目的 探讨多聚胞嘧啶结合蛋白(PCBP)3过表达对结直肠癌(CRC)细胞增殖和迁移的影响.方法 收集2022年5至6月在嘉兴市第一医院行CRC切除术患者的CRC组织及癌旁正常组织标本各10份,比较CRC组织与癌旁正常组织中PCBP3 mRNA及蛋白表达水平.取人CRC细胞系HCT116、HT29,使用含有PCBP3 CDS区序列的过表达质粒分别转染HCT116和HT29细胞(设为HCT116过表达组、HT29过表达组),未经转染的HCT116和HT29细胞分别设为HCT116对照组、HT29对照组,检测PCBP3过表达对CRC细胞增殖、侵袭能力以及E-钙黏蛋白(E-cadherin)、裂解的胱天蛋白酶3(Cleaved Caspase-3)蛋白表达水平的影响.结果 CRC组织中PCBP3 mRNA及蛋白表达水平均明显低于癌旁正常组织(均P＜0.05).与对照组比较,PCBP3过表达可明显减弱HCT116和HT29细胞增殖和侵袭能力(均P＜0.05),上调HCT116和HT29细胞E-cadherin、Cleaved Caspase-3蛋白表达水平(均P＜0.05).结论 PCBP3过表达能抑制CRC细胞增殖和侵袭,可能通过上调E-cadherin、Cleaved Caspase-3蛋白表达水平发挥作用.

目的:观察腰骶穴区铺灸治疗湿热内蕴型轻、中度活动期溃疡性结肠炎(UC)的临床疗效.方法:将纳入研究的70例患者按随机数字表法分为观察组与对照组,2组均予现代医学常规治疗,观察组加予腰骶穴区铺灸治疗,2组均连续治疗2个疗程.治疗前后评定症状积分,检测血清白细胞介素-23(IL-23)、白细胞介素-17(IL-17),统计治疗2个疗程后1个月内、3个月内的再发率,比较2组临床疗效,开展安全性评价.结果:治疗2个疗程后,2组主要症状积分、症状总积分均较治疗前减少(P＜0.05);观察组腹泻、腹胀积分及症状总积分均低于对照组(P＜0.05).2组血清IL-23、IL-17水平均较治疗前降低(P＜0.05);观察组血清IL-23、IL-17水平均低于对照组(P＜0.05).观察组临床疗效总有效率、再发率及不良反应发生率均与对照组相近,2组比较,差异均无统计学意义(P＞0.05).结论:腰骶穴区铺灸联合现代常规疗法治疗湿热内蕴型轻、中度活动期UC能提高临床疗效,与单纯实施常规治疗相比,能更为有效地改善临床症状,减轻肠道的炎症程度.

目的 探讨酪酸梭菌二联活菌散联合奥美拉唑四联治疗老年胃溃疡(SU)的效果及对相关指标变化的影响.方法 回顾分析106例老年SU患者临床资料,按患者入院时间分为两组.常规组(53例)以常规奥美拉唑四联疗法治疗,联合组(53例)在常规组用药基础上联合酪酸梭菌二联活菌散治疗,比较两组治疗差异及治疗后胃黏膜形态和肠道菌群变化.结果 治疗前两组血清胃动素(MTL)、胃泌素(GAS)、黏膜厚度、炎性细胞浸润程度和腺体密度评分差异无统计学意义(P>0.05);治疗后联合组MTL水平高于常规组,GAS水平和黏膜厚度、炎性细胞浸润程度和腺体密度评分低于常规组,差异有统计学意义(P<0.05).治疗后联合组肠球菌、双歧杆菌、乳酸杆菌数量多于常规组,且治疗总有效率高于常规组,差异有统计学意义(P<0.05);两组不良反应发生率比较差异无统计学意义(P>0.05).结论 在奥美拉唑四联治疗老年SU基础上以酪酸梭菌二联活菌散辅助治疗可以提高治疗效果,改善胃黏膜形态和胃肠功能,恢复肠道菌群平衡.

