目的 分析肝硬化患者门脉性肺动脉高压(PoPH)的发生率、临床特征及危险因素.方法 收集2021年3月至2022年3月于中国医科大学附属第一医院住院的115例肝硬化门静脉高压患者的一般临床资料、实验室化验及检查结果,根据超声心动图结果是否合并肺动脉高压为标准分为PoPH组和非PoPH组.分析两组患者的一般临床特征及多因素logistic回归分析肝硬化发生PoPH的独立危险因素.结果 (1)肝硬化患者PoPH的发生率为8.7％(10/115).(2)PoPH组10例,平均年龄(54.5±14.3)岁,平均肺动脉压力(44.0±4.3)mmHg.非PoPH组105例,平均年龄(56.9±10.7)岁.PoPH组患者血红蛋白(Hb)、血清白蛋白(ALB)显著低于非PoPH组(P＜0.05);PoPH组平均红细胞容积(MCV)、平均红细胞血红蛋白含量(MCH)、Child-Pugh评分及终末期肝病模型(MELD)评分显著高于非PoPH组(P＜0.05).(3)多因素logistic回归分析结果显示:低Hb(OR 0.95,95％CI0.90～1.00,P=0.034)是肝硬化门脉高压患者发生肺动脉高压的独立危险因素.结论 本研究肝硬化门脉高压患者中PoPH的发生率为8.7％,Hb和ALB降低以及MCV和MCH升高与肝硬化PoPH的发展密切相关,低Hb是肝硬化门脉高压患者发生肺动脉高压的独立危险因素.

摘 要 目的：研究代谢综合征(MS)及相关组分与结直肠腺瘤(CRA)的关系。方法：选取2019年9月-2021年3月就诊于锦州医科大学附属第一医院消化科行肠镜检查的患者486例，根据病理检查结果是否为CRA分为观察组(286例)和对照组(200例)。分析两组患者一般临床资料及实验室指标情况，包括体重指数(BMI)、腰围、臀围、收缩压(SBP)、舒张压(DBP)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、空腹血糖(FPG)、尿酸(UA)，同时观察CRA的病理类型和肠镜下表现(腺瘤大小、数量、部位)。结果：观察组MS、中心型肥胖、高血压、糖尿病、血脂异常检出率均明显高于对照组，差异有统计学意义(P＜0.05)。观察组BMI、腰围、SBP、TG、UA高于对照组，HDL-C低于对照组，差异有统计学意义(P＜0.05)。MS和CRA的病理类型与腺瘤的大小均呈正相关关系(P＜0.05)。TG、BMI、SBP、UA、腰围是CRA发生的危险因素(P＜0.05)。结论：患有MS以及代谢性相关疾病的人群是CRA发生的高危人群，应加强对此类人群的肠镜检查，早期发现CRA并进行治疗。

目的 观察贝伐珠单抗联合伊立替康与雷替曲塞方案在氟尿嘧啶类药物耐药后的晚期结直肠癌患者中的疗效及安全性.方法 收集中国医科大学附属第一医院2014-2019年收治的氟尿嘧啶类耐药的60例晚期结直肠癌患者,对照组30例,应用伊立替康联合雷替曲塞方案(IR);实验组30例,应用IR联合贝伐珠单抗方案.分析比较两组患者的客观有效率(ORR)、疾病控制率(DCR)、无进展生存时间(PFS)及不良反应发生情况.结果 实验组和对照组ORR分别为6.67％和3.33％,DCR分别为66.67％和53.33％,两组ORR和DCR比较差异无统计学意义.实验组和对照组中位PFS分别为6.0个月和3.1个月,差异有统计学意义(P=0.0204).两组不良反应以Ⅰ/Ⅱ级多见,Ⅲ/Ⅳ级不良反应发生率低,实验组蛋白尿的发生率高于对照组,差异有统计学意义(P=0.001).其余如出血、转氨酶升高、恶心、呕吐、腹泻、发热、皮疹、高血压等不良反应发生率均为实验组高于对照组,但差异无统计学意义.结论 贝伐珠单抗联合伊立替康与雷替曲塞方案可提高既往氟尿嘧啶类治疗耐药后的晚期结直肠癌患者的疗效,无进展生存期增加,不良反应可耐受,值得进一步研究.

