Nomogram based on liver stiffness and spleen area with ultrasound for posthepatectomy liver failure:A multicenter study

BACKGROUND Liver stiffness(LS)measurement with two-dimensional shear wave elastography(2D-SWE)correlates with the degree of liver fibrosis and thus indirectly reflects liver function reserve.The size of the spleen increases due to tissue proliferation,fibrosis,and portal vein congestion,which can indirectly reflect the situation of liver fibrosis/cirrhosis.It was reported that the size of the spleen was related to posthepatectomy liver failure(PHLF).So far,there has been no study combining 2D-SWE measurements of LS with spleen size to predict PHLF.This prospective study aimed to investigate the utility of 2D-SWE assessing LS and spleen area(SPA)for the prediction of PHLF in hepatocellular carcinoma(HCC)patients and to develop a risk prediction model.AIM To investigate the utility of 2D-SWE assessing LS and SPA for the prediction of PHLF in HCC patients and to develop a risk prediction model.METHODS This was a multicenter observational study prospectively analyzing patients who underwent hepatectomy from October 2020 to March 2022.Within 1 wk before partial hepatectomy,ultrasound examination was performed to measure LS and SPA,and blood was drawn to evaluate the patient’s liver function and other conditions.Least absolute shrinkage and selection operator logistic regression and multivariate logistic regression analysis was applied to identify independent predictors of PHLF and develop a nomogram.Nomogram performance was validated further.The diagnostic performance of the nomogram was evaluated with receiver operating charac-teristic curve compared with the conventional models,including the model for end-stage liver disease(MELD)score and the albumin-bilirubin(ALBI)score.RESULTS A total of 562 HCC patients undergoing hepatectomy(500 in the training cohort and 62 in the validation cohort)were enrolled in this study.The independent predictors of PHLF were LS,SPA,range of resection,blood loss,international normalized ratio,and total bilirubin.Better diagnostic performance of the nomogram was obtained in the training[area under receiver operating characteristic curve(AUC):0.833;95%confidence interval(95%CI):0.792-0.873;sensitivity:83.1%;specificity:73.5%]and validation(AUC:0.802;95%CI:0.684-0.920;sensitivity:95.5%;specificity:52.5%)cohorts compared with the MELD score and the ALBI score.CONCLUSION This PHLF nomogram,mainly based on LS by 2D-SWE and SPA,was useful in predicting PHLF in HCC patients and presented better than MELD score and ALBI score.

Non-invasive model for predicting high-risk esophageal varices based on liver and spleen stiffness

BACKGROUND Acute bleeding due to esophageal varices(EVs)is a life-threatening complication in patients with cirrhosis.The diagnosis of EVs is mainly through upper gastrointestinal endoscopy,but the discomfort,contraindications and complications of gastrointestinal endoscopic screening reduce patient compliance.According to the bleeding risk of EVs,the Baveno VI consensus divides varices into high bleeding risk EVs(HEVs)and low bleeding risk EVs(LEVs).We sought to identify a non-invasive prediction model based on spleen stiffness measurement(SSM)and liver stiffness measurement(LSM)as an alternative to EVs screening.AIM To develop a safe,simple and non-invasive model to predict HEVs in patients with viral cirrhosis and identify patients who can be exempted from upper gastrointestinal endoscopy.METHODS Data from 200 patients with viral cirrhosis were included in this study,with 140 patients as the modelling group and 60 patients as the external validation group,and the EVs types of patients were determined by upper gastrointestinal endoscopy and the Baveno Ⅵ consensus.Those patients were divided into the HEVs group(66 patients)and the LEVs group(74 patients).The effect of each parameter on HEVs was analyzed by univariate and multivariate analyses,and a noninvasive prediction model was established.Finally,the discrimination ability,calibration ability and clinical efficacy of the new model were verified in the modelling group and the external validation group.RESULTS Univariate and multivariate analyses showed that SSM and LSM were associated with the occurrence of HEVs in patients with viral cirrhosis.On this basis,logistic regression analysis was used to construct a prediction model:Ln[P/(1-P)]=-8.184-0.228×SSM+0.642×LSM.The area under the curve of the new model was 0.965.When the cut-off value was 0.27,the sensitivity,specificity,positive predictive value and negative predictive value of the model for predicting HEVs were 100.00%,82.43%,83.52%,and 100%,respectively.Compared with the four prediction models of liver stiffness-spleen diameter to platelet ratio score,variceal risk index,aspartate aminotransferase to alanine aminotransferase ratio,and Baveno VI,the established model can better predict HEVs in patients with viral cirrhosis.CONCLUSION Based on the SSM and LSM measured by transient elastography,we established a non-invasive prediction model for HEVs.The new model is reliable in predicting HEVs and can be used as an alternative to routine upper gastrointestinal endoscopy screening,which is helpful for clinical decision making.