收集2012年1月至2018年1月嘉兴市第一医院收治的诊断为肝硬化门静脉高压症食管-胃底静脉曲张破裂出血、手术后恢复良好且2年内未再复发的136例患者资料，运用机器学习随机森林算法建立肝硬化门静脉高压症食管-胃底静脉曲张破裂出血治疗方式预测模型。结果显示白细胞计数、血肌酐、凝血酶时间、血小板计数、活化部分凝血活酶时间和年龄是治疗方式的影响因素，且机器学习建立的预测模型精确度高。该模型为患者治疗方式的选择提供了科学依据，并且对大数据人工智能融入临床工作有一定启示。

目的 观察重组慢病毒载体介导Nrf2表达下调对肝星状细胞生物学行为的影响,同时探讨其可能的作用机制.方法 利用重组DNA技术将特异性shRNA序列插入慢病毒表达载体pGLV3.GFP中,形成pGLV3.GFP.Nrf2.shRNA,将其转染至293T细胞中,随后进行病毒包装、滴度测定、转染率计算.采用实时荧光定量、Western blot测定转染肝星状细胞株(HSC-T6细胞)Nrt2 mRNA及蛋白的表达情况,利用Tunel染色法检测HSC-T6细胞的凋亡情况,同时对HSC-T6细胞中PI3K、Akt、p-Akt、p-Bad、Bcl-2、Bax蛋白水平进行测定.结果 构建的重组病毒载体LV3-H1-GFP-shRNA可有效感染293T细胞.激光共聚焦显示空白组细胞凋亡率低于A组和B组,与A组比较,B组的细胞凋亡率降低(P＜0.05).实时荧光定量PCR法结果显示空白组Nrf2 mRNA水平高于A组和B组(P＜0.05),与A组比较,B组mRNA水平升高(P＜0.05).Western blot法显示空白组Nrf2蛋白水平高于A组和B组(P＜0.05),与A组比较,B组蛋白水平升高(P＜0.05).与空白组相比,A组和B组PI3K、p-Akt、p-bad、Bcl-2的蛋白表达量增加(P＜0.05),Bax蛋白减少(P＜0.05),其中A组PI3K、p-Akt、p-Bad、Bcl-2的蛋白水平较B组增加(P＜0.05),Bax蛋白水平低于B组(P＜0.05).结论 Nrf2基因的shRNA慢病毒载体pGLV3.GFP.Nrf2.shRNA在体外可抑制肝星状细胞活化,其作用机制可能与通过抑制PI3K-Akt通路促肝星状细胞凋亡有关.

目的 探讨锌指蛋白545(ZNF545)对结直肠癌上皮间质转化(EMT)和迁移侵袭的影响.方法 免疫印迹试验检测ZNF545在结直肠癌细胞系中的表达,并构建过表达和敲低ZNF545的细胞株;采用Transwell小室实验检测细胞的迁移和侵袭能力,免疫印迹试验检测EMT相关分子标志物[E钙黏蛋白(E-cadherin)、磷酸化锌指转录因子(slug)]的表达;细胞免疫荧光检测ZNF545表达变化对结直肠癌细胞E-cadherin表达的影响.结果 内源性ZNF545蛋白在SW480细胞中表达最高,在Lovo、Caco2细胞中的表达次之,在HCT116细胞中表达最低.过表达ZNF545可抑制HCT116细胞的迁移和侵袭能力(均P<0.01),抑制slug的表达(P<0.01),增加E-cadherin的表达(P<0.01);而敲低ZNF545的表达后,SW480细胞的迁移和侵袭能力明显增强(均P<0.01),可增加slug的表达(P<0.01),抑制E-cadherin的表达(P<0.01).在荧光显微镜下,过表达ZNF545可增加E-caherin表达;敲低ZNF545表达后抑制E-caherin表达.结论 ZNF545通过参与结直肠癌EMT过程调控结直肠癌细胞迁移和侵袭能力.

