目的 评估超声内镜检查术(EUS)诊断消化道黏膜下病变(SML)的临床价值.方法 回顾性分析2020年1月-2021年12月该院消化内科使用EUS诊断,并经组织病理学证实为SML患者的病例资料.结果 共有142例消化道SML患者进行了EUS检查.其中,135例为实体瘤,7例为壁外压迫.实体瘤中,EUS诊断黏膜层病变14例,黏膜肌层病变20例,黏膜下层病变62例,固有肌层病变39例,其诊断准确率分别为:100.0%、100.0%、95.0%和89.7%.EUS诊断平滑肌瘤30例(21.1%),间质瘤29例(20.4%),神经内分泌肿瘤25例(17.6%),异位胰腺15例(10.6%),息肉14例(9.9%),脂肪瘤11例(7.7%),囊肿9例(6.3%),壁外压迫7例(4.9%),颗粒细胞瘤2例(1.4%).107例行内镜治疗或手术切除后送病检,99例病理与EUS诊断相符,EUS总体诊断准确率为92.5%.结论 EUS对消化道SML诊断的准确性与病变的起源有关,起源于黏膜层与黏膜肌层的诊断准确性最高,在鉴别壁内病变与壁外压迫方面,也具有较好的诊断价值.EUS在一定程度上可以判断SML的性质,有助于确定病变的治疗方式.

目的 基于一次性胃部细胞无创采样器采集胃液标本进行幽门螺杆菌耐药基因检测,指导幽门螺杆菌个体化治疗,探讨此技术的临床应用价值.方法 选取2021年5月至2022年5月北京大学深圳医院收治的根治失败2次或以上的难治性幽门螺杆菌感染患者50例,使用一次性胃部细胞无创采样器采集胃液,通过荧光定量PCR法检测抗生素耐药基因,根据耐药结果给予患者制订基于铋剂四联根除治疗方案,疗程14d,治疗结束至少4周后复查尿素呼气试验,确定幽门螺杆菌是否被成功根除.结果 在50例送检样本中,检测幽门螺杆菌阳性者为43例.43例个体化治疗患者根除成功41例,幽门螺杆菌感染根除率意向性分析为95.35%(95%CI为84.19%～99.43%),遵循方案分析为97.62%(95%CI为87.43%～99.94%),均显著优于标准铋剂四联疗法(P＜0.001).结论 基于一次性胃部细胞无创采样器采集胃液标本进行幽门螺杆菌耐药基因检测技术指导的个体化治疗在顽固性幽门螺杆菌感染患者中取得比较理想的临床效果,具有较好的应用价值.

目的:分析难治性胃食管反流病(RGERD)的食管动力学状态及反流特点.方法:选取2019年8月-2020年12月本院消化内科收治的60例RGERD患者作为病例组,另选取本院消化内科收治的60例非难治性的胃食管反流病(GERD)患者作为对照组.采用高分辨率食管测压(HREM)监测并比较两组食管动力学参数[食管上端括约肌(UES)压力、食管下端括约肌(LES)压力、LES长度、远端收缩积分(DCI)、收缩前沿速度(CFV)、胃食管连接处收缩积分(EGJ-CI)].采用24 h食管pH-阻抗监测(24 h MⅡ-pH)监测并比较两组反流指标.结果:病例组UES压力与LES压力均低于对照组(P<0.05);病例组弱酸反流、非酸反流、气体反流及气液混合反流次数均多于对照组(P<0.05).结论:RGERD患者的食管动力学状态以UES压力及LES压力明显降低为主,反流特点以弱酸、非酸、气体及气液混合反流为主.

