我国炎症性肠病、结直肠息肉及结直肠癌的发病率呈逐年上升趋势,通过生物标志物辅助诊断此类肠道疾病对于这些疾病的临床治疗至关重要.研究表明,同型半胱氨酸(Hcy)是炎症性肠病、结直肠息肉及结直肠癌发生的主要危险因素,可作为上述疾病诊断的血清标志物.本文从体内代谢途径及其血浆水平的影响因素等方面对Hcy进行概述,并针对Hcy与炎症性肠病、结直肠息肉、结直肠癌等肠道疾病关系的研究进展进行综述,以期为上述疾病的预防和临床治疗提供新思路.

[目的]探讨肠系膜上动脉栓塞(superior mesenteric artery embolism,SMAE)的临床特征.[方法]纳入诊断为SAME患者42例,根据治疗结果分为好转组与死亡组,对其临床资料进行统计学分析.[结果]42例患者平均年龄为(65.8±13.7)岁,男27例(64.3％)女15例(35.7％),伴有高血压22例、动脉硬化16例、心房颤动17例、动脉栓塞史14例、糖尿病9例、腹部手术史8例.所有患者均为急性腹痛起病,伴有恶心呕吐27例、便血17例.中性粒细胞百分比升高32例、白细胞升高27例、C-反应蛋白升高29例、凝血酶原时间延长32例、活化部分凝血酶原时间延长17例、纤维蛋白原升高22例、D-二聚体升高23例.血管CT确诊的36例患者均发现肠系膜上动脉管腔充盈缺损,腹腔积液21例、肠管增厚积气14例、肠坏死11例,肠梗阻3例.死亡组平均年龄为(74.5±9.8)岁,显著高于好转组的(62.8±13.7)岁,2组比较P＜0.05.死亡组患有心脏疾病、多处动脉栓塞人数明显多于好转组(P＜0.05).死亡组患高血压、糖尿病、心房颤动例数多于好转组,伴有恶心、呕吐、消化道出血、肠坏死、腹膜刺激征人数多于好转组,但均差异无统计学意义.保守治疗、外科开腹治疗及血管内介入治疗死亡率分别为28.0％(7/25)、16.7％(2/12)及20.0％(1/5例).[结论]SMAE临床表现及实验室资料无特异性,腹部症状较重而体征较轻为其特点之一,腹部CTA检查是诊断本病的最佳方法,血管内溶栓或取栓,以及开腹手术治疗是最有效的治疗措施,血小板显著减少及存在多处血管栓塞者预后差.

肠系膜上动脉栓塞(superior mesenteric artery ischemia,SMAE)是导致急性肠系膜缺血最常见的原因.由于肠系膜血管网的大部分供血来源于肠系膜上动脉,当发生栓塞时,会造成大部分肠管缺血,其中小肠缺血最为明显,若血供不能及时恢复,随着病情的进展可发展到肠透壁坏死,为治疗带来更多挑战.目前本病治疗方法主要为外科开腹取栓、切除坏死肠管和血管内介入治疗.但因肠坏死进展不明确,外科手术有2次开腹风险,介入治疗也有后续剖腹探查的可能,且会因介入治疗使肠坏死进展更严重,耽误病情.若能在早期发现肠道缺血坏死并及时干预,可改善预后,提高本病治愈率.本文就目前已知SMAE肠坏死的早期诊断方法进行综述.

目的 探讨肠系膜上动脉栓塞(SMAE)发生及影响其预后的危险因素,以提高对该病的认识.方法 收集2015年9月～2020年12月在某三甲医院确诊为SMAE的住院患者42例作为研究组,随机选取同期出院第一诊断为慢性胃炎患者42例作为对照组;同时根据研究组治疗结局,将其分为死亡组(n=10例)、好转组(n=32例).收集84例住院患者资料进行统计学分析.结果 伴有房颤、动脉硬化、栓塞史、腹部手术史、纤维蛋白原升高与SMAE的发生呈正相关(P＜0.05).单因素分析示高龄、有心脏疾病、存在多处血管栓塞与SMAE患者死亡呈正相关,血小板数量与SMAE患者死亡呈负相关(P＜0.05).多因素分析示血小板数量与SMAE患者死亡呈负相关(P＜0.05),存在多处血管栓塞与SMAE患者死亡,为可疑危险因素(0.05＜P＜0.1).结论 伴有房颤、动脉硬化、栓塞史、腹部手术史、纤维蛋白原升高是发生SMAE的危险因素,血小板减少是SMAE患者死亡的危险因素,多处血管栓塞为可疑危险因素.