幽门螺杆菌（Hp）是一种定植于胃黏膜的革兰氏阴性杆菌，其感染与胃炎、胃溃疡、十二指肠溃疡、胃淋巴瘤和胃癌的发生、发展密切相关。我国 Hp 感染率达42％～84％，而传统标准三联疗法 Hp 根除率已经低于80％［1］，目前寻找提高 Hp 根除率的治疗方案很有必要。我们选择标准三联疗法分别联合布拉氏酵母菌和双歧杆菌四联活菌进行临床观察。

Objective To valuate the effect of Siliankang on a rat model with alcoholic liver disease.Methods Totally 32 male Wister rats were randomly divided into 4 groups (8 rats in each group) :normal group, alcoholic group, siliankan group, and heat-killed group.Serum endotoxin, occludin, and ZO-1 were tested by Western blotting.Results Compared to the alcohol group, endotoxin was decreased significantly in Siliankan group (P ＜0.05).Occludin and ZO-1 were increased significantly compared to alcohol group (P ＜ 0.05).The expressions endotoxin and tight junction had no significant difference between Siliankang and heat-killed Siliankang groups.Conclusions Siliankang and heat-killed Siliankang have a certain therapeutic effect on alcoholic liver injury without significant difference between both treatments.

Objective To study the expression and effect of TNFα in the acute alcohol induced intestine injury of rat. Methods Six- to-eight-week-old male Wistar rats were divided into four groups,ND group,alcohol group,TNFα group and anti-TNFα group. TNFα in serum was measured by ELISA, reverse transcription PCR and Western blot were used to determin the expression of tight junction protein(occludin) in intestine of rats. Results Compared with ND group, the content of TNFα in serum was obviously higher( 0.05), the expression level of occludin protein and m RNA in intestine was obviously lower( 0.05) in alcohol group. The exogeneous TNFα promotes the further increase of TNFα in serum and the decrease of the expression level of occludin in intestine. However, anti-TNFα antibody could downregulate the expression level of occludin in intestine. Conclusion The overexpression of TNFα in the acute alcohol induced intestine injury indicates that TNFα would be a treatment target for alcohol induced intestinal mucosal damage.

Objective To investigate the role of tumor necrosis factor alpha (TNFα) in a rat model of experimental acute alcoholic liver disease,and further elucidate the relationship among TNFα,forkhead box subtype O4 (FOXO4),nuclear factor κB (NF-κB),and zonula occludens-1 (ZO-1).Methods Sixty four Wister (WT) rats were divided into eight groups (8 in each group):normal group,alcohol group,alcohol + TNFα group,alcohol + wortmannin group,alcohol + insulin-like growth factor-1 (IGF-1) group,alcohol + anti-TNFo group,and two placebo groups (treated with saline).TNFα in plasma was measured by enzyme linked immunosorbent assay (ELISA).Western blot was used to identify the mechanisms of FOXO4 in regulating the epithelial permeability.Electron microscopy,reverse transcription polymerase chain reaction and western blot were used to examine the tightjunction proteins and NF-κB.Results Compared to control group,TNFα in alcohol group was obviously high.At the same time,TNFα could induce the phosphorylation of FOXO4.Phosphorylated FOXO4 was excluded into cytoplasm and was inactive.The inactive FOXO4 at a high level lose the ability to restrain NF-κB.Therefore,the expression of NF-κB was increased,then it down-regulated the expressions of tight junction proteins (including ZO-1 and occludin) and increased epithelial permeability.As a result,the intestinal bacteria were grown excessively,endotoxin was released into portal circulation and liver injury was deteriorated.Conclusions TNFα can up-regulate phosphorylation of FOXO4.Phosphorylated FOXO4 in the nucleus is excluded into cytoplasm and is inactive.The inactive FOXO4 lose the ability to restrain NF-κB activity,then down-regulate the expression of tight junction proteins and increase epithelial permeability.