Angiotensin-converting enzyme 2 alleviates liver fibrosis through the renin-angiotensin system

The present letter to the editor is related to the study titled‘Angiotensin-converting enzyme 2 improves liver fibrosis in mice by regulating autophagy of hepatic stellate cells’.Angiotensin-converting enzyme 2 can alleviate liver fibrosis by regulating autophagy of hepatic stellate cells and affecting the renin-angiotensin system.

Letter to editor‘Non-invasive model for predicting high-risk esophageal varices based on liver and spleen stiffness’

predicting high-risk esophageal varices based on liver and spleen stiffness".Acute bleeding caused by esophageal varices is a life-threatening complication in patients with liver cirrhosis.Due to the discomfort,contraindications,and associated complications of upper gastrointestinal endoscopy screening,it is crucial to identify an imaging-based non-invasive model for predicting high-risk esophageal varices in patients with cirrhosis.

“肝脾同调-血水同治”对增殖性糖尿病性视网膜病变PPV围手术期的影响

目的探究“肝脾同调-血水同治”对增殖性糖尿病性视网膜病变(proliferative diabetic retinopathy,PDR)玻璃体切除术(pars plana vitrectomy,PPV)患者围手术期的影响。方法选取2021年6月—2023年6月本院收治的63例PDR患者,按照简单随机法分为常规组(n=31)和同调组(n=32),常规组给予常规围术期治疗(术前3~5 d至术后7 d),同调组在常规组基础上实施“肝脾同调-血水同治”治法,比较2组临床指标、并发症(高眼压、玻璃体积血、视力下降)、眼压、炎症反应分级(前房闪辉、前房炎症细胞、纤维蛋白渗出),干预前后炎症因子水平[前房液白细胞介素-6(Interleukin-6,IL-6)、血清C反应蛋白(C-reactive protein,CRP)]。结果同调组手术时间、住院时间低于常规组(P<0.05);2组并发症总发生率比较无统计学意义(P>0.05);术后1 d、3 d,2组眼压均随时间延长而下降(P<0.05),且术后1 d同调组低于常规组(P<0.05);术后1 d、1周,2组前房闪辉、前房炎症细胞和纤维蛋白渗出评级随时间延长明显减轻(P<0.05),且术后1 d同调组前房闪辉评级明显低于常规组(P<0.05);术后1 d、1周,2组前房液IL-6、血清CRP均随时间延长而降低(P<0.05),且同调组均低于常规组(P<0.05)。结论“肝脾同调-血水同治”应用于PPV治疗的PDR患者,可减少患者围术期并发症,有效控制炎症反应,缩短手术时间和住院时长,具有临床应用价值。