[目的]了解幽门螺杆菌(Helicobacter pylori,Hp)在综合内科住院患者中的现症感染情况.[方法]采用13C-尿素呼气试验对综合内科住院1 618例患者的Hp感染情况进行检测,分析其与不同性别、年龄、病种间的关系.[结果]1 618例患者Hp现症感染率为35.7％(578/1 618).其中男性为37.0％,女性为34.4％,性别比较差异无统计学意义(P＞0.05).从年龄分布来看,Hp现症感染率在中年组(39.2％,152/387)及老年组(38.0％,260/684)中均显著高于青年组(27.3％,47/172)和高龄组(31.7％,119/375),呈现出随着年龄的增长,其感染率逐渐增高后又逐渐降低,在中年组中达到高峰.各个系统及不同病种间的Hp现症感染率不同,各有其不同的临床意义.[结论]综合内科住院患者的Hp现症感染率较高,尤其在中年组及老年组中更高;不同病种间的感染率不同,但无性别差异.

病例女性,80岁,主因“上腹饱胀、疼痛、体重下降半月”入院.患者半月前无明显诱因出现上腹部饱胀、持续性胀痛,与进食、体位无关,伴有乏力、纳差,无发热、恶心、呕吐、反酸、嗳气、胸闷、心悸等不适,在当地医院给予“奥美拉唑、头孢他啶、间苯三酚”治疗后,上述症状无明显缓解,遂至医院就诊,门诊以“腹痛查因”收住院.患者近半月体重下降3 kg.入院查体:体型消瘦,腹平软,中上腹部压痛明显.入院行腹部B超检查示:胆囊显像不清,中上腹位于前方探及大小约13.0 cm×6.1 em的厚壁含液性回声团,界清规则,彩色多普勒血流显像(CDFI):厚壁含液性回声团内未测及明确血流信号(倾向良性).

目的 探讨肺结核并发慢性肺曲霉病的临床特征,以提高对该病的认识.方法 对6例肺结核并发慢性肺曲霉病患者的临床资料进行回顾分析.结果 主要表现为咳嗽/咳痰6例,咯血5例,发热5例,盗汗6例,胸闷/气短4例,体重减轻5例.外周血白细胞计数正常5例,降低1例;血沉增高5例,C反应蛋白增高5例,γ-干扰素释放试验阳性5例,真菌(1-3)-β-D葡聚糖阳性4例.胸部CT检查除继发性肺结核的表现外,均有肺空洞,其特征是空洞内赘生物形成,部分形似“空洞内鸟巢征”;3例出现“实心球征”及“空气新月征”;1例左上肺呈蜂窝状改变.均经病理学确诊.在正规抗结核治疗基础上,均给予伏立康唑治疗,总疗程5～6个月.出院后来院复查者仅3例(50％),3例肺空洞均逐渐缩小,2例空洞内赘生物逐渐缩小至消失,1例形成肺曲霉菌球,长期治疗无改变,经手术治疗痊愈.绪论肺结核患者较易并发慢性肺曲霉病,可使原有结核病症状加重,咯血较为多见.胸部CT检查具有特征性表现,组织病理检查可确诊.抗真菌治疗要有足够的疗程,特殊情况可考虑手术治疗.

[目的]对慢性便秘患者结肠镜检查前的肠道准备方法进行改良并对比3种不同方法对肠道准备效果的影响.[方法]收集2014-01--2015-12期间接受结肠镜检查并常规使用复方聚乙二醇电解质散(PGE)的慢性便秘患者(便秘组)及非便秘患者(非便秘组)各100例.分析2组患者的清肠效果.选取2016-1-2018-05期间行结肠镜检查的200例慢性便秘患者,随机分为3组,即常规PGE组(常规组)65例、改良PGE组68例、改良硫酸镁组67例,观察受检者的肠道清洁程度,同时记录肠镜检查完成时间、不良反应、总体耐受性等.[结果]在常规使用聚乙二醇作肠道准备时,便秘组的清肠合格率为61.0％(61/100),显著低于非便秘组的80.0％(80/100),P<0.01.清肠合格率改良PGE组(79.4％,54/68)、改良硫酸镁组(80.6％,54/67)均显著高于常规组(60.0％,39/65),P<0.05;而改良PGE组与改良硫酸镁组的清肠合格率比较差异无统计学意义(P>0.05).3组患者结肠镜检查完成时间、不良反应及总体耐受性比较均差异无统计学意义(P>0.05).[结论]慢性便秘患者常规方法清肠合格率低,改良肠道准备后可显著提高便秘患者的清肠合格率,且不良反应小,患者耐受性好,值得进一步推广.

