XRCC1和XPD单核苷酸多态性与非小细胞肺癌铂类药物化疗敏感性的关系

目的研究X线修复交叉互补基因1（XRCC1）和着色性干皮病基因（XPD）单核苷酸多态性与老年晚期非小细胞肺癌（NSCLC）铂类药物化疗敏感性关系。方法应用聚合酶链反应结舍限制性片段长度多态性（PCR-RFLP）的方法检测81例以铂类药物为主要化疗方案的NSCLC患者XRCC1 Arg399Gln和XPD Lys751Gin基因型多态性，采用非条件Logistic回归分析不同基因型与化疗疗效的关系。结果81例患者化疗总有效率为35．8％，其中完全缓解（CR）、部分缓解（PR）、稳定（SD）和进展（PD）患者分别为0、29、31、21例。携带至少1个XRCC1 399Arg等位基因的患者化疗敏感性是携带Gln／Gln基因型患者的4.52倍（OR=4．52，95％CI=1.11—18．38）。未发现XPD Lys751Gin遗传多态与化疗敏感性相关。结论XRCC1 Arg399Gln多态可能与晚期NSCLC铂类药物化疗敏感性有关。     

汉民族XRCC1基因399位密码子单核苷酸多态性与原发肝癌关系的研究

目的探讨汉民族XRCC1基因399位密码子单核苷酸多态性与原发肝癌之间的关系。方法原发肝癌患者50例,肝炎肝硬化患者61例,健康献血人员92例。针对XRCC1基因的10号外显子设计引物,PCR产物利用MspⅠ限制性酶切进行基因分型,基因型分成XRCC1 399Arg/Arg,399Arg/Gln,399Gln/Gln三种,分析XRCC1多态性与肝癌之间的关系。结果原发肝癌患者中XRCC1 399Arg/Arg 32例(64.0%),Arg/Gln 14例(28.0%),Gln/Gln 4例(8.0%);肝炎肝硬化患者中Arg/Arg 30例(49.2%),Arg/Gln 23例(37.7%),Gln/Gln 8例(13.1%);健康人群Arg/Arg 46例(50.0%),Arg/Gln 41例(44.5%),Gln/Gln 5例(5.5%)。以健康人群为对照组,XRCC1399Gln基因(基因型Arg/Gln和Gln/Gln)并不增加患肝癌的风险性(OR=0.563,95%CI:0.277-1.141,P=0.109);以肝炎肝硬化为对照组,XRCC1 399Gln基因同样与患肝癌的易感性之间没有显著的相关性(OR=0.544,95%CI:0.253-1.170,P=0.118)。结论XRCC1基因密码子399位点的基因多态性与汉民族原发肝癌危险性无统计学相关关系。     

人类XRCC1-399单核苷酸多态性与原发性肝细胞癌的相关研究

目的以病例-对照研究方式探讨人类DNA修复基因XRCC1-399单核苷酸多态性(SNP)与HBV感染者的原发性肝细胞癌(HCC)的发生关系。方法72例HCC患者经病理检查证实,根据地缘、性别、年龄,按1：1～2比例匹配137例非HCC对照者。采用聚合酶链反应一限制片段长度多态性(PCR-RFLP)技术检测受试者XRCC1-399位SNP。结果(1)XRCC1-399SNP和年龄均与HCC的发生无关,但在XRCC1-399Arg／Arg受试者中,HCC的发生与年龄呈负相关(P=0．028);(2)HBV感染是HCC发生的肯定因素(P=0．007);在XRCC1-399Gln／Gln或Arg／Gln受试者中,伴HBV感染者HCC发生率(25．7％)远高于不伴HBV感染者(5．3％,P=0．047);(3)XRCC1-399Arg／Arg受试者HBV感染率与Gln/Gln或Arg／Gln受试者近似(36．6％对38．0％,P=0．052)。结论(1)XRCC1-399Arg／Arg可能具有潜在抵抗HCC发生的作用;(2)XRCC1-399Gln／Gln或Arg／Gln联合HBV感染是HCC发生的高危因素。     

XRCC1和XPD单核苷酸多态性预测晚期NSCLC铂类化疗敏感性的研究

目的探讨DNA损伤修复基因XRCC1和XPD单核苷酸多态性与晚期非小细胞肺癌(NSCLC)对铂类药物化疗敏感性的关系。方法以聚合酶链反应结合限制性片段长度多态性(PCR-RFLP)方法,检测166例以顺铂(DDP)为基础药物化疗的晚期NSCLC患者XRCC1 Arg194Trp和XPD Asp312Asn多态基因型,并比较不同基因型与化疗敏感性的关系。结果化疗总有效率(CR PR)为31.3%,其中CR2例,PR50例,SD70例,PD44例。携带至少1个XRCC1第194位密码子Trp等位基因患者化疗敏感性是携带Arg/Arg基因型患者的4.3倍(OR=4.32,95%CI=2.10~8.87,P=0.000);携带XPD第312位密码子Asp/Asp基因型患者化疗敏感性是携带至少1个Asn基因型患者的3.5倍(OR=3.49,95%CI=1.76~6.96,P=0.000)。联合分析这两个遗传多态性发现,尚不能认为XRCC1 Arg194Trp和XPD Asp312Asn多态性在NSCLC对铂类药物敏感性中存在联合作用(P>0.05)。结论XRCC1 Arg194Trp和XPD Asp312Asn单核苷酸多态性可能与NSCLC铂类药物敏感性有关。     