基于Thinc-it工具分析抑郁症不同证型患者认知功能

目的:通过Thinc-it工具探讨抑郁症不同证型患者认知功能特点。方法:从2020年6月至2022年7月宁波市第一医院心身医学科确诊为抑郁症的患者中选取肝气郁结、气郁化火、痰气郁结、心脾两虚证型患者各50例为受试者,并选取同期在医院健康体检志愿者50例为健康对照组。应用汉密尔顿抑郁量表(hamilton depression scale,HAMD)、汉密尔顿焦虑量表(hamilton anxiety scale,HAMA)对各组受试者临床症状进行评估,并分别通过Thinc-it工具进行认知功能评估,具体包括认知损害5项问卷(5-item questionnaire for cognitive impairment,PDQ-5-D)、选择反应时间任务(selection response time,CRT)、1-Back记忆任务(selection response time,1-Back)、数字符号替代测试(digit symbol substitution test,DSST)和连线测试B(line test B,TMT-B)测试。结果:抑郁症各证型组病程、HAMD评分、HAMA评分比较,痰气郁结证组和心脾两虚证组病程时间相对更长,但组间比较,差异无统计学意义(P>0.05)。郁证各证型组HAMD评分、HAMA评分高于健康对照组,差异具有统计学意义(P<0.05)。郁证各证型组PDQ-5-D评分高于健康对照组(P<0.05),郁证各证型组间比较,差异无统计学意义(P>0.05)。与健康对照组比较,郁证各证型组CRT计数减少,CRT反应时间延长,差异具有统计学意义(P<0.05)。组间比较,心脾两虚证组CRT计数高于肝气郁结证组,痰气郁结证组CRT反应时间长于肝气郁结证组,差异具有统计学意义(P<0.05)。与健康对照组比较,郁证各证型组1-Back计数减少,痰气郁结证组、心脾两虚证组1-Back反应时间延长,差异具有统计学意义(P<0.05),郁证各证型组间比较,差异无统计学意义(P>0.05)。与健康对照组比较,郁证各证型组DSST计数减少,DSST反应时间、TMT-B耗时延长,差异具有统计学意义(P<0.05)。心脾两虚证组、痰气郁结证组DSST反应时间长于肝气郁结证组、气郁化火证组,差异具有统计学意义(P<0.05)。结论:抑郁症各证型患者均存在主观认知功能、注意力、记忆力、执行功能、信息加工处理速度等方面的损害,且各证型受损程度不一,且痰气郁结证组、心脾两虚证组在注意力、执行功能、处理速度方面较肝气郁结证组和气郁化火证组受损更严重。

基于脑-肠轴理论的便秘型肠易激综合征伴焦虑抑郁中西医认识述要

随着西医学的研究和进展,多数医家认为精神心理状态与便秘型肠易激综合征(IBS-C)二者之间有着明确的联系。脑肠轴在二者的发病机制中皆处于重要的地位,以脑肠互动理论来论治本病已经受到了广泛的关注。西医认为脑-肠肽、肠道菌群失调等因素可导致肠易激综合征腹痛、精神心理状态改变等症状,中医上则多把脑-肠轴理论与中医各证型特点相关联。因此,以脑-肠轴为基点从脑-肠肽、肠道微生物、下丘脑-垂体-肾上腺(HPA)轴、心理因素、中医药治疗方面综述IBS-C伴焦虑抑郁状态的发病机制,为同行在临床的诊疗中提供新的思路。

Liver-spleen axis: Intersection between immunity, infections and metabolism

Spleen has been considered a neglected organ so far, even though is strictly linked to liver. The spleen plays an important role in the modulation of the immune system and in the maintenance of peripheral tolerance via the clearance of circulating apoptotic cells, the differentiation and activation of T and B cells and production of antibodies in the white pulp. Moreover, splenic macrophages are able to remove bacteria from the blood and protect from sepsis during systemic infections. We review the spleen function and its assessment in humans starting from the description of spleen diseases, ranging from the congenital asplenia to secondary hyposplenism. From the literature data it is clear that obesity in humans affects different compartments of immune system, even thought there are still few data available on the implicated mechamisms. The intent is to enable clinicians to evaluate the newly recognized role of metabolic and endocrine functions of the spleen with special emphasis to obesity and nonalcoholic fatty liver disease in the context of the available literature.Moreover, understanding the spleen function could be important to develop appropriate prevention strategies in order to counteract the pandemia of obesity. In this direction, we suggest spleen longitudinal diameter at ultrasonography, as simple, cheap and largely available tool, be used as new marker for assessing splenic function, in the context of the so-called liver-spleen axis.

