目的 通过观察难治性胃食管反流病(rGERD)患者治疗前后精神心理及睡眠情况的变化,探讨阿戈美拉汀联合富马酸伏诺拉生治疗rGERD的效果.方法 选择2021年3月至2021年10月于天津医科大学总医院就诊的54例rGERD患者,分为常规组(26例)和试验组(28例).常规组给予富马酸伏诺拉生治疗,试验组在给予与常规组相同治疗的基础上,联合阿戈美拉汀治疗,疗程均为8周.采用胃食管反流病问卷(GERDQ)、抑郁症筛查量表(PHQ-9)、广泛性焦虑量表(GAD-7)及睡眠障碍评定量表(SDRS)对2组治疗前后的消化道症状、精神心理状态及睡眠情况进行比较,并采用治疗前后各项评分的差值比较2组的疗效.结果 2组患者的性别构成、平均年龄、平均病程,以及治疗前GERDQ、PHQ-9、GAD-7、SDRS评分的差异均无统计学意义(P均>0.05).治疗8周后,常规组治疗后GERDQ评分较治疗前下降[(6.58±0.26)分比(10.00±0.32)分],差异有统计学意义(P<0.05).试验组的治疗后GERDQ、PHQ-9、GAD-7及SDRS评分均较治疗前显著下降[(6.64±0.19)分、(2.86±0.64)分、(1.64±0.54)分、(6.50±0.81)分比(10.93±0.41)分、(8.07±1.05)分、(5.57±0.93)分、(12.50±1.35)分],差异均有统计学意义(P均<0.05).试验组治疗前后的GERDQ、PHQ-9、GAD-7及SDRS评分差值均显著大于常规组[(4.27±0.33)分、(5.21±0.57)分 、(3.93±0.53)分、(6.70±3.72)分比(3.42±0.31)分、(1.62±0.30)分、(0.88±0.37)分、(1.46±0.47)分],差异均有统计学意义(P均<0.05).2组患者治疗后均未发生不良反应.结论 rGERD患者存在精神心理异常和睡眠障碍,阿戈美拉汀联合富马酸伏诺拉生治疗能显著改善rGERD患者的消化道症状,并能缓解睡眠障碍及抑郁、焦虑状态,联合用药的疗效优于单用富马酸伏诺拉生.

Objective: To investigate the prognostic value of albumin-to-bilirubin scores in the assessment of autoimmune hepatitis-related cirrhosis. Methods: The receiver operating characteristic curve was used to evaluate the accuracy of ALBI, Child-Pugh and model for end-stage liver disease (MELD) for prognosis prediction. Survival analysis was performed according to the ALBI classification. Spearman correlation analysis was performed on the ALBI score and the Child-Pugh score. Survival curves were plotted by Kaplan-Meier method, and Log-rank method was used to compare the survival difference curves between different groups. Results: 149 patients were recruited in the study. The ROC analysis showed that the ALBI scores (0.861, 0.826, 0.779, 0.744)was superior to Child-Pugh scores(0.703, P = 0.006; 0.672, P < 0.001; 0.613, P < 0.001; 0.583, P < 0.001)and MELD score(0.774, P = 0.031; 0.731, P = 0.007; 0.669, P < 0.001; 0.631, P < 0.001) for predicting 6, 12, 24, and 36 months mortality. Patients with ALBI grade 3 had a significantly lower survival rate than those with ALBI grade1 and grade 2. Conclusion: ALBI score may be useful to evaluate the long-term prognosis of patients with autoimmune hepatitis-related cirrhosis.

目的 评价沙利度胺及其类似物在炎症性肠病(IBD)治疗中的有效性以及安全性.方法 检索PubMed、Cochrane Center Register of Controlled Trails、Embase、Web of Science、中国期刊全文数据库、万方数据库、维普数据库,系统性评价沙利度胺及其类似物治疗IBD的有效性及安全性,就诱导缓解率、维持缓解率、不良反应事件进行总结分析.结果 共纳入16篇文献(3篇RCT,13篇病例系列研究),333例IBD患者.2篇RCT显示在克罗恩病(Crohn's disease,CD)和溃疡性结肠炎(ulcerative colitis,UC)患者中,沙利度胺均能够显著提高诱导缓解率(46.4％vs 11.5％,P=0.010;83.3％vs 18.8％,P=0.005).病例系列研究显示沙利度胺能够诱导CD缓解,合并缓解率为50％(95％CI=36％～65％).沙利度胺不良反应中神经系统不良反应最为常见(207/316,65.5％),周围神经病变是患者停药的最常见原因.结论 沙利度胺治疗IBD疗效理想,在CD诱导缓解治疗中效果尤为显著.

