加减半夏泻心汤治疗肝胃病临床体会

自拟加减半夏泻心汤治疗因外感湿热所致肝胃诸疾,临证每获佳效。尽管所患疾病病名不同,但其显现的临床证候却是一样,显示了祖国医学辨证施治的灵活性。

如何辨治肝原性胃病?

答:原有胃病者合并肝炎感染,可使胃部病变加重;无胃病者患了病毒性肝炎可以合并胃及十二指肠粘膜病变。肝原性胃病常见表现有胃脘部疼痛,泛酸、嗳气、恶心、呕吐等。有报道,急性黄疸型肝炎进行胃镜检查,发现胃及十二指肠粘膜损伤率在90％左右,其中浅表性胃炎和十二指肠球部溃疡发病最高。对15例肝病患者进行胃粘膜活检,证实血清HBV阳性者的胃粘膜内有HBsAg的存在。现代医学研究认为,肝原性胃病的发生机理可能是:(1)由于肝炎病毒的泛嗜性,存在于胃粘膜内,形成免疫复合物在胃及十二指肠粘膜基底微血管沉积造成局部免疫反应;(2)肝功能减退,对激素灭活减少,使内分泌和植物神经功能等紊乱,致胃与十二指肠粘膜受损,幽门螺杆菌易于感染,进一步损害胃粘膜屏障;(3)胃酸与胆汁反流增多,造成胃及十二指肠的炎性改变,出现一系列消化道症状。中医学认为,胃为水谷之海,直通降不宜滞。

乙肝患者如何养胃

很多人终其一生都会受到胃病的困扰。正常人况且如此，更不用说乙肝患者了，在导致乙肝患者胃病的病因中，肝源性胃病占有相当比例。提到肝源性胃病，大家可能知之甚少。那么什么肝源性胃病？我们还是听听专家怎么讲吧!

乙肝患者须养胃

俗话说“十人九胃”,也就是说,九成人一生中都会或多或少受到胃病的困扰。正常人况且如此,更不用说乙肝患者了。事实上,超过80%的患者会同时遭受胃病的侵害。最近,乙肝患者陈某总感觉胃口不好,没有食欲,上腹部不适,有时出现泛酸、嗳气、恶心等症状。陈某以为一定是肝炎发作了,于是在家人陪同下,赶忙来到医院检查肝功,结果显示正常。医生建议陈某再做一次胃镜检查,结果提示陈某患有胆汁返流性胃炎,属于肝源性胃病。医生为陈某开了一些硫糖铝和胃动力药,吃了5天后,陈某的症状基本消失。

杜建民学术思想探究

杜建民主任医师从小受家庭影响,学习中医,热爱中医,在学术上重视中医经典的学习,强调中西医结合。在近70年的行医生涯中,积累了丰富的中医内科学临床经验,尤其擅长治疗肝胆病、脾胃病和其他疑难病。杜老对黄疸病的分类、病因病机、治疗法则和用药有自己的独到经验和特色。

Multicenter Clinical Randomized Controlled Trial and Network Pharmacology Analysis of Zhenzhu Qingyuan Granules for the Treatment of Gastroesophageal Reflux Disease

Objective To evaluate the clinical efficacy and safety of Zhenzhu Qingyuan Granules through a clinical randomized controlled trial and to analyze the potential action targets and pathways of this formula using network pharmacology.Methods Patients with gastroesophageal reflux disease(GERD)of liver–stomach stagnant heat pattern who met the inclusion and exclusion criteria were randomly divided into the control group and the observation group.The control group received oral rabeprazole,whereas the observation group were given Zhenzhu Qingyuan Granules in addition to the rabeprazole.The treatment duration was 8 weeks.Clinical efficacy was observed in both groups after 8 weeks.Network pharmacology was used to analyze the action targets of ZhenzhuQingyuanGranules and the genes related to GERD,and core targets were inferred.Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses were conducted to explore the potential mechanisms of this formula.Results The clinical research results showed that the total effective rate in the treatment group was 92.68%,compared with 70.00%in the control group,with a statistically significant difference(p<0.05).After treatment,both Chinese medicine syndrome score and endoscopic score improved in both groups compared with before treatment(p<0.05),and the treatment group showed greater improvement than the control group(p<0.05).Network pharmacology identified effective components of Zhenzhu Qingyuan Granules for treating GERD,including quercetin,luteolin,andβ-sitosterol,with potential action targets such as tumor protein 53(TP53),protein kinase B(AKT1),and tumor necrosis factor.Conclusion Zhenzhu Qingyuan Granules can significantly improve clinical symptoms in patients with GERD of liver–stomach stagnated heat pattern,enhance clinical efficacy,and have high safety.This formula may exert therapeutic effects through multiple targets and pathways.

