目的 探讨溃疡性结肠炎(UC)患者采用复方谷氨酰胺联合美沙拉秦治疗对炎症状况及凝血功能的影响.方法 选取 2021 年 1 月至 2022 年 6 月收治的UC患者共 82 例,根据随机摸球法分成观察组与对照组,每组 41例.对照组采用美沙拉秦治疗,观察组采用复方谷氨酰胺联合美沙拉秦治疗,比较 2 组临床疗效、炎性状况及凝血功能.结果 与对照组(82.93%)比较,观察组(97.56%)治疗总有效率明显更高(P＜0.05);2 组治疗后肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)水平明显降低(P＜0.05),与对照组比较,观察组明显更低(P＜0.05);2 组治疗前Fbg、D-D比较差异无统计学意义(P＞0.05),治疗后较治疗前明显降低(P＜0.05),与对照组比较,观察组明显更低(P＜0.05).治疗后,观察组胃肠症状改善时间[排便(2.62±0.23)周、腹痛(1.72±0.23)周、腹泻(2.41±0.23)周]更短,差异有统计学意义(P＜0.05).结论 UC患者采用复方谷氨酰胺联合美沙拉秦可疗效,降低炎症水平,改善患者凝血功能,加速患者症状改善,值得临床借鉴.

目的 探讨内镜下金属钛夹联合组织胶注射治疗对GOV1、GOV2、IGV1型胃静脉曲张的临床疗效.方法 回顾性分析 2017 年 1 月 1 日—2020年 12 月 31 日于西安交通大学第一附属医院住院治疗的 150 例GOV1、GOV2、IGV1型胃静脉曲张患者.依据治疗方案分为对照组(组织胶治疗,105 例)、观察组(钛夹联合组织胶治疗,45 例),对比分析两组的临床疗效、再出血率、并发症等.按 0、1、3、6 个月行随访序贯治疗,共计 10 个月.结果 观察组合并胃/脾肾分流率为22.2%,显著高于对照组0%(P＜0.001);观察组胃静脉曲张条数为3(3,3)条,显著高于对照组3(2,3)条(P= 0.028);观察组术中平均组织胶用量为(3.29±1.0)mL,显著低于对照组[(4.11±1.51)mL,P= 0.020];观察组术后再出血率为11.1%,显著低于对照组(27.6%,P= 0.027).两组内镜治疗次数、组织胶点数、有效率、静脉曲张根除/基本消失率、术后胸骨后疼痛及发热发生率等差异均无统计学意义(P＞0.05),两组均未发生菌血症、异位栓塞等严重并发症.结论 钛夹联合组织胶注射治疗可减少组织胶用量、降低术后再出血发生率,并可能阻断胃/脾肾分流者异位栓塞的发生,是GOV1、GOV2、IGV1 型胃静脉曲张的有效治疗方式.

Objective: To explore and evaluate infection control measures of preventing cross-contamination of novel coronavirus during gastrointestinal endoscopy treatment Methods: According to the hospital's infection control requirements and related documents, infection control measures were formulated and implemented by combining with our actual clinical situation, including the management of the endoscope room, management and protection of patients and endoscopists Then, we evaluated the effect of these measures Results: From January 25 to March 10, 2020, a total of 71 patients (53 males and 18 females) completed gastrointestinal endoscopy treatment, with an average age of 54 years (28-81 years) There were 36 (50 7%) cases of emergency treatment All patients had been kept in quarantine for about 14 days (24±13), and no cross-contamination of novel coronavirus occurred Conclusion: During the novel coronavirus infection epidemic period, reasonable and effective measures should be taken to minimize the risk of infection in doctors and patients The endoscope center should strengthen preoperative screening and management of patients, master indications of endoscopic procedures, complete endoscopists' management and protection work, strictly follow the specifications of sterilizing gastrointestinal endoscopes, and construct the layout of three zones and two passages

为了探索虚拟仿真内镜联合CBL教学在ERCP规范化培训中的应用及效果评价.选取2018年9月—2019年12月在我院肝胆病院ERCP培训基地进修的ERCP医师40人为研究对象,随机分为实验组和对照组,实验组采取CBL+虚拟内镜教学,对照组采用CBL教学.结果表明:实验组学员在提高学习兴趣、学习效率、并发症处理尤其是手术操作能力、团队协作方面等方面,优于对照组,差异有统计学意义(P<0.05);在影像学读片能力、术中应变能力、医患沟通能力方面差异无统计学意义.因此,虚拟仿真内镜联合CBL教学在ERCP规范化培训中有助于提升学员的临床思维及学习曲线,协助学员更快更好地掌握ERCP技术.