Gut microbial diversity analysis using Illumina sequencing for functional dyspepsia with liver depression-spleen deficiency syndrome and the interventional Xiaoyaosan in a rat model

AIM To investigate gut microbial diversity and the interventional effect of Xiaoyaosan(XYS) in a rat model of functional dyspepsia(FD) with liver depression-spleen deficiency syndrome. METHODS The FD with liver depression-spleen deficiency syndrome rat model was established through classic chronic mild unpredictable stimulation every day. XYS group rats received XYS 1 h before the stimulation. The models were assessed by parameters including state ofthe rat, weight, sucrose test result and open-field test result. After 3 wk, the stools of rats were collected and genomic DNA was extracted. PCR products of the V4 region of 16 S rD NA were sequenced using a barcoded Illumina paired-end sequencing technique. The primary composition of the microbiome in the stool samples was determined and analyzed by cluster analysis.RESULTS Rat models were successfully established, per data from rat state, weight and open-field test. The microbiomes contained 20 phyla from all samples. Firmicutes, Bacteroidetes, Proteobacteria, Cyanobacteria and Tenericutes were the most abundant taxonomic groups. The relative abundance of Firmicutes, Proteobacteria and Cyanobacteria in the model group was higher than that in the normal group. On the contrary, the relative abundance of Bacteroidetes in the model group was lower than that in the normal group. Upon XYS treatment, the relative abundance of all dysregulated phyla was restored to levels similar to those observed in the normal group. Abundance clustering heat map of phyla corroborated the taxonomic distribution. CONCLUSION The microbiome relative abundance of FD rats with liver depression-spleen deficiency syndrome was significantly different from the normal cohort. XYS intervention may effectively adjust the gut dysbacteriosis in FD.

Nonalcoholic fatty liver disease, spleen and psoriasis:New aspects of low-grade chronic inflammation

AIM: To investigate spleen status in psoriasis and itsrelationship with hepatic steatosis, Psoriasis Area and Severity Index, and insulin resistance.METHODS: Seventy-nine psoriatic patients who were not suffering from any chronic inflammatory disease were retrospectively selected for inclusion in this study,and their complete medical records were accessed.An age- and sex-matched group of 80 non-psoriatic,obese patients was included as a control. The following relevant data were collected: age, sex, weight, height,body mass index, waist circumference, blood pressure,insulin resistance status, age at psoriasis onset, and severity of psoriasis. Abdominal ultrasonography was performed to determine spleen longitudinal diameter(SLD), and hepatic steatosis grade.RESULTS: The SLD of control obese patients was greater than that of psoriatic subjects(P = 0.013),but body mass index predicted the size of the spleen in psoriatic patients(P < 0.001). The SLD of psoriatic patients with normal weight was significantly reduced with respect to the overweight/obese psoriatic patients(P = 0.002). A multiple regression analysis revealed that body mass index was a unique predictor of the spleen size(P < 0.001). Finally, the disease duration predicted the spleen size in psoriatic subjects(P =0.038).CONCLUSION: This study shows a correlation between the SLD and the duration of psoriasis.

