西藏各地市健康人群H.pylori菌感染状况分析

目的了解目前西藏地区人群幽门螺旋杆菌(Helicobacter pylori, H. pylori)的感染状况,为西藏地区幽门螺杆菌感染的防治提供临床数据.方法回顾2017年于西藏自治区人民政府驻成都办事处医院就诊且同时完成13C-尿素呼气试验的西藏地区体检者,收集临床资料、常居留地及H. pylori检测结果等.结果共纳入931例病例, H. pylori总体阳性率为480/931(51.6%,95%C I:48.3%-54.8%),其中藏族586例, H.pylori阳性率为331/586(56.5%,95%CI:52.5%-60.5%);汉族345例, H.pylori阳性率为149/345(43.2%,95%CI:37.9%-48.4%).藏汉族之间H.pylori阳性率存在显著差异(P <0.001).西藏地区各地市的H. pylori阳性率分别为:拉萨市99/219(45.2%,95%C I:38.6%-51.8%),昌都市213/372(57.3%,95%C I:52.2%-62.3%),林芝市56/110(50.9%,95%CI:41.4%-60.4%),山南市25/63(39.7%,95%CI:27.3%-52.1%),日喀则市21/51(41.2%,95%C I:27.2%-55.2%),那曲地区17/40(42.5%,95%C I:26.5%-58.5%),阿里地区49/76(64.5%,95%C I:53.5%-75.5%),各地市之间的H.pylori阳性率存在差异(P=0.002).结论西藏地区H. pylori现患率已下降趋于全国水平,藏汉族之间现患率存在差异,各地市H. pylori现患率亦存在差异.

西藏、四川藏汉族健康人群Helicobacter pylori感染情况比较

目的比较分析西藏和四川地区藏幽门螺杆菌(Helicobacter pylori,H.pylori)感染的情况.方法检索西藏成办分院及华西医院接受14C呼气试验检查的体检者,筛选来自西藏和四川地区的藏汉族体检资料,并收集临床资料、常居留地、H.pylori检测结果等.结果西藏和四川地区分别纳入藏汉族体检者547/297和308/1011例,其总体H.pylori阳性率西藏明显高于四川(50.8%/39.3%,P<0.001).西藏和四川地区的藏族健康人群H.pylori阳性率均高于汉族(56.9%/39.7%,P<0.001;52.3%/35.4%,P<0.001).藏族和汉族健康人群H.pylori阳性率在西藏与四川地区之间无差异(P=0.196和P=0.192).高龄组的H.pylori阳性率在汉族健康人群中出现升高,而在藏族健康人群中出现降低(年龄<45 vs年龄≥45:32.3%/40.5%,P=0.002;61.5%/50.0%,P=0.001).结论西藏与四川地区藏汉族健康人群的H.pylori感染情况相似,均为藏族高于汉族.汉族健康人群H.pylori感染与年龄正相关,而藏族健康人群却相反.

基于高通量测序技术的藏族肝硬化患者肠道菌群多样性研究

背景大量研究已证实肝硬化患者存在肠道菌群失调的现象,这为临床防治肝硬化及并发症提供了新的线索与思路.藏族人群生活环境和饮食习惯有别于汉族人群,因而藏族肝硬化患者肠道菌群结构及多样性亦可能存在差异.目的探讨藏族肝硬化患者肠道菌群结构、丰度与多样性,并对比汉族肝硬化患者肠道菌群的差异及特点.方法前瞻性纳入2017-10/2018-10四川大学华西医院成办分院消化内科36例肝硬化患者,其中20例藏族设为实验组,16例汉族肝硬化患者设为对照组;收集患者基本信息、血常规、生化、凝血功能、影像学等,并采集大便标本,提取基因组DNA并对细菌16S rRNA基因V4区进行PCR扩增,应用Illumina Miseq平台进行高通量测序,测序原始结果进行Reads拼接、操作分类单元(operational taxonomic units,OTUs)聚类、物种注释、Alpha多样性分析等,最终得到样品的生物信息学结果.结果对照组和实验组分别获得15006和36872条有效序列,在实验组中Chao1指数显著降低(P<0.01),实验组的物种丰富度较对照组显著降低.基于97%的相似性进行物种注释,对实验组和对照组进行微生物物种丰度比较.结果显示,相较于对照组,在门水平上,实验组中拟杆菌门显著减少(P<0.001),厚壁菌门和放线菌门在实验组中增加(P<0.01和P<0.05);在属水平上,葡萄球菌属、放线菌属在实验组中显著减少(P<0.01),乳杆菌属显著增加(P<0.01).结论藏族肝硬化患者的肠道微生物丰度明显低于汉族肝硬化患者,肠道微生物组成存在着差异.本研究首次展现了藏族肝硬化患者的肠道微生物组成特点,为肝硬化的个性化治疗奠定了基础.

