目的:对于肝硬化失代偿期的治疗,分析恩替卡韦与保肝药物合用的治疗效果.方法:本次研究对象共58例,是我院收治的肝硬化失代偿期患者,选取时间段为2018年1月至2020年12月.根据治疗方法不同进行分组,分为对照组(保肝药物治疗)和实验组(恩替卡韦+保肝药物治疗),每组29例.结果:两组治疗前后经影像学检查发现,同治疗前相比,治疗后患者的脾静脉内径、脾脏厚度、门静脉内径均有显著降低,但实验组更明显(P<0.05);与治疗前相比,治疗后总胆红素(TBiL)、天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)水平降低,但实验组低于对照组(P<0.05).结论:在保肝药物治疗的基础上应用恩替卡韦治疗肝硬化失代偿期,疗效肯定,能有效改善患者的肝功能,利于改善患者预后.

Objective To investigate changes and clinical significance of helper T cell/regulatory T cell (Th17/Treg) and related cytokines in patients with nasopharyngeal carcinoma before and after radiotherapy.Methods A total of 50 patients with nasopharyngeal carcinoma admitted during February 2015 and February 2016 were chosen as nasopharyngeal carcinoma group,and 50 healthy people taking medical examination at the same period were chosen as control group.Changes of Th17 and Treg cell proportions accounting for total T cell,and related cytokine levels were compared between two groups (before and after radiotherapy,and in follow-up for 3 month in nasopharyngeal carcinoma group).Results Compared with those in control group,serum Th17 and Treg cell accounting for total T cell proportions,interleukin (IL)-17,IL-23,IL-10 and transforming growth factor (TGF)-β1 levels were significantly increased in nasopharyngeal carcinoma group (P<0.05).Compared with those before radiotherapy,serum Th17 cell proportion after radiotherapy,serum IL-17 and IL-23 levels were significantly increased after radiotherapy (P<0.05),and Treg cell accounting for total T cell proportion after radiotherapy,Th17 and Treg cell accounting for total T cell proportions in follow-up for 3 months,IL-17 and IL-23 levels in follow-up for 3 months,serum TGF-β1 and IL-10 levels were significantly decreased after radiotherapy and 3 month after radiotherapy (P<0.05).Compared with those after radiotherapy,serum Th17 and Treg cell accounting for total T cell proportions,IL-17,IL-23,IL-10 and TGF-β1 levels were significantly decreased 3 months after radiotherapy (P<0.05).Conclusion Radiotherapy can aggravate Th17/Treg immunodissonance of patients with nasopharyngeal carcinoma,and therefore immunotherapy should be supplemented during radiotherapy to improve immune function.

目的：观察肠易激综合征（IBS）和溃疡性结肠炎（UC）患者肠道菌群和肥大细胞的变化。方法选取 IBS 患者（IBS 组）、UC 患者（UC 组）及健康者（对照组）各60例，检测粪便标本中菌群的数量及病变部位组织中肥大细胞的数量，并进行统计学比较。结果UC 组和 IBS 组大肠杆菌数量较对照组增多（P ＜0.05），双歧杆菌、乳酸杆菌数量较对照组减少（P ＜0.05）；UC 组大肠杆菌数量与 IBS 组比较差异无统计学意义（P ＞0.05），双歧杆菌及乳酸杆菌数量较 IBS 组增多（P ＜0.05）。 UC 组和 IBS 组肥大细胞数量较对照组增加（P ＜0.05），而 IBS 组较 UC 组增加更明显（P ＜0.05）。结论IBS 和 UC 患者均存在肠道菌群失调及肠黏膜免疫激活，IBS 在肠黏膜免疫激活方面更突出，而 UC 则在肠道菌群失调方面更明显。

