理学检查慢性胃十二指肠炎280例

目的:探索诊断胃十二指肠炎的简易方法.近10a 消化道发病率增加,每千居民从80人增加为140人.主要是上消化道慢性炎症,慢性胃十二指肠炎最常见,其确诊主要靠胃镜或 X 线检查.光学纤维内镜和胃肠造影学的进步是胃肠病学在20世纪的成就,但是受设备、技术限制,家长和患者不愿接受.几乎所有患者对这些检查不同程度地畏惧和厌烦,怕感染幽门螺杆菌、乙型肝炎等,或者对检查结果也不全相信,因而这些检查难以普及.胃肠病学临床和有关文献对理学检查很少提及或语焉不详.我们多年致力探索诊断胃十二指肠炎的简单、经济、无创性的理学检查,包括系统全面查体,重视腹部和背部的触诊和叩诊.这符合现提倡的开展随机对照试验和从经验医学模式转向循证医学、进行经济分析等,谨总结1990-10/1994-11的工作报告.方法:采用配对四格表资料的 X^2检验和齐同化原则,选择年龄相近的门诊患儿,每个患儿均接受理学检查和器械检查(胃镜或 X 线上消化道气钡双重造影),作出有无胃十二指肠炎的诊断.根据“全国慢性胃炎研讨会共识意见” (?),以器械检查阳性为确诊依据.理学检查的局部压痛或(?)痛检查共5项,将3项或3项以上阳性者列为疑似诊断.然后对比两种检查法的阳性符合率.结果:两种检查法都阳性(诊断胃十二指肠炎)者256例,都男性者228例.器械检查阳性而理学检查阴性者24例,(?)械检查阴性而理学检查阳性者32例.(?)法检出率无明显差异.结论:鉴于目前小儿胃镜和 X 线检查尚难普及,理学检查可以作为诊断胃十二指肠炎的简易方法来普及和推广应用.

胶态果胶铋治疗慢性胃十二指肠炎的临床疗效观察

选取我院2013年2月-2015年2月收治的64例慢性胃十二指肠炎患者。分为试验组和对照组各32例。对照组患者采用奥美拉唑、甲硝唑、阿莫西林进行治疗,试验组患者同时配合果胶铋进行治疗。比较两组患者治疗效果。结果试验组32例患者中有19例患者痊愈,有10例患者治疗有效,总有效率为90.6%;对照组32例患者中有8例患者痊愈,有12例患者治疗有效,总有效率为62.5%,两组比较存在差异（P〈0.05）。试验组患者治疗后,有6例患者幽门螺杆菌检测为阳性,有26例患者检测为阴性,阳性率为18.8%;对照组患者治疗后,有18例患者幽门螺杆菌检测为阳性,有14例患者检测为阴性,阳性率为43.8%,两组比较存在差异（P〈0.05）。试验组患者症状缓解时间平均为5.8±1.4d;对照组为9.5±1.8d,两组比较存在差异（P〈0.05）。胶态果胶铋在慢性胃十二指肠炎患者中的效果较为理想,能够有效清除幽门螺杆菌。

Evidence for the role of gastric mucosa at the secretion of soluble triggering receptor expressed on myeloid cells(strem-1) in peptic ulcer disease

AIM： To investigate the role of gastric mucosa at the secretion of sTREM-1 in peptic ulcer.METHODS： Seventy two patients were enrolled; 35 with duodenal, 22 with gastric ulcer and 26 with chronic gastritis. Patients were endoscoped and gastric juice was aspirated. Patients with duodenal and gastric ulcer underwent a second endoscopy post-treatment. Biopsies were incubated in the absence/presence of endotoxins or gastric juice. Supernatants were collected and sTREM-2 and TNF~ were measured by enzyme immunoabsorbent assays. Scoring of gastritis was performed before and after treatment according to updated Sydney score.RESULTS： Patients with duodenal and gastric ulcer and those with chronic gastritis had similar scores of gastritis, sTREM-1 was higher in supernatants of tissue samples of H pylori-positive than of H pylori-negative patients with gastric ulcer. Median （± SE） sTREM-1 was found increased in supernatants of patients with gastric ulcer before treatment （203.21 ± 88.91 pg/1000 cells） compared to supernatants either from the same patients post-treatment （8.23 ± 5.79 pg/1000 cells） or from patients with chronic gastritis （6.21 ± 0.71 pg/1000 cells） （P 〈 0.001 and 〈 0.001, respectively）. Similar differences for sTREM-1 were recorded among LPS-stimulated tissue samples of patients （P = 0.001）. Similar differences were not found for TNFα. Positive correlations were found between sTREM-1 of supernatants from patients with both duodenal and gastric ulcer before treatment and the degree of infiltration of neutrophils and monocytes.CONCLUSION： sTREM-1 secreted by the gastric mucosa is an independent mechanism connected to the pathogenesis of peptic ulcer, sTREM-1 was released at the presence of H pylori from the inflamed gastric mucosa in the field of gastric ulcer.

Assay of gastrin and somatostatin in gastric antrum tissues of children with chronic gastritis and duodenal ulcer

AIM： To study the expressions of gastrin （GAS） and somatostatin （SS） in gastric antrum tissues of children with chronic gastritis and duodenal ulcer and their role in pathogenic mechanism. METHODS： Specimens of gastric antrum mucosa from 83 children were retrospectively analyzed. Expressions of GAS and SS in gastric antrum tissues were assayed by the immunohistochemical Fn Vision method. RESULTS： The expressions of GAS in chronic gastritis Hp＋ group （group A）, chronic gastritis Hp-group （group B）, the duodenal ulcer Hp＋group （group C）, duodenal ulcer Hp group （group D）, and normal control group （group E） were 28.50＋4.55, 19.60＋2.49, 22.69＋2.71, 25.33 ＋ 4.76, and 18.80 ＋ 2.36, respectively. The value in groups A-D was higher than that in group F. The difference was not statistically significant. The expressions of SS in groups A-E were 15.47＋ 1.44, 17.29＋ 2.04, 15.30＋ 1.38, 13.11 ＋0.93 and 12.14＋ 1.68, respectively. The value in groups A-D was higher than that in group F. The difference was also not statistically significant. CONCLUSION： The expressions of GAS and SS are increased in children with chronic gastritis and duodenal ulcer.

国家基本药物目录之药品鉴宝:多面手甲硝唑

甲硝唑是硝基咪唑衍生物，从上世纪50年代末开始用于治疗阴道滴虫病，故又称灭滴灵。1987年，WHO将其列入抗感染的基本药物，预防和治疗厌氧菌引起的感染，广泛用于各种类型阿米巴病、消化性溃疡、妇科盆腔感染、口腔疾病、急性出血性坏死性小肠炎、慢性胃十二指肠炎、局限性肠炎、手术感染、肺脓肿、胸膜感染和心内膜炎、脑脓肿、胸膜炎、腹腔感染.