DNA修复基因XRCC1 Arg194Trp Arg280His和Arg399Gln多态性与前列腺癌相关性的Meta分析

目的探讨DNA修复基因X线修复交叉互补因子1（XRCC1）主要单核苷酸多态性与前列腺癌易感性的关系。方法在MEDLINE、EMBASE和OVID数据库上检索文献,收集及提取符合纳入标准的以XRCC1密码子194、280、399多态性与前列腺癌易感性为内容的病例对照研究文献,应用Stata统计软件进行Meta分析,比值比（ORs）及其95%可信区间（95%CI）评价关联强度;应用SPSS软件分析吸烟与前列腺癌关系,OR？评价其相对危险度。结果 XRCC1 399 Gln/Gln和XRCC1 280 Arg/His与前列腺癌的发病风险有关（Gln/Gln vs Arg/Arg：OR？=1.27,95%CI=1.02～1.59;Arg/His vs Arg/Arg：OR？=1.66,95%CI=1.09～2.52）,尤其在亚组分析中亚洲人的Gln/Gln明显增加了前列腺癌的发病风险（OR？=1.52,95%CI=1.18～1.96）;Arg194Trp与前列腺癌的发病风险无明显关联。吸烟是前列腺癌的危险因素（χ2=13.974,P=0.000,OR？=1.22）。结论 XRCC1 399 Gln/Gln和280 Arg/His可能与前列腺癌的易感性相关。     

中国人群XRCC1 Arg399Gln基因多态性与肝癌易感性Meta分析

目的:系统评价中国人群X线修复交叉互补基因1(X-ray repair cross complementing group 1,XRCC1)Arg399Gln基因多态性与肝癌易感性的关系.方法:在Pub Med、MEDLINE、EMBASE、CNKI、CBM、VIP及万方数据库中检索2000-01-01/2015-01-10发表的所有有关中国人群XRCC1 Arg399Gln基因多态性与肝癌易感性关系的相关文献.按照纳入和排除标准独立选择文献、提取资料,采用Stata12.0软件进行Meta分析,计算合并比值比(odds ratio,OR)及其95%可信区间(95%confidence interval,95%CI),并进行敏感性分析和发表偏倚的估计.结果:按照入选标准,共纳入13个研究,包括2972例患者和3789例对照者.Meta分析结果显示,与基因型Arg/Arg、Arg/Arg+Arg/Gln分别进行比较,基因型Gln/Gln均增加中国人群罹患肝癌风险(OR=1.47,95%CI:1.24-1.74,P0.001;O R=1.26,95%C I:1.08-1.48,P=0.003);与基因型Arg/Arg进行比较,基因型Gln/Gln+Arg/Gln增加中国人群罹患肝癌风险(OR=1.49,95%CI:1.21-1.83,P0.001).与等位基因Argalele比较,等位基因Gln-allele增加中国人群罹患肝癌的风险(OR=1.33,95%CI:1.16-1.54P0.001).结论:XRCC1 Arg399Gln基因多态性与中国人群肝癌易感性相关,基因型Gln/Gln增加中国人群罹患肝癌的风险.     

原发性肝癌患者DNA损伤修复酶基因多态性分析

目的探讨DNA损伤修复酶基因多态性与原发性肝癌发生发展的关系。方法 PCR-RFLP法检测150例肝癌患者（肝癌组）和150例健康体检者（对照组）DNA损伤修复酶基因的表型,并进行比较。结果肝癌组XRCC1 Arg399Gln位点野生型的比率明显低于对照组（P〈0.05）;XRCC1（Arg194Trp、Arg280His）、hOGG1Ser326Cys位点多态性型别在两组中出现的频率相近（P〉0.05）;各基因位点不同表型者的尿8-羟基脱氧鸟苷（8-OHdG）水平相比,P均〉0.05。结论 DNA修复酶基因多态性与肝癌的发生发展无明确的相关关系。     

