目的 探讨胃癌合并糖尿病患者血清胰岛素样生长因子-1(IGF-1)和胰岛素样生长因子结合蛋白-3(IGFBP-3)的变化及其临床意义.方法 选取2017年3月至2018年12月间收治的100例胃癌患者,按照是否合并糖尿病进行分组,其中,合并糖尿病的55例患者纳入糖尿病合并胃癌组,未合并糖尿病的45例患者纳入单纯胃癌组,比较两组患者的血清IGF-1和IGFBP-3水平.结果 糖尿病合并胃癌组IGF-1和IGFBP-3阳性率显著较单纯胃癌组高,差异均有统计学意义(均P＜0.05).糖尿病合并胃癌组IGF-1和IGF-1/IGFBP-3水平显著高于单纯胃癌组,差异均有统计学意义(均P＜0.05),两组患者IGFBP-3组间比较,差异无统计学意义(P＞0.05).糖尿病合并胃癌组空腹血糖、餐后2h血糖和糖化血红蛋白显著高于单纯胃癌组,差异均有统计学意义(均P＜0.05).IGF-1与IGFBP-3呈正相关,差异有统计学意义(P＜0.05).将以上影响因素纳入多因素分析,结果表明,IGF-1、IGFBP-3、IGF-1/IGFBP-3、空腹血糖和糖化血红蛋白是糖尿病合并胃癌发生的危险因素,差异均有统计学意义(均P＜0.05),餐后2h血糖对糖尿病合并胃癌发生无明显影响,差异无统计学意义(P＞0.05).结论 IGF-1和IGFBP-3均参与糖尿病合并胃癌疾病发生过程,其值对于预测病情发展具有一定作用.

目的 探讨平均血小板体积、血小板分布宽度和癌胚抗原(CEA)对胃癌和胃溃疡的鉴别诊断作用.方法 选取2012年1月～2016年1月商洛市中心医院收治的100例胃癌患者和100例胃溃疡患者,及同期体检的健康人群100例作为对照组,比较临床和生化指标、平均血小板体积(MPV)及血小板分布宽度(PDW),分析胃癌患者术前MPV及PDW与临床病理特征的相关性,并采用ROC曲线分析联合检测区分健康人群、胃溃疡及胃癌患者的灵敏度和特异度.结果 对照组、胃溃疡组和胃癌组MPV(fl)分别为10.3±1.3,10.7±1.5和8.7±1.2,两两比较差异均具有统计学意义(F=65.165,P<0.001);三组PDW分(％)别为14.8±2.3,12.8±2.3和17.8±3.2,两两比较差异均具有统计学意义(F=101.552,P<0.001).肿瘤<4.5cm的胃癌患者PDW(17.7％ ±1.4％)显著高于肿瘤 ≥4.5cm的胃癌患者(17.2％ ±1.6％),差异具有统计学意义(t=2.020,P<0.05).CEA+PDW联合检测区分健康组和胃癌组患者的灵敏度、特异度和AUC分别为0.835,0.908和0.939(0.910～0.961);CEA+PDW联合检测区分胃溃疡和胃癌患者的灵敏度、特异度和AUC分别为0.990,0.979和0.996(0.984～1.000).结论 平均血小板体积、血小板分布宽度和癌胚抗原联合检测可以有效区分胃癌和胃溃疡患者,值得进一步研究.

[Objective]To evaluate and compare the safety and clinical efficacy of levosulpiride,domperidone and metoclopramide in the treatment of functional dyspepsia.[Methods]One hundred and fifty patients with functional dyspepsia from June 2014 to March 2015 were randomly divided into three groups with 50 cases in each group. The three groups were treated with levosulpiride,domperidone and metoclopramide respectively. The degree of functional dyspepsia before and after treatment was evaluated by Leeds indigestion questionnaire and Likert five-point scale.[Results]143 of 150 patients (50 in the levosulpiride group, 45 in the domperidone group and 48 in the metoclopramide group) completed the test successfully. All three drugs can improve patients' symptoms of functional dyspepsia to varying degrees. However, the overall improvement of dyspepsia in the levosulpiride group was significantly higher than that in the other two groups (P<0.05), and the incidence of adverse reactions (including nausea,headache,diarrhea, etc.) was the lowest in the levosulpiride group. [Conclusion] Levosulpiride has higher safety and efficacy than domperidone and metoclopramide in the treatment of functional dyspepsia.

