Peptic ulceration,gastric secretion,and renal transplantation.

Fifty-four patients on haemodialysis for chronic renal failure underwent renal transplantation. Basal and maximum acid output and the incidence of peptic ulcer before transplantation were not significantly different from those of controls. But after renal transplantation the incidence of symptoms of peptic ulcer was high (22%) and four out of six patients who developed gastrointestinal bleeding died from this complication. In men peak acid output was significantly increased after renal transplantation and was associated with a 30% incidence of symptoms of peptic ulcer compared with 10% in women, who showed no significant change in mean basal or peak acid output. Peptic ulceration after transplantation was not associated with steroid dosage, hyperparathyroidism, or the height of blood urea concentrations. Given criteria of a history of dyspepsia, abnormal barium meal findings, or gastric hypersecretion, it was not possible to identify patients at risk from peptic ulceration or life-threatening complications after renal transplantation. Thus the routine screening of these patients for peptic ulcer has no practical value, and the incidence of fatal complications is not high enough to justify routine prophylactic anti-ulcer surgery aimed at reducing acid secretion before renal transplantation.     

Gastric Ulceration Occurring during Indomethacin Therapy

Dyspeptic symptoms, gastrointestinal bleeding, or the development of anaemia without dyspepsia in patients treated with indomethacin may be manifestations of peptic ulceration. Such manifestations occur with suppositories as well as with capsules. The ulcers in the present series tended to be prepyloric, and often aroused the suspicion of malignancy. Symptoms were promptly relieved and radiological healing occurred rapidly after withdrawal of the drug.     

Mast cells are critical for protection against peptic ulcers induced by the NSAID piroxicam

Many commonly used non-steroidal anti-inflammatory drugs (NSAIDs) also cause gastrointestinal toxicity, including the development of life-threatening peptic ulcers. We report that mast cell-deficient mice have an extremely high incidence of severe peptic ulceration when exposed to the NSAID piroxicam. This enhanced ulcer susceptibility can be reversed by reconstitution with mast cells. Furthermore, wild type mice treated with diphenhydramine hydrochloride, a commonly used antihistamine that blocks histamine H1 receptors, develop a similarly high incidence of peptic ulcers following piroxicam exposure. The protective effect of mast cells is independent of TNF, blockade of H2 receptors, or acid secretion. These data indicate a critical role for mast cells and the histamine that they produce in prevention and/or repair of piroxicam-induced gastric mucosal injury. Additional studies will be required to determine whether this represents a NSAID class effect that can be exploited to develop novel therapeutic strategies to limit the incidence of NSAID-induced side effects in humans.     

尿毒症维持性血液透析患者血清CRP与营养状态及感染的相关性

目的:探讨尿毒症维持性血液透析患者的血清C-反应蛋白(CRP)与营养状态及感染的相关关系。方法:按照是否发生感染将2013年2月-2015年8月我院收治的238例尿毒症维持性血液透析患者分为感染组(118例)和非感染组(120例),对两组患者的血清CRP、营养状态相关指标进行比较,并分析CRP水平与营养状态及感染的相关性。结果:感染组的体质量指数(BMI)、白蛋白、前白蛋白、转铁蛋白、血红蛋白水平低于非感染组,重组人促红细胞生成素、血清CRP水平高于非感染组,肱三头肌皮褶厚度低于非感染组,差异均有统计学意义(P0.05)。经Pearson积矩相关分析,血清CRP与BMI、白蛋白、前白蛋白、转铁蛋白、血红蛋白呈负相关关系(r=-0.81、-0.93、-0.85、-0.79、-0.91),差异有统计学意义(P0.05),血清CRP与肱三头肌皮褶厚度(TSF)呈负相关关系(r=-0.76,P0.05),与重组人促红细胞生成素呈正相关关系(r=0.89,P0.05)。结论:尿毒症维持性血液透析患者的血清CRP水平可作为评估患者营养状态及感染的重要指标,具有重要的参考价值。     