目的 分析乌司他丁联合生长抑素治疗重症急性胰腺炎的临床效果.方法 病例纳入时间段为2010年6月至2018年5月,纳入范围为我院住院部收治重症急性胰腺炎患者,共纳入70例.按照数字随机表方法 进行分组处理,组别设置为对照组/实验组,各组平均分配患者35例.对照组患者采取单用生长抑素治疗方案,实验组患者采取乌司他丁联合生长抑素治疗方案.对比观察两组患者在临床疗效;干预前/后白蛋白、白细胞计数、血淀粉酶水平;并发症发生率方面的差异.结果 实验组患者临床干预总有效率为94.29％(33/35),显著高于对照组,经检验有统计学差异(P<0.05).临床干预前,两组患者白蛋白、白细胞计数、血淀粉酶水平对比,经检验无统计学差异(P>0.05);临床干预后,实验组患者白蛋白均值(30±0.2)g/L,显著高于对照组;白细胞计数均值(11.0±1.1)×109/L,血淀粉酶均值(415.8±35.6)U/L,显著低于对照组;经检验有统计学差异(P<0.05).治疗期间实验组患者并发症发生率为11.43％(4/35),显著低于对照组,经检验有统计学差异(P<0.05).实验组患者平均住院时间为(21.5±1.6)d,病死率为5.71％(2/35),均明显低于对照组,经检验有统计学差异(P<0.05).结论 乌司他丁联合生长抑素治疗重症急性胰腺炎的临床效果确切,其总有效率优于单纯生长抑素方案,且对改善患者白蛋白、白细胞以及血淀粉酶水平,降低并发症发生率有积极作用,值得推广.

目的:分析感染后肠易激综合征(PI-IBS)与非感染后肠易激综合征(NPI-IBS)两种疾病类型的临床特征及差异.方法:将2016年10月至2018年10月期间于北京大学深圳医院确诊并治疗的PI-IBS患者50例作为观察1组,NPI-IBS患者60例作为观察2组,选取同期在本院接受健康体检的人员50例作为对照组.所有研究对象均接受血清肠脂肪酸结合蛋白(I-FABP)指标检测及肠黏膜白细胞介素(IL)-17A、干扰素-γ(IFN-γ)、IL-10检测,比较各组差异;分析比较观察1组和观察2组的临床特征及差异.结果:观察2组患者的焦虑自评量表(SAS)评分及患病至就诊时间显著少于观察1组,差异具有统计学意义(P＜0.01);观察1组和观察2组的胃肠道症状评定量表(GSRS)评分比较,差异无统计学意义(P＞0.05);观察1组患者的血清I-FABP测定结果为(43.01±4.00)μg·L-1,观察2组为(18.32±1.44)μg·L-1,对照组为(10.58±1.22)μg·L-1.观察1组患者的I-FABP值显著高于观察2组和对照组,观察2组显著高于对照组,差异均具有统计学意义(P＜0.01);观察1组与观察2组肠黏膜IL-17A、IFN-γ水平均显著高于对照组,差异具有统计学意义(P＜0.05),但IL-10水平均明显低于对照组,差异具有统计学意义(P＜0.01).观察1组IFN-γ水平显著高于观察2组,差异具有统计学意义(P＜0.05);观察1组与观察2组肠黏膜IL-17A、IL-10水平比较,差异无统计学意义(P＞0.05).结论:PI-IBS伴有焦虑状态,细胞因子的改变可能是肠道上皮细胞损伤及肠黏膜屏障功能障碍的机制之一.I-FABP有可能是PI-IBS的特异性检测指标.

神经内分泌肿瘤是起源于分布全身的神经内分泌细胞的少见肿瘤,2010年WHO将消化道神经内分泌肿瘤分为三类:神经内分泌瘤、神经内分泌癌、混合性腺神经内分泌癌,其中混合性腺神经内分泌癌是罕见、恶性程度极高的一类,病理诊断是"金标准",免疫组化是病理诊断的重要补充及分级标准.本研究回顾性分析一例极其罕见的发生在胃底贲门的混合鳞癌成分的神经内分泌癌,并复习相关文献,以期提高对神经内分泌肿瘤的认识.