目的 研究美沙拉嗪联合益生菌对老年中度活动期溃疡性结肠炎患者因子的影响.方法 选取100例老年中度活动期溃疡性结肠炎患者,按照随机分组的方式,分为对照组和研究组各50例.对照组予口服美沙拉嗪1.0 g/次,4次/d;研究组予口服美沙拉嗪联合益生菌(双歧三联活菌420 mg/次,3次/d).两组均治疗8 w,观察比较两组治疗后总有效率及血清超氧化物歧化酶(SOD)、丙二醛(MDA)、肿瘤坏死因子(TNF)-α的水平.结果 研究组治疗后总有效率明显大于对照组,差异有统计学意义(P<0.05);研究组血清MDA、TNF-α水平明显较对照组降低,差异有统计学意义(P<0.05).研究组血清SOD水平明显高于对照组,差异有统计学意义(P<0.05).结论 益生菌联合美沙拉嗪治疗老年中度活动期溃疡性结肠炎,可调节患者相关细胞因子的水平,其效果优于单用美沙拉嗪.

目的 探索泛素结合酶UBE2T在结直肠癌的表达及其生物学作用.方法 运用免疫组化法检测78对结直肠癌和对应癌旁正常组织中UBE2T的蛋白表达水平.脂质体转染法将UBE2T-siRNA及对照NC-siRNA转染结直肠癌细胞SW480后,采用细胞计数试剂盒(CCK-8)及平板克隆实验分析增殖情况;流式细胞仪检测细胞周期情况;Western blotting检测细胞中UBE2T、cyclin D1、cyclin E等蛋白表达情况.结果 与正常结直肠组织相比,结直肠癌组织中UBE2T表达水平增高(P＜0.001).癌组织中UBE2T异常高表达与不良病理指标相关:肿瘤大小(P=0.014)、组织分化程度(P=0.00S)、浸润深度(P=0.033)和TNM分期(P =0.014).CCK-8增殖实验和平板克隆形成实验都提示沉默UBE2T表达能显著抑制结直肠癌细胞的增殖.沉默UBE2T抑制周期蛋白cyclin D1和cyclin E的表达,促进结直肠癌细胞发生G1/S期细胞周期阻滞.结论 UBE2T在结直肠癌组织中异常高表达,并与不良病理指标相关.沉默UBE2T通过促进G1/S期细胞周期阻滞抑制结直肠癌细胞的增殖.

目的 探讨结直肠癌HOXA11基因启动子异常甲基化及其与临床病理特征之间的关系.方法 从89对结直肠癌组织和配对的正常肠黏膜组织中分别提取基因组DNA,采用甲基化特异PCR(MSP)检测HOXA11基因启动子区甲基化状态,比较结直肠癌及正常肠黏膜组织中HOXA11甲基化的发生率,并统计分析结直肠癌组织中甲基化水平与患者临床病理特征的关系.在体外实验中,采用甲基化转移酶抑制剂5-Aza-dC处理细胞,实时荧光定量PCR检测HOXA11 mRNA表达水平的变化.结果 结直肠癌组织中HOXA11基因启动子甲基化阳性率显著高于配对的正常肠黏膜组织(P<0.01).HOXA11基因启动子异常甲基化与直肠癌淋巴结转移(P<0.01)及TNM分期(P<0.01)密切相关.结直肠癌细胞经5-Aza-dC处理后HOXA11 mRNA表达水平显著增高(P<0.05).结论 在结直肠癌组织中,HOXA11基因启动子区异常甲基化抑制HOXA11基因的转录表达.HOXA11启动子区异常甲基化与结直肠癌患者的淋巴结转移及TNM分期密切相关.