高磷血症维持性血液透析患者的临床分析

目的:比较不同血磷水平的维持性血液透析的尿毒症患者的临床表现和实验室指标,探讨其临床意义。方法:选择上海交通大学医学院附属新华医院(崇明)肾内科28例高血磷(SP>1.6mmol/L)的维持性血液透析患者为病例组,30例血磷正常(SP≤1.6mmol/L)维持性血液透析患者为对照组,比较两组患者的原发病组成,年龄,性别,透析龄,皮肤瘙痒发生率,腰背痛发生率,血钙,血碳酸氢根,血红蛋白,红细胞压积,血碱性磷酸酶,肾功能,血浆白蛋白水平及左心室肥厚发生率。结果:病例组与对照组在原发病组成,年龄(43.2±9.8岁vs 40.5±12.2岁),男女性别比例(16/12 vs.17/13),透析龄(32.56±6.71月vs.35.43±5.82月)等方面无显著性差异(P>0.05),有可比性,在血红蛋白(83.22±6.71g/L vs 103.36±5.84g/L),红细胞压积(24.83±1.92%vs.30.76±1.52%),血钙(1.71±0.16mmol/L vs.2.23±0.21 mmol/L),血碳酸氢根(14.2±3.1mmol/L vs 20.6±4.9 mmol/L),血碱性磷酸酶(124.26±16.33U/L vs.61.47±14.91 U/L),皮肤瘙痒发生率(22/28 vs.7/30),腰背痛发生率(19/28 vs.6/30),左心室肥厚发生率(20/28 vs 12/30),有显著性差异(P<0.05),肌酐(956±142mmol/L vs.923±156 mmol/L),尿素氮(23.1±6.3mmol/L vs.24.8±8.9mmol/L),血浆白蛋白(30.5±3.8g/L vs.31.2±2.9g/L),无显著性差异(P>0.05)。结论:伴有高磷血症的维持性血液透析患者与血磷正常的患者相比,血碱性磷酸酶,皮肤瘙痒发生率,腰背痛发生率及左心室肥厚发生率较高,而血钙,血碳酸氢根,血红蛋白及红细胞压积较低,有一定差异。     

Clinical experience with metiamide.

The new histamine H2-receptor antagonist, metiamide, was shown to inhibit acid and pepsin secretion in gastric secretion studies performed on patients suffering from peptic ulceration. The new drug was administered intravenously in these experiments, but effective plasma levels could also be produced by oral administration. When symptomatic patients were treated with the drug nearly all experienced marked symptomatic relief, and there was some evidence that ulcer healing occurred during treatment. When the drug was withdrawn symptoms tended to return. No toxic reactions were encountered in this trial. Double-blind studies are now being made in Britain to establish the place metiamide may have in the treatment of duodenal ulceration.     

Incidence of peptic ulcer disease in Gothenburg, 1985.

OBJECTIVE--To determine the incidence and age distribution of peptic ulcer disease in adults in Gothenburg. DESIGN--Retrospective study of patients with symptoms over one year. SETTING--All gastroenterology and x ray departments. PATIENTS--Any patient found to have an active ulcer crater during 1985. MAIN OUTCOME MEASURES--Sex, age, past history of gastrointestinal ulcers, and smoking habit. RESULTS--In 1985, 1402 peptic ulcers were diagnosed in 1137 adults. Over half (403; 54%) of the ulcers in men and 393 (60%) ulcers in women were in patients aged over 60. All types of ulcer showed increasing incidence with age. The sex ratio of patients aged 40-50 with peptic ulcers was 1:1. Nearly half (109; 48%) of ulcers diagnosed for the first time in men and 129 (57%) of such ulcers in women were in patients aged over 60. Elderly men and women were also more likely to develop haemorrhage. CONCLUSIONS--In Gothenburg there is a surprisingly high incidence of peptic ulcer disease, which increases considerably with age, possibly explained by the availability of modern diagnostic techniques as 1121 (80%) ulcers had been diagnosed by gastroscopy. Compared with earlier studies there was no difference in the incidence between men and women aged 40-50.     

