目的:探讨胰腺癌远处器官转移的影响因素及其预后分析.方法:2018-11-2021-11武汉大学人民医院140例确诊胰腺癌患者,以是否发生远处器官转移分为转移组(n=69)和非转移组(n=71).根据两组患者基本资料、实验室检测指标、肿瘤标志物水平和瘤体特征的组间差异,应用单因素和多因素Logistic回归分析胰腺癌远处器官转移影响因素.应用单因素和多因素COX回归,分析相关因素对胰腺癌患者生存率的影响.通过受试者工作特征(ROC)曲线预测糖类抗原19-9(CA19-9)对胰腺癌转移的临床价值.结果:Logistic回归分析显示:白细胞计数(RR=1.454,95％CI:1.112-1.902,P＜0.01)、中性粒细胞计数(RR=1.235,95％CI:1.093-1.328,P＜0.05)和血清CA19-9水平(RR=7.16,95％CI:3.043-16.843,P＜0.01)是影响胰腺癌器官远处转移的独立危险因素.COX回归分析显示:血清CA19-9水平是影响胰腺癌患者生存的独立危险因素(HR=1.882,95％CI:1.127-1.882,P＜0.05).ROC结果为CA19-9临界值为377.8U/ml,其曲线下面积(AUC)为0.79,检测胰腺癌转移的敏感度为0.826,特异度为0.676.结论:早期监测CA19-9及炎症指标,有利于早期干预胰腺癌远处器官转移,改善胰腺癌患者预后.

急性胰腺炎(acute pancreatitis,AP)是临床常见的急腹症之一,且发病率有逐渐上升的趋势.而AP的病程进展被证明与病人肠道菌群失衡密切相关.临床上也常运用抗生素、益生菌等疗法,以调节AP病人肠道菌群.更加深入与系统地了解肠道菌群失衡在AP进展中的作用及其相关机制,可能为未来AP的治疗带来新思路.

目的:分析急性胰腺炎男性患者血清睾酮水平变化.方法:纳入急性胰腺炎男性患者154例,其中包括128例轻症急性胰腺炎(MAP组)和26例重症急性胰腺炎(SAP组),同期34例体检健康男性为对照组(HC组),常规测定其临床生化指标,并使用液相色谱-串联质谱(LC-M S/M S)法检测各组血清睾酮(T)水平.结果:与HC组相比,MAP组和SAP组血清T水平均降低(P<0.05或0.01),且SAP患者组血清T水平明显低于MAP组(P<0.05);ROC曲线分析结果显示血清T水平对AP和SAP患者均具有一定的诊断价值.结论:AP男性患者血清T水平明显降低,且SAP患者下降更明显,血清T水平或可作为AP的早期诊断指标.

目的:探讨可溶性程序死亡配体1(sPD-L1)是否可为重症急性胰腺炎(SAP)病人后期胰周坏死感染的预测提供帮助.方法:收集2017年3月1日至2019年3月31日在发病24 h内首诊于武汉大学人民医院胰腺外科、住院时间>14 d且年龄>18岁SAP病人109例,将其分为后期胰周坏死感染组(41例)和后期无胰周坏死感染组(68例).收集统计相关实验室资料和临床数据.采用SPSS 16.0统计软件进行统计分析.结果:两组病人的性别、年龄、BMI和入院24 h内的sPD-L1、绝对淋巴细胞计数(ALCs)、Balthazar CT评分均无明显差异(P＞0.05).但后期胰周坏死感染组2周左右的sPD-L1、Balthazar CT评分明显高于后期无胰周坏死感染组[108.32(100.92,118.13)ng/mL vs 88.76(80.97,97.14)ng/mL,P＜0.01;8(6,8)分vs 6(5,8)分,P＜0.01],ALCs 明显偏低[0.85(0.71,1.07)X109个/L vs 1.07(0.88,1.28)X 109个/L,P＜0.01].发病2周左右的sPD-L1>95 ng/mL(OR=1.08,95％CI:1.04～1.13,P＜0.01)、Balthazar CT 评分≥6分(OR=1.52,95％CI:1.10～2.09,P＜0.05)是SAP 后期胰周坏死感染的独立危险因素.结论:SAP发病2周左右的sPD-L1≥95 ng/mL和Balthazar CT评分>6分是后期胰周坏死感染的独立危险因素.