目的 探讨医师床旁发药对住院患者满意率和所服药物认知率的影响.方法 以2016年8月1日～2016年9月30日在综合内科住院的所有162例患者作为研究组,由每一经管医师负责给自己经管的患者发药,在发药时给每一患者讲解所服药物的名称、简要作用、服用方法和注意事项,并教患者认识所服药物的外部特征.在患者出院时对其总体满意度及发药满意率进行测评,并观察患者对其所服药物外观性状的辨识情况及服用方法知晓情况.以试点前的2016年6月1日～2016年7月31日在我院综合内科住院的所有168例患者作为对照组.结果 研究组的总体满意率96.91％、发药满意率97.53％均显著高于对照组的90.48％和91.67％,差异均具统计学意义(P<0.05);研究组量化的总体满意度(4.47±0.74)、发药满意度(4.52±0.78)均显著高于对照组(4.15±0.98)和(4.18±0.92)(P<0.05);研究组对所服药物外观性状正确辨识率97.53％及正确服用方法认知率98.15％,显著高于对照组85.12％和88.09％(P<0.01);研究组慢性病长期服药患者对所服药物基本作用良好掌握率(94.64％)显著高于对照组(76.67％),差异具有统计学意义(P<0.01).结论 医师发药能够显著提高住院患者的满意率和对所服药物的认知率.

Objective To compare the changes of red blood cell distribution width(RDW)among posthepatitic liver cirrhosis,alcoholic liver cirrhosis,and liver cirrhosis caused by other reasons,and to determine if RDW follows the severity of the disease according to Child-Pugh score.Methods A total of 128 hospitalized patients with liver cirrhosis, who admitted to Kunming General Hospital of Chengdu Military Command from November 2015 to February 2017, were selected as the study group.According to etiology,there were 68 cases of posthepatitic liver cirrhosis,21 cases of alcoholic liver cirrhosis and 39 cases of cirrhosis due to other causes.The RDW and several main examination parame-ters were collected and analyzed among the three groups with different etiology of cirrhosis,as well as the changed char-acteristics of RDW in different liver function Child-Pugh classification were analyzed.Results The RDW of posthep-atitic liver cirrhosis group,alcoholic liver cirrhosis group and the group caused by other factors were(15.09±2.20)%, (15.71 ± 2.53)%, (16.16 ± 2.77)%, respectively.And no statistically significant difference among them was found (P>0.05). Likewise, there was no significant difference of RDW among hepatic cirrhotic Child-Pugh A, B, and C (P>0.05). Conclusion RDW cannot be used to identify cirrhosis of different etiology. There is no correlation between RDW and Child-Pugh grading of liver function in cirrhosis.RDW may not be used as a reference for Child-Pugh classifi-cation in the course of liver cirrhosis.

[Objective] To explore the clinical significance of red blood cell distribution width(RDW) in the course of liver cirrhosis. [Methods]The totals of 128 hospitalized patients with liver cirrhosis in Kunming General Hospital from November 2015 to February 2017 were selected as study group. The results of the blood routine examination, blood biochemistry indexes and coagulation function indexes were collected. And the relationship between the main parameters and the course of liver cirrhosis was analyzed. Another 120 cases selected randomly from the health check-up crowd in our hospital in February 2017 were served as control group. [Results]The parameters of RDW, platelet distribution width(PDW), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), glutamyl transpeptidase(γ-GT)and total bilirubin(TBil)in liver cirrhosis group were significantly higher than those in control group(P＜0.01, respectively). However, the parameters of hemoglobin(Hb), red blood cell count (RBC), hematokrit(HCT), platelet count(PLT)and serum albumin (Alb) were significantly lower than the control group (P < 0.01, respectively). In patients with liver cirrhosis, the RDW in the decompensated group was significantly higher than that in the compensated group, and the RDW in the patients with gastrointestinal bleeding group was significantly higher than that in the non gastrointestinal bleeding group(P＜0.01,respectively). The RDW value of cirrhosis patients was positively related to TBil and prothrombin time(PT),while negatively correlated with serum Alb and fibrinogen(FIB)(P＜0.05-0.01). [Conclusion] RDW can be used as one of the important indexes for evaluating the progress of liver cirrhosis patients. It can provide some reference value for clinical diagnosis and treatment.