Objective To investigate the relationship between total serum IgG concentration and tumor progression in patients with gastric cancer.Methods From January 2010 to May 2017,a total of 90 patients with gastric cancer in Sun Simiao Hospital of Beijing University of Chinese Medicine were enrolled as study subjects and 90 age-and-sex-matched adults from normal physical examination were enrolled as control subjects.The serum IgG subgroup and total IgG concentrations were measured by enzyme-linked immunosorbent assay.The relationships between serum IgG concentration in patients with gastric cancer and clinicopathologic features were analyzed.The numbers of plasma cells with CD138 antibody in both tumor and non-cancerous tissues were evaluated by immunohistochemistry.Results The total serum IgG concentration in patients with gastric cancer was significantly lower than that in healthy control group [(923.6±290.5) mg/dl vs.(1 072.5 ±298.6) mg/dl],with a significant difference (t =3.391,P =0.001).The total serum IgG and IgG1 concentrations were correlated with lymphatic metastasis (t =3.585,P ＜ 0.001;t =3.545,P ＜ 0.001) and gastric cancer stages (t =3.669,P ＜0.001;t =3.401,P ＜0.001).Furthermore,the CD138 + plasma cells in tumor tissues were significantly fewer than those in non-cancerous gastric mucosa (88.7 ± 31.9 vs.108.5 ± 33.4),with significant differences (t =2.778,P =0.007).Multivariate analysis suggested that total serum IgG concentration (HR =0.411,95％ CI:0.094-0.989,P =0.011) and lymph node metastasis (HR =3.148,95％ CI:1.988-5.297,P ＜ 0.001) were independent predictors for poor prognosis.Conclusion Decreased total serum IgG concentration is closely related to tumor progression and poor prognosis in patients with gastric cancer,which indicates that the impaired humoral immunity is associated with tumor progression.

Objective To investigate the influence factors of serum stimulating hormone levels and coronary atherosclerosis in postmenopausal women.Methods During January 2015 to January 2016 in our hospital,300 cases of healthy postmenopausal women were selected to study,to collect the general clinical data and blood biochemical index,300 patients were divided into the health group (n =272) and the coronary atherosclerosis (n =28).To compare the general data of the two groups,and analyze serum thyroid hormone levels and related factors the general index of correlation and influence of serum thyroid hormone level,and regression analysis in healthy postmenopausal women's risk of coronary atherosclerosis risk factors by univariate and multivariate logistic.Results The TSH,age,SBP,fasting blood glucose,total bilirubin,total cholesterol,high-density lipoprotein,low density lipoprotein and triglyceride in coronary atherosclerosis group were significantly higher than those in healthy group(t =4.953,3.459,3.242,4.553,6.075,4.263,4.563,3.562,5.035,P=0.000,0.015,0.026,0.004,0.000,0.002,0.001,0.012,0.000).;the serum TSH levels were positively correlated with age,triglycerides (r=0.148,0.169,P =0.020,0.008),and negatively correlated with high density lipoprotein (r=-0.145,P =0.024);multiple regression analysis showed that age,high density lipoprotein and triglycerides significantly effected serum TSH levels (P＜0.05);multivariate logistic regression analysis showed that age and TSH levels are risk factors of coronary atherosclerosis in healthy postmenopausal women (OR=1.109,1.304,95％CI:1.024-1.197,1.024-1.678,P=0.013,0.034).Conclusion The healthy postmenopausal women with increased serum thyrotropin levels significantly increased risk of coronary atherosclerosis,it was worthy of clinical attention.

