Characteristics of nonvariceal upper gastrointestinal hemorrhage in patients with chronic kidney disease

AIM:To evaluate the clinical characteristics of nonvariceal upper gastrointestinal hemorrhage(NGIH)in patients with chronic kidney disease(CKD).METHODS:From 2003 to 2010,a total of 72 CKD patients(male n=52,72.2%;female n=20,27.8%)who had undergone endoscopic treatments for NGIH were retrospectively identified.Clinical findings,endoscopic features,prognosis,rebleeding risk factors,and mortality-related factors were evaluated.The characteristics of the patients and rebleeding-related data were recorded for the following variables:gender,age,alcohol use and smoking history,past hemorrhage history,endoscopic findings(the cause,location,and size of the hemorrhage and the hemorrhagic state),therapeutic options for endoscopy,endoscopist experience,clinical outcomes,and mortality.RESULTS:The average size of the hemorrhagic site was 13.7±10.2 mm,and the most common hemorrhagic site in the stomach was the antrum(n=21,43.8%).The most frequent method of hemostasis was combination therapy(n=32,44.4%).The incidence of rebleeding was 37.5%(n=27),and 16.7%(n=12)of patients expired due to hemorrhage.In a multivariate analysis of the risk factors for rebleeding,alcoholism(OR=11.19,P=0.02),the experience of endoscopists(OR=0.56,P=0.03),and combination endoscopic therapy(OR=0.06,P=0.01)compared with monotherapy were significantly related to rebleeding after endoscopic therapy.In a risk analysis of mortality after endoscopic therapy,only rebleeding was related to mortality(OR=7.1,P=0.02).CONCLUSION:Intensive combined endoscopic treatments by experienced endoscopists are necessary for the treatment of NGIH in patients with CKD,especially when a patient is an alcoholic.

Chronic kidney disease severely deteriorates the outcome of gastrointestinal bleeding: A meta-analysis

AIM To understand the influence of chronic kidney disease(CKD) on mortality, need for transfusion and rebleeding in gastrointestinal(GI) bleeding patients.METHODS A systematic search was conducted in three databases for studies on GI bleeding patients with CKD or endstage renal disease(ESRD) with data on outcomes of mortality, transfusion requirement, rebleeding rate and length of hospitalization(LOH). Calculations were performed with Comprehensive Meta-Analysis software using the random effects model. Heterogeneity was tested by using Cochrane's Q and I2 statistics. Mean difference(MD) and OR(odds ratio) were calculated.RESULTS1063 articles(EMBASE: 589; PubM ed: 459; Cochrane: 15) were found in total. 5 retrospective articles and 1 prospective study were available for analysis. These 6 articles contained data on 406035 patients, of whom 51315 had impaired renal function. The analysis showed a higher mortality in the CKD group(OR = 1.786, 95%CI: 1.689-1.888, P < 0.001) and the ESRD group(OR = 2.530, 95%CI: 1.386-4.616, P = 0.002), and a rebleeding rate(OR = 2.510, 95%CI: 1.521-4.144, P < 0.001) in patients with impaired renal function. CKD patients required more unit red blood cell transfusion(MD = 1.863, 95%CI: 0.812-2.915, P < 0.001) and spent more time in hospital(MD = 13.245, 95%CI: 6.886-19.623, P < 0.001) than the controls.CONCLUSION ESRD increases mortality, need for transfusion, rebleeding rate and LOH among GI bleeding patients. Prospective patient registries and observational clinical trials are crucially needed.