基于胆汁酸-肠道菌群对话机制探讨非酒精性脂肪性肝病肝郁脾虚病机特点

胆汁酸与肠道菌群关系失衡与非酒精性脂肪性肝病密切相关。基于中医理论及临床研究,发现“肝郁脾虚”是非酒精脂性肪性肝病发病过程中的关键病机。结合现代医学及分子生物学研究,认为肠道菌群紊乱与中医“脾虚”密切相关,胆汁酸分泌异常为“肝郁”的微观体现,而且在非酒精性脂肪性肝病发展进程中,“胆汁酸与肠道菌群失衡”与中医“肝郁脾虚”的基本病机相契合。因此,从“胆汁酸与肠道菌群失衡”角度探讨非酒精性脂肪性肝病“肝郁脾虚”的现代生物学内涵,研究“肝郁脾虚”的病机实质及其代表方药,有望为非酒精性脂肪性肝病的防治提供更有效的方法和策略。

痛泻要方通过调控肠道菌群-ENS-MM串扰减轻IBS-D结肠运动亢进的机制研究

目的 探讨痛泻要方通过调控肠道菌群-肠神经系统(ENS)-肌层巨噬细胞(MM)串扰减轻腹泻型肠易激综合征(IBS-D)大鼠结肠运动亢进的作用机制。方法 将40只新生雄性SD大鼠随机分为对照组、模型组、中药组[痛泻要方2.68 g/(kg·d),以生药量计]、阳性对照组[双歧杆菌乳杆菌三联活菌片0.27 g/(kg·d)],每组10只。除对照组外,其余3组大鼠均采用母子分离+慢性束缚+番泻叶致泻法复制肝郁脾虚证型IBS-D模型。造模后,各药物组大鼠灌胃相应药液,每天1次,持续2周。于造模结束时和给药后观察各组大鼠的粪便性质(稀便出现率、稀便率)、结肠运动功能(小球排出时间)、内脏敏感性[不同压力下的腹部回缩反射(AWR)评分];于给药后检测各组大鼠血清脂多糖(LPS)浓度,结肠组织中骨形态生成蛋白2(BMP2)、集落刺激因子1(CSF1)、Toll样受体4(TLR4)蛋白的表达和分布情况,以及肠道菌群的多样性、物种组成及差异。结果 造模结束时,除对照组外的其余3组大鼠均100%出现稀便,稀便率和各压力下的AWR评分均较对照组显著升高,小球排出时间均较对照组显著缩短(P<0.01或P<0.05)。中药组和阳性对照组大鼠的稀便出现率分别为20%、80%;中药组大鼠稀便率、各压力下的AWR评分、血清LPS浓度和结肠组织肌层中CSF1、TLR4蛋白的表达均较模型组显著降低;小球排出时间,结肠组织肌层中BMP2蛋白的平均光密度,Chao 1、Shannon、Faith’s PD、Simpson均较模型组显著延长或升高(P<0.01或P<0.05);厚壁菌门/拟杆菌门相对丰度比值由低到高依次为中药组、对照组、阳性对照组、模型组,中药组大鼠的肠道菌群物种组成更贴近于对照组,其优势菌属包括普雷沃氏菌属、布劳特氏菌属等。结论 痛泻要方能通过调节肠道菌群来调控肠道菌群-ENS-MM串扰关键蛋白BMP2、CSF1的表达,从而发挥减轻IBSD大鼠结肠运动亢进的作用。

Clinical Observation on Modified Huan'gan Lipi Decoction Combined with Acupuncture in Treating Spleen Deficiency and Liver Hyperactivity Type Tic Disorders

[Objectives]To observe the clinical efficacy of Modified Huan'gan Lipi Decoction combined with acupuncture in the treatment of spleen deficiency and liver hyperactivity type tic disorders(TD).[Methods]Sixty patients with spleen deficiency and liver hyperactivity type TD were randomly divided into a treatment group of 40 cases and a control group of 20 cases.The treatment group received Modified Huan'gan Lipi Decoction combined with acupuncture,and the control group received Haloperidol Tablets.After 4 weeks of treatment,the Yale Global Tic Severity Scale(YGTSS)score,the total score of TCM syndrome and the clinical efficacy were compared between the two groups before and after treatment.[Results]After treatment,the total effective rate of 87.5%in the treatment group was higher than 80.0%in the control group(P>0.05);the total score of YGTSS and the total score of TCM syndromes in the two groups were compared within groups,P﹤0.01;between groups,P﹤0.01.The recurrence rates of the treatment group and the control group were 11.1%and 71.4%,respectively.The difference between the two groups was statistically significant(P﹤0.01).[Conclusions]Modified Huan'gan Lipi Decoction combined with acupuncture in the treatment of spleen deficiency and liver hyperactivity type TD can significantly improve the patient's tic symptoms,and its long-term efficacy is stable.