目的 探讨成人型环形胰腺的临床特征及误诊、漏诊情况.方法 纳入西安交通大学第一附属医院2014年8月至2019年12月收治的7例成人型环形胰腺患者,回顾性分析分析其临床特征及误诊、漏诊原因.结果 成人型环形胰腺以上腹痛(85.7％)、恶心呕吐(71.4％)等十二指肠梗阻表现为主,初步诊断5例(71.4％)均误诊、漏诊,但其中4例(57.1％)经X线钡餐造影、腹部CT、磁共振胆胰管成像等检查并由经验丰富的影像科教授阅片后均明确诊断,1例(14.3％)经外科手术诊断.结论 影像学检查对成人型环形胰腺具有重要诊断价值,其误诊、漏诊与影像科医师诊断经验不足密切相关.

Numerous studies have investigated the link between oral contraceptives and risk of ulcerative colitis (UC), but the results have been controversial. We systematically reviewed all relevant published studies and evaluated the association between the use of oral contraceptives and the development of UC by meta-analysis. Databases including PubMed, EMbase, CNKI and WanFang data were thoroughly searched from inception to September 2018 to collect the studies on the correlation between oral contraceptives and the risk of UC. The studies were screened according to the inclusion and exclusion criteria by two researchers independently, and the data were extracted and the quality was evaluated. Meta-analysis was performed using Stata 13.0 software. There were 12 studies involving 303,340 participants that reported on the association between oral contraceptives and UC. The pooled odds ratio (OR) of UC in oral contraceptive users was 1.25 [95% confidence interval (CI) 1.04-1.51, p = 0.02]. The risk was significant in the current oral contraceptive users (OR 1.49, 95% CI 1.12-1.96, p = 0.005) whereas the past oral contraceptive use was not significantly associated with UC (OR 1.17, 95% CI 0.95-1.43, p = 0.141). This study provides evidence of an association between the use of oral contraceptives and the onset risk of UC. The study also shows that the risk for patients who stop using the oral contraceptives was decreased. These findings may be used as important reference for the use of oral contraceptives and the management of UC patients.

目的 本文基于数据挖掘探索高迁移率族蛋白1(HMGB1)在胃癌中的表达及对预后的影响.方法 Oncomine数据库提取HMGB1在胃癌组织和正常组织中转录水平的变化数据,并对数据库中的基因表达信息进行二次分析;利用Kaplan-Meier Plotter分析HMGB1表达水平与胃癌预后的关系.结果 Oncomine数据库中共收集了443项不同类型的研究结果,其中关于HMGB1表达有统计学差异的研究结果有20项,HMGB1表达增高的研究有17项、表达降低的研究有3项,在胃癌中高表达的研究有1项,低表达的有0项.11项研究涉及HMGB1在胃癌组织和正常组织中的转录水平的表达,共包括318个样本,与正常组织相比,HMGB1在胃癌组织中高表达(P=0.002).不仅如此,Kaplan-Meier Plotter数据库分析结果显示,HMGB1的mRNA表达量与胃癌总体生存率存在相关性,即高表达HMGB1的患者总体生存率较好,低表达HMGB1的患者预后较差(P=1.8E-05).结论 HMGB1 mRNA在胃癌组织中高表达,而且与肠型胃癌预后相关,这为探索HMGB1在胃癌中的作用提供了基础,也为今后胃癌的临床治疗和预后研究提供重要理论依据.

Objective To explore the correlation between the oral contraceptives(OCs)and the risk of Crohn's disease(CD). Methods Databases including PubMed,EMBASE,CNKI and Wanfang data were searched from inception to November 10,2017 to collect the cohort studies and case-control studies on the correlation between oral contraceptives and the risk of Crohn's disease.The studies were screened according to the inclusion and exclusion criteria by two researchers independently,the data was extracted and the quality was evaluated. Meta-analysis was performed using Stata 13.0 software. Results A total of 17 literatures involving 308 747 participants were included.The results of meta-analysis showed that the pooled OR for the risk of CD for women taking the OCs was 1.42[95%CI(1.24,1.61),P<0.001],in the subgroup analysis,the OR for the risk of CD in women currently taking the OCs was 2.07[95%CI(1.27, 3.38),P=0.004],and 1.17[95% CI(1.07,1.74),P=0.027]for women used in the past. Conclusion This study provides evidence of an association between the use of oral contraceptives and the onset risk of CD.The study also showed that the risk for patients who stop using the OCs decreased. But the study did not find time-effect relationship or dose-effect relationship for lack of sufficient data.