目的 探讨锌指蛋白545(ZNF545)在结直肠癌组织中的表达及临床意义.方法 采用qRT-PCR法检测32对结直肠癌组织及癌旁正常组织中(来自本院行结直肠癌根治术的32例患者)ZNF545 mRNA相对表达量;进一步采用免疫组化法检测136对结直癌组织及配对癌旁正常组织(来自组织芯片)中ZNF545蛋白表达,并分析这一表达与患者临床特征及生存预后的关系.结果 结直肠癌组织中ZNF545 mRNA相对表达量明显低于配对癌旁正常组织,差异有统计学意义(P＜0.05).结直肠癌组织中ZNF545蛋白低表达(免疫组化评分≤3分)率为65.4％,明显高于配对癌旁正常组织的25.7％(P＜0.05);ZNF545蛋白低表达与患者肿瘤直径、浸润深度、TNM分期相关(均P＜0.05),与患者性别、年龄、肿瘤位置、分化程度、淋巴结转移无关(均P＞0.05).Kaplan-Meier生存分析结果显示,与ZNF545蛋白高表达的结直肠癌患者比较,ZNF545蛋白低表达患者的5年生存率明显降低,差异有统计学意义(P＜0.05).结论 ZNF545在结直肠癌组织中呈低表达,与患者肿瘤直径、浸润深度、TNM分期及生存预后有关.

AIM To evaluate the effect of endoscopic intervention combined with somatostatin on clinical symptoms and biochemical indexes in patients with severe acute pancreatitis (SAP).METHODS One hundred and forty-eight patients with SAP treated from January 2015 to June 2016 at the Jiaxing First Hospital were divided into either an observation group or a control group.Both groups were given conventional therapy.The control group was given somatostatin infusion therapy,and the observation group was given endoscopic intervention combined with somatostatin artery perfusion therapy.Clinical symptoms,serum inflammatory factors,gastrointestinal hormones,and complications were compared between the two groups.RESULTS Times to remission of abdominal pain,high fever,and signs of peritoneal irritation were significantly shorter in the observation group than in the control group (t =10.720,8.226,11.840,and 9.143,respectively;P ＜ 0.05 or 0.01).Serum levels of interleukin-8,hypersensitive C-reactive protein,and tumor necrosis factor α were significantly lower in the observation group than in the control group (t =17.509,20.189,and 14.847,respectively;P ＜ 0.01).Serum levels of vasoactive intestinal peptide and gastrin were significantly lower and that of motilin was significantly higher in the observation group than in the control group (t =14.586,11.374,and 7.126,respectively;P ＜ 0.05 or 0.01).The incidence of pancreatic or surrounding tissue necrosis,pancreatic fistula,pancreatic abscess,and pancreatic pseudocyst was significantly lower in the observation group than in the control group (x2 =7.306,7.955,8.976,and 5.049,respectively;P ＜ 0.05 or 0.01).CONCLUSION Endoscopic intervention combined with somatostatin can help relieve the inflammatory response,modulate gastrointestinal function,improve the clinical symptoms,and reduce complications in patients with SAP.