Patient selection and preparation strategies for the use of contrast material in patients with chronic kidney disease

The prevalence of chronic kidney disease and peripheral arterial disease is increasing.Thus,it is increasingly problematic to image these patients as the number of patients needing a vascular examination is increasing accordingly.In high-risk patients with impaired kidney function,intravascular administration of iodinated contrast media can result in contrast-induced acute kidney injury and Gadolinium can induce nephrogenic systemic fibrosis(NSF).It is important to identify these highrisk patients by means of se-creatinine/e glomerular filtration rate.The indication for contrast examination should counterbalance the increased risk.One or more alternative examination methods without contrast media,such as CO 2 angiography,Ultrasound/Doppler examination or magnetic resonance angiography without contrast should be considered,but at the same time,allow for a meaningful outcome of the examination.If contrast is deemed essential,the patient should be well hydrated,the amount of contrast should be restricted,the examination should be focused,metformin and diuretics stopped,and renal function monitored.Sodium bicarbonate and N-acetylcysteine are popular but their efficiency is not evidence-based.There is no evidence that dialysis protects patients with impaired renal function from contrast-induced nephropathy or NSF.

Diabetic patients with chronic kidney disease: Non-invasive assessment of cardiovascular risk

The prevalence and burden of diabetes mellitus and chronic kidney disease on global health and socioeconomic development is already heavy and still rising.Diabetes mellitus by itself is linked to adverse cardiovascular events,and the presence of concomitant chronic kidney disease further amplifies cardiovascular risk.The culmination of traditional(male gender,smoking,advanced age,obesity,arterial hypertension and dyslipidemia)and non-traditional risk factors(anemia,inflammation,proteinuria,volume overload,mineral metabolism abnormalities,oxidative stress,etc.)contributes to advanced atherosclerosis and increased cardiovascular risk.To decrease the morbidity and mortality of these patients due to cardiovascular causes,timely and efficient cardiovascular risk assessment is of huge importance.Cardiovascular risk assessment can be based on laboratory parameters,imaging techniques,arterial stiffness parameters,ankle-brachial index and 24 h blood pressure measurements.Newer methods include epigenetic markers,soluble adhesion molecules,cytokines and markers of oxidative stress.In this review,the authors present several non-invasive methods of cardiovascular risk assessment in patients with diabetes mellitus and chronic kidney disease.

Gastrointestinal symptoms as the first sign of chronic granulomatous disease in a neonate: A case report

BACKGROUND Chronic granulomatous disease(CGD)characterized by recurrent and severe bacterial and fungal infections is most common in childhood.CASE SUMMARY We reported a 24-d-old male infant who developed gastrointestinal symptoms as the first sign of CGD.CONCLUSION Gastrointestinal symptoms representing the first sign of CGD are very rare,and prompt diagnosis and treatment with broad-spectrum antibiotics were of crucial importance.

Chronic gastrointestinal symptoms and quality of life in the Korean population

AIM： To evaluate the prevalence of chronic gastroin- testinal symptoms and their impact on health-related quality of life （HRQOL） in the Korean population. METHODS： A cross-sectional survey, using a reliable and valid Rome I] based questionnaire, was per- formed on randomly selected residents, between 18 and 69 years in age. All respondents were interviewed at their homes or offices by a team of interviewers. The impact of chronic gastrointestinal symptoms on HRQOL was assessed using the Korean version of the 36-item Short-Form general health survey （SF-36）. RESULTS： Of the 1807 eligible subjects, 1417 （78.4%： male 762; female 655） were surveyed. Out of the respondents, 18.6% exhibited at least one chronic gastrointestinal symptom. The prevalence of gastro- esophageal reflux disease （GERD）, defined as heart- burn and/or acid regurgitation experienced at least weekly, was 3.5% （95% CI, 2.6-4.5）. The prevalence of uninvestigated dyspepsia, irritable bowel syndrome （IBS） and chronic constipation based on Rome Ⅱ criteria were 11.7% （95% CI, 10.1-13.5）, 2.2% （95% CI, 1.5-3.1）, and 2.6% （95% CI, 1.8-3.5） respectively. Compared with subjects without chronic gastrointesti- nal symptoms （n = 1153）, those with GERD （n = 50）, uninvestigated dyspepsia （n = 166） and IBS （n = 31） had significantly worse scores on most domains of the SF-36 scales. CONCLUSION： The prevalence of GERD, uninvesti- gated dyspepsia and IBS were 3.5%, 11.7% and 2.2% respectively, in the Korean population. The health- related quality of life was significantly impaired in subjects with GERD, uninvestigated dyspepsia and IBS in this community.