目的:探讨埃索美拉唑与奥美拉唑治疗幽门螺杆菌(H pylori)相关性胃溃疡的临床效果.方法:将82例幽门螺杆菌相关性胃溃疡患者随机分为两组,每组41例.对照组患者前2周行奥美拉唑四联疗法,第3~6周使用枸橼酸铋钾胶囊联合奥美拉唑肠溶片治疗;观察组患者前2周行埃索美拉唑四联疗法,第3~6周使用枸橼酸铋钾胶囊联合埃索美拉唑肠溶片治疗.治疗结束后,对比两组患者治疗效果、H pylori根除情况、胃肠道症状改善以及不良反应发生率.结果:两组患者胃肠道症状较治疗前均得到明显改善(P<0.05).在腹痛及胃灼热发生率上,观察组优于对照组(P<0.05).在腹胀及嗳气发生率上,两组差异无统计学意义(P>0.05);观察组治疗总有效率明显优于对照组(P<0.05);在H pylori根除率上,观察组明显优于对照组(P<0.05);两组不良反应发生率对比差异无统计学意义(P>0.05).结论:对幽门螺杆菌(H pylori)相关性胃溃疡进行治疗时,埃索美拉唑与奥美拉唑均有疗效,但以埃索美拉唑为主的四联疗法治疗效果更好,能更为有效的改善患者的胃肠道临床症状,提高患者生活质量,安全性高.

Objective To investigate the effects of all-trans retinioc acid (ATRA)on proliferation of rat hepatic stellate cells (HSC-T6)and expressions of collagen Ⅰ,matrix metalloproteinase-2 (MMP-2),tissue inhibitor of metalloproteinases-1 (TIMP-1 )and signal protein Smad2/3 in TGF-β1-simulated HSC-T6 so as to explore the impact and molecular mechanisms of ATRA on liver fibrosis in vitro .Methods Cultured HSC-T6s were treated with different concentrations of ATRA (0.1,1,10 μmol/L)for fixed time (12,24,48 hours).After intervention time,cell proliferation was evaluated by MTT.Meanwhile,HSC-T6s stimulated by TGF-β1 (5 ng/mL)were treated with different concentrations of ATRA for 24 h.The mRNA expressions of COL1α2,MMP-2 and TIMP-1 were quantified by RT-PCR;the expression of Smad 2/3 protein was determined by cell immunochemistry.Results The proliferation of hepatic stellate cells was inhibited by ATRA in a dose-dependent manner (P < 0.05 ).After induced by TGF-β1,the mRNA expressions of COL1α2,MMP-2 and TIMP-1 and the expression of Smad 2/3 protein were increased significantly compared with control group (P <0.05).However,ATRA could obviously reduce themRNA expressions of COL1α2,MMP-2 and TIMP-1 and the expression of Smad 2/3 protein in HSC-T6 induced by TGF-β1 (P < 0.05 ).Conclusion ATRA can inhibit the proliferation of HSC-T6s and reduce the mRNA expressions of COL1α2,MMP-2 and TIMP-1 in HSC-T6 which were induced by TGF-β1.The anti-hepatic fibrosis function of ATRA may be related to its inhibition on the expression of Smad 2/3 protein in HSC-T6 to influence TGF-β1/Smad signaling pathway.

ABSTRACT:Objective To validate that relaxin can resist hepatic fibrosis at the cellular level and explore its molecular mechanism in order to provide experimental basis for the treatment of liver cirrhosis.Methods Cultured HSC-T6s were treated with different concentrations (20,50 and 100 ng/mL)of recombinant human relaxin-2 (RLX-2).The proliferation of HSC-T6 was measured by MTT colorimetric assay.The content of type Ⅰcollagen in the cell culture supernatant of each group was detected by ELISA at 48 h of drug intervention;RT-PCR was used to detect the mRNA expressions of CTGF and TGF-β1 in HSC-T6 at 48 h of drug intervention.Results RLX-2 inhibited the proliferation of HSC and reduced type Ⅰ collagen content of HSC cells.It also inhibited the CTGF mRNA expression of HSC,but did not have a significant effect on the expression of TGF-β1 mRNA. Conclusion In the experiment of culturing HSC-T6 in vitro,RLX-2 may play a role in rat liver fibrosis by inhibiting cell proliferation and type Ⅰ collagen and CTGF mRNA expressions.

