拉唑40mg,1次／d;对照组47例,口服埃索美拉唑40mg,1次／d。治疗期间每周随访1次,记录症状转归情况。疗程结束后,胃镜复查评估溃疡愈合情况。[结果]各项临床症状的改善和疼痛消失情况2组相比差异无统计学意义（P〉0．05）。PU的愈合率和总有效率治疗组分别为88．00％和98．00％,对照组为57．45％和93．62％,2组比较差异有统计学意义（P〈0．05）。2组在用药期间,不良反应少,均有良好的耐受性。[结论]荆花胃康胶丸联合埃索美拉唑治疗PU可提高溃疡的愈合率和总有效率,缩短溃疡的愈合时间。     

孤束核、脊髓损毁后艾灸预处理对急性胃黏膜损伤大鼠PGE2与EGF含量的影响

目的:损毁大鼠中枢神经通路中的孤束核和脊髓,观察艾灸预处理对胃黏膜内源性保护物质前列腺素E2(prostaglandin E2,PGE2)和表皮生长因子(epidermal growth factor,EGF)含量的影响,进而探讨艾灸启动内源性保护信息与中枢神经通路的关系.方法:50只SD大鼠随机分5组,即A:空白对照组;B:模型对照组;C:温和灸+模型组;D:温和灸+模型组+孤束核损毁组;E:温和灸+模型组+脊髓损毁组.预先按要求对D、E组大鼠分别实施孤束核、脊髓的损毁手术,再对相应组别进行艾灸处理,最后用无水酒精灌胃造成急性胃黏膜损伤模型.运用酶联免疫吸附法(enzyme linked immunosorbent assay,ELISA)法检测胃黏膜组织中PGE2和EGF的含量.结果:艾灸预处理有上调胃黏膜中PGE2、E G F含量的作用(338.82g/L±19.87g/Lvs279.52g/L±16.53g/L,P<0.01;4037.12g/L±300.20g/L vs2923.73g/L±251.23g/L,P<0.05),孤束核和脊髓被损毁的2组大鼠胃黏膜PGE2和EGF的含量明显低于神经通路未损伤的温和灸组(298.65g/L±12.89g/L,317.56g/L±16.60g/Lvs338.82g/L±19.87g/L;3176.21g/L±242.35g/L,3337.43g/L±249.86g/L vs4037.12g/L±300.20g/L,均P<0.01),且孤束核损毁的大鼠胃黏膜中PGE2的含量较脊髓损毁的低(P<0.05).结论:损毁大鼠中枢神经通路中的孤束核和脊髓对艾灸预处理提高胃黏膜组织中PGE2、EGF含量有影响,提示孤束核和脊髓均参与了艾灸保护胃黏膜信号的传导.其中,艾灸诱导胃黏膜PGE2的产生可能主要受控于孤束核,而其对胃黏膜EGF表达调控则与孤束核和脊髓均有关.     

胃康舒宁对大鼠慢性萎缩性胃炎癌前病变癌相关细胞因子的影响

目的: 探讨胃康舒宁对胃癌前病变(PLGC)大鼠血清多种癌相关细胞因子的影响.方法: 将60只Wistar大鼠随机分为4组: 正常组、模型组、维酶素组和胃康舒宁组. 采用饮用N-甲基- N-亚硝基- N-硝基胍(MNNG)建立大鼠胃癌前病变模型, 用维酶素和胃康舒宁治疗12 wk后, 用放射免疫法检测各组大鼠血清中表皮生长因子(EGF)、转化生长因子-α(TGF-α)、生长激素(GH)、肿瘤坏死因子-α(TNF-α)、胰岛素样生长因子-Ⅱ(IGF-Ⅱ)、碱性成纤维细胞生长因子(bFGF)的水平.结果: 与模型组大鼠相比, 胃康舒宁组大鼠血清GH, TNF-α, IGF-Ⅱ水平显著增高(0.24±0.10 μg/L vs 0.11±0.04 μg/L, 91.46±7.63μg/L vs 83.64±3.75 μg/L, 0.38±0.12 μg/L vs0.27 ±0.17 μg/L, P<0.05或0.01), EGF, TGF-α,bFGF水平明显降低(0.40±0.11 μg/L vs 0.56±0.15 μg/L, 0.021±0.006 μg/L vs 0.029±0.012μg/L, 1.44±0.37 μg/L vs 3.26±0.45 μg/L,P<0.05或0.01).结论: 胃康舒宁对大鼠胃癌前病变具有良好的治疗和逆转作用, 其疗效优于维酶素, 而调节EGF, TGF-α, GH, TNF-α, IGF-Ⅱ, bFGF的分泌水平是其防治慢性萎缩性胃炎的作用机制之一.     