BACKGROUND:Circular RNAs (circRNAs) are implicated in modulating cancer progression, exerting a pro- or anti-cancer effect. This work is aimed to probe the biological function of circ_0084615 in colorectal cancer (CRC) and its underlying mechanism.METHODS:Circ_0084615 was selected from two circRNA microarray datasets (GSE138589 and GSE142837). Circ_0084615, microRNA (miR)-599 and DNA methyltransferases 3A (DNMT3A) mRNA expression in CRC tissues and cell lines were examined by qRT-PCR. The relationship between circ_0084615 expression level and clinical features were analyzed with chi-square test. Circ_0084615 knockdown model was constructed by siRNA in two CRC cell lines. The biological functions of circ_0084615 in CRC cells were evaluated by CCK-8 and Transwell experiments. The effect of circ_0084615 on CRC cell metastasis in vivo was examined with lung metastasis model of nude mice. Dual luciferase reporter gene assay was used to determine whether circ_0084615 and miR-599, and miR-599 and DNMT3A interacted with each other. Western blot was employed to examine the regulatory effects of circ_0084615 and miR-599 on DNMT3A protein expression in CRC cells.RESULTS:Circ_0084615 was up-regulated in CRC and was correlated with poor overall survival rate and advanced clinical stage of CRC patients. Functional assays validated that depletion of circ_0084615 impeded CRC cell proliferation, migration and invasion. Circ_0084615 acted as a molecular sponge for miR-599 to repress its expression. DNMT3A was a downstream target of miR-599. Functional compensation experiments showed that miR-599 inhibitors partially counteracted the the biological effects of silencing circ_0084615 on CRC cells.CONCLUSIONS:Circ_0084615 is a tumor-promoting circRNA in CRC that functions as a competing endogenous RNA to regulate DNMT3A expression via sponging miR-599. Our research provides a potential therapeutic target for CRC patients.

目的 利用可视化基因芯片检测技术检测结果指导幽门螺杆菌"个体化"治疗,评价其优越性.方法 244例初诊幽门螺旋杆菌感染患者的胃黏膜组织,检测组织标本中幽门螺旋杆菌gyrA基因上喹诺酮耐药相关的Asn87(N87K)、Asp91(D91G/Y/N)突变位点和23s rRNA基因上克拉霉素耐药相关的A2142G、A2143G突变位点,以及人CYP2C19上与PPI代谢相关的等位基因2C19*2、2C19*3突变位点.根据检测结果喹诺酮和克拉霉素的敏感性分为敏感及耐药;PPI药物代谢活性分为强代谢型(EM)、中代谢型(IM)和弱代谢型(PM);结合检测结果给予幽门螺杆菌"个体化"四联根除治疗,并统计根除率.结果 244例中检出63例对抗生素耐药,耐药率25.80％(63/244),其中左氧氟沙星和克拉霉素耐药率耐药率2.86％(7/244)和20.49％(50/244),两者双重耐药率2.45％(6/244).244例中检出CYP2C19代谢类型有242例(99.18％),其中 EM、IM、PM、分别占40.08％(97/242)、58.26％(141/242)和 1.65％(4/242).242例检测结果阳性患者根据检测结果给予幽门螺杆菌个体化的"四联"治疗,240例完成治疗,初次根除率达到91.67％.EM、IM、PM的根除率分别为89.58％、92.86％和100％,差异无统计学意义(P＞0.05).结论 可视化基因芯片技术能够同时提供准确的CYP2C19代谢类型和克拉霉素、左氧氟沙星耐药情况,指导临床用药,具有较好的临床应用价值.