患者从幼年(1岁)开始发病,期间出现多种症状和并发症,至成年(19岁)才初次确诊为克罗恩病.为了提高医务人员对幼年克罗恩病的认识,早诊早治,减少误诊,笔者对这1例的临床资料进行分析总结,并结合文献进行复习,报道如下.

病例1 男性,25岁,战士,因腹痛10 d,便血1 w入院.患者于10 d前无明显诱因出现腹痛,全腹均有疼痛,以上腹和脐周为主,呈持续性隐痛、胀痛,伴阵发性绞痛,偶有恶心.1 w前出现便血,为柏油样黑便,2～3次/d,100～300 ml/次,活动后感心慌、头昏,无发热.入院查体:中度贫血貌,皮肤巩膜无黄染,心肺无异常,腹平软,全腹压痛,伴轻度反跳痛,肝脾肋下未触及,未触及包块,肠鸣音活跃,移动性浊音阳性.

目的 了解呼出气一氧化氮(FeNO)在老年慢性阻塞性肺疾病(慢阻肺,COPD)稳定期、慢阻肺急性发作期(AECOPD)及哮喘发作期患者中的变化情况.方法 对我院在2014年6月-2016年6月收治的154例老年慢阻肺稳定期(62例)、急性发作期(62例)及哮喘(30例)患者进行FeNO测定,观察治疗前后FeNO的变化情况,并与同期收治的62例非呼吸系统疾病老年患者进行比较.结果 治疗前FeNO的测定值在老年哮喘组[(56.6±14.6) ppb]＞慢阻肺急性发作期组[(33.2±11.2) ppb]＞慢阻肺稳定期组[(26.3±10.4) ppb]＞非呼吸系统疾病组[(20.2±9.2) ppb],各组间比较差异均有统计学意义(均P＜0.01).各组自身治疗前后比较,治疗后哮喘组[(31.7±13.1) ppb] FeNO和慢阻肺急性发作期组[(25.8±9.6) ppb]均较治疗前显著下降(均P＜0.01),但仍高于非呼吸系统疾病组(均P＜0.01);慢阻肺稳定期组治疗后其FeNO[(23.9±9.4) ppb]有所下降,但与治疗前比较差异无统计学意义(P＞0.05).结论 FeNO在老年哮喘患者中显著增高,在慢阻肺急性发作期患者中明显增高,在慢阻肺稳定期患者中轻度增高,治疗后则明显下降.FeNO测定对老年患者气道炎症的评估具有很好的作用.

ObjectiveTo investigate and compare the heart B ultrasound and ECG(Electrocardiogram) in the diagnosis of hypertensive heart disease. MethodsFrom May 2013 to January 2016, 96 cases hypertensive heart disease in in our hospital were collected as the observation group, 50 cases of healthy volunteers were collected as the control group.ResultsFor healthy people, the diagnosis of heart B ultrasound and electrocardiogram had no significant differences. Compared with electrocardiogram, the cases of left ventricular hypertrophy, left atrial enlargement, left ventricle increases, aortic dilatation and aortic elasticity weaken detected had increased by the heart B ultrasound way (P <0.05).ConclusionCompared with electrocardiogram, the heart B ultrasound has a higher accuracy of diagnosis of hypertensive heart disease, which can be used as the preferred method for diagnosis of hypertensive heart disease in clinic.

[目的]了解消化内科住院患者幽门螺杆菌(helicobacter pylori,HP)现症感染的情况.[方法]选取2011年10月～2015年5月在我院消化内科住院的患者共3684例,应用13C-尿素呼气试验检测幽门螺杆菌现症感染情况,以年龄、性别和病种进行分组,分析不同状况下幽门螺杆菌的感染情况.[结果]该消化内科住院患者HP总的现症感染率为23.0％(848/3684),其中男性为23.5％,女性为22.4％,2组比较差异无统计学意义(P＞0.05).从年龄分布来看,中年组的HP现症感染率(26.3％,322/1223)显著高于青年组(19.4％,160/664)(P＜0.01)和老年组(23.1％,378/1259)(P＜0.05),老年组也显著高于青年组(P＜0.05);呈现出随着年龄的增长,其感染率逐渐增高后又逐渐降低,在中年组中达到高峰.上消化道疾病、下消化道疾病、肝胆疾病、胰腺疾病HP现症感染率分别为25.5％、20.3％、19.0％、10.4％,其中以上消化道疾病患者最高(P＜0.05);HP现症感染率最高的3种疾病分别是消化性溃疡、胃恶性肿瘤和慢性胃炎,而胃食管返流病最低.[结论]消化内科住院患者HP现症感染率较高,尤其在中年组中更高.不同病种间的HP现症感染率不同,各有其不同的临床意义.