Objective To observe the therapeutic effect of siliankang combining with mesalazine in treatment of patients with mild to moderate ulcerative colitis.Methods A total of 78 patients were randomly divided into control group and treatment group,39 cases in each group.Patients in treatment group were given mesalazine and siliankang,while patients in control group were only given the same doses of mesalazine.The periods of treatment were 6 weeks.The change of the clinical symptoms,disease activity index,score of endoscopic findings were evaluated before and after the treatment.Results After treatment,the clinical symptoms of patients in both groups improved noticeably,and mucopurulent bloody stool of the treatment group was superior to that of the control group (P＜0.05).Sutherland disease activity index and endoscopic mucosal manifestations showed significant decrease in both groups after treatment,more significantly in treatment group(P＜0.05).Conclusion Combination of siliankang and mesalazine is more effective and safer than using mesalazine alone in the treatment of mild to moderate ulcerative colitis.

目的：观察肝硬化患者血清胃蛋白酶原（ PG Ⅰ、PG Ⅱ）及胃泌素17（ G-17）水平变化，并探讨其临床意义。方法应用ELISA法检测52例肝硬化患者空腹血清PG Ⅰ、PG Ⅱ及G-17水平。结果肝硬化患者血清PGⅠ、PGⅡ及G-17水平在肝功能Child-Pugh C级高于A级（P均＜0．05）；血清PG I及G-17水平在肝功能Child-Pugh B级高于A级（P均＜0．05）。肝硬化患者中门静脉主干内径＞13 mm者血清PG Ⅰ、PG Ⅱ及G-17水平均高于≤13 mm者（P均＜0．05）。结论肝硬化患者血清PGⅠ、PGⅡ及G-17水平升高，并与肝功能分级及肝脏门静脉主干内径有关。

目的 评价胶囊内镜对小肠出血的诊断价值.方法 对126例不明原因消化道出血患者行OMOM胶囊内镜检查的结果进行分析.结果 126例均成功完成胶囊内镜检查,未发生任何并发症.病变检出率为73.02％ (92/126),病因包括小肠血管发育不良79例(85.87％),小肠溃疡7例(7.61％),小肠蛔虫症3例(3.26％),小肠肿瘤2例(2.17％),小肠毛细血管扩张1例(1.09％).结论 患者对胶囊内镜耐受性好.胶囊内镜对病变检出率较高,主要病因为血管发育不良,可见胶囊内镜对不明原因消化道出血具有较高的诊断价值.

<正>对以腹水首发的嗜酸性粒细胞增多症1例分析如下。1病历摘要男,25岁。患者3a前无明显诱因出现左上腹痛,就诊于当地医院诊断为胃溃疡,对症治疗后好转,此后未再发作。

Objective To explore the relationship between urine albumin creatine ratio(ACR) and serum thyrotropin(TSH).Methods In October 2007,a total of 1534 adult inhabitants in Dadong district of Shenyang were asked to fulfill the questionnaires and measure the blood pressure,height,weight and waist.The vein blood was drawn to measure thyrotropin(TSH),thyroid peroxidase antibody(TPOAb),Thyroglobulin antibody(TGAb),fasting plasma glucose(FPG),OGTT 30minPG,OGTT 2hPG,fasting insulin,triglyceride(TG),total cholestoral(TC),high density lipoprotein cholesterol(HDL-C) and low density lipoprotein cholesterol(LDL-C).Fasting urine samples were collected for measurement of creatinine and microalbumin,and the microalbumin/creatinine ratio(ACR) was calculated.Results The prevalence of microalbuminuria was 11.8% and was increasing with age(P0.01).Compared with subjects with normal microalbumin,the waist,BMI,systolic pressure,diastolic pressure,heart rate,FPG,OGTT 30minPG,OGTT 2hPG,serum TG,and homeostasis model assessment insulin resistance(HOMA-IR) were all significantly increased in subjects with microalbuminuria(P0.05).However serum TSH,the prevalence of subclinical hypothyroidism and hyperthyroidism was no statistical difference between the two groups(P0.05).Hyperglycemia and hypertension was independently associated with the prevalence of microalbuminuria(hypertension OR=1.868,P0.01;hyperglycemia OR=1.469,P0.05).Conclusion ACR was not related with serum TSH,while the hyperglycemia and hypertension was independently associated with the prevalence of microalbuminuria.