ObjectiveTo investigate the association of nonalcoholic fatty liver disease (NAFLD) with the severity of hyperlipidemic acute pancreatitis (HLAP). MethodsA retrospective analysis was performed for 895 patients with acute pancreatitis (AP) who were admitted to Department of Pancreatic Surgery in Renmin Hospital of Wuhan University from February 20, 2018 to January 20, 2020, among whom 101 patients with HLAP were screened out. According to the presence or absence of NAFLD, the 101 patients with HLAP were divided into non-NAFLD group with 41 patients and NAFLD group with 60 patients. Related clinical data were collected, including general information (sex, age, body mass index, diabetes, and hypertension), biochemical parameters (amylase, lipase, alanine aminotransferase, aspartate aminotransferase, albumin, total bilirubin, blood urea, serum creatinine, blood glucose, blood sodium, blood calcium, cholesterol, triglyceride, lactate dehydrogenase, and high-sensitivity C-reactive protein), white blood cell count (WBC), severity of AP, local complications under CT scan, systemic inflammatory response syndrome, bacteremia, organ failure, hospitalization, and recurrence of HLAP ［length of hospital stay, rate of admission to the intensive care unit (ICU), 1-year recurrence rate of HLAP, and number of HLAP attacks within 1 year］. The independent samples t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. ResultsCompared with the non-NAFLD group, the NAFLD group had significantly higher blood glucose and WBC and a significantly lower blood sodium level on admission (Z=-2.241, t=2.187, t=-2.533, all P＜0.05). Compared with the non-NAFLD group, the NAFLD group had a significantly higher proportion of patients with severe AP (750% vs 53.7%, χ2= 4.968, P＜0.05), as well as significantly higher incidence rates of local complications, systemic inflammatory response syndrome, bacteremia, and respiratory failure (χ2=6.059, 4.611, 4.056, and 4.568, all P＜0.05). There was no significant difference in length of hospital stay between the two groups (P＞0.05), and the NAFLD group had a significantly higher rate of admission to the ICU than the non-NAFLD group (23.3% vs 7.3%, χ2= 4.463, P＜0.05). In addition, there were no significant differences in 1-year recurrence rate of HLAP and number of HLAP attacks within 1 year between the two groups (both P＞005). ConclusionNAFLD is significantly associated with the severity of HLAP, and furthermore, NAFLD may play an important role in the early severity assessment, disease progression, and prognosis prediction of HLAP.

Objective:To investigate the risk factors and pathogen distribution of catheter-related bloodstream infection (CRBSI) in patients with acute pancreatitis(AP).Methods:A retrospective analysis was performed on the clinical data of moderately severe acute pancreatitis (MSAP) & severe acute pancreatitis (SAP) patients with central venous catheter (CVC) insertion admitted in Department of Pancreatic Surgery, Renmin Hospital of Wuhan University from April 2017 to March 2019. Patients with CRBSI were 1∶1 matched to those without CRBSI based on age, gender, diabetes, blood transfusion, parenteral nutrition, the site of CVC insertion and duration of catheterization. Accompanying abdominal infection, a APACHEⅡ score≥20, early enteral nutrition and antibiotics were included for logistic regression analysis on the risk factors for the occurrence of CRBSI in MSAP and SAP patients, and pathogen distribution was also investigated.Results:A total of 352 patients were enrolled, and 39 patients had CRBSI with an incidence of 11.08%, 8.83 per 1 000 catheter days. Multivariate logistic regression demonstrated that accompanying abdominal infection( OR=1.69, 95% CI 1.20-2.23)and APACHEⅡ score≥20 ( OR=2.87, 95% CI 1.79-5.46)were independent risk factors for CRBSI. Early enteral nutrition( OR=0.81, 95% CI 0.43-0.96) was protective factor. A total of 43 pathogens were detected, which were mainly Gram negative organisms, accounting for 58.13% (25/43), and Klebsiella pneumoniae was the most common (44.2%, 19/43). The ratio of multi-drug resistant (MDR) organisms was high (67.4%, 29/43). Conclusions:Accompanying abdominal infection and APACHEⅡ score≥20 were independent risk factors for AP complicated with CRBSI, while early enteral nutrition was the protective factor. Pathogens were mainly Gram negative organisms, and MDR organisms should be paid special attention to.