Objective To investigate the measurement of fractional exhaled nitric oxide ( FeNO) in elderly patients with asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS). Methods FeNO test was applied for 42 elderly patients with ACOS before treatment. Another 42 patients with chronic obstructive pulmonary disease ( COPD) , 35 patients with asthma and 42 patients without respiratory diseases were taken as control groups. Results (1) Before treatment, the level of FeNO in the ACOS group was (48. 6 ± 13. 9) ppb, which was higher than in the non-respiratory disease group [(21. 5 ± 11. 8)ppb] and the COPD group [(34. 7 ± 13. 4)ppb] (P<0. 01, respectively), but lower than in the asthma group [(61. 5 ± 15. 1)ppb] (P<0. 01). (2) Taking 27 ppb as cut-off value of FeNO, the increased rate of FeNO (≥27 ppb) in the ACOS group (83. 3%) was significantly higher than that in the COPD group (52. 4%) and the non-respiratory disease group (21. 4%) (P<0. 01, respectively), while it had no significant difference with the asthma group ( 88. 6%) ( P>0. 05 ) . Conclusion FeNO is signifi-cantly higher in elderly ACOS patients, and its determination has a good effect to assess airway inflammation in elder-ly patients.

[目的]探讨综合医院消化内科门诊患者焦虑抑郁障碍的发病情况及其影响因素.[方法]随机入选547例消化内科就诊的患者,采用Zung氏焦虑自评量表(SAS)与抑郁自评量表(SDS)对其进行测评.[结果]在547例受试者中,SAS得分高于正常值152例(占27.8％),其中112例(20.5％)为轻度焦虑,33例(6.0％)为中度焦虑,7例(1.3％)为重度焦虑;SDS得分高于正常值158例(占28.9％),其中113例(20.7％)为轻度抑郁,38例(7.0％)为中度抑郁,7(1.3％)例为重度抑郁.焦虑抑郁障碍患者性别、婚姻情况及教育程度间的比较差异有统计学意义(P＜0.05～0.01).女性、离异或丧偶者、高学历人群处于高焦虑抑郁状态.[结论]在综合医院消化内科门诊患者中焦虑抑郁障碍的发生率较高,尤其是女性、离异或丧偶者、高学历人群是影响焦虑与抑郁的重要因素.

Objective To survey the Helicobacter pylori (Hp) present infection in cases with cerebral infarction. Methods 13C-Urea Breath Test was applied in the detection of Hp infection in 634 cases with cerebral infarction ( cerebral infarction group) and 878 cases with no cerebral infarction (control group), and the correlation of Hp infection to age and attacks of cerebral infarction was analyzed. Re-sults The Hp positive rate in cerebral infarction group was 40.5%, much higher than that in control group (31.8%);there existed no sta-tistical difference in Hp positive rates among each age group (P<0.05) nor among cases with different attacks of cerebral infarction (P<0.05). Conclusions The rate of Hp present infection is very high in cases with cerebral infarction;Hp infection may be one of the risk factors of cerebral infarction occurrence.

目的：探讨不明原因肺部病变 CT 引导经皮肺穿刺活检的临床特征和护理措施。方法总结分析该院在2013年3月—2014年12月间收治的69例不明原因肺部病变患者进行 CT 引导下经皮肺穿刺活检的临床情况和护理体会。结果在围术期制订和实施相应的护理措施，保证了肺穿刺的顺利进行。69例（100％）患者全部穿刺成功，68例（98．6％）明确诊断，其中肺部恶性肿瘤42例（60．9％），良性病变26例（37．7％），未明确诊断1例（1．4％）。总的并发症发生率为15．9％（11／69），包括气胸7例（10．1％），痰中带血4例（5．8％），其中肺少许出血2例（2．9％），症状均较轻微。结论CT 引导经皮肺穿刺活检对不明原因肺部病变确诊率高、安全、并发症少而轻微，正确有效的护理能提高穿刺成功率及减少并发症。