Non-invasive model for predicting esophageal varices based on liver and spleen volume

BACKGROUND Upper endoscopy is the gold standard for predicting esophageal varices in China.Guidelines and consensus suggest that patients with liver cirrhosis should undergo periodic upper endoscopy,most patients undergo their first upper endoscopy when esophageal variceal bleeds.Therefore,it is important to develop a non-invasive model to early diagnose esophageal varices.AIM To develop a non-invasive predictive model for esophageal varices based on liver and spleen volume in viral cirrhosis patients.METHODS We conducted a cross-sectional study based on viral cirrhosis crowd in the Second Affiliated Hospital of Xi'an Jiaotong University.By collecting the basic information and clinical data of the participants,we derived the independent risk factors and established the prediction model of esophageal varices.The established model was compared with other models.Area under the receiver operating characteristic curve,calibration plot and decision curve analysis were used to test the discriminating ability,calibration ability and clinical practicability in both the internal and external validation.RESULTS The portal vein diameter,the liver and spleen volume,and volume change rate were the independent risk factors of esophageal varices.We successfully used the factors to establish the predictive model[area under the curve(AUC)0.87,95%CI:0.80-0.95],which showed better predictive value than other models.The model showed good discriminating ability,calibration ability and the clinical practicability in both modelling group and external validation group.CONCLUSION The developed non-invasive predictive model can be used as an effective tool for predicting esophageal varices in viral cirrhosis patients.

基于“肠道微生物群-胆汁酸”探讨2型糖尿病肝郁脾虚型病机的生物学内涵

2型糖尿病是当今社会极为普遍的慢性代谢性疾病,严重威胁着人类健康。文章先简述2型糖尿病患者通常存在着肠道微生物群紊乱和胆汁酸代谢异常,再分析论证肝郁脾虚为2型糖尿病关键病机,最后发现肠道微生物群-胆汁酸与中医脾虚肝郁病机十分契合。通过对肠道微生物群-胆汁酸的研究揭示2型糖尿病肝郁脾虚病机的生物学内涵,从而丰富2型糖尿病的中医药防治理论,拓展临床诊疗思路。

Abnormal expression and significance of circ-CBLB/miR-486-5p in patients with rheumatoid arthritis of spleen deficiency and dampness excess type

