目的 探究血清丙酮酸、乳酸及极低密度脂蛋白胆固醇水平对急性胰腺炎(AP)病情进展的预测价值.方法 回顾性分析我院2020年9月至2022年9月113例AP患者临床病例资料,按照病情进展分为轻症组51例和重症组62例.比较两组患者一般资料、实验室指标等,分析影响AP病情进展的危险因素,绘制受试者工作特征(ROC)曲线评估实验室指标对重症AP的预测价值.结果 重症组患者急性生理与慢性健康评分(APACHEⅡ)评分、急性胰腺炎严重程度床边指数(BISAP)评分、血乳酸、极低密度脂蛋白胆固醇及三酰甘油水平均高于轻症组,血清丙酮酸水平低于轻症组(P<0.05);血清丙酮酸、乳酸、极低密度脂蛋白胆固醇及三酰甘油均与AP患者APACHEⅡ评分及BISAP评分呈正相关(P<0.05);多因素分析结果显示,血清丙酮酸、乳酸、极低密度脂蛋白胆固醇及三酰甘油均是造成重症AP的危险因素(P<0.05);ROC曲线显示,丙酮酸、乳酸、极低密度脂蛋白胆固醇、三酰甘油及四者联合预测AP患者病情进展的AUC分别为0.622、0.632、0.752、0.623、0.833,四者联合检测预测重症AP患者的价值最高(P<0.05),其灵敏度为77.42％,特异性为82.35％.结论 血清丙酮酸、乳酸、极低密度脂蛋白胆固醇及三酰甘油水平变化可反映AP患者脏器衰竭情况,低水平血清丙酮酸及高水平全血乳酸、极低密度脂蛋白胆固醇、三酰甘油可加重患者胰腺周围组织损伤,四者联合检测对AP患者病情进展有较高预测价值.

目的 探讨EIF4A3/基质金属蛋白酶(MMP)11对结直肠癌侵袭、迁移和上皮间质转化(EMT)的影响.方法 从我院获取结直肠癌患者癌及癌旁组织样本各20例,生物信息学预测MMP11在结直肠癌中的表达水平,qRT-PCR和western blot验证结直肠癌组织和细胞中MMP11的表达水平.在结直肠癌细胞中,RIP实验检测EIF4A3/MMP11之间的相互作用,添加放线菌素D检测MMP11 mRNA的半衰期.HCT15细胞中共转染si-EIF4A3和MMP11,Transwell和划痕实验检测细胞侵袭和迁移能力的变化.Western blot检测EMT相关蛋白表达的变化.结果 MMP11在结直肠癌组织和细胞中表达升高(均P<0.001),EIF4A3能和MMP11相互作用,并增强MMP11 mRNA的稳定性(P<0.05).抑制EIF4A3表达降低MMP11蛋白表达水平并抑制结直肠癌细胞HCT15的侵袭、迁移和EMT进程(均P<0.05),而抑制EIF4A3表达同时过表达MMP11则能逆转上述作用.结论 MMP11在结直肠癌组织和细胞中表达升高,EIF4A3能结合并增强MMP11 mRNA稳定性,促进结直肠癌侵袭迁移和EMT进程.

目的 评价肺力咳胶囊结合多索茶碱对慢性阻塞性肺疾病急性加重期患者血气指标和炎症因子的影响研究.方法 以2019年10月—2020年4月医院收治的慢性阻塞性肺疾病急性加重期患者114例为研究对象,依据随机对照法将患者分为观察组和对照组各57例,对照组给予吸氧、解痉平喘、维持水电解质平衡等治疗,同时口服多索茶碱,200 mg/次,2次/d.观察组在对照组治疗的基础上,口服肺力咳胶囊治疗,0.6 g/次,3次/d.两组均持续治疗14 d.比较两组治疗前后临床证候积分和治疗疗效,比较两组治疗前后血气指标(血氧分压、动脉血氧饱和度和血二氧化氮分压)变化,比较两组治疗前后血清单核细胞趋化蛋白1(MCP-1)、血清淀粉样蛋白(SAA)、可溶性髓样细胞触发受体-1(s TREM-1)水平变化.结果 观察组治疗总有效率为91.23％(52/57),对照组治疗总有效率为77.19％(44/57).组间结果比较显示,观察组治疗疗效高于对照组(P＜0.05);两组治疗后发热、气喘、咳嗽和咳痰等中医证候积分较治疗前降低,且观察组降低幅度优于对照组(P＜0.05);两组治疗后血氧分压、动脉血氧饱和度高于治疗前,血二氧化氮分压低于治疗前,且观察组改善幅度优于对照组(P＜0.05);观察组治疗后血清MCP-1、SAA和sTREM-1水平低于治疗前,且观察组降低幅度优于对照组(P＜0.05).结论 肺力咳胶囊结合多索茶碱治疗慢性阻塞性肺疾病急性加重期效果确切,可显著降低患者的中医证候积分,降低炎症反应,调控血气指标,改善肺功能,提高治疗疗效,值得临床借鉴.