X线损伤交叉互补基因1多态性与结直肠癌易感性研究

目的 探讨DNA修复酶X线损伤交叉互补基因1(XRCC1 )外显子三个位点的基因多态性(Arg194Trp 、Arg280His、Arg399Gln)与结直肠癌(CRC)发病风险的关系.方法 以聚合酶链反应和限制性片段长度多态性(PCR-RFLP)分析方法,采用病例-对照研究,对250例CRC患者(病例组,其中结肠癌128例,直肠癌122例)和213名健康人(对照组)的XRCC1基因三个位点的多态性进行了检测,采用SPSS 11.0软件包统计分析各位点的基因型分布和等位基因频率.结果 XRCC1基因194和399二个位点的各基因型频率在两组间分布差异均无统计学意义(P值均>0.05),但病例组XRCC1基因280 Arg/His基因型频率较对照组显著增高(校正后OR=1.66,95%CI:1.01～2.73,P=0.047).在直肠癌患者组中,280Arg/His基因型频率较对照组显著增高(OR=1.82,95%CI:1.02～3.27),携等位基因280His(Arg280His +His280His)的CRC患者的频率显著高于其在对照组中的频率(校正后OR=1.85,95%CI:1.06～3.22),而在结肠癌患者中风险系数相对较低且差异无统计学意义(校正后OR=1.31,95%CI:0.74～2.35).结论 XRCC1 Arg194Trp和 Arg399Gln基因多态性与结肠癌易感性无关,但280Arg/His基因型能增加CRC易感性,等位基因280His是直肠癌风险因素.

Abstract：

Objective To investigate the correlation between three gene locus polymorphisms of X-ray repair cross-complementary protein 1 (XRCC1) exon (Arg194Trp, Arg280His and Arg399Gln) and the risk of colorectal cancer (CRC). Methods A case-control study was performed in 250 CRC patients (case group, 128 colon cancer patients and 122 rectal cancer patients) and 213 healthy individuals (control group). The three gene locus polymorphism of XRCC1 was tested by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) method. The genotype distribution and allele frequency of each locus was analyzed with SPSS 10.0 software. Results There was no significant difference in allele frequency of XRCC1 at 194 and 399 loci (P > 0.05). However, the 280 Arg/His allele frequency of XRCC1 was higher in case group than that in control group (OR=1.66,95%CI:1.01~2.73,P=0.047). The 280Arg/His allele frequency was higher in rectal cancer group than that in control group (OR =1.82,95%CI:1.02~3.27). The frequency of 280His allele (Arg280His and His280His) was higher in case group than that in control group (OR=1.85,95%CI:1.06~3.22). However, it was a relative low risk factor of colon cancer and there was no significant difference between colon cancer group and control group (OR=1.85, 95%CI:1.06~3.22). Conclusions There was no correlation between XRCC1 Arg194Trp and Arg399Gln polymorpohisms and the risk of CRC. However, 280Arg/His genotype may increase the risk of CRC, and 280His allele is a risk factor of rectal cancer.     

XRCC1单核苷酸多态性对非小细胞肺癌患者顺铂疗效的影响

目的探讨人类X射线交错互补修复基因1(XRCC1)单核苷酸多态性(SNP)与非小细胞肺癌(NSCLC)铂类药物化疗后预后的关系。方法采用MALDI-TOF-MS法检测204例经病理学确诊的接受铂类药物化疗的晚期NSCLC患者XRCC1(399)的基因型,并随机抽取5%的样本进行基因测序来验证该方法的准确性。比较不同基因型与铂类药物化疗后生存期的关系。结果 204例NSCLC患者中,部分缓解61例,疾病稳定116例,疾病进展27例;治疗有效率为29.9%,无效率为70.1%。携带XRCC1(399)G/G、G/A+A/A基因型的NSCLC患者铂类化疗后有效率分别为36.9%(38/103)和22.8%(23/101),两者比较差异有统计学意义(P<0.05)。XRCC1(399)G/G基因型患者对顺铂类药物的敏感性是G/A+A/A基因型患者的1.983倍(95%可信区间(CI):1.073~3.662,P=0.028)。携带XRCC1(399)G/G、G/A+A/A基因型的NSCLC患者铂类化疗后中位生存期(MST)、1年生存率及2年生存率分别为12.0月、52.4%、11.7%和10.0月、37.6%、3.0%,两者比较差异均有统计学意义(P<0.05)。结论 XRCC1(399)基因多态性与晚期NSCLC患者铂类药物化疗后的生存期有显著相关性,有可能成为铂类药物化疗后生存期的预测指标。     