糖尿病肾病维持性血液透析患者低血糖发生情况及其影响因素的Logistic回归分析

摘要 目的：探讨糖尿病肾病（DN）维持性血液透析患者低血糖发生情况,并分析其影响因素。方法：选择2018年7月~2021年2月期间收治的100例DN维持性血液透析患者,记录低血糖发生情况,按照是否发生低血糖将患者分为低血糖组（n=47）和无低血糖组（n=53）。收集两组患者的临床资料,采用多因素Logistic回归分析DN维持性血液透析患者低血糖发生的影响因素。结果：100例患者1个月内共检测血糖 1200次,其中有47例出现低血糖症状,低血糖发生率为47.00%（47/100）,53例患者未发生低血糖。DN维持性血液透析患者低血糖发生与性别、婚姻状况、工作状况、医保类型、维持性血液透析方式、收缩压、空腹血糖（FBG）、内生肌酐清除率（Ccr）、低密度脂蛋白胆固醇（LDL-C）、三酰甘油（TG）无关（P>0.05）,而与年龄、DN病程、体质量指数、文化程度、尿微量蛋白尿排泄率（UAER）、用药依从性、自我管理能力、照护能力有关（P<0.05）。多因素logistic回归性分析结果显示：年龄偏大、DN病程偏长、体质量指数偏低、UAER偏高是DN维持性血液透析患者低血糖发生的危险因素,而用药依从性、照护能力良好则是DN维持性血液透析患者低血糖发生的保护因素（P<0.05）。结论：DN维持性血液透析患者低血糖发生率较高,其中年龄偏大、DN病程偏长、体质量指数偏低、UAER偏高是DN维持性血液透析患者低血糖发生的危险因素,而用药依从性、照护能力良好则是其保护因素。     

高通量血液透析对慢性肾衰竭尿毒症患者TLC 及免疫球蛋白水平的影响

目的:探究高通量血液透析对慢性肾衰竭尿毒症患者TLC及免疫球蛋白水平的影响。方法:选取我院收治的慢性肾衰竭尿毒症患者100例,随机分为实验组和对照组。对照组采用常规血液透析治疗,实验组采用高通量血液透析治疗。观察并比较两组患者治疗前后TLC及免疫球蛋白水平的变化情况以及临床疗效。结果:实验组治疗有效率(96.0%)高于对照组(86.0%),差异有统计学意义(P0.05);与治疗前相比,两组患者治疗后血肌酐水平下降,IgA,IgM及IgG水平升高,肺功能TLC水平升高,差异具有统计学意义(P0.05);与对照组相比,实验组患者治疗后血肌酐水平较低,IgA,IgM及IgG水平较高,肺功能TLC水平较高,差异具有统计学意义(P0.05)。结论:高通量血液透析治疗能够改善慢性肾衰竭尿毒症患者的肺功能,增强免疫功能。     

Vagotomy and Pyloroplasty for Gastric Ulcer

In a series of 68 patients with gastric ulcer who were treated by vagotomy and pyloroplasty there were no operative deaths, though one patient who received massive transfusions died 14 weeks later from hepatic necrosis probably associated with serum hepatitis. Four patients developed recurrent peptic ulceration requiring further surgical treatment. The clinical condition of all but three of the remainder was satisfactory after an average follow-up period of three years and two months. Of the 14 patients who presented with an acutely bleeding gastric ulcer, one subsequently required gastrectomy for continued bleeding; in all the others the immediate and long-term results were satisfactory. Of 21 patients with a “high” ulcer and 29 with combined gastric and duodenal ulceration one (4·8%) and three (10%) respectively suffered recurrences. We conclude that vagotomy and pyloroplasty is a satisfactory form of treatment for a high or bleeding gastric ulcer, but that for all other gastric ulcers some form of gastric resection is preferable.     