Abstract Objectives To evaluate the safety and efficacy of high-dose amoxicillin-proton pump inhibitor dual therapy, and to provide a new eradication regimen as a first-line option for patients with H. pylori infection. Methods A total of 971 H. pylori positive patients who received initial treatment were recruited from March to August 2020, and randomly divided into treatment group and control group. The treatment group received of 20 mg esomeprazole four times daily and 750 mg amoxicillin four times daily for 14 days. Control group received of 220 mg bismuth potassium citrate twice daily, 20 mg esomeprazole twice daily, 1000 mg amoxicillin twice daily and 250 mg clarithromycin capsule twice daily for 14 days. Four weeks after the end of treatment, the urea breath test was reviewed to detect whether H. pylori was eradicated. Results There were no statistical differences in age, gender, the total clinical symptom scores before and after initial treatment, the compliance, and the degree of remission of symptoms before and after initial treatment between the two groups. The eradication rates of H. pylori between dual therapy and quadruple therapy were 88.31% and 85.26% (p=.158) by intention-to-treat (ITT) analysis, 88.66% and 85.44% (p=.186) by modified intention-to-treat (mITT) analysis, and 91.63% and 90.60% (p=.116) by PP analysis, respectively. Adverse events in dual therapy group were significantly lower than quadruple therapy group (13.3% vs. 28.2% (p<.01)). Conclusions For the initial treatment of H. pylori infection, the high-dose dual therapy regimen has the same efficacy as the bismuth-containing quadruple therapy regimen, good compliance, less adverse reactions and high safety, so it can be recommended as the empirical first-line treatment regimen for the eradication of H. pylori (KY2019173).

目的 探讨血清Cys-C、TBA及血常规指标在乙肝肝硬化失代偿期患者中的应用价值.方法 选择2019年1月至2020年12月本院收治的134例乙肝肝硬化失代偿期患者纳入肝硬化组,另择同期收治的80例乙型肝炎患者及100例查体的健康体检者纳入肝炎组及对照组.测定各组受试者白细胞计数(WBC)、血红蛋白(Hb)、血小板计数(PLT)、白蛋白(ALB)、国际标准化比值(INR)及谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)、TBA、Cys-C、肾小球滤过率(eGFR)水平,评估肝硬化患者治疗效果.结果(1)肝硬化组患者Cys-C、TBA、ALT、AST、TBIL、INR显著高于肝炎组、对照组,Hb、PLT、ALB、eGFR显著低于肝炎组、对照组(P<0.05);肝硬化Child-Pugh-C级患者Cys-C、TBA、ALT、AST、TBIL、INR显著高于肝硬化Child-Pugh-B级患者,Hb、PLT、ALB、eGFR显著低于肝硬化Child-Pugh-B级患者(P<0.05).(2)Pearson相关性分析示,Cys-C、TBA与ALT、AST、TBIL等肝功能指标呈正相关,Hb、PLT与ALT、AST、TBIL等肝功能指标呈负相关(P<0.05).(3)肝硬化失代偿期治疗有效组患者Cys-C、TBA、ALT、AST、TBIL、INR显著低于治疗无效组患者,Hb、PLT、eGFR显著高于治疗无效组患者(P<0.05).(4)受试者特征工作曲线显示,Cys-C、TBA、WBC、Hb、PLT、INR、ALB、eGFR预测临床治疗效果的曲线下面积分别为0.729、0.800、0.557、0.693、0.788、0.702、0.609、0.815.结论 乙肝肝硬化失代偿期患者存在血清Cys-C、TBA及Hb、PLT等血常规指标的变化,且其水平与肝功能及治疗效果密切相关,可能可作为病情评估、预后预测的参考指标.