本研究回顾性分析武汉大学人民医院胰腺外科2017年5月～2019年2月行经皮全覆膜自膨胀食道金属支架置入治疗感染性胰腺坏死的25例患者的临床资料。25例患者技术成功率100%，支架微创治疗成功率84%，总治愈率92%，结果表明，经皮全覆膜自膨胀食道金属支架置入辅助胰腺坏死组织清除是临床上治疗感染性胰腺坏死的一种有效方法，值得临床推广应用。

目的:回顾性分析急性胰腺炎(AP)患者空腹高血糖发生率及其危险因素.方法:收集2018-01—2018-12武汉大学人民医院胰腺外科133例AP且无糖尿病(DM)病史的住院患者病历资料,按照不同性别、年龄、AP临床分型、病因、CT指数评分(CISI)等分组,χ2检验分析各组临床因素与空腹高血糖(FPG≥6.1mmol/L)发生率的关系,多因素二元logistic回归分析空腹高血糖独立危险因素.结果:AP临床分型(χ2=5.494,P=0.019)和CTSI(χ2=6.236,P=0.013)与AP患者空腹高血糖相关(P<0.05).CTSI≥6分(P=0.015,OR=2.920,95％Cl=1.234—6.905)为AP患者空腹高血糖的独立危险因素(P<0.05).结论:临床分型中重症+重症及CTSI≥6分的AP患者易发生空腹高血糖,尤其CTSI≥6分是AP后空腹高血糖的独立危险因素,临床应高度关注.

Objective:Some of patients with severe acute pancreatitis (SAP), especially those complicated with peripancreatic necrotic infection may develop into persistent inflammation-immunosuppression-catabolism syndrome (PICS). Soluble programmed death ligand 1 (sPD-L1) plays an important role in the negative regulation of immunological functions. This article aims to observe and search whether sPD-L1 can predict PICS in patients with PICS.Methods:This study collected the clinical data of 131 patients with SAP first treated in Renmin Hospital within 24 h after outset of disease and spending more than 14 days in hospital from Mar. 1, 2017 to Oct. 31st, 2019. They were divided into PICS group ( n=45) and non-PICS group ( n=86). We collected the data of sPD-L1 in 24 h and around 2 weeks and other relative statistics. Statistical analysis was done using SPSS 16.0 statistics software. Results:There was no significant difference in aspects of gender, age, body mass index (BMI), sPD-L1, white blood cells (WBC), albumin (ALB), ALCs, Balthazar CT scores with in 24 h after the onset of SAP between two groups. The C-reactive protein (CRP) level on the admission, liquid in positive equilibrium within 24 h after 24 h, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores on the admission, sPD-L1 and Balthazar CT scores 2 weeks after onset were significantly higher in PICS group than in non-PICS group [175.50 (128.00, 212.25) mg/L vs. 135.26 (108.06, 171.93) mg/L, Z=-2.823, P<0.05; (1 914.7±668.2) ml vs. (1 600.5±613.1) ml, t=-2.410, P<0.05; (12.12±2.31) scores vs. (10.91±2.75) scores, t=-2.237, P<0.05; 108.93 (101.35, 118.96) μg/L vs. 90.03 (81.57, 99.36) μg/L, Z=-5.599, P<0.05; 8 (6-8) scores vs. 6 (5-8) scores, Z=-3.251, P<0.05]. At about 2nd week after onset, sPD-L1 level and Balthazar CT scores were independent risk factor of PICS [odds ratio ( OR)=1.07, 95% confidence interval ( CI): 1.03-1.12, P<0.01; OR=1.52, 95% CI: 1.10-2.12, P<0.05]. Conclusion:sPD-L1 and Balthazar CT scores at 2nd week after onset were independent risk factors of PICS.