目的 采用磁共振T1 mapping、T2 mapping评估大鼠肝纤维化和肝脂肪变性,观察其应用价值.方法 将80只大鼠随机分成实验组(n=70)对照组(n=10),分别于背部注射四氯化碳橄榄油溶液及生理盐水,制作大鼠肝纤维化模型.于注药后第4、6、8、10和12周,分别随机选取实验组14只和对照组2只大鼠采集MRI,测量肝实质T1值和T2值,并行组织病理检查.根据病理结果将大鼠肝纤维化划分为S0～S4期,脂肪变性划分为F0～F4度,比较肝纤维化各期T1值和T2值,分析其与肝纤维化及肝脂肪变性相关性.结果 S0期大鼠肝脏T1值和T2值与肝纤维化各期差异有统计学意义(P均＜0.05),S1期[(402.01士57.14)ms]肝实质T1值较S3期[(514.83±87.10) ms]和S4期[(518.72士36.50)ms]短(P均＜0.05),S2期[(417.49±47.00) ms]肝实质T1值较S4期短(P＜0.05);S1期[(65.12±9.46) ms]肝实质T2值较S4期[(55.33±7.30) ms]略延长(P＜0.05).T1值与肝纤维化程度呈正相关(r=0.68,P＜0.01),T2值与脂肪变性程度呈正相关(r=0.72,P＜0.01).结论 磁共振T1 mapping可无创评估大鼠肝纤维化,T2 mapping可无创评估大鼠肝脂肪变性,有望为临床诊断肝纤维化和肝脂肪变性提供新的影像学方法.

Objective: To investigate the effect of Apatinib on MGC-803 cells in gastric cancer and the mechanism of possible signal pathway. Methods: Human gastric cancer MGC-803 cells were selected to detect the effects of Apatinib on the toxicity, growth cycle, apoptosis, and VEGFR2-PLC-ERK1/2 pathway of human gastric cancer MGC-803 cells by using CCK-8 assay, propidium iodide staining, Annexin-V/PI double staining method, and Western blot assay, respectively. Results: The CCK-8 assay showed that Apatinib can significantly inhibit the growth of MGC803 cells in human gastric cancer, and in a concentration-dependent manner. Propidium iodide staining showed that the observation group was obviously blocked in the G1 phase (P<.01). Annexin-V/PI double staining showed no statistically significant difference in early apoptosis rates between the observation group and the control group (P> .05). The Western blot assay showed that there was no significant change in the expression of ERK1/2, PLC, and other proteins after Apatinib treatment at different doses (0 mu M, 10 mu M, 20 mu M, 40 mu M, 80 mu M) compared with a control group (P > .05). Moreover, the expression levels of p-ERK1/2 and p-PLC proteins decreased remarkably (P<.05). Conclusion: Apatinib can block the growth cycle of gastric cancer MGC803 cells to inhibit cell proliferation. This may be achieved by inhibiting the phosphorylation of the VEGFR2-PLC-ERK1/2 signal pathway, leading to the obstruction of DNA synthesis in MGC803 cells. This result is not related to apoptosis.

目的 增加对以肠道溃疡性病变为主要表现的疾病的认识,提高其诊断率.方法 收集2017年～2019年在我院诊治的病例239例,对其病因、临床特点、内镜表现进行回顾性分析.结果 以肠道溃疡性病变为主要表现的疾病病因分两大类,肿瘤性溃疡76例,约占31.8％,其中局限溃疡型大肠癌72例(30.1％)、胃肠粘膜相关性淋巴瘤4例(1.7％).非肿瘤性溃疡150例,占62.8％,其中感染性疾病47例(19.7％)、非感染性疾病103例(43.1％).感染性疾病中,急性感染者23例(9.6％),慢性感染者24例(10.1％).非感染性疾病中,以溃疡性结肠炎最为常见,共62例(25.9％),其次为克罗恩病17例(7.1％)、缺血性肠病15例(6.3％).另有13例肠道溃疡原因不明,约占5.4％.结论 以肠道溃疡性病变为主要表现的疾病病因复杂,部分疾病的临床表现及内镜特征不典型,应重视其诊断与鉴别诊断.