目的 研究健康体检人群血清尿酸(SUA)水平及高尿酸血症(HUA)的分布特点.方法 选取2018年2月至2019年2月我院健康体检人群20 874例并采集晨起空腹外周静脉血5 mL,凝固、分离后取上清,采用酶比色法检测SUA水平同时进行HUA诊断,分析不同年龄和性别人群SUA水平和HUA检出率变化,比较不同SUA水平人群高血压、糖尿病及心血管疾病等发生率.结果 60岁以上男性SUA水平低于18～60岁组;50岁以上女性SUA水平高于18～50岁组,60岁以上女性SUA水平高于51 ～60岁组;且各年龄段男性SUA水平均高于女性,差异有统计学意义(P ＜0.05);20 874例受检者中共检出HUA患者4 584例,占比21.96％,男性和女性HUA检出率分别为29.39％和13.80％,其中男性60岁以上年龄段HUA检出率明显低于18 ～60岁组,女性HUA检出率随年龄增加而升高,51 ～60岁年龄段HUA检出率高于18～ 50岁组,60岁以上年龄段HUA检出率高于18 ～60岁组,且18 ～60岁年龄段男性HUA检出率高于女性,60岁以上年龄段男性HUA检出率低于女性,差异均有统计学意义(P＜0.05);多因素Logistic回归分析显示,男性、HUA家族史、BMI增加、GFR降低、饮酒史、糖尿病以及高脂血症均为HUA发病的独立危险因素(P＜0.05).结论 60岁以上男性SUA水平明显降低,50岁以上女性SUA水平明显升高,针对不同年龄段男性和女性分别制定相应参考值范围有利于提升HUA诊断和治疗水平,对改善患者身心健康具有重要意义.

目的:探讨实时荧光定量-聚合酶链反应(qRT-PCR)法分析复治患者中幽门螺杆菌(Hp)感染及其耐药性情况.方法:选择疑似Hp感染复治患者36例进行研究,所有患者临床资料完整,均接受13C呼气试验、快速尿素酶试验、病理染色及qRT-PCR法Hp基因检测,同时对常用抗生素克拉霉素与喹诺酮类耐药情况进行分析,比较不同检验方法诊断Hp阳性率,分析复治患者耐药性情况.结果:经13C呼气试验或快速尿素酶试验检出Hp阳性26例,而qRT-PCR法Hp基因检测检出Hp阳性26例,二者无明显差异(P>0.05);Hp阳性的26例患者对克拉霉素耐药24例(92.30％),而喹诺酮耐药18例(69.23％).结论:qRT-PCR法分析复治患者Hp感染情况有不错的价值,其检出Hp阳性率与13C呼气试验或快速尿素酶试验相当,但相较于HP传统检测方式,qRT-PCR法可同时检测抗HP相关抗生素的耐药性,对指导个体化治疗具有临床意义,本实验中复治患者对克拉霉素与喹诺酮类抗生素耐药率极高,临床应重视.

Objective To investigate the effects of somatostatin combined with pantoprazole in treatment of acute upper gastrointestinal bleeding and its intervention effects on serum high sensitivity C reactive protein.Methods 72 patients with acute upper gastrointestinal bleeding were selected and randomly divided into control group (36 patients) and observation group (36 patients).The patients in control group accepted somatostatin treatment while observation group accepted somatostatin plus pantoprazole treatment.Results The total efficiency of observation group was 91.67% which was significantly higher than that of control group (72.22%) (P<0.05).The hospitalization time and bleeding time of the observation group were significantly less than that in the control group (P<0.01).After treatment, high sensitive C reactive protein level in, serum and levels of cortisol in the observation group were significantly lower than those of the control group (P<0.01).Conclusion Somatostatin combined with pantoprazole in the treatment of acute upper gastrointestinal hemorrhage showed a promisingclinical curative effect, can also effectively reduce the serum high sensitivity C reactive protein.