目的 探讨发生持续炎症-免疫抑制-分解代谢综合征(persistent inflammation immunosuppression catabolism,HCS)的重症急性胰腺炎(severe acute pancreatitis,SAP)病人是否比未发生PICS者的免疫抑制更加严重,并为临床诊断和治疗PICS提供参考.方法 本研究观察评估了63例SAP病人,依照PICS诊断标准,将SAP病人分为PICS组(23例)和非PICS组(40例).发生院内继发感染则判为免疫抑制,收集临床资料.在规定时点采血测定绝对淋巴细胞计数(ALCs)和可溶性程序性死亡配体-1(sPD-L1)水平.结果 PICS组病人继发感染发生率为100％,而非PICS组为27.5％(P＜0.05).与非PICS组相比,PICS组SAP病人在发病早期ALCs、sPD-L1水平无统计学差异(P＞0.05).2周后两组SAP病人的sPD-L1水平和ALCs计数均存在统计学差异(P＜0.05).结论 SAP病人均存在免疫抑制,其中PICS组病人的免疫抑制更严重,继发感染发生率高.

胰腺癌是一种高度恶性的消化系统肿瘤,由于其起病隐匿,患者就诊时多为中、晚期,失去了根治性手术的机会,因此早期诊断是提高患者生存率的关键.液体活组织检查主要包括检测循环肿瘤细胞(CTC)、循环肿瘤DNA(ctDNA)和外泌体等,在胰腺癌早期诊断中具有潜在的优势.该文就液体活组织检查在胰腺癌早期诊断中的研究进展作一综述.

目的:本研究旨在阐明过表达COX-2的结直肠癌中花生四烯酸代谢与PTEN及其下游通路的相互关系.方法:利用过表达COX-2结直肠癌细胞系CT26和ApcMin/+小鼠腺瘤模型,联合花生四烯酸、COX-2抑制剂NS-398和COX-2基因敲除的干预,采用流式细胞仪检测细胞凋亡、细胞周期及活性氧的产生;Transwell和克隆形成试验观察细胞的迁移和增殖能力;Western blot和免疫组化检测PTEN及其下游相关蛋白的表达.结果:花生四烯酸通过COX-2酶代谢产生活性氧并失活PTEN抑癌基因表达,从而激活PI3K-AKT蛋白促进CT26结直肠癌细胞迁移和增殖,抑制细胞凋亡;而COX-2抑制剂NS-398阻止了花生四烯酸在CT26结直肠癌细胞中的恶性生物学行为.同时,在COX-2基因敲除ApcMin/+小鼠腺瘤组织中,减弱了氧化应激水平,增加了PTEN表达,抑制了PI3K-AKT磷酸化,进一步抑制腺瘤生长,提高小鼠生存率.结论:花生四烯酸通过COX-2酶代谢产生活性氧下调PTEN活性,并激活PI3K-AKT促进结直肠癌生长;COX-2抑制剂可间接促进PTEN表达,抑制结直肠癌生长,能够作为CRC的潜在治疗靶点.