Objective:To explore the abnormal expression and significance of circ-CBLB/miR-486-5p in patients with rheumatoid arthritis of spleen deficiency and dampness excess type.Methods:The 30 healthy individuals included in the method were from the Physical Examination Center of Anhui Provincial Hospital of Traditional Chinese Medicine,and the 60 rheumatoid arthritis patients included were from the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine.The disease activity score of patients with rheumatoid arthritis was evaluated using VAS score and DAS28 score,joint symptoms and spleen deficiency syndrome score were evaluated using graded quantification method,immune inflammation indicators were detected using relevant instruments,inflammatory cytokines were detected using ELISA method,macrophage markers were detected using FCM method,and pathway gene expression was detected using RT-qPCR;Evaluate the predictive effect of circ-CBLB and miR-486-5p on disease activity in rheumatoid arthritis using ROC curves.Results:(1)miR-486-5p,CD14^(+)CD86^(+),ESR,CRP,RF,Anti CCP Ab,IL-6,TNF in patients with rheumatoid arthritis-αThe levels of circ-CBLB,CD14^(+)CD163^(+),IL-4,and IL-10 were significantly higher than those of healthy individuals;(2)The expression level of circ-CBLB in patients with rheumatoid arthritis is positively correlated with CD14^(+)CD163^(+),and negatively correlated with miR-486-5p and CD14^(+)CD86^(+);The expression level of miR-486-5p is negatively correlated with CD14^(+)CD163^(+)and positively correlated with CD14^(+)CD86^(+);There is a negative correlation between CD14^(+)CD86^(+)and CD14^(+)CD163^(+);ESR is negatively correlated with circ-CBLB,and positively correlated with miR-486-5p,CD14^(+)CD86^(+),CRP;CRP is negatively correlated with circ-CBLB,CD14^(+)CD163^(+),and positively correlated with CD14^(+)CD86^(+),ESR;(3)The expression level of circ-CBLB in patients with rheumatoid arthritis is negatively correlated with joint tenderness,morning stiffness,lack of qi and lazy speech,and postprandial abdominal distension score;The expression level of miR-486-5p is positively correlated with the scores of joint tenderness and decreased appetite.(4)The ROC curve shows that in terms of circ-CBLB,ESR,CRP,VAS,and DAS28 AUC are 0.662(P=0.032),0.658(P=0.035),0.516(P=0.830),and 0.791(P=0.000),respectively.In terms of miR-486-5p,ESR,CRP,VAS,and DAS28 AUC were 0.566(P=0.385),0.511(P=0.883),0.592(P=0.223),and 0.727(P=0.003),respectively.Conclusion:The abnormal expression of circ CBLB and miR-486-5p in peripheral blood mononuclear cell of patients with rheumatoid arthritis of spleen deficiency and dampness excess type is related to inflammatory polarization markers,immune inflammation,disease activity,joint symptoms and spleen deficiency syndrome of rheumatoid arthritis,and the low expression of circ CBLB and high expression of miR-486-5p have certain predictive value for disease activity of rheumatoid arthritis.

从中医谈脑-肠轴与腹泻型肠易激综合征的研究进展

肠易激综合征(IBS)是常见的功能性肠病,其症状反复出现,受情绪压力和生活方式影响较大,与中医肝郁脾虚型,情志不舒诱发腹痛、泄泻相似。脑肠轴对中枢神经系统的感觉和调节异常都可恶化其感知和反射反应,导致内脏感觉高敏状态及胃肠道运动功能的失常。近年来中医治疗腹泻型肠易激综合征(IBS-D)取得良好临床成效,本文通过查阅临床资料和相关文献,从脑-肠轴入手探讨中医治疗IBS-D的临床效果及研究进展,为其治疗提供进一步理论依据。

CT参数联合FIB-4和血清VEGF水平预测乙型肝炎肝硬化患者并发食管静脉曲张效能分析

目的分析应用X线计算机断层摄影(CT)检测参数联合纤维化-4因子(FIB-4)和血清血管内皮生长因子(VEGF)水平预测乙型肝炎肝硬化患者食管静脉曲张(EV)的效能。方法2020年3月~2023年4月我院收治的乙型肝炎肝硬化患者98例,均接受胃镜检查诊断EV。行CT检查,采用层切法勾画,应用liver volume软件测量肝脏和脾脏体积,并测量门静脉内径(MPV)、脾静脉内径(SPV)和胃左静脉直径(LGV)。常规检测血小板计数和血生化指标,计算FIB-4,采用ELISA法检测血清VEGF水平,绘制受试者工作特征曲线(ROC),依据曲线下面积(AUC)判定指标联合预测EV的效能。结果在本组肝硬化患者中,胃镜检查发现并发EV者48例;EV组脾脏体积、MPV和LGV分别为(581.7±98.6)cm^(3)、(15.2±1.3)mm和(6.1±0.5)mm,显著大于无EV组【分别为(452.6±84.9)cm^(3)、(12.1±0.8)mm和(4.2±0.3)mm,P<0.05】;EV组FIB-4和血清VEGF水平分别为(6.0±1.3)和(101.7±28.1)ng/L,显著高于无EV组【分别为(4.3±0.9)和(65.7±15.7)ng/L,P<0.05】;应用脾脏体积、MPV、LGV、FIB-4和血清VEGF水平联合预测EV存在的AUC为0.967(95%CI为0.931~0.997),其敏感度和特异度分别为91.8%和90.0%,显著优于指标单独预测(P<0.05)。结论应用CT参数联合FIB-4和血清VEGF水平预测肝硬化患者发生EV具有较高的诊断效能。