Antihypertensive prescribing patterns in non-dialysis dependent chronic kidney disease:Findings from the Salford Kidney Study

BACKGROUND Hypertension is commonly observed in patients living with chronic kidney disease(CKD).Finding an optimal treatment regime remains challenging due to the complex bidirectional cause-and-effect relationship between hypertension and CKD.There remains variability in antihypertensive treatment practices.AIM To analyze data from the Salford Kidney Study database in relation to antihypertensive prescribing patterns amongst CKD patients.METHODS The Salford Kidney Study is an ongoing prospective study that has been recruiting CKD patients since 2002.All patients are followed up annually,and their medical records including the list of medications are updated until they reach study endpoints[starting on renal replacement therapy or reaching estimated glomerular filtration rate(eGFR)expressed as mL/min/1.73 m2≤10 mL/min/1.73 m2,or the last follow-up date,or data lock on December 31,2021,or death].Data on antihypertensive prescription practices in correspondence to baseline eGFR,urine albumin-creatinine ratio,primary CKD aetiology,and cardiovascular disease were evaluated.Associations between patients who were prescribed three or more antihypertensive agents and their clinical outcomes were studied by Cox regression analysis.Kaplan-Meier analysis demonstrated differences in survival probabilities.RESULTS Three thousand two hundred and thirty non-dialysis-dependent CKD patients with data collected between October 2002 and December 2019 were included.The median age was 65 years.A greater proportion of patients were taking three or more antihypertensive agents with advancing CKD stages(53%of eGFR≤15 mL/min/1.73 m2 vs 26%of eGFR≥60 mL/min/1.73 m2,P<0.001).An increased number of patients receiving more classes of antihypertensive agents was observed as the urine albumin-creatinine ratio category increased(category A3:62%vs category A1:40%,P<0.001),with the upward trends particularly noticeable in the number of individuals prescribed renin angiotensin system blockers.The prescription of three or more antihypertensive agents was associated with all-cause mortality,independent of blood pressure control(hazard ratio:1.15;95%confidence interval:1.04-1.27,P=0.006).Kaplan-Meier analysis illustrated significant differences in survival outcomes between patients with three or more and those with less than three antihypertensive agents prescribed(log-rank,P<0.001).CONCLUSION Antihypertensive prescribing patterns in the Salford Kidney Study based on CKD stage were consistent with expectations from the current United Kingdom National Institute of Health and Care Excellence guideline algorithm.Outcomes were poorer in patients with poor blood pressure control despite being on multiple antihypertensive agents.Continued research is required to bridge remaining variations in hypertension treatment practices worldwide.

Functional gastrointestinal disorders,mental health,genetic susceptibility,and incident chronic kidney disease