Objective To observe the effect of glutamine on superoxide dismutase(SOD)and malonaldehyde(MDA)in neonates with upper digestive tract hemorrhage and to explore its safety.Methods A total of 100 neonates with upper gastrointestinal tract hemorrhage treated in the First Hospital of Jiaxing and Jiaxing Maternity and Child Health Care Hospital during 2016 to 2017 were selected and divided into experimental group and control group by random number table method with 50 cases in each group.The neonates in the control group were given intravenous drip of omeprazole with 0.8mg/kg,twice a day,while besides the therapy for the control group,the neonates in the experimental group were given oral administration of glutamine granules with 100mg/kg,3 times a day,and one course was 3 days.The SOD activity,MDA,clinical efficacy and incidence of adverse reactions in neonates in two groups were observed and recorded,and its security was discussed and analyzed.Results After treatment,the SOD activity in the experimental group(44.64 ± 5.83IU/mL)was significantly higher than that in the control group(34.26 ± 5.41IU/mL),and the difference was statistically significant(t=9.23,P<0.01).After treatment,MDA of neonates in the experimental group(31.22 ± 6.74μmol/L)was significantly lower than that of neonates in the control group(43.47 ± 6.81μmol/L),and the difference was statistically significant(t=9.04,P<0.01).The stop time of coffee-ground vomiting or fresh blood bleeding in the experimental group(14.58 ± 4.42h)was significantly shorter than that in the control group(25.41 ± 4.76h)with significant difference(t=11.79,P<0.01).The time of occult blood test results turning to negative in the experimental group(30.93 ± 10.42h)was significantly shorter than that in the control group(57.78 ± 10.21h),and the difference was statistically significant(t=13.01,P<0.01).The effective rate of the experimental group was 98.00%,which was significantly higher than that of the control group (76.00%)(χ2=35.10,P<0.01).In the experimental group,there was 1 case of vomiting,1 case of constipation and 1 case of diarrhea,while in the control group,there were 2 cases of vomiting,1 case of constipation,1 case of rash.There was no significant difference in the incidence of adverse reactions between two groups(P>0.05).Conclusion Glutamine is of significant effect in inhibiting oxidative stress reaction and protecting gastric mucosa in children with upper digestive tract bleeding.It has obvious efficacy and high safety,and is worthy of wide clinical application.

目的 分析幽门螺杆菌感染与胃部疾病的相关性.方法 将2014年1月～2015年12月在本院进行治疗的1200例胃部疾病作为研究对象,应用Hp培养及药敏试验对研究对象的幽门螺杆菌感染阳性率进行检测,并根据检测结果分析幽门螺杆菌感染与胃部疾病的相关性.结果 不同胃部疾病类型中以胃癌的阳性率最高、慢性浅表性胃炎的阳性率最低,慢性萎缩性胃炎、胃食管反流、胃溃疡及十二指肠溃疡、胃溃疡非典型性增生的阳性率差异无统计学意义;幽门螺杆菌感染阳性率在慢性胃炎中会随着病情程度的加重而增加,但不同病情程度的阳性率差异无统计学意义;51～60岁年龄段胃部疾病患者的幽门螺杆菌感染阳性率最高,21～30岁年龄段胃部疾病患者的幽门螺杆菌感染阳性率最低.结论 幽门螺杆菌感染是引起胃部疾病的危险因素,临床确认胃部疾病是由幽门螺杆菌感染引起后给予抗幽门螺杆菌感染治疗,可有效提高临床疗效.

[目的]探讨Notch1及COX2在胃癌组织中的表达及意义.[方法]收集我院胃癌及癌旁正常胃组织标本115例,采用免疫组化EnVision法测定Notch1和COX2在胃癌和癌旁正常胃组织中的表达,分析其表达水平与胃癌各临床病理指标之间的关系.[结果] Notch1在胃癌和癌旁正常胃组织中的表达分别为73.91％(85/115)和3.48％(4/115),COX2在胃癌和癌旁正常胃组织中的表达分别为89.57％(103/115)和6.96％(8/115),两者差异有统计学意义(P＜0.01).Notch1和COX2在胃癌组织中的表达与胃癌的淋巴结转移及TNM分期有关(P＜0.05).[结论]Notch1-COX2信号轴可能参与了胃癌的发生、发展和转移.