艾灸预处理对大鼠应激性胃黏膜损伤增殖修复相关因子的影响

目的:观察艾灸预处理对应激性胃黏膜损伤大鼠血清和胃黏膜表皮生长因子(EGF)、转化生长因子-α(TGF-α)、胃黏膜三叶因子家族-1(TFF1)、增殖细胞核抗原(PCNA)的影响,探讨艾灸预处理促进胃黏膜损伤增殖修复的作用机制.方法:将48只健康SD大鼠随机分为4组,即空白组、模型组、艾灸穴位组、艾灸非穴组.束缚冷应激法制作大鼠应激性胃黏膜损伤模型.造模之前,艾灸组选取足三里、中脘、脾俞和胃俞等穴位行艾灸预处理8d,艾灸非穴组选取非穴对照点进行预处理.以Guth法计算胃黏膜损伤指数,光镜下观察大鼠胃黏膜组织学改变,放射免疫法测定血清EGF与TGF-α的含量,酶免法检测胃黏膜组织中EGF、TGF-α、TFF1和PCNA的含量.结果:与模型组和艾灸非穴组比较,艾灸足三里、中脘等穴位可使应激性胃黏膜损伤大鼠胃黏膜损伤指数明显下降(14.667±5.710vs27.250±7.448,24.750±7.300,P<0.01),血清EGF、TGF-α含量升高(2.167±0.756vs1.147±0.983,1.358±0.962,P<0.05;11.170±1.315vs4.585±0.720vs5.118±0.659,P<0.01),胃黏膜EGF、TGF-α和PCNA含量升高(343.560±27.644vs269.610±45.119,279.590±58.890,P<0.05;147.470±17.784vs115.530±24.319,116.620±14.908,P<0.01;191.910±37.262vs154.580±18.910,152.450±20.333,P<0.05);与模型组比较,艾灸穴位组胃黏膜TFF1含量明显升高(4.573±0.121vs3.654±0.507,P<0.05).结论:艾灸足三里、中脘等穴位预处理可减轻束缚水浸应激所造成大鼠胃黏膜损伤、促进胃黏膜损伤组织增殖修复,可能是通过上调胃黏膜损伤增殖修复相关因子(EGF、TGF-α、TFF1和PCNA)而达到其促胃黏膜损伤修复的作用.     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

CagA-Hp抗体IgG与胃炎的组织学分析

研究幽门螺杆菌(Hp)感染与胃炎的关系。方法对204例慢性胃炎患者胃粘膜进行观察分析,并测定其中137例Hp阳性患者血清CagA-Hp抗体IgG水平,与组织学对照。结果慢性萎缩性胃炎伴肠上皮化生患者血清CagA抗体IgG明显高于对照组(P＜0.01);其他类型胃炎患者血清CagA抗体IgG水平无明显增高(P＞0.05)。结论CagA-Hp可能是导致慢性萎缩性胃炎伴肠上皮化生的因素之一,对这类患者应密切随访观察。     

慢阻肺急性加重期患者预后的影响因素分析

目的探讨慢性阻塞性肺病急性加重期(AECOPD)患者预后的相关危险因素。方法回顾性调查、收集58例AECOPD患者可能影响其预后的相关因素,并对其分别进行单因素分析。并进行Logistic多元逐步回归进行多因素分析,筛选影响AECOPD患者预后的独立危险因素。结果单因素分析后将结果 P0.1的因素纳入多因素Logistic回归,分析发现是否合并呼吸衰竭、气促程度、白细胞计数、APACHEⅡ、应用抗氧化剂、慢阻肺治疗依从性为影响AECOPD患者预后不佳的独立因素(P0.05)。结论根据AECOPD患者预后的独立危险因素,及早判断,选择合适的后续治疗方案,对提高其生存率及生存质量具有重要意义。