目的 系统评价持续静脉-静脉血液滤过(CVVH)联合血液灌流(HP)治疗高脂血症性急性胰腺炎(HLAP)的疗效.方法 计算机检索Cochrane Library、PubMed、维普科技期刊数据库、万方数据库、中国知网数据库自建库至2018年12月发表的关于CVVH联合HP治疗HLAP疗效的临床随机对照试验(RCT).由2位研究者按照纳入与排除标准独立进行文献筛选、资料提取和质量评价后,采用Review Manager 5.1软件进行Meta分析.结果 最终纳入10篇RCT,共有687例患者,其中试验组(CVVH联合HP治疗)患者343例,对照组(CVVH治疗)患者344例.Meta分析结果显示,与对照组比较,试验组患者治疗后血清甘油三酯水平[均数差(MD)=-7.37,95％置信区间(CI)(-10.54,-4.20),Z=4.55,P<0.00001]、住院病死率[相对危险度=0.43,95％CI(0.26,0.71),Z=3.32,P=0.0009],急性病生理学和长期健康评价Ⅱ评分[MD=-1.93,95％CI(-2.63,-1.23),Z=5.40,P<0.00001],血清肿瘤坏死因子α水平[MD=-67.21,95％CI(-98.88,-35.54),Z=4.16,P<0.0001]及血清白细胞介素6水平[MD=-50.60,95％CI(-62.91,-38.28),Z=8.05,P<0.0001]均显著降低.结论 在常规治疗的基础上,CVVH联合HP治疗HLAP的疗效优于单用CVVH治疗.

重症急性胰腺炎的诊治已进入一个微创治疗的时代,这必将是未来的发展趋势,但是临床工作中仍然存在着诸多问题及困难.此文报告1例重症急性胰腺炎胰周坏死性感染合并脓毒症休克病人的诊疗过程,采用金属支架对窦道保护,在视频辅助下进行胰周坏死组织清除,取得良好效果,为重症急性胰腺炎的诊治提供新的思路.

主观全面评定(subjective global assessment,SGA;名词编号:01.030)[1]又称"主观整体评定".1984年加拿大学者德茨基(A.Detsky)提出.1987年发表,以主观评价为主[2].患者参与的主观全面评定(scored patient-generated subjective global assessment,PG-SGA;名词编号:01.031)[1]在SGA基础上发展起来,1994年由美国奥特里(F.D.Ottery)提出,与SGA类似,但有患者自我评定和医务人员评定两部分,PG-SGA与SGA本质类似.虽然有文章报告此量表用于癌症患者[3],但PG-SGA并没有被美国肠外肠内营养学会(American Society for Parenteral and Enteral Nutrition,ASPEN)[4]和欧洲肠外肠内营养学会即欧洲营养与代谢学会)(European Society Clinical Nutrition and Metabolism,ESPEN)推荐专门用于癌症患者.

Severe acute pancreatitis (SAP) has a severe attack and high incidence of case fatality rate.Almost all the SAP patients would undergo some different immune status including systemic inflammatory response syndrome,compensatory anti-inflammatory response syndrome and mixed antagonistic response syndrome.With more acknowledgement of the pathophysiology of SAP,come researches have revealed that a few SAP patients may gradually come into a terribly and durably consumptive phase,and ultimately progress to persistent inflammation-immunosuppression catabolism syndrome (PICS).Now the morbidity of PICS has increased in recent years,therefore,it is helpful to recognize PICS early and improve the prognosis by discussing the pathophysiology deeply.Based on the new research progress at home and abroad,this article reviewed the diagnostic criteria,occurrence and development,and treatent of PICS in SAP,in order to offer treatment strategy for the SAP.