XRCC1、GSTM1基因多态性与肺癌易感性的相关性

目的探讨X射线损伤修复的交叉互补基因(XRCC)1、谷胱甘肽硫转移酶基因(GSTM)1多态性与肺癌易感性的相关性。方法选取150例作为肺癌组,依据病理类型分为75例鳞癌、22例腺癌、20例小细胞癌、33例其他类型癌,同期选取健康体检者150例作为正常组,采用PCR扩增技术检测XRCC1、GSTM1基因型,采用叉生分析法分析二者基因的联合作用与易感性危险度的关系,统计分析所有研究对象的XRCC1、GSTM1基因型表达情况。结果 XRCC1基因分为野生纯合型(Arg/Arg)、杂合型(Arg/His)、突变纯合型(His/His),其中肺癌组Arg/Arg检出率明显低于健康组(P0.05),前者His/His检出率明显高于后者(P0.05),二者Arg/His检出率基本相同(P0.05),鳞癌、腺癌、其他类型癌与正常组比较有显著差异(P0.05),小细胞癌与正常组比较无显著差异(P0.05)。肺癌组GSTM1+检出率明显低于正常组(P0.05),前者GSTM1-检出率明显高于后者(P0.05),鳞癌、腺癌、其他类型癌与正常组比较有显著差异(P0.05),小细胞癌与正常组比较无显著差异(P0.05);叉生分析法显示在患肺癌危险度方面,同时携带XRCC1(Arg/His+His/His52)和GSTM1-XRCC1(Arg/Arg)和GSTM1-XRCC1(Arg/His+His/His52)和GSTM1+XRCC1(Arg/Arg)和GSTM1+(P0.05)。结论 XRCC1(Arg/His+His/His52)和GSTM1-是肺癌的重要易感因素,个体携带者具有较高的患肺癌风险,且二者具有联合作用,可显著增加肺癌发生的风险,提示医师应重点关注和谨慎筛查此类群体。     

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。     

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     

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。     

治疗高血压药物的经济学评价

重视高血压治疗中的经济学评价,对利用我国有限的卫生资源来遏制高血压对人民群众的危害有着重要的现实意义。药物经济学对于药物治疗的成本和治疗的结果给予同样的关注。因为治疗高血压的费用,不仅涉及药物价格,还包括患者的危险水平,降压疗效和对临床终点事件的影响,以及治疗的依从性和安全性。因此药物经济学更强调整体成本和价-效比。低危病人,若非药价低廉,治疗的价-效比不够理想。而在高危的患者,价-效比越小越经济而不是药费越便宜越好。     

南通市老年人生命质量影响因素的因子分析

目的 了解南通市老年人的生命质量及其影响因素.方法 2010年7月应用欧洲五维健康量表(EQ-5D)对南通市994例＞60岁的老年人进行问卷调查,探索性因子分析生命质量的影响因素.结果 英国权重计算城市老年人生命质量指数得分均数(0.590±0.092)高于农村老年人(0.560±0.115),农村老年人得分高于养老院老年人(0.447 ±0.154).社会经济因素、闲暇生活方式、慢性病、睡眠食欲、婚姻家庭和社会支持是影响老年人生命质量的主要因子.结论 政府应完善养老保险和医疗保险制度,加强老年人慢性病的健康管理,促进居家养老服务体系建设.     

胆囊腺肌增生症23例临床分析

目的探讨胆囊腺肌增生症的病因、诊断和治疗方法。方法在1046例胆囊切除术中,对病理检查确诊的23例胆囊腺肌增生症的临床资料进行回顾性分析,患者术前均行超声、CT或MRI检查。结果23例胆囊腺肌增生症临床表现与慢性胆囊炎胆石症类似。病变大体形态:局限型13例(均位于胆囊底部)、节段型7例和弥漫型3例。23例均行胆囊切除,合并胆囊结石6例,合并胆囊炎14例。结论胆囊腺肌增生症是一种好发于成年人的胆囊壁增生性病变,此病常与慢性胆囊炎、胆石症并存,临床诊断困难,确诊需依赖病理检查。联合超声、CT和MRI等影像学检查可提高术前诊断准确度。目前手术是治疗的最好方法。     

糖尿病肾病血液透析护理效果分析

目的探讨糖尿病肾病血液透析中不同护理模式的护理效果。方法选择该院2018年3月—2019年3月收治的糖尿病肾病患者72例。该次选取的病例均拟行血液透析治疗,按照随机数表将患者分为对照组(35例)和观察组(37例),其中对照组在患者血液透析期间行常规基础护理,观察组行优质护理干预,观察两种不同的护理模式对患者血液透析的影响。结果观察组患者因低血压等中断透析的发生率低于对照组,差异有统计学意义(P<0.05)。观察组透析期间并发症发生率低于对照组,差异有统计学意义(P<0.05)。观察组患者的生活质量SF-36评分均高于对照组患者,差异有统计学意义(P<0.05)。结论在糖尿病肾病患者透析期间行优质护理,有助于保障血液透析的顺利开展,同时降低各种并发症的风险,使得患者的生活质量有最基本的保障。     

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.