Coexistence of hepatocellular carcinoma and gastrointestinal stromal tumor:A case report

Malignant gastrointestinal stromal tumors （GIST） are rare mesenchymal tumors originating from the wall of the gastrointestinal tract. Their coexistence with other tumors originating from other germ layers is unique. We have reported a case of a 63-year-old GIST patient presenting as an epigastric mass associated with hepatic tumor. Histologically, the mesenteric tumor was composed of spindle cells showing both neural and smooth muscle differentiation. Immunohistochemical examination showed positive staining for CDl17, vimentin, S-100, and SMA, while CD34 antigen was negative. The hepatic tumor was diagnosed as hepatocellular carcinoma （HCC）. To the best of our knowledge, this is the first case of GIST and HCC coexistence. The rarity of the case, however, should not lead to ignoring such a possibility in differential diagnosis.

Involvement of serum retinoids and Leiden mutation in patients with esophageal, gastric, liver, pancreatic, and colorectal cancers in Hungary

AIM: To analyze the serum levels of retinoids and Leiden mutation in patients with esophageal, gastric, liver,pancreatic, and colorectal cancers.METHODS: The changes in serum levels of retinoids (vitamin A, α- and β-carotene, α- and β-cryptoxanthin,zeaxanthin, lutein) and Leiden mutation were measured by high liquid performance chromatography (HPLC)and polymerase chain reaction (PCR) in 107 patients (70 males/37 females) with esophageal (0/8), gastric (16/5), liver (8/7), pancreatic (6/4), and colorectal (30/21including 9 patients suffering from in situ colon cancer)cancer. Fifty-seven healthy subjects (in matched groups)for controls of serum retinoids and 600 healthy blood donors for Leiden mutation were used.RESULTS: The serum levels of vitamin A and zeaxanthin were decreased significantly in all groups of patients with gastrointestinal (GI) tumors except for vitamin A in patients with pancreatic cancer. No changes were obtained in the serum levels of α- and β-carotene,α- and β-cryptoxanthin, zeaxanthin, lutein in patients with GI cancer. The prevalence of Leiden mutation significantly increased in all groups of patients with GI cancer.CONCLUSION: Retinoids (as environmental factors)are decreased significantly with increased prevalence of Leiden mutation (as a genetic factor) in patients before the clinical manifestation of histologically different (planocellular and hepatocellular carcinoma, and adenocarcinoma) GI cancer.

Primary gastrointestinal stromal tumor of the liver: A case report

We report a case of primary gastrointestinal stromal tumor （GIST） of the liver. A 17-year-old man with a solid mass in the anterior segment of the right liver was asymptomatic with negative laboratory examinations with the exception of positive HBV. Contrast-enhanced ultrasound （CEUS） revealed a hypervascular lesion in the arterial phase and hypoechoic features during the portal and late phases. However, enhanced spiral computed tomography （CT） showed hypoattenuation in all three phases. Following biopsy, immunohistochemical evaluation demonstrated positive CDl17. Different imaging features of primary GISTs of the liver are due to pathological properties and different working systems between CEUS and enhanced spiral CT.

Malnutrition affects quality of life in gastroenterology patients

AIM： To investigate the association between malnutrition and quality of life in patients with benign gastrointestinal disease.METHODS： Two hundred patients （104 wellnourished and 96 malnourished） were assessed according to the Subjective Global Assessment, anthropometric measurements and bioelectrical impedance analysis. Quality of life was determined with the validated Medical Outcomes Study 36-item Short-Form General Health Survey （SF 36）. Muscle function was assessed by hand grip strength and peak flow.RESULTS： Body mass index, body cell mass, arm muscle area and hand grip strength were significantly lower in the malnourished patients. Quality of life was generally lower when compared to norm values. Seven out of eight quality of life scales （excluding bodily pain） were significantly reduced in the malnourished patients. Comparing patients with liver cirrhosis and inflammatory bowel disease （IBD）, patients with IBD experienced significantly lower values in the perception of bodily pain, social functioning and rnenta/health. Malnourished liver cirrhotics suffered reductions in more scales （six out of eight） than malnourished IBD patients did （four out of eight）.CONCLUSION： Quality of life is generally low in benign gastrointestinal disease and is further reduced in patients who are classified as malnourished. It appears that liver cirrhosis patients experience a higher quality of life than IBD patients do, but the impact of malnutrition seems to be greater in liver cirrhosis than in IBD.