目的 比较胰十二指肠切除术(PD)中标准淋巴结清扫(SPD)与扩大淋巴结清扫(EPD)治疗胰头癌的临床疗效.方法 回顾性分析2010年1月至2014年1月在武汉大学人民医院普外科接受PD的79例胰腺癌患者临床资料,根据PD中淋巴结清扫范围分为标准淋巴结清扫组(SPD组,40例)和扩大淋巴结清扫组(EPD组,39例).比较两组患者的围手术期资料及术后疗效;并对患者进行随访,统计患者的生存情况.结果 与SPD组比较,EPD组手术时间明显延长[(512±68)min vs.(398±52)min,P<0.05],术中出血量明显增多[(732±72)ml vs.(482±34)ml,P<0.05].两组术后总并发症发生率差异无统计学意义(43.6％vs.32.5％,P>0.05),而EPD组术后腹泻、胃排空障碍发生率高于SPD组(P<0.05);两组术后住院时间差异无统计学意义(P>0.05),但EPD组住院费用高于SPD组(P<0.05).EPD组淋巴结获得数多于SPD组(19.4±11.7 vs.13.6±5.2,P<0.05),而阳性淋巴结数目差异无统计学意义(5.6±2.3 vs.4.3±2.1,P>0.05);SPD组与EPD组1、3、5年生存率和中位生存期差异均无统计学意义(65.0％vs.53.8％;22.5％vs.15.4％;12.5％vs.7.7％;16.5个月vs.14.0个月,P>0.05).结论 PD中行扩大淋巴结清扫治疗胰腺导管腺癌不能提高患者生存率,但会延长手术时间,增加术中出血量,甚至可能导致术后并发症的增加.

目的 通过Meta分析的方法对国内应用吉西他滨(GEM)联合高强度聚焦超声(HIFU)治疗中晚期胰腺癌(PC)疗效进行评价.方法 计算机检索VIP(1989 ～ 2018年)、万方数据(1999 ～ 2018年)、CNKI(1994 ～ 2018年)、CAJD(1995 ～ 2018年)数据库中关于GEM联合HIFU治疗中晚期PC疗效的临床随机对照试验(RCT),对符合要求的RCT进行Meta分析.结果 最终纳入15篇RCT,共有718例病人符合纳入标准.Meta分析结果,GEM联合HIFU治疗PC的临床有效率,临床受益率,半年生存率,1年生存率均明显高于单用GEM或HIFU治疗,且CA19-9降低更显著(P＜0.05).结论 GEM联合HIFU治疗PC的疗效确切,且明显优于单用GEM或HIFU治疗.

Objective To explore the effect of invasion and migration of hepatocellular carcinoma (HCC) endothelial cells (TECs) affected by overexpression of microRNA-3178 (miR-3178) through the transfection of miR-3178 mimic.Methods Real-time polymerase chain reaction (Real-time PCR) was used to identify differential expression of miR-3178 in normal hepatic sinusoidal endothelial cells (HSECs) and HCC TECs.Furthermore,HCC TECs were divided into 3 groups:control (CON) group,miRNA-3178 upregulation (Mimics,up-regulation of miR-3178 expression was achieved using miR-3178 mimics transfected into HCC TECs) group and negative control (NC,negative control sequence was transfected into HCC TECs) group.RT-PCR was used to detect expression of miR-3178 in HCC TECs before and after transfection.Transfection efficiency was observed by using an inverted fluorescence microscope.HCC TECs invasionand migration were measured by matrigel invasion and transwell migration assay.EGR3 protein expression of HCC TECs were identified by Western blotting analysis.EGR3 mRNA expression of HCC TECs were identified by RT-PCR analysis.Results The results of RT-PCR showed that miR-3178 was significantly down-regulated in HCC TECs compared to HSECs (P ＜0.05),and expression of miR-3178 was significantly increased after the transcienttransfection (P ＜ 0.05).The transfection efficiency in HCC TECs was morethan 90％.Number of migrated and invaded cells and in miR-3178 group was significantly less than those in other groups.Target gene prediction software showed EGR3 was a possible candidate target.Transfection of miR-3178 mimic significantly decreased the mRNA and protein expression levels of EGR3.Conclusion MiR-3178 was downregulated in HCC TECs and overexpression of miR-3178 can specifically inhibit migration and invasion of HCC TECsin vitro through inhibiting EGR3 expression,thus,miR-3178 might be a critical targeted therapy strategv for HCC.