Objective To investigate the relationship between serum thyrotrophin(TSH)and dyslipidemia in subclinical hypothyroid and euthyroid subjects. Methods An epidemiological study on diabetes and thyroid diseases was performed in Dadong community, Shenyang city, in 2007. 110 subjects with subclinical hypothyroidism(SCH)and 1 240 euthyroid subjects were enrolled in the study. Neither history of thyroid diseases nor administration of thyroid-related and lipid-regulating medicines were reported in these subjects. The levels of serum thyroid hormones, lipids, fasting plasma glucose(FPG), and insulin were determined. Results (1)Patients with SCH had significantly lower HDL-C levels than those who were euthyroid.(2)According to the guideline of treatment of adult dyslipidemia in China, the lipid profiles were each categorized. Mean TSH levels were higher in subjects in the dyslipidemia subclass than subjects in the normal subclass. The differences were significant in high LDL-C subclass in overweight individuals. In euthyroid overweight women, mean TSH levels were significantly higher in high LDL-C subclass. In the euthyroid population, TSH was positively associated with total cholesterol in overweight population. The association was not modified by the homestasis model assessment for insulin resistance(HOMA-IR)values.(3)TSH was associated positively with serum triglycerides and negatively with serum HDL-C in women. TSH was positively associated with total cholesterol in overweight population and positively associated with total cholesterol and LDL-C in overweight women after adjustment for age, sex, and body mass index. Conclusion Raised serum TSH seems to be a risk factor of dyslipidemia in subclinical hypothyroid and euthyroid subjects, which is independent of insulin sensitivity.

Objective To verify the criteria proposed by National Academy of Clinical Biochemistry(NACB)guidelines in investigating the factors that affect serum TSH determination, and to determine the reference range of serum TSH in iodine-sufficient areas of China. Methods In 2007, 5 348 inhabitants were enrolled from 3 iodine-sufficient areas of Liaoning Province, and were asked to fulfill the questionnaire. Serum TSH, thyroid peroxidase antibody(TPOAb), and thyroglobulin antibody(TgAb)were determined, and thyroid ultrasonography was carried out. Results The distribution of TSH levels was skewed in healthy people and closely fit the curve of Gaussian distribution after logarithmic transformation. The levels of TSH in subjects of 12-19 years of age were significantly higher than those of other age groups(P＜0.01), and no significant difference was found among the latter groups. TSH level in females [(1.68±1.90)mIU/L] was higher than in males[(1.45±1.92)mIU/L, P＜0.01]. The reference range of TSH was 0.43-4.74 mIU/L in males, and 0.48-5.39 mIU/L in females. Family history of thyroid disease, abnormal thyroid ultrasonography, and positive thyroid antibodies were the factors that influenced TSH level. Conclusion The reference range of serum TSH in iodine-sufficient areas of China is established.

The aims of this study performed in 2007 were to verify the selection criteria proposed by the National Academy of Clinical Biochemistry (NACB) guidelines, to investigate factors that influence thyrotropin (TSH) levels, and to determine serum TSH reference range in iodine sufficient areas of China. After excluding 291 subjects, a total of 5,348 inhabitants from three iodine sufficient areas of Liaoning province were asked to fulfill the questionnaire, and take TSH, thyroid peroxidase antibody (TPOAb), and thyroglobulin antibody (TgAb) measurements and a thyroid ultrasound examination. The distribution of TSH was right skewed in normal people. It has been customary to log transform the values to observe the Gaussian distribution. In the subjects 12-19 years of age, the TSH level was significantly higher than in the other age groups (p<0.001), while there were no significant difference in the TSH values of the other age groups. The TSH levels in females(1.68±1.90mIU/L) were significantly higher than in males (1.45±1.92mIU/L) (p<0.001). Therefore, the normal TSH range in males over age 20 was 0.43-4.74mIU/L, and in females the range was 0.48-5.39 mIU/L. A family history of thyroid disease, abnormal thyroid ultrasound, a thyroid antibody-positive status were the factors that influenced the TSH reference range. Non-thyroid disease did not impact the TSH reference range significantly. We recommend use of a TSH reference range 0.46-5.19mIU/L in iodine sufficient areas of China for males and females over 20 years old. We suggest using a normal thyroid ultrasound as a new criterion in addition to the NACB guidelines to determine the TSH reference range.