The aim of this study was to evaluate the association between proton pump inhibitor (PPI) use and risk of osteoporosis and fracture by performing an updated meta-analysis. We searched PubMed, EMBASE, and Web of Knowledge from inception to March 2017 for observational studies reporting the risk of osteoporosis and/or fracture with PPIs. Random-effects meta-analysis was used to obtain pooled estimates of effect due to heterogeneity. We identified 27 studies with a total of 1885507 subjects included. According to recent studies, use of PPIs was associated with an elevated risk of osteoporosis (OR 1.39, 95% CI 1.22-1.58). A meta-analysis of 20 observational studies showed that the overall risk of hip fracture was higher among people using PPIs (OR 1.22, 95% CI 1.15-1.30). Similar to hip fracture, high risk of any-site and spine fractures was observed in PPI users (OR 1.19 95% CI 1.12-1.27 and OR 1.53, 95% CI 1.36-1.73, respectively). Subgroup analyses by dose indicated that the high dose and the low dose group were consistent on the strength of the association between PPIs therapy and risk of hip fracture. In addition, no time response relationship was found in subgroup analysis. This meta-analysis demonstrates PPI therapy may be linked to an increased risk of both osteoporosis and fracture, but no evidence of dose-response and duration-response relationship was found in subgroup analysis. Considering the effect of unmeasured confounding, more rigorous experiments are needed to clarify whether PPI therapy or residual confounding lead to the increased risk of osteoporosis and fracture.

目的采用Meta分析方法评价H 2 受体拮抗剂（histamine H 2 -receptor antagonists,H 2 RA）对髋部骨折风险的影响。方法计算机检索CNKI、Pub Med和EMbase数据库,搜集H 2 RA使用与髋部骨折风险的观察性研究,检索时限均从1997年至2016年9月19日。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata 13软件进行Meta分析。结果共纳入11个研究,包括206 276例患者。Meta分析结果显示,H 2 RA使用组发生髋部骨折的风险是非使用组的1.12倍[OR=1.12,95%CI（1.02,1.24）,P=0.022]。亚组分析结果显示,H 2 RA连续服药组发生髋部骨折的风险高于非使用组[OR=1.11,95%CI（1.01,1.24）,P=0.039],而H 2 RA不连续服药组髋部骨折风险与非使用组相比无显著性差异。结论 H 2 RA的应用可能会增加髋部骨折风险,对于不连续服药患者,停药30天以上可能逆转该效应,但本研究未发现时间-效应关系和剂量-效应关系,鉴于此次研究的局限性,未来需要设计更加严谨的临床试验进一步证实。

目的：探讨奥美拉唑三联疗法治疗幽门螺杆菌（ Hp）相关性消化性溃疡（ PU）的临床效果。方法将252例Hp相关性PU患者随机分为两组，各126例。对照组给予奥美拉唑、阿莫西林和甲硝唑三联疗法，观察组给予奥美拉唑、阿莫西林和克拉霉素三联疗法。疗程均为7 d，对比两组临床治疗效果。结果治疗后，观察组患者上腹胀痛、烧心不适、反酸嗳气、恶心呕吐等消化道症状积分均低于对照组（ P ＜0．01）；观察组Hp根除率高于对照组（ P ＜0．01）；两组临床治愈率和总有效率比较，差异均无统计学意义（ P ＞0．05）。结论奥美拉唑、阿莫西林和克拉霉素三联疗法治疗Hp相关性PU疗效确切，值得临床推广应用。