Effect of early propranolol administration on portal hypertensive gastropathy in cirrhotic rats

AIM:To investigate any protective effect of early propranolol administration in the development of portal hypertensive gastropathy in cirrhotic rats. METHODS:For the development of liver cirrhosis and portal hypertensive gastropathy,60 rats underwent ligation of the left adrenal vein and complete devascularization of the left renal vein,followed by phenobarbital and carbon tetrachloride(CCl4) administration.After two weeks of CCl4 administration, the rats were randomly separated into two groups.In group A,propranolol was continuously administered intragastrically throughout the study,whereas in group B normal saline(placebo)was administered instead. Hemodynamic studies and vascular morphometric analysis of gastric sections were performed after complete induction of cirrhosis. RESULTS:Vascular morphometric studies showed higher numbers of vessels in all mucosal layers in the control group.Statistical analysis revealed a significantly higher total vascular surface in the control group compared to the propranolol group,but with no statistically significant difference between the mean vascular surfaces between the groups.Our study clearly shows that the increased mucosal blood flow is manifested by a marked increase of vessel count. CONCLUSION:Early propranolol's administration in portal hypertensive cirrhotic rats seems to prevent intense gastric vascular congestion that characterizes portal hypertensive gastropathy.

Gastroenterology service in a teaching hospital in rural New Zealand, 1991-2003

AIM: To retrospectively collect inpatient and outpatient data and to assess the use of endoscopic procedures during the years 1991, 1997 and 2003 to analyse for trends. METHODS: This retrospective survey was conducted in a University-associated Gastroenterology Unit offering secondary and tertiary health care services for a population of approximately 182 000 people in Southern New Zealand. Data collected included patient contacts (inand outpatients), gastroscopic and colonoscopic investigations. RESULTS: We observed a significant increase in the absolute numbers of patient contacts over the years (1991: 2308 vs 1997: 2022 vs 2003: 2783, P < 0.0001) with inflammatory bowel disease, other diseases of the colon, anus and rectum and iron studies related disorders decreasing significantly but liver disease and constipation increasing linearly over time. The use of endoscopy services remained relatively stable but colonoscopic investigations for a positive family history of colorectal cancer increased significantly while more gastroscopies were performed for unexplained anaemia. CONCLUSION: The whole spectrum of gastroenterology contacts was studied. A substantial proportion of colonoscopies and outpatient consultations were undertaken to screen for colorectal cancer. This proportion is likely to grow further. Our fi ndings have implications for the recruitment and training of the next generation of gastroenterologists.

Perivascular epithelioid cell tumor of the liver coexisting with a gastrointestinal stromal tumor

Approximately 10% of patients with gastrointestinal stromal tumors (GIST) develop other neoplasms, either synchronously or metachronously. In this report we describe coexistence of a gastrointestinal stromal tumor and a hepatic perivascular epithelioid cell tumor (PEComa) in a 51-year-old woman with no evidence of tuberous sclerosis. A subcapsular hepatic nodule (0.8 cm in diameter) was found during surgery for symptomatic gastric neoplasm (15 cm in diameter) arising from the lesser curvature. Both tumors revealed histomorphological and immunohistochemical features confirming a diagnosis of a small incidental hepatic PEComa and a high risky extramural gastric GIST, respectively. The patient remained disease-free 25 mo after surgery with no evidence of tumor recurrence or new neoplasms. To our knowledge, this is the first report of PEComa in a patient with GIST. Hepatic lesions detected synchronously or metachronously in patients with GISTs may represent histogenetically distinct lesions and should be sampled to confirm or exclude metastatic GISTs.

Pathologic complete response confirmed by surgical resection for liver metastases of gastrointestinal stromal tumor after treatment with imatinib mesylate

A 39-year-old male underwent distal gastrectomy for a high grade gastrointestinal stromal tumor(GIST) . Computed tomography(CT) and magnetic resonance imaging(MRI) 107 mo after the operation,revealed a cystic mass(14 cm in diameter) and a solid mass(9 cm in diameter) in the right and left lobes of the liver,respectively. A biopsy specimen of the solid mass showed a liver metastasis of GIST. The patient received imatinib mesylate(IM) treatment,400 mg/day orally. Following the IM treatment for a period of 35 mo,the patient underwent partial hepatectomy(S4 + S5) . The effect of IM on the metastatic lesions was interpreted as pathologic complete response(CR) . Pathologically verified cases showing therapeutic efficacy of IM have been rarely reported.

The Human Microbiota in Health and Disease

Trillions of microbes have evolved with and continue to live on and within human beings. A variety of environmental factors can affect intestinal microbial imbalance, which has a close relationship with human health and disease. Here, we focus on the interactions between the human microbiota and the host in order to provide an overview of the microbial role in basic biological processes and in the development and progression of major human diseases such as infectious diseases, liver diseases, gastrointestinal cancers, metabolic diseases, respiratory diseases, mental or psychological diseases, and autoimmune diseases. We also review important advances in techniques associated with microbial research, such as DNA sequencing, metabonomics, and proteomics combined with computation-based bioinformatics.Current research on the human microbiota has become much more sophisticated and more comprehensive.Therefore, we propose that research should focus on the host-microbe interaction and on causeeffect mechanisms, which could pave the way to an understanding of the role of gut microbiota in health and disease, and provide new therapeutic targets and treatment approaches in clinical practice.