Objective: To analyze the therapeutic efifcacy and safety of bismuth pectin quadruple therapy for Helicobacter pylori-positive peptic ulcer, providing a reference for improving the treatment of H. pylori-positive peptic ulcers.Methods:82 cases of Helicobacter pylori (HP-positive) peptic ulcer in our hospital during July 2012 to February 2014 were enrolled in the study, All cases were randomly divided into two groups using a random number table. Patients in the control group received routine regimen (rabeprazole, amoxicillin and clarithromycin), while the study group receiving bismuth pectin quadruple therapy (rabeprazole, amoxicillin, bismuth pectin and clarithromycin). The therapeutic effects and adverse reactions in the two groups were observed and compared.Results:The clinical effects of the study group were better compared to the control group, including the patient symptom scores and HP negative rate. The differences are statistically signiifcant (P<0.05). The adverse reactions in the study group was limited, compared to the control group no signiifcant difference was observed (P>0.05).Conclusion:The therapeutic effects of bismuth pectin quadruple therapy in Helicobacter pylori-positive peptic ulcer are preferable to the routine triple therapy. The therapy can promote early rehabilitation of patients it is worth of application.

目的 探讨缺血性结肠炎的临床及内镜特征,提高对该疾病早期诊治水平.方法 收集2005年3月～2010年6月经临床、电子结肠镜确诊的缺血性结肠炎患者16例的相关资料, 对其临床特征及内镜特点行回顾性分析.结果 11例患者存在冠心病.高血压、糖尿病等基础疾病.临床症状缺乏特异性,几乎都有腹痛,但体征与其剧烈腹痛主诉不相符.结论 缺血性结肠炎早诊断,早治疗预后一般较好,结肠镜检查对其诊断有重要价值,对具有冠心病、高血压等患者出现腹痛等症状时需考虑本病可能.

^131I已广泛应用于甲状腺疾病的诊断、治疗。本研究用^131I溶液对大鼠灌胃，旨在观察不同剂量的^131I对大鼠胃黏膜是否有损伤作用，现报道如下。一、材料与方法1．材料。一级SD大鼠80只，雌雄各半，体质量0．13～0．2kg，由四川大学实验动物中心提供，动物许可证号：川实动管10；^131I口服溶液购自成都中核高通同位素股份有限公司，成人平均剂量为按体质量4．44MBq／kg，大鼠灌胃剂量为成人平均剂量的6.25倍。

131Ⅰ已广泛应用于甲状腺疾病的诊断、治疗.本研究用131Ⅰ溶液对大鼠灌胃,旨在观察不同剂量的131Ⅰ对大鼠胃黏膜是否有损伤作用,现报道如下.

Objective:To study the prevalence and the risk factors of helicobacter pylori(Hp) infection in Chengdu.Methods:A serum test of Hp antibody detected the infection of HP,and through questionnaire the risk factors were analyzed.Results:The infection rate of Hp was 55.58% in Chengdu,and the infection rate were obviously correlate with age(P0.02).The infection rates of Hp for male and female were 52.05% and 58.57%(P0.05),respectively,and its rates for the people whose income was under 20 thousands yuan per year and above 20 thousands yuan per year were 55.44% and 61.84%(P0.05),respectively.The positive rate of Hp for the people who complained gastrointestinal symptom and who do not complaine gastrointestinal symptom were 56.30% and 55.60%(P0.05),respectively.Conclusion:The infection rate of Hp is positive correlate with age.Our investigation shows that HP infection has not relationship with sexuality,family income and gastrointestinal symptom.

患者,女,60岁,因进行性吞咽困难伴呕吐40余天入院.查体无异常发现.食管吞钡剂X线摄片示食管上段可见明显扩张,最粗段约3.5 cm,食管中段可见不规则狭窄长约7.0 cm,管壁僵硬,黏膜破坏明显.胃镜示距门齿18 cm处食管黏膜呈菜花样隆起,质脆,易出血,进镜至20 cm处管腔狭窄,胃镜不能通过.