目的:探讨深圳市幽门螺杆菌感染患者细胞色素P450 2C19 (CYP2C19)基因多态性的分布频率,提高该地区幽门螺杆菌的清除率.方法:采用多重PCR及可视化基因芯片技术对244例初诊于北京大学深圳医院的幽门螺杆菌感染患者的胃黏膜组织进行检测,测定内容为组织标本中人细胞色素P450与质子泵抑制剂代谢相关的等位基因2C19*2、2C19*3突变位点,检测结果根据药物代谢活性分为强代谢型、中代谢型和弱代谢型.结果:本研究共检测到CYP2C19强代谢型患者占39.7％(97例),中代谢型患者占57.7％(141例),弱代谢型患者占1.6％(4例),未检出的患者占0.8％(2例).通过x2检验发现,不同年龄及性别的患者其CYP2C19的代谢型差异无统计学意义(P＞0.05).结论:北京大学深圳医院就诊的幽门螺杆菌感染患者中CYP2C19的代谢型以强代谢型和中代谢型为主,在行幽门螺杆菌根除治疗的过程中要注意个体差异及精准化治疗.

[目的]了解本院检测的质子泵抑制剂(PPI)代谢相关的CYPC219基因多态性、幽门螺杆菌(Hp)对克拉霉素和左氧氟沙星的耐药情况及相关耐药基因突变特征,检验可视化基因检测芯片的临床应用价值,为临床Hp个体化治疗提供理论依据.[方法]收集2016～2017年北京大学深圳医院感染Hp患者的胃黏膜标本244例,提取胃黏膜DNA,通过Hp感染个体化治疗检测试剂盒(基因芯片法)对个体CYP2 C19代谢类型、克拉霉素及左氧氟沙星耐药基因片段进行检测.[结果]244例样本中有181例对2种抗生素均敏感(74.18％),63例对至少1种抗生素耐药,耐药率25.82％(63/244).耐药患者中有50例对克拉霉素耐药,耐药率20.49％(50/244),7例对左氧氟沙星耐药,耐药率2.86％(7/244),6例对克拉霉素和左氧氟沙星双重耐药,耐药率2.45％(6/244).244例样本中242例检出个体CYP2 C19基因代谢类型(99.18％),97例野生型(39.75％),141例杂合子型(57.78％),4例突变型(1.63％),另有2例未检出(0.8％).[结论]与传统检测手段相比,可视化基因芯片技术能够同时提供准确的CYP2 C19代谢类型和克拉霉素、左氧氟沙星耐药情况,指导临床针对性地选择药物进行Hp个体化用药,不仅能够提高Hp根除的成功率,同时减少抗生素滥用带来的不良反应和资源浪费,在临床中具有很好的应用前景.

目的:利用基因芯片检测技术检测幽门螺旋杆菌(Hp)对抗菌药物的耐药性,分析深圳地区Hp耐药状况,为该地区临床根除Hp合理选择抗菌药物提供依据.方法:采用基因芯片检测技术对2015年2月至2017年2月北京大学深圳医院收治的244例合并Hp感染患者的胃黏膜组织进行克拉霉素、左氧氟沙星的耐药性检测,观察不同性别、不同年龄段患者对克拉霉素、左氧氟沙星的耐药情况.结果:共纳入感染Hp的患者244例(男性141例,女性103例),对克拉霉素耐药者有56例,耐药率为22.9％,对左氧氟沙星耐药者有13人,耐药率为5.3％,对克拉霉素、左氧氟沙星双重耐药者有5人,耐药率为2.0％,男女性患者对克拉霉素耐药率比较,差异无统计学意义(P＞0.05).按年龄段分组的耐药率显示,30岁以上年龄组的抗茵药物耐药率逐渐增加(17.6％、24.3％、39.1％),60岁以后年龄组的耐药率则呈下降趋势(13.5％、2.7％).结论:深圳地区对克拉霉素的耐药性较高,与国内平均水平相近,对左氧氟沙星的耐药性较低,明显低于国内平均水平,本研究为该地区合理选用抗菌药物根除Hp提供了理论依据.

Objective To analyze the mental psychological characteristics of the patients with functional constipation.According to its characteristic and to give corresponding nursing intervention and improve the life quality and prognosis.Methods ZUNG's anxiety,depression self rating scale (SAS,SDS) were used to investigate sixty cases of FC patients and 30 matched healthy patients with the same age,sex and body mass index,the mental scores were compared.All the patients received psychological care and health education intervention for one month,The clinical symptoms score and SDS,SAS score were observed.Results SAS,SDS standard scores of the patients with FC were higher than those in the control group significantly ; Through the nursing intervention a month,SAS,SDS standard scores of the patients were lowered significantly,the clinical symptoms had been improved,the total effective rate was 56.7％.Conclusions Patients with FC have the abnormal state of mental obviously,nursing intervention can improve the state of anxiety and depression in patients with FC,improve the clinical symptoms of patient,achieve the purpose of curing.