Background:Whether functional gastrointestinal disorders(FGIDs)are associated with the long-term risk of chronic kidney disease(CKD)remains unclear.We aimed to investigate the prospective association of FGIDs with CKD and examine whether mental health mediated the association.Methods:About 416,258 participants without a prior CKD diagnosis enrolled in the UK Biobank between 2006 and 2010 were included.Participants with FGIDs(including irritable bowel syndrome[IBS],dyspepsia,and other functional intestinal disorders[FIDs;mainly composed of constipation])were the exposure group,and non-FGID participants were the non-exposure group.The primary outcome was incident CKD,ascertained from hospital admission and death registry records.A Cox proportional hazard regression model was used to investigate the association between FGIDs and CKD,and the mediation analysis was performed to investigate the mediation proportions of mental health.Results:At baseline,33,156(8.0%)participants were diagnosed with FGIDs,including 21,060(5.1%),8262(2.0%),and 6437(1.6%)cases of IBS,dyspepsia,and other FIDs,respectively.During a mean follow-up period of 12.1 years,11,001(2.6%)participants developed CKD.FGIDs were significantly associated with a higher risk of incident CKD compared to the absence of FGIDs(hazard ratio[HR],1.36;95%confidence interval[CI],1.28-1.44).Similar results were observed for IBS(HR,1.27;95%CI,1.17-1.38),dyspepsia(HR,1.30;95%CI,1.17-1.44),and other FIDs(HR,1.60;95%CI,1.43-1.79).Mediation analyses suggested that the mental health score significantly mediated 9.05%of the association of FGIDs with incident CKD and 5.63-13.97%of the associations of FGID subtypes with CKD.Specifically,the positive associations of FGIDs and FGID subtypes with CKD were more pronounced in participants with a high genetic risk of CKD.Conclusion:Participants with FGIDs had a higher risk of incident CKD,which was partly explained by mental health scores and was more pronounced in those with high genetic susceptibility to CKD.

Constipation, hard stools, fecal urgency, and incomplete evacuation, but not diarrhea is associated with diabetes and its related factors

AIM: To determine the bowel symptoms associated with diabetes and diabetes-related factors after excluding gastrointestinal (GI) organic diseases.METHODS: Participants were 4738 (603 diabetic and 4135 non-diabetic) patients who underwent colonoscopy and completed a questionnaire. On the day of pre-colonoscopy, 9 symptoms (borborygmus, abdominal distension, increased flatus, constipation, diarrhea, loose stools, hard stools, fecal urgency, and incomplete evacuation) were prospectively evaluated on a 7-point Likert scale. The test-retest reliability of the bowel symptom scores from the baseline and second questionnaires was analyzed using kappa statistics. Associations between bowel symptom scores and diabetes or diabetes-related factors were analyzed by a rank-ordered logistic model adjusted for related confounders, and odds ratios (ORs) were estimated.RESULTS: In multivariate analysis, constipation [adjusted odds ratio (AOR) = 1.57, CI: 1.33-1.85, P &#x0003c; 0.01] and hard stools (AOR = 1.56, CI: 1.33-1.84, P &#x0003c; 0.01) were associated with diabetes, and fecal urgency (AOR = 1.16, CI: 0.99-1.37, P = 0.07) and incomplete evacuation (AOR = 1.16, CI: 1.00-1.36, P = 0.06) were marginally associated with diabetes. These symptoms remained associated even after excluding organic GI diseases on colonoscopy. Test-retest reliability of symptom score with a mean duration of 3.2 mo was good (mean kappa, 0.69). Associations of symptoms with diabetes-related factors were found; constipation with HbA1c &#x02265; 8.0% (AOR = 2.11, CI: 1.19-3.73), body mass index (BMI) &#x0003c; 25 (AOR = 2.11, CI: 1.22-3.66), and insulin use (AOR = 1.90, CI: 1.08-3.36); hard stools with diabetes duration (AOR = 1.03, CI: 1.00-1.07); fecal urgency with BMI &#x0003c; 25 (AOR = 1.73, CI: 1.00-2.98); and incomplete evacuation with BMI &#x0003c; 25 (AOR = 2.60, CI: 1.52-4.43), serum creatinine level (AOR = 1.27, CI: 1.10-1.47), and insulin use (AOR = 1.92, CI: 1.09-3.38).CONCLUSION: Diabetes is associated with constipation, hard stools, fecal urgency, and incomplete evacuation, and poor glycemic control, duration, leanness, and nephropathy affect the risk of these symptoms.