Gastroduodenal lesions and Helicobacter pylori infection in dyspeptic patients with and without chronic renal failure

BACKGROUND: Patients with chronic renal failure (CRF) often have dyspeptic symptoms and may develop peptic disease or digestive disorders leading to severe gastrointestinal complications. The primary aim of this study was to evaluate the prevalence of peptic lesions and Helicobacter pylori infection, and the severity of dyspeptic symptoms, in dyspeptic patients with and without CRF. Our secondary aim was to investigate whether uremic status may affect the diagnostic efficiency of the [13]C-urea breath test ([13]C-UBT). PATIENTS AND METHODS: We consecutively enrolled in the study 50 dyspeptic patients with chronic kidney failure (mean age 52 +/- 5 years), of whom 11 were on hemodialysis treatment (HD), and 93 subjects (mean age 54 +/- 7 years) with chronic dyspepsia and normal renal function (NRF). All patients completed an oriented and validated questionnaire scoring the severity of nine dyspeptic symptoms (i.e. epigastric pain, epigastric burning, postprandial fullness, early satiety, bloating, belching, nausea and vomiting) and underwent upper endoscopy with multiple bioptic sampling for rapid urease test and histological examination, [13]C-UBT and HpSA test. RESULTS: The prevalences of peptic lesions and H. pylori infection and mean symptom score were 74%, 52% and 3.5 +/- 3, respectively, in dyspeptic patients with CRF and 18%, 36% and 8 +/- 5, respectively, in dyspeptic patients with NRF. The diagnostic accuracy of [13]C-UBT with respect to histological diagnosis was 94% and 97% for dyspeptic patients with and without renal failure, respectively. CONCLUSIONS: 1, A high frequency of peptic lesions and low symptom scores were observed in uremic patients in spite of H. pylori infection; 2, uremic status did not affect the diagnostic accuracy of [13]C-UBT.     

血液透析联合血液灌流及依达拉奉对尿毒症RLS患者外周血清中毒素水平、临床症状及睡眠质量的影响

摘要 目的：探讨高通量血液透析（HFD）联合血液灌流（HP）及依达拉奉对尿毒症不宁腿综合征（RLS）患者外周血清中毒素水平、临床症状、睡眠质量、负性情绪的影响。方法：选择2018年2月至2019年12月我院肾内科收治的174例尿毒症RLS患者,采用随机数字表法将患者分为三组。常规血液透析（HD）组（58例）采用常规血液透析治疗,联合A组（58例）采用HFD联合HP治疗,联合B组（58例）采用HFD联合HP及依达拉奉治疗。观察三组治疗前后肾功能[尿素氮（BUN）、血肌酐（SCr）、尿白蛋白排泄率（UAER）]、血清毒素[甲状旁腺激素（PTH）、硫酸吲哚酚（IS）、硫酸对甲酚（PCS）]水平、RLS评分、睡眠质量、负性情绪以及不良反应的差异。结果：三组治疗后血清BUN、SCr、UAER、PTH、IS、PCS水平、RLS评分、匹兹堡睡眠质量指数（PSQI）评分、汉密尔顿焦虑量表（HAMA)评分、汉密尔顿抑郁量表（HAMD）评分均有所下降（P＜0.05）。联合B组、联合A组治疗后血清BUN、SCr、UAER、PTH、IS、PCS水平低于HD组（P＜0.05）,联合B组、联合A组上述指标比较无统计学差异（P＞0.05）。联合B组治疗后RLS评分、PSQI评分、HAMA评分、HAMD评分均低于联合A组和HD组（P＜0.05）,联合A组低于HD组（P＜0.05）。三组治疗期间不良反应发生率比较无统计学差异（P＞0.05）。结论：HFD联合HP及依达拉奉可改善尿毒症RLS患者的临床症状和肾功能,可降低血清毒素水平,并改善睡眠质量和负性情绪。     