熄风止动汤治疗儿童肝亢风动型抽动障碍的临床效果

目的观察熄风止动汤治疗儿童肝亢风动型抽动障碍的临床有效性、安全性及复发情况。方法按照随机数字表原则将120例肝亢风动型抽动障碍患儿分为对照组和观察组,各60例。对照组采用硫必利进行治疗,观察组采用熄风止动汤进行治疗。比较两组的中医证候总积分、耶鲁综合抽动严重程度量表(YGTSS)评分、临床疗效及随访3个月复发情况;分析两组患儿的脑电图检查结果及安全性指标。结果治疗后,两组的中医证候总积分均低于治疗前,且观察组低于对照组(P<0.001)。治疗后,两组的运动抽动、发声抽动、缺损率评分及YGTSS总分均低于治疗前,且观察组低于对照组(P<0.001)。观察组的治疗总有效率为93.33%,高于对照组的75.00%(P<0.01)。随访3个月,观察组的复发率为10.71%,低于对照组的42.22%(P<0.01)。120例抽动障碍患儿中有9例脑电图异常(7.50%),9例脑电图异常患儿经治疗后异常放电区域、异常波形式及波幅均未见明显变化。观察组患儿未发生不良反应,对照组患儿有2例发生不良反应,两组的不良反应总发生率无显著差异(P>0.05)。结论熄风止动汤治疗儿童肝亢风动型抽动障碍的效果显著,可明显改善临床体征和症状,复发率低,且安全性高。

抗痫煎剂添加治疗儿童难治性癫痫的临床效果

目的观察抗痫煎剂添加治疗儿童难治性癫痫的临床效果。方法采用随机数字表法将60例儿童难治性癫痫患儿分为对照组和治疗组,各30例。对照组根据患儿病情规范使用2~3种抗癫痫药物联合治疗。治疗组在对照组基础上根据病情添加抗痫煎剂治疗。比较两组的治疗效果。结果治疗后,两组的癫痫发作频次均较治疗前显著减少,且治疗组少于对照组(P<0.05)。治疗后,治疗组的癫痫发作持续时间优于对照组,差异具有统计学意义(P<0.05)。结论抗痫煎剂添加治疗儿童难治性癫痫的效果显著,可降低癫痫发作频率,缩短癫痫发作持续时间,改善脑电图,且安全性高。

One-year status of hepatic venous pressure gradient measurement from 85 hospitals in China

Aims:Surveys and research on the applications of the hepatic venous pressure gradient(HVPG)are important for understanding the current status and future development of this technology in China.This article aimed to investigate the status of hepatic venous pressure gradient measurement in China in 2022.Methods:We investigated the overall status of HVPG technology in China-including hospital distribution,hospital level,annual number of cases,catheters used,average cost,indications,and current challenges by using online questionnaire.By counting the number and percentages of cases of these results,we hope to clarify the current status of HVPG measurements in China.Results:According to the survey,85 hospitals in China used HVPG technology in 2022 distributed across 29 provinces.A total of 4989 HVPG measurements were performed in all of the surveyed hospitals in 2022,of which 2813 cases(56.4%)were measured alone.The average cost of HVPG measurement was 5646.8±2327.9 CNY.Of the clinical teams who performed the measurements(sometimes multiple per hospital),94.3%(82/87)used the balloon method,and the majority of the teams(72.4%,63/87)used embolectomy catheters.Conclusions:This survey clarified the clinical application status of HVPG in China and confirmed that some medical institutions in China have established a foundation for this technology.It is still necessary to continue promoting and popularizing this technology in the future.

Tolerance and acceptance of hepatic venous pressure gradient measurement in cirrhosis(CHESS1904):An international multicenter study

Aim:To determine the tolerance and acceptance of hepatic venous pressure gradient(HVPG)measurements in patients with liver cirrhosis.Methods:This prospective international multicenter study included 271 patients with cirrhosis who were scheduled to undergo HVPG measurement between October 2019 and June 2020.Data related to the tolerance and acceptance of HVPG measurements were collected using descriptive questionnaires.Results:HVPG measurements were technically successful in all 271 patients,with 141(52.0%)undergoing HVPG measurement alone.The complication rate was 0.4%.Postoperative pain was significantly lower than preoperative expected pain(p<0.001)and intraoperative pain(p<0.001),and intraoperative pain was also significantly lower than preoperative expected pain(p=0.036).No,mild,moderate,severe,and intolerable discomfort scores were reported by 36.9%,44.6%,11.1%,6.3%,and 0.4%of these patients,respectively,during HVPG measurement and by 54.6%32.5%,11.4%,1.5%,and 0%,respectively,after HVPG measurement.Of these patients,39.5%had little understanding and 10%had no understanding of the value of HVPG measurement,with 35.1%and 4.1%regarding HVPG measurements as being of little or no help,respectively.Most patients reported that they would definitely(15.5%),probably(46.9%),or possibly(29.9%)choose to undergo additional HVPG measurements again,and 62.7%regarded the cost of the procedure as acceptable.Conclusion:HVPG measurement was safe and well‐tolerated in patients with cirrhosis,but patient education and communication are warranted to improve the acceptance of this procedure.