Simultaneous pancreas-kidney transplantation for end-stage renal failure in type 1 diabetes mellitus: Current perspectives

Type 1 diabetes mellitus(T1DM)is one of the important causes of chronic kidney disease(CKD)and end-stage renal failure(ESRF).Even with the best available treatment options,management of T1DM poses significant challenges for clinicians across the world,especially when associated with CKD and ESRF.Substantial increases in morbidity and mortality along with marked rise in treatment costs and marked reduction of quality of life are the usual consequences of onset of CKD and progression to ESRF in patients with T1DM.Simultaneous pancreas-kidney transplant(SPK)is an attractive and promising treatment option for patients with advanced CKD/ESRF and T1DM for potential cure of these diseases and possibly several complications.However,limited availability of the organs for transplantation,the need for long-term immunosuppression to prevent rejection,peri-and post-operative complications of SPK,lack of resources and the expertise for the procedure in many centers,and the cost implications related to the surgery and postoperative care of these patients are major issues faced by clinicians across the globe.This clinical update review compiles the latest evidence and current recommendations of SPK for patients with T1DM and advanced CKD/ESRF to enable clinicians to care for these diseases.

间者并行,甚者独行——国医大师皮持衡辨治慢性肾衰临证思路发微

慢性肾衰病机复杂,症候繁多,混淆疑惑,辨证难明,此为“疑”;多脏腑虚损,气血阴阳不调,津液输布失常,病理产物相兼为病,处方不定,此为“难”。因其病情复杂性和多变性,且单一治法容易顾此失彼,故临床不可简单的扶正或祛邪,应有计划有层次多角度多途径施治。皮持衡教授从事肾病研究四十余年,认为慢性肾衰为本虚标实之证,治疗需紧扣病机、标本兼顾、病证结合、中西合参,以调阴阳平衡。皮持衡教授认为“间者并行、甚者独行”理论可有效指导临床,根据该理论采取扶正与祛邪交替给药的治疗方法,使药物既各自独行,又并行其治,既用药精专,又无犯虚虚实实之弊,取效颇佳,值得借鉴。现将皮老临证思路稍作探析,并结合医案进一步佐证,以飨同道。

陆为民教授运用乌梅丸化裁治疗脾胃病举隅

[目的]探讨陆为民教授运用乌梅丸化裁治疗脾胃病的临证经验。[方法]从慢性脾胃病的病机与乌梅丸证病机相对应,及慢性脾胃病发作时间与乌梅丸之厥阴病发作时间一致两方面来论述陆教授相关学术、临床心得,并附3则验案以佐证。[结果]陆教授认为慢性脾胃病病机多为寒热错杂,发作时间多在凌晨1~5点,与乌梅丸之主证寒热错杂证、厥阴病欲解时之丑至卯时不谋而合,因此诊治时陆为民教授以乌梅丸为主方,依证化裁,寒温并用,补泻兼顾,收获良效。[结论]陆为民教授治疗运用乌梅丸治疗慢性脾胃病的临床经验行之有效,值得进一步推广与应用。

足三里艾炷灸对慢性肾脏病患者胃肠道症状的影响

目的观察足三里艾炷灸对慢性肾病患者胃肠道症状的作用效果。方法将入选的60例慢性肾脏病伴有胃肠道症状的患者随机分为试验组和对照组(各30例),在常规治疗、护理的基础上,试验组辅以足三里艾炷灸,对照组不采用其他特殊辅助治疗。观察患者恶心呕吐、纳食情况及血二氧化碳结合力(CO2-CP)、碱剩余(BE)、尿pH值的变化。结果试验组临床疗效与对照组相比有统计学意义(P<0.05);两组治疗后恶心呕吐、纳食均有显著性改善(P<0.05,P<0.01),组间比较,差异有统计学意义(P<0.05);两组血CO2-CP、BE、尿pH值治疗前后比较有统计学意义(P<0.01),组间治疗后比较,差异无统计学意义(P>0.05);试验组患者无局部皮肤损伤及全身不适等情况发生。结论足三里艾炷灸有利于改善慢性肾病患者胃肠道症状,且操作简便,无副作用,宜推广应用。