Nesidioblastosis and islet cell changes related to endogenous hypergastrinemia

The endocrine pancreas from four hypergastrinemic patients with recurrent peptic ulceration has been studied by light and electron microscopy. Greatly increased numbers of ducts and centroacinar cells have been observed associated with a striking increase in the number of islets and endocrine cells scattered in the acinar tissue (nesidioblastosis). The islet cells scattered throughout the exocrine parenchyma are of all the known islet cell types, with a prevalence of B and especially A cells. Many islets, probably formed de novo, are of a considerable size, have irregular contours and are in close apposition to centroacinar cells and ducts. The degree of nesidioblastosis and islet hyperplasia does not seem to be related to the plasma gastrin levels. Cytological changes have also been found in the islet cells of the hypergastrinemic patients compared with controls. These changes mainly affect the B cells and consist of a striking decrease in the number of mature secretory granules associated with a fairly extended ergastoplasm and Golgi apparatus and with a relevant increase in the number of immature granules. In two of the four patients examined, who had more severe hypergastrinemia, cytological signs of enhanced secretion are also recognized in A cells. The features indicating hypersecretion of B and A cells seem to be related to the plasma gastrin levels. The above findings indicate that chronic endogenous hypergastrinemia promotes proliferation and differentiation of islet cells and stimulates the secretory function of B cells and, to a lesser extent, of A cells, thus providing evidence for a trophic and secretagogue action of gastrin on the endocrine pancreas.     

Peritoneal Dialysis in Chronic Renal Failure

The long-term results of intermittent peritoneal dialysis in long-term treatment of renal disease have yet to equal those of intermittent hemodialysis. However, further exploration and refinement of this technique is justified.Performed in acute stages of disease, both peritoneal dialysis and hemodialysis relieve the symptoms of uremia and specifically “buy time” for the patient so that proper medical or surgical therapy may be instituted. In acute situations, peritoneal dialysis is the procedure of choice, and is an important adjunct to more conventional treatment for chronic renal disease. It may be useful sometimes even in chronically hemodialyzed patients—for example, when the hemodialysis cannula for one reason or another is inaccessible because of clots, replacement, or infection. It is especially valuable when the hemorrhagic complications of uremia contraindicate hemodialysis treatment.Its use in chronic uremia remains sharply limited in time, but for brief periods chronic peritoneal dialysis appears to be a reasonably satisfactory means of prolonging life while awaiting homotransplant or decision for maintenance hemodialysis therapy.     

幽门螺杆菌根除治疗对消化性溃疡患者血清胃泌素水平的影响

目的 观察幽门螺杆菌(H.pylori)根除治疗对消化性溃疡患者血清胃泌素水平的影响,为该病治疗提供参考。 方法 选择我院2017年8月至2019年8月收治的120例H.pylori感染的消化性溃疡患者作为观察组,根据H.pylori分型结果进一步分为HPⅠ型组和HPⅡ型组,观察组患者接受根除幽门螺杆菌治疗。选择同期入院的40例非幽门螺杆菌感染消化性溃疡患者作为对照组,对照组患者接受常规治疗。比较两组患者治疗效果、胃镜检查结果、H.pylori清除情况及血清胃泌素、IL10、IL17水平。 结果 HPⅠ型组、HPⅡ型组和对照组患者临床总有效率差异无统计学意义(92.75%、96.08%、97.50%,χ2=1.384,P=0.051)。HPⅠ型组、HPⅡ型组、对照组患者胃镜检查总有效率差异无统计学意义(91.30%,96.08%,97.50%,χ2=1.384,P=0.051)。HPⅡ型组患者幽门螺杆菌根除率高于HPⅠ型组(98.04% vs 85.51%,χ2=4.129,P=0.042)。HPⅠ型组患者治疗后血清胃泌素、IL10、IL17水平均高于对照组(均P结论 不同类型H.pylori感染消化性溃疡患者行幽门螺杆菌根除治疗后临床效果无显著差异。幽门螺杆菌根除治疗可降低消化性溃疡患者血清胃泌素、IL10、IL17水平。     