幽门螺杆菌(Helicobacter pylori,H.pylori)自发现至今被认为能够导致多种疾病的发生,包括消化性溃疡、慢性胃炎、胃癌以及胃淋巴细胞相关性肿瘤.近年来传统三联疗法(质子泵抑制剂+两种抗生素)对于H.pylori根除率明显下降,这与细菌耐药性的增强有关.在传统三联疗法基础上添加益生菌能够有效的提高H.pylori根除率,同时降低不良反应的发生.其机制可能为益生菌能够修复H pylori引起的化学屏障、生物屏障、机械屏障以及免疫屏障的破坏,恢复消化系正常防御功能,从而辅助H.pylori根除.此文将就益生菌修复H.pylor相关消化系屏障功能破坏的具体机制进行综述.

Objective To evaluate the iodine nutritional status of university students in Tianjin and analyze influencing factors affecting urinary iodine levels.Methods Students of Tianjin Medical University,Tianjin Nankai University,Tianjin University of Finance and Economics and Tianjin University of Traditional Chinese Medicine were selected as survey subjects,and 50 - 100 morning urinary samples were collected from each university,respectively.Urinary iodine was measured by arsenic-cerium catalytic spectrophotometry.The students were surveyed with questionnaires,which included family information,age, sex, specialty, iodine nutrition knowledge,source of drinking water,smoking or not and dietary habits.Results A total of 269 urine samples were collected,and the median urinary iodine was 213.68 μg/L.Urinary iodine levels(263.86 μg/L) of medical students was significantly higher than that( 168.01 μg/L,x2 =12.144,P ＜ 0.01 ) of non-medical students.There was an increasing trend of the level of urinary iodine of students with iodine nutrition knowledge scores ＞ 5 points (223.70 μg/L) over that of ≤5 points( 185.56 μg/L),but the difference was not significantly different statistically (x2 =2.297,P ＞ 0.05).Different gender and water sources had no significant effect on urinary iodine level(x2 =0.002,0.687,respectively,all P ＞ 0.05).Smokers urinary iodine levels( 154.55 μg/L) decreased compared with non-smokers(215.38 μg/L),but the difference was not statistically significant (x2 =0.515,P＞ 0.05).Vegetarian urinary iodine levels were lower than that of non-vegetarians,but the difference was not statistically significant(x2 =0.594,P ＞ 0.05).Conclusions Iodine nutritional status of students in university of Tianjin are generally at an appropriate level,but professional knowledge,habits and other factors may affect the intake of iodine,so students should develop good dietary habits to ensure a normal iodine nutrition status.

Objective To observe the effects of short-term iodine deficiency and excess intake on apoptosis and apoptosis-related genes expression(Bcl-2,and Bax) in the thyroid follicular epithelium cells of rats of different sexes and at different times.Methods 90 Wistar rats were randomly divided into low iodine group,normal iodine group and high iodine group,each containing two equal male and female subgroups.By controlling iodine content in the food and drinking water,the total iodine intake of each group were 0.6 μg,6.15 μg,and 61.5 μg daily,respectively.After 7,14,and 28 days,the rats were sacrificed and thyroid glands were removed.The thyroids were fixed in paraformaldehyde and stained with HE and immunohistochemistry,and observed under light microscope for morphological changes and expression of the apoptosis-related proteins.MIAS-2000 image analysis system was used to measure the percentage of positive area of thyroid follicular epithelium cells expressing Bcl-2 and Bax proteins.Results Apoptosis was not detected in follicular epithelium cells in the thyroids of male and female rats at different times.In the low iodine group and normal iodine group,the expression of apoptosis-related gene proteins was negative.The expression in the high iodine group was higher than that in the normal iodine group at different levels,and it increased with time prolonging.That is,on the 14th day,Bax appeared positive expression;and on the 28th day,Bcl-2 and Bax expressions were positive and higher than that in the normal iodine group(P0.01).On the 7th and 14th days,Bax was expressed in both male and female rats with no significant differences,and on the 28th day,the expression of apoptosis-related genes in the male rats were higher than that in the female rats with a significant difference(P 0.01).Conclusion Short-term iodine deficiency and excess intake does not cause apoptosis of thyroid and does not change the expression of apoptosis-related genes significantly.But short-term iodine excess intake may result in increase the expression of pro-apoptosis and anti-apotosis genes with the extension of treatment period.Effects of sex difference on the expression of apoptosis-related genes are observed in thyroid cells to a certain extent.