Objective To analyze the relative risk factors of recurrent acute pancreatitis and learn more about its prognosis.Methods The data of 191 inpatients with acute pancreatitis in our hospital collected retrospectively were divided into tow groups, simple acute pancreatitis and recurrent acute pancreatitis, and further analyzed the difference of the epidemiology, etiology, clinical characters and assessment of the severity of actue pancreatitis.Results 35 patients (18.3%) with recurrent acute pancreatitis in total 191 acute pancreatits, frequency of male patients was higher than female patients(P0.005) and most of recurrent acute patients aged during 21 to 40 years. alcohol, hyperlipidemia( elevated serum triglyceride level) and hyperglycaemia were associated with recurrent of acute pancreatits in univariate general linear mode analysis .Alcoholan and hyperlipidemia( elevated serum triglyceride level) may be more possible risk factor of recurrent acute pancrreatitis in step Logistic regression analysis. And the frequency of severe acute pancreatitis was higher in recurrent acute pantients than in simple acute pancreatitis(P0.005).Conclusion alcohol and the elevated serum triglyceride level may be important risk factors of recurrent acute pancreatits and severe acute pancreattis more often occur in recurrent acute pancreatits.

Objective To understand the clinical characteristics of acute pancreatitis and its various therapeutic measures in clinical practice for guidance of further clinical diagnosis and treatment.Methods The clinical symptoms,complications and therapeutic measures in 191 cases of acute pancreatitis admitted in this hospital during recent 10 years were retrospectively reviewed and analyzed.Results Among them,150(78.5%) patients with mild acute pancreatitis were cured by conservative medical treatment.Twelve of 41 patients with severe acute pancreatitis were treated with surgical operation,2 of them died,and the remaining 29 patients were treated with conservative medical treatment,3 of them died.Conclusion It should be emphasized that conservative medical treatment is the main therapeutic measure for acute pancreatitis.Severe acute pancreatitis induced by biliary diseases should be treated with therapeutic endoscopy in early stage including opening Oddis' sphincter in time,dislodging the calculus and drainage via nose and bile duct.Surgical operation should be strictly taken based on its indication.In the meanwhile,individualized principle for surgical treatment should also be obeyed.This is the key procedure for lessening complications and reducing mortality.

目的观察四逆散加味治疗功能性消化不良的疗效。方法300例患者按3:2比例随机分为2组,治疗组180例用四逆散加味治疗,对照组120例用莫沙必利治疗。结果总有效率治疗组92.8%,对照组76.7%,两组差异非常显著(P<0.01)。结论四逆散加味治疗功能性消化不良有良好疗效。

目的总结恙虫病病程对肝功能损害的影响。方法对283例恙虫病进行回顾性分析。结果84例表现有肝功能损害,占36.2%,其中有黄疸者18例,肝大42例,脾大51例。成人大多数用氯霉素,少数用喹诺酮类和头孢类抗生素,小儿均用红霉素。用氯霉素治疗的退热效果最快,一般在24～48小时内基本降至正常,很少超过72小时。本组全部治愈,无一死亡。结论恙虫病的毒素可损害全身各脏器,而以中毒性肝损害多见,病程越长者肝损害越严重,个别可导致肝功能衰竭,易误诊为重症肝炎。

十二指肠憩室是常见的消化道憩室病,国内报道人群中患病率约3.3%～14.5%;[1].多数患者无特殊症状,部分患者可有上腹隐痛、腹胀、恶心、呕吐、嗳气、体重减轻、发热、黄疸、便血甚至出现穿孔或胆胰疾患等.本文所指的十二指肠憩室是指真性十二指肠憩室,本文对我院近15年因有症状而住院的98例的临床资料进行回顾性分析,总结归纳本病常有的临床特征合并症及并发症.

经过近30年的努力,急性胰腺炎的疗效已有显著提高,"治疗方案个体化"使急性胰腺炎的治疗选择有了可以依循的标准,十四肽生长抑素的应用给内科保守治疗的成功带来更大的希望.本文对我院1990年以来142例急性胰腺炎病例进行总结研究,并结合有关文献作简单讨论.

上消化道出血如出血量不大,可有充分时间处理,但如在短时间内大出血,来势凶猛,则极易危及生命,必须紧急抢救.不同部位、不同情况的大出血,应采取不同的治疗手段,方能达到满意的效果.笔者根据我院近几年收治的几个病例,谈谈少见上消化道大出血的诊治体会.