This study investigated the relationship between serum thyrotrophin levels and dyslipidemia in subclinical hypothyroid and euthyroid subjects. A total of 110 subjects with subclinical hypothyroidism and 1,240 euthyroid subjects enrolled in this study. Patients with subclinical hypothyroidism had significantly lower high density lipoprotein cholesterol (HDL-C) levels than those who were euthyroid. The lipid profiles were each categorized and mean thyrotrophin levels were higher in subjects in the dyslipidemia subclasses than subjects in the normal subclasses. Thyrotrophin was positively associated with serum triglyceride and negatively associated with serum HDL-C in women. Thyrotrophin was also positively associated with total cholesterol (TC) in the overweight population along with TC and LDL-C in overweight women. In the euthyroid population, thyrotrophin was positively associated with TC in the overweight population. In conclusion, serum thyrotrophin was correlated with dyslipidemia in subclinical hypothyroid and euthyroid subjects; the correlation was independent of insulin sensitivity.

To explore the relationship between serum thyrotropin and components of metabolic syndrome in a Chinese cohort. A total of 1534 adult inhabitants in DaDong district of Shenyang were asked to fulfill the questionnaire, complete physical examination and OGTT. Blood samples were collected to test thyrotropin (TSH), fasting plasma glucose (FPG), OGTT 2h PG, fasting insulin (FINS), triglyceride (TG) and high density lipoprotein cholesterol (HDL-C). Serum TSH in metabolic syndrome group was higher than that in the non-metabolic syndrome group (2.54 mIU/L vs. 2.22 mIU/L, p<0.05). TG level increased significantly in subclinical hypothyroid group compared with euthyroid subjects (1.73±0.12 mmol/L vs. 1.47±0.03 mmol/L, p<0.05), and HDL-C decreased significantly in patients with subclinical hypothyroidism compared with euthyroid subjects (1.26±0.27 mmol/L vs. 1.33±0.27 mmol/L, p<0.05). The prevalence of hypertension was higher in the subclinical hypothyroid group than that in euthyroid group (42.86% vs. 33.2%, p<0.05). The serum TSH within the reference range was positively related with the prevalence of overweight/obesity. Slight increase in serum TSH maybe a risk factor for metabolic syndrome.

目的 探讨血清促甲状腺激素(TSH)与代谢综合征(MS)及其组分的关系.方法 2007年10月在沈阳市大东区分层抽样调查1534人,详细填写流行病学调查表格,测量血压、身高、体重及腰围,采集血样测定TSH、空腹血糖(FPG)、胰岛素浓度、甘油三酯(TG)和高密度脂蛋白胆固醇(HDL-C).结果 MS组血清TSH明显高于非MS组(2.54 mU/L对2.22 mU/L,P<0.05);亚临床甲减组TG明显高于甲状腺功能正常组[(1.73±0.12)mmol/L对(1.47±0.03)mmol/L,P<0.05],HDL-C明显低于甲状腺功能正常组[(1.26±0.27)mmol/L对(1.33±0.27)mmol/L,P<0.05];亚临床甲减组高血压患病率明显高于甲状腺功能正常组(42.86%对33.2%,P<0.05).正常范围内血清TSH与超重或肥胖的患病危险显著相关(P=0.001).结论 甲状腺功能轻度降低发生代谢综合征的危险性增加.

目的:研究代谢综合征(MS)及其组分患者的血清促甲状腺激素(TSH)水平,是否应该在MS人群中筛查TSH提供理论依据.方法:对1 399例受检者进行询问病史、体格检查并采集空腹血检测血糖(FPG)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)及TSH、游离的四碘甲腺原氨酸(FT4)、游离的三碘甲状腺氨酸(FT3)水平;比较MS组及其各组分与非MS组血清TSH水平.结果:MS患病率为18.9%,MS患者的血清TSH水平明显高于非MS者(P<0.01),MS组中超重或肥胖、高血压、高TG血清TSH水平高于相应指标的正常者(P<0.01).结论:MS及其组分患者的血清,TSH水平增高,临床应注意其血清TSH水平.