慢性HBV携带者的肝组织损伤研究

目的:分析慢性HBV携带者的肝组织病理改变,为慢性HBV携带者的诊治提供依据。方法:113例慢性HBV携带者进行肝组织学检查和血清学、病毒核酸检测。结果:57.52%的慢性HBV携带者肝组织炎症(G)在2级以上,HBeAg阴性携带者G≥2占70.59%,符合抗病毒治疗指征。肝组织炎症活动程度分级与HBV-DNA滴度无相关性(P>0.05),肝组织炎症分级与纤维化分期显著相关(χ2=51.589,P<0.001)。结论:对慢性HBV携带者应建议行肝脏穿刺检查,尤其是HBeAg阴性的慢性HBV携带者,以提高诊断的准确性并进行合理治疗。

快速进展性肾功能衰竭19例分析

目的：分析慢性肾功能不全（CRF）患者肾功能快速进展的药物因素,探讨肾功能的保护。方法：回顾性分析19例快速进展性肾功能衰竭患者的用药情况。发现所有患者都同时应用3-4类药：调整降压药、利尿药、排毒护肾药、活血化淤中成药等,而这些药都有不同程度的影响肾血流动力学的作用。结果：平均18.35 d,患者肾功能不可逆成倍增高或进入尿毒症终末期须替代治疗。结论：病情比较平稳的CRF患者,调整用药要慎重,不宜同时加2种以上的对肾血流动力学有影响的药物。

Consensus statement AIGO/SICCR:Diagnosis and treatment of chronic constipation and obstructed defecation(partⅠ:Diagnosis)

Chronic constipation is a common and extremely troublesome disorder that significantly reduces the quality of life,and this fact is consistent with the high rate at which health care is sought for this condition.The aim of this project was to develop a consensus for the diagnosis and treatment of chronic constipation and obstructed defecation.The commission presents its results in a "Question-Answer" format,including a set of graded recommendations based on a systematic review of the literature and evidence-based medicine.This section represents the consensus for the diagnosis.The history includes information relating to the onset and duration of symptoms and may reveal secondary causes of constipation.The presence of alarm symptoms and risk factors requires investigation.The physical examination should assess the presence of lesions in the anal and perianal region.The evidence does not support the routine use of blood testing and colonoscopy or barium enema for constipation.Various scoring systems are available to quantify the severity of constipation;the Constipation Severity Instrument for constipation and the obstructed defecation syndrome score for obstructed defecation are the most reliable.The Constipation-Related Quality of Life is an excellent tool for evaluating the patient's quality of life.No single test provides a pathophysiological basis for constipation.Colonic transit and anorectal manometry define the pathophysiologic subtypes.Balloon expulsion is a simple screening test for defecatory disorders,but it does not define the mechanisms.Defecography detects structural abnormalities and assesses functional parameters.Magnetic resonance imaging and/or pelvic floor sonography can further complement defecography by providing information on the movement of the pelvic floor and the organs that it supports.All these investigations are indicated to differentiate between slow transit constipation and obstructed defecation because the treatments differ between these conditions.

Consensus statement AIGO/SICCR diagnosis and treatment of chronic constipation and obstructed defecation(Part Ⅱ:Treatment)

The second part of the Consensus Statement of the Italian Association of Hospital Gastroenterologists and Italian Society of Colo-Rectal Surgery reports on the treatment of chronic constipation and obstructed defecation. There is no evidence that increasing fluid intake and physical activity can relieve the symptoms of chronic constipation. Patients with normal-transit constipation should increase their fibre intake through their diet or with commercial fibre. Osmotic laxatives may be effective in patients who do not respond to fibre supplements. Stimulant laxatives should be re- served for patients who do not respond to osmotic laxatives. Controlled trials have shown that serotonin- ergic enterokinetic agents, such as prucalopride, and prosecretory agents, such as lubiprostone, are effec- tive in the treatment of patients with chronic constipa- tion. Surgery is sometimes necessary. Total colectomy with ileorectostomy may be considered in patients with slow-transit constipation and inertia coil who are resistant to medical therapy and who do not have defecatory disorders, generalised motility disorders or psychological disorders. Randomised controlled trials have established the efficacy of rehabilitative treat- ment in dys-synergic defecation. Many surgical proce- dures may be used to treat obstructed defecation in patients with acquired anatomical defects, but none is considered to be the gold standard. Surgery should be reserved for selected patients with an impaired quality of life. Obstructed defecation is often associated with pelvic organ prolapse. Surgery with the placement of prostheses is replacing fascial surgery in the treatment of pelvic organ prolapse, but the efficacy and safety of such procedures have not yet been established.

Diagnosis and Treatment of Chronic Cough due toGastroesophageal Reflux Disease

Gastroesophageal reflux disease is one of most common causes of chronic cough. Medical history offers few clues as to the cause of cough induced by this disease. 24-h esophageal ph monitoring is considered as the most sensitive and specific test for the diagnosis. When it is unavailable or unsuitable, upper gastrointestinal endoscopy and barium esophagography can be used as an alternative examination. Combined multichannel intraluminal impedance and pH testing is promising because of its ability to detect non-acid reflux as well as acid reflux. Empiric therapy trial is a simple and cheap way to identify suspected patients. Drug therapy is effective in most of the patients, in which proton pump inhibitors is the most powerful. Antireflux surgery is the last choice,used only when intensive drug therapy fails. The definitive diagnosis of cough due to gastroesophageal reflux disease can be established only after cough improves or cc.npletely disappears with antireflux therapy.

慢性硬膜下血肿69例分析

慢性硬脑膜下血肿（CSDH）是颅脑外伤后引起的迟发性血肿,一般3周后才出现临床症状,位于硬脑膜与蛛网膜之间,是有包膜的血肿,约占颅内血肿的10%[1]。如不能尽早诊断和及时治疗,极易致残甚至引起死亡。我院自2008-11-2011-03共收治慢性硬脑膜下血肿69例,疗效显著,现报告如下。

慢性阻塞性肺疾病的血清标志物研究进展

慢性阻塞性肺疾病（慢阻肺）是一种慢性气道炎症性疾病，以其高患病率和致死率越来越受到重视，给我国造成了沉重的社会经济负担。了解可供客观测定和评价慢阻肺诊断、分级、治疗及其预后的标志物，利用其变化获得有价值的临床信息，有助于满足日益增长的临床需求。笔者回顾性查阅近五年文献，对慢阻肺诊断、治疗和预后相关的血清标志物进行分析并讨论。多种血清标志物水平均与肺功能严重程度相关，可用于判断慢阻肺病情严重程度；某些指标与诊断急性加重、预测死亡或住院等风险相关；一些血清标志物在判断病原学、指导治疗及评估预后方面有重要价值，可有效应用于临床。对慢阻肺血清标志物的研究旨在为临床医师在慢阻肺诊断、治疗及预后评估中提供更多的参考信息。