目的 探讨慢性丙型肝炎(chronic hepatitis C,CHC)患者血清自分泌运动因子(autotaxin,ATX)水平与肝纤维化程度的关系.方法 回顾性分析2013年1月至2015年12月北京中医药大学孙思邈医院收治的CHC患者90例(CHC组,n=90),另选择同期来院体检的90名健康人群作为对照(对照组,n=90).比较对照组和不同肝纤维化分期患者血清ATX水平,并比较血清ATX水平与实验室指标及纤维化标志物间的相关性.绘制ROC曲线,通过血清ATX水平预测CHC患者不同肝纤维化程度的ROC曲线下面积、诊断界值及其对应的敏感度和特异度.结果 CHC患者肝纤维化分期:F0 ～ F4分别有8例、29例、32例、15例、6例.对照组中血清ATX水平为(0.92±0.11)mg/L,F1患者中为(1.34±0.21)mg/L,F2患者中为(1.69±0.28) mg/L,F3患者中为(2.01±0.54) mg/L,F4患者中为(2.39-±0.41)mg/L,两两比较,差异有统计学意义(P＜0.05).CHC患者血清ATX水平与AFP、AST、ALT、GGT、FIB-4指数、APRI、Forns指数呈正相关(P＜0.05),与PLT呈负相关(P＜0.05),与总胆红素无相关性(P＞0.05).经肝组织学检查发现,82例≥F1、53例≥F2、21例≥F3、6例=F4,分别以血清ATX水平0.91 mg/L、1.21 mg/L、1.52 mg/L、1.71 mg/L作为其截断点.结论 血清ATX水平是评估CHC患者肝纤维化程度较为有临床价值的指标,CHC患者中血清ATX水平升高提示肝纤维化程度增加.

Objective To investigate the clinical effect of compound Danshen dropping pills therapy in patients with congestive hearts failure, and to analysis its effect on the plasma pro-BNP. Methods Ninety-two patients with congestive hearts failure were randoly divided into control group and observation group, each group 46 cases. The control group were treatment by routine western medicine, and the observation group were treatment by compound Danshen dropping pills 10 pills one time, 3 times one day, one course of the treatment of each group is six months . Then observed and recorded the level of the plasma pro-BNP before and one, three, six months after treatment, the clinical effect and the adverse reaction . Results In the control group,six months after treatment, the level of the plasma pro-BNP was significantly lower than that before treatment, a statistically significant difference . In observation group, three and six months after treatment, these levels of the plasma pro-BNP were significantly lower than those before treatment, and also significantly lower than those in the control group, a statistically significant difference . Six months after treatment, the total efficacy rates of the observation group (91.3%) was significantly higher than that in the control group (76.1%), a statistically significant difference . Conclusion Compound Danshen dropping pills can effectively reduce the level of the plasma pro-BNP, enhance the clinical effect, safe and reliable.

目的：对比雷贝拉唑与奥美拉唑在治疗反流性食管炎中的临床效果。方法：选择160例反流性食管炎患者，随机分为观察组和参照组，予以参照组患者奥美拉唑治疗，观察组患者采用雷贝拉唑治疗。观察对比两组患者治疗后临床效果。结果：观察组患者总有效率（98.75%）明显高于参照组（91.25%），内镜下食管炎改善总有效率（97.50%）比参照组（88.75%）高，差异有统计学意义。结论：雷贝拉唑治疗反流性食管炎的临床效果显著，值得临床推广。

目的：探讨急性食管胃底静脉曲张出血止血时机及影响出血控制成败影响因素分析。方法：选择2011年12月～2014年12月期间我院收治的急性食管胃底静脉曲张出血患者80例为研究对象，均采用药物配合内镜下止血方法，记录止血成功率、再出血发生率，分析影响出血控制成败的相关因素。结果：止血成功率为58.75%（47/80），再出血率6.38%（3/47），不同时段控制出血失败患者死亡率比较差异具有统计学意义（P＜0.05）；患者在入院时收缩压升高、总胆红素升高、腹水、肝功能分级升高、门冬氨酸氨基转移酶升高、门静脉宽度增加是止血成功的危险因素。结论：药物配合内镜下止血，止血失败率在≤2h时段最高，针对危险因素采取干预措施可以降低死亡率，提高止血成功率。