三联疗法与胃复春联合治疗幽门螺杆菌阳性胃溃疡的疗效评估

目的:探讨三联疗法与胃复春联合治疗幽门螺杆菌(Hp)阳性胃溃疡的临床疗效。方法:选择2011年11月到2014年11月在我院就诊的240例Hp阳性胃溃疡患者,随机分为实验组(n=120)和对照组(n=120)。对照组采用三联疗法,实验组在对照组基础上加服胃复春。比较两组患者的临床疗效、Hp根除率、胃泌素、胃动素水平。结果:实验组患者的总有效率和Hp根除率均明显高于对照组,具有显著性差异(均P0.05)。实验组治疗后胃泌素水平低于治疗前,亦低于对照组治疗后,具有显著性差异(均P0.05),胃动素变化无显著性差异。结论:三联疗法联合胃复春治疗Hp阳性胃溃疡能有效根除Hp,降低胃泌素水平,治疗效果良好。     

Abnormal fatty acid profile in chronic hemodialysis patients: possible deficiency of essential fatty acids

Plasma fatty acid profiles from maintenance hemodialysis patients (n = 9) were compared with those from healthy volunteers (n = 9). Hemodialysis patients had significantly higher levels of oleic acid, 15.3 +/- 1.1 vs. 8.9 +/- 0.6% (p less than 0.0001), and lower levels of arachidonic acid (6.0 +/- 0.5 vs. 8.4 +/- 0.3%, p less than 0.0009). Linolenic and linoleic acids, the essential fatty acid and precursors of arachidonic acid, were also significantly lower than normal in the dialysis group. These data show that dialysis patients have fatty acid abnormalities suggesting relative depletion of essential fatty acids. These observations are important because these abnormalities may play an important role in the pathogenesis of some common clinical conditions associated with uremia, such as a constellation of skin problems, fragility of erythrocytes, lipid anomalies and hormonal aberrations.     

奥美拉唑联合克拉霉素、阿莫西林对老年消化性溃疡患者胃泌素水平与外周血红细胞免疫功能的影响

目的:探讨奥美拉唑联合克拉霉素、阿莫西林对老年消化性溃疡患者胃泌素水平与外周血红细胞免疫功能的影响。方法:收集我院就诊的100例消化性溃疡患者,随机分为实验组和对照组,每组50例。对照组患者给予奥美拉唑肠溶片治疗;实验组患者给予奥美拉唑肠溶片、克拉霉素及阿莫西林胶囊治疗。观察并比较两组患者治疗前后胃泌素(Gastrin)、红细胞免疫功能(RBC-C3b、RBC-ICRRR)水平、临床疗效及不良反应。结果:与治疗前相比,两组患者治疗后胃泌素、RBC-ICRRR水平均下降,RBC-C3b水平均升高,差异具有统计学意义(P0.05);与对照组相比,实验组患者治疗后胃泌素、RBC-ICRRR水平较低,RBC-C3b水平较高,差异具有统计学意义(P0.05);实验组患者治疗总有效率高于对照组,差异具有统计学意义(P0.05);两组患者不良反应发生率相比,差异无统计学意义(P0.05)。结论:奥美拉唑联合克拉霉素、阿莫西林能够降低老年消化性溃疡患者胃泌素水平,改善红细胞免疫功能,临床疗效较好。     

Gastric Acid Secretion in Chronic Renal Failure

Contrary to the small amount of published evidence, but in accordance with clinical impression, we have found an increased incidence of peptic ulceration in people with chronic renal failure. Hyperacidic secretion in response to a standard pentagastrin test occurs in patients established on long-term dialysis treatment. The traditional liability of azotaemic patients to peptic ulceration seems not to be decreased by adequate long-term dialysis and indeed may be worsened.     

Studies of fibrinolytic activity of uremic and longterm hemodialytic patients with special reference to fibrinolytic inhibitor.

Fibrinolytic activities on cases