目的:探讨CEA、CA19-9以及CA72-4诊断老年胃癌的临床价值.方法:对192例经活检确诊为老年胃癌患者的血清CEA、CA19-9以及CA72-4水平进行分析,比较不同TNM分期老年胃癌患者的血清CEA、CA19-9以及CA72-4阳性率,并评价血清CEA、CA19-9以及CA72-4水平诊断老年胃癌的敏感性和特异性.结果:TNM 3期及4期的胃癌患者CEA以及CA19-9阳性率明显高于l期及2期胃癌患者,而TNM1-4期的胃癌患者CA72-4的阳性率都明显高于CEA以及CA19-9.以6.5 ng/mL、30U/mL以及4ng/mL分别作为CEA、CA19-9以及CA72-4的上限临界值,其诊断老年患者的胃癌的敏感性分别为15.6％、19.3％以及29.2％,特异性分别为98.9％、97.2％以及98.0％,曲线下面积分别为0.59、0.62以及0.66.结论:CEA、CA19-9以及CA72-4对于诊断老年胃癌都有较好的特异性,但敏感性一般,尤其对于早期胃癌,CEA及CA19-9敏感性较差,CA72-4敏感性要优于二者.

Objective To investigate the plasma level and clinical significance of microRNA-181b (miR-181b)in patients with colon cancer.Methods The plasma level of miR-181b in 42 patients with colon cancer and 42 healthy controls were detected by stem-loop RT-PCR.The relationship between clinicopathological characteristics of colon cancer and miR-181b was analyzed.Results Compared with healthy controls,the plasma miR-181b in patients with colon cancer was significantly higher (0.38±0.13 vs 0.64±0.22,respectively,P <0.01).There was no significant difference between plasma miR-181b and gender,age and tumor size in patients with colon cancer (P >0.05).There were significant differences between plasma miR-181b and lymph node metastasis,distant metastasis and tumor stage (P <0.05).Conclusion The plasma miR-181b in patients with colon cancer increased and miR-181b may contribute to the development of colon cancer.

目的:检测microRNA-100(miR-100)在胰腺癌患者血浆中的表达水平,初步探讨其临床意义.方法:收集33例胰腺癌患者和40例正常对照者的血浆,采用定量茎-环逆转录聚合酶链反应(RT-PCR)方法检测血浆中miR-100的表达水平,统计分析正常对照组与胰腺癌组血浆中miR-100表达差异及其表达水平与胰腺癌病理参数之间的关系.结果:胰腺癌患者血浆中miR-100水平(0.61 +0.24)显著高于正常对照组(0.38 +0.13),差异具有统计学意义(P＜0.01);胰腺癌患者血浆中miR-100水平在不同性别、年龄、吸烟、临床分期、局部淋巴结转移、远处转移、CA199浓度之间差异无统计学意义(P＞0.05).结论:胰腺癌患者血浆中miR-100水平增高,miR-100可能参与了胰腺癌的发生过程.

目的 探讨结肠癌患者血浆中microRNA-100(miR-100)的水平变化及其临床意义. 方法采用茎环逆转录聚合酶链反应(reverse transcription polymerase chain reaction,RT-PCR)方法 检测40例结肠癌患者和40例正常对照血浆中miR-100的表达水平,统计分析miR-100表达水平与结肠癌病理参数之间的关系. 结果 结肠癌患者血浆中miR-100水平显著低于正常对照组,差异具有统计学意义(0.39 ±0.14 vs 0.65 ±0.21,P＜0.01);结肠癌患者血浆中miR-100水平在不同性别、年龄及肿瘤大小之间差异无统计学意义(P＞0.05),而与肿瘤的淋巴转移、远处转移及临床分期明显相关(P＜0.05). 结论 结肠癌患者血浆中miR-100水平降低,miR-100可能参与了结肠癌的病理过程.

目的 分析结核性腹膜炎(tuberculosis peritonitis,TBP)的临床特点和实验室检查,探讨各种诊断方法在TBP诊断中的应用.方法回顾分析116例以腹水待查入院并得到确诊的TBP病例,对其临床特点、实验室检查及诊断方法进行总结分析.结果各项检查的阳性率分别为PPD 53.5%(38/71),TB-Ab 15.4%(2/13),CA125 92.4%(61/66),CEA 29.1%(23/79),CA199 1.7%(1/60),ADA 83.3%(20/24),腹膜活检 47.6%(10/21),腹腔镜80%(4/5),剖腹探查100%(10/10).各种诊断方法诊断的例数所占比例分别为诊断性治疗 77.6%(90/116),淋巴结活检 1.7%(2/116),腹膜活检8.6%(10/116),腹腔镜3.4%(4/116),剖腹探查 8.6%(10/116).结论诊断性治疗是TBP确诊的主要方法.腹膜活检、腹腔镜及剖腹探查对TBP诊断的阳性率高,在有适应证的前提下应适时、及早进行.