Objective: To explore the efficacy of Lactulose and Probiotics in preventing hepatic encephalopathy(HE) after upper gastrointestinal bleeding.Methods: 68 cases of cirrhosis complicated with upper gastrointestinal bleeding were randomly divided into therapy group(34 cases) and control group(34 cases).Patients in the control group received routine comprehensive therapy while those in the therapy group received combined Lactulose and Probiotics.The efficacy after 2 weeks was observed.Results: The incidence of hepatic encepha1opathy was 17.7% in the therapy group and 55.9% in the control group,there was significant difference between two groups(P0.05).The blood ammonia in the therapy group decreased obviously;number connection test(NCT) was shorter and number digit symbol test(DST) increased compared with the control group(P0.01).Hepatic function all improved significantly in two groups after treatment,but there was no statistical significance(P0.05).Conclusion: Lactulose and Probiotics can prevent hepatic encephalopathy effectively after upper gastrointestinal bleeding caused by cirrhosis.

目的:总结缺血性结肠炎的临床特点和转归.方法:对64例缺血性结肠炎患者的临床特点、实验室及内镜检查、病理资料进行回顾性分析.结果:本病多发生于50岁以上中老年人(48/64,75.0 %),女性多见(男:女约为1:2);伴有相关基础疾病者53例(82.8%),包括心脑血管疾病、糖尿病,血液病、风湿免疫病或腹腔手术史;主要表现为腹痛(61/64,95.3%)及便血(55/64,85.9%);早期内镜表现主要为结肠黏膜高度水肿、充血、出血、糜烂及溃疡;病变大多为一过型,如能早期诊断与治疗,多数转归良好.结论:中老年患者出现急性腹痛和便血应警惕缺血性结肠炎,结肠镜检查是早期诊断缺血性结肠炎的主要方法.

Objective To investigate the signal changes and metabolic alterations in the brain by using MRI and proton magnetic resonance spectroscopy(1H-MRS) in patients with minimal hepatic encephalopathy (MHE). Methods 22 patients with MHE were diagnosed by neuropsychological tests. MRI plain scan and 1H-MRS were performed for the patients and 13 age and education matched healthy controls. Localized magnetic resonance spectra were acquired in the bilateral basal ganglia. Results Bilateral symmetrical hyper intensity in basal ganglia was detected in 17 of the patients. NAA/Cr levels had no significant difference between the patients and healthy controls (P0.05). The ratios of mI/Cr and Cho/Cr of the bilateral basal ganglia were significantly reduced in MHE patients(L:P0.01;R: P0.01). Conclusion Signal hyper intensities and the mI/Cr and Cho/Cr ratios measured in the basal ganglia correlated significantly with the MHE. MRI and 1H-MRS in basal ganglia play a significant role in the pathophysiology of MHE.

目的探讨轻微肝性脑病患者颅脑MRI及^1H-MRS的代谢变化。方法 22例经神经心理测试诊断为轻微肝性脑病患者和13例年龄、性别和受教育程度相匹配的健康志愿者,行MRI、^1H-MRS扫描,^1H-MRS兴趣区为双侧基底节。结果 22例患者中17例双侧基底节在T1WI上可见高信号,NAA/Cr值患者组与健康对照组之间差异无显著性（P〉0.05）,而mI/Cr和Cho/Cr值患者组与健康对照组比较显著降低（L：P〈0.01;R：P〈0.01）。结论 T1WI高信号是诊断轻微肝性脑病较为特征性征象,1HMRS能够无创性观察到轻微肝性脑病患者的脑代谢异常,有助于揭示肝性脑病的病理生理机制。