疏肝健脾中药联合益生菌治疗失眠的临床疗效及对血清5-羟色胺、褪黑素、血管活性肠肽水平的影响

[目的]观察疏肝健脾中药联合益生菌治疗失眠(肝郁脾虚型)的临床疗效及对血清5-羟色胺(5-HT)、褪黑素(MT)、血管活性肠肽(VIP)水平的影响。[方法]选取2021年10月-2022年10月于河北中医药大学第一附属医院睡眠中心门诊就诊的130例中医辨证属于肝郁脾虚型失眠患者作为研究对象,按随机数字表法随机分为观察组65例和对照组65例。对照组给予右佐匹克隆片,2 mg/日,睡前口服。观察组给予基于疏肝健脾法拟定的中药免煎颗粒及双歧杆菌乳杆菌三联活菌片,均为2次/日,饭后服用。两组疗程均为4周。观察2组患者治疗前后匹兹堡睡眠质量指数评定量表(PSQI)评分、汉密尔顿抑郁量表(HAMD-17)评分、胃肠道症状量表(GSRS)评分和血清5-HT、MT、VIP水平以及多导睡眠图(PSG)相关参数的变化情况,于停药2周后随访时重复观察患者PSQI、HAMD-17、GSRS评分情况,并评价2组患者的临床疗效和安全性。[结果]1)PSQI、HAMD-17、GSRS评分:治疗4周后及停药2周随访时,2组患者的PSQI各因子评分、PSQI总分、HAMD-17评分及GSRS评分均低于治疗前(P<0.05);观察组PSQI的睡眠时间、睡眠质量、睡眠障碍、日间功能障碍等各因子评分、PSQI总分、HAMD-17评分及GSRS评分的降低程度显著优于对照组(P<0.05)。2)实验室指标:治疗4周后,2组患者血清5-HT、MT及VIP水平均高于治疗前(P<0.05);观察组血清5-HT、MT及VIP水平均显著高于对照组(P<0.05)。3)PSG监测:治疗4周后,2组患者PSG的总睡眠时间(TST)、睡眠潜伏期(SL)、觉醒时间(AWT)等3项参数值均优于治疗前(P<0.05);观察组PSG的TST、AWT参数值的改善程度显著优于对照组(P<0.05),而SL参数值的改善程度虽低于对照组,但差异无统计学意义(P>0.05)。4)临床疗效:治疗4周后,观察组的愈显率为70.97%,高于对照组的45.16%(P<0.05)。5)不良反应发生率:治疗期间,观察组不良反应发生率为4.84%,低于对照组的22.58%(P<0.05)。[结论]疏肝健脾中药联合益生菌可有效提高患者的睡眠质量,改善抑郁情绪及胃肠道功能,提升相关神经递质和激素的水平,临床疗效确切,远期疗效显著,且不良反应较少,安全性较高。

Non-invasive assessment of esophageal varices:Status of today

With increasing burden of compensated cirrhosis,we desperately need noninvasive methods for assessment of clinically significant portal hypertension.The use of liver and spleen stiffness measurement helps in deferring unnecessary endoscopies for low risk esophageal varices.This would reduce cost and patient discomfort.However,these special techniques may not be feasible at remote areas where still we need only biochemical parameters.More prospective studies validating the non-invasive risk prediction models are definitely needed.