BiPAP预防慢性阻塞性肺疾病伴呼吸衰竭患者并发上消化道出血的效果

目的评价双水平气道正压无创通气(BiPAP)预防慢性阻塞性肺疾病伴呼吸衰竭患者并发上消化道出血的效果。方法回顾性分析2007年2月至2011年10月收治的慢性阻塞性肺疾病伴Ⅱ型呼吸衰竭73例患者的临床资料,将使用BiPAP的患者41例作为观察组,拒绝使用BiPAP的32例患者作为对照组,观察上消化道出血的发生情况。结果观察组上消化道出血发生率为4.88%(2/41),与对照组[发生率为31.25%(10/32)]比较,差异有统计学意义(χ2=5.31,P<0.05)。结论 BiPAP对慢性阻塞性肺疾病伴呼吸衰竭患者并发上消化道出血有一定的干预作用,是一种有效、简便、无创而实用的治疗方法。

慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭并发上消化道出血的诱发因素分析

目的探讨慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭并发上消化道出血的诱发因素,分析总结其临床特征。方法选择2008年2月至2011年10月收治的43例COPD合并Ⅱ型呼吸衰竭并发上消化道出血患者作为观察组,另同期随机选择40例未并发上消化道出血的COPD合并Ⅱ型呼吸衰竭患者作为对照组。观察比较两组患者血气分析结果及诱发因素,分析其并发上消化道出血的原因。结果观察组pH值和动脉血氧分压明显低于对照组,动脉血二氧化碳分压明显高于对照组,差异均有统计学意义(P<0.05);观察组因肝肾功能损害、重症感染、全身激素使用而发生上消化道出血的发生率均高于对照组,差异均有统计学意义(P<0.05)。结论 COPD合并Ⅱ型呼吸衰竭并发上消化道出血与低氧血症、高碳酸血症、重症感染及应用损害胃肠黏膜药物等因素有密切关系,且以低氧血症、高碳酸血症为主要因素,需尽早干预。

慢性病毒性肝病与胃十二指肠粘膜病变相互关系的研究

研究慢性病毒性肝病与胃十二指肠粘膜病变的相互关系。内镜检查患者 2 2 9例 ,检查前临床诊断为慢性病毒性肝病组 137例和胃肠病组 92例 ,并进行内镜检查结果比较。慢性病毒性肝病组 (CVH)与胃肠病组 (GEP)的Pu、CSG、EG、GMP比较 ,无统计学差异 (P >0 0 5 ) ,慢性病毒性肝病组的GEV、DI、EI、ED和BRG与胃肠病组比较 ,有显著性差异 (P <0 0 5 )。在胃十二指肠粘膜病变与病毒性肝病类型的比较中 ,肝炎肝硬化、慢性重症肝炎的GEV、DI、EI、ED、BRG及慢性肝炎重度的EI、BRG、CSG与慢性肝炎 (轻、中度 )比较 ,有统计学差异 (P <0 0 5 )。慢性病毒性肝病时 ,胃十二指肠粘膜病变的发生率相对较高 ,肝功能减退、肝炎病毒在胃十二指肠粘膜病变中起到了重要作用。