目的:在幽门螺杆菌(Helicobacter pylori,H.pylori)感染的患者中,根据药物敏感试验选择治疗方案与常规一线治疗方案进行临床疗效优劣的随访.方法:在浙江省嘉兴市第一医院内镜室行胃镜检查的患者中,胃镜检查时取材标本2块,分别送检常规组织病理学检查及组织切片染色检测及H.pylori的分离、培养、鉴定:其中H.pylori培养结果阳性的纳入治疗组,仅组织切片染色检测H.pylori阳性纳入对照组,治疗组根据药敏试验结果治疗10d,对照组根据标准一线治疗方案治疗10d.治疗结束4 wk后的患者进行复查,任选一种复查方式(H.pylori培养或组织切片染色或14C呼气试验),三项之一阴性者可判断H.pylori根除.结果:H.pylori培养结果阳性的纳入治疗组(n=4680),仅组织切片染色检测H.pylori阳性纳入对照组(n=3505).治疗组根据药敏试验结果选用2种敏感度最高值抗生素参与的四联疗法治疗,对照组选用常规四联疗法,治疗结束4 wk后复查评估根除率.最终,治疗组的根除率为91.18％,比对照组根除率73.07％高,且差异有统计学意义(P＜0.05).结论:依据H.pylori的药物敏感试验选择的治疗方案明显优于标准一线治疗方案.

Background:Resistance of Helicobacter pylori(Hp)to antibiotics is the primary reason for failure of Hp eradication therapies. It has been reported that there are regional differences in the resistance rate of Hp to commonly used antibiotics. Monitoring the regional Hp resistance status is helpful for improving the eradication rate in local area. Aims:To investigate the resistant spectrum of clinical Hp strains to commonly used antibiotics in Jiaxing Area,Zhejiang Province. Methods:A total of 17 402 patients who underwent gastroscopy from Jan. 2009 to Dec. 2013 at Jiaxing First Hospital were recruited for Hp culturing by using gastric antral biopsies. Then a drug sensitive test was performed for the Hp strains obtained from the culturing. Sensitivity of these Hp strains to metronidazole,amoxicillin,gentamicin,furazolidone,clarithromycin and levofloxacin was determined. Results:Among the 17 402 cases of gastric antral biopsies,5 898(33. 9% )were positive for Hp culturing. Drug sensitive test revealed that the resistance rate of metronidazole was extremely high in all year and age groups;the resistance rates of clarithromycin and levofloxacin were increasing by years;and the resistance rates of furazolidone,amoxicillin and gentamicin were considerably low in all year and age groups. When two antibiotics were combined,amoxicillin and gentamicin accounted for the lowest resistance rate,and the next were amoxicillin and furazolidone,and gentamicin and furazolidone,respectively. Conclusions:The clinical Hp strains isolated from all age groups in Jiaxing Area,Zhejiang Province are highly resistant to metronidazole,therefore it is not recommended to be used in first line eradication regimen. Amoxicillin combined with gentamicin/ furazolidone is an ideal antibiotic combination for patients with Hp infection in all age groups;and combination of gentamicin and furazolidone is recommended to patients who are allergic to penicillin.

目的 探讨雷贝拉唑、呋喃唑酮及阿莫西林三联疗法对萎缩性胃炎伴幽门螺旋杆菌感染患者血清超氧化物歧化酶(SOD)、丙二醛(MDA)、谷胱甘肽过氧化物酶(GSH-Px)水平的影响.方法 选取2013年10月～2015年9月入住嘉兴市第一医院消化科的萎缩性胃炎伴幽门螺旋杆菌感染患者120例,随机分为实验组和对照组,各60例.对照组患者使用奥美拉唑进行治疗,实验组患者使用雷贝拉唑、呋喃唑酮及阿莫西林三联疗法进行治疗.比较治疗前后2组患者血清SOD、MDA、GSH-Px水平,比较治疗结束后2组临床总有效率、Hp转阴率.结果 治疗结束后,与对照组相比,实验组血清SOD、GSH-Px水平较高,MDA水平较低(P＜0.05).实验组临床总有效率显著高于对照组[57(95.00)vs.50(83.33),x2 =4.23,P＜0.05].实验组患者的Hp转阴率显著高于对照组[56(93.33％)vs.48(80.00％),x2 =4.62,P＜0.05].结论 雷贝拉唑、呋喃唑酮及阿莫西林三联疗法能够提高萎缩性胃炎伴幽门螺旋杆菌感染的临床总有效率及Hp根除率,推测其机制可能与升高SOD、GSH-Px水平,降低MDA水平有关.