慢性阻塞性肺病呼吸衰竭并发上消化道出血22例

目的对78例慢性阻塞性肺病（COPD）呼吸衰竭患者并发上消化道出血22例临床分析．方法78例COPD呼衰患者均采用血气分析、肾功能检查．结果COPD呼衰患者长期缺氧和高碳酸血症，胃粘膜血液循环失调营养障碍，通透性增多，增加H＋的反向弥散，破坏了胃粘膜屏障导致糜烂或溃疡．本组78例呼衰上消化道出血与非出血组血气检查结果比较表明，当pH≤7．2时，两组比较相差非常显著（P＜0．01）当PaCO2≥100mmHg或PO2≤35mmHg时，两组之间均无显著差别．提示pH≤7．20可作为上消化道出血的临界指标；由于缺氧和二氧化碳潴留，反射性的引起肾血管收缩，肾小球滤过率明显减低，加重了氮质血症．当BUN明显升高时，血中促胃液素可能升高，胃粘膜抵抗力降低，易发生粘膜糜烂溃疡出血，本组资料表明，BUN＞21．4mmol／L与＜21．4mmol／L者，消化道出血率相差显著（P＜0．05）；提示严重肾衰BUN升高与消化道出血密切相关；COPD患者呼吸功能由代偿变为失代偿，患者精神状态，大脑皮层功能障碍，皮层下中枢迷走神经张力增高，胃平滑肌收缩，促胃液素、组胺释放增加，胃蛋白酶活性增强，胃粘膜受侵蚀以致糜烂出血结论COPD呼衰患者，应激性溃疡是上消化道出血的主要及致死原因．

食欲对维持性透析患者蛋白质能量消耗发生风险的影响研究

目的探究食欲对维持性透析患者蛋白质能量消耗(protein-energy wasting,PEW)发生风险的影响。方法通过方便抽样调查稳定维持性透析治疗患者。使用营养不良炎症量表和食欲可视化量表分别评估患者PEW和食欲状况。应用人体成分检测仪、人体测量及血液生化指标评估患者人体成分和营养状况。采用二元Logistic回归分析PEW和食欲之间的关系。结果研究共纳入101例维持性透析患者,其PEW发生率为31.7%。PEW组患者饱腹感评分高于非PEW组(Z=3.136,P=0.002);且PEW组存在胃肠道症状的患者比例高于非PEW组(Z=2.613,P=0.009)。存在胃肠道症状(OR=4.445,P=0.005)和高餐后饱腹感(OR=1.023,P=0.012)是透析患者发生PEW的危险因素。结论近三分之一维持性透析患者存在PEW。高餐后饱腹感和胃肠道症状是PEW发生的危险因素。

肺移植术后胃肠道并发症的研究进展

由于免疫抑制和神经损伤等综合因素的影响,肺移植术后胃肠道并发症的总体发生率较高,可引起受者药物吸收障碍和慢性排斥反应。近年来,关于该并发症的研究逐渐增多,但由于各肺移植中心胃肠道并发症发病情况差异较大,临床医师对其认知并不全面。本文对肺移植术后胃肠道并发症的一般情况、常见类型以及危险因素进行了综述,旨在为肺移植术后胃肠道并发症的综合管理提供参考依据。

肝病实脾对反复肝功异常慢乙肝患者生化指标和证候的影响

目的:运用中医肝病实脾治法改善反复肝功异常未行抗病毒治疗的慢乙肝患者生化指标和症候,从而控制肝炎的发作。方法:在门诊患者中采用随机抽取60例e抗原阳性慢乙肝中度肝炎且未行抗病毒治疗且胃肠道证候明显的患者,对照组、观察组各30例。对照组采取口服五酯软胶囊+复方甘草酸苷片护肝降酶,观察组在对照组治疗方法基础上采用肝病实脾为主要治法的中药方剂加减,随访第4周观察两组患者治疗前后肝酶、胆红素变化水平,并随访第8周、第12周观察其肝酶、胆红素升高情况;胃肠道证候经治疗后按中医临床疗效评价指标——显效、有效、无效进行比较。结果:经研究表明,观察组肝酶、胆红素与对照组相比下降水平较高,随访第8周、第12周后其观察组肝酶出现反复升高的控制程度较对照组高。观察组证候改善与对照组相比,总有效率多于对照组。结论:肝病实脾,从中医治未病思想出发,见肝之病,知肝传脾,当先实脾,有效降低e抗原阳性慢乙肝肝酶、胆红素升高水平,改善肝炎所致的胃肠道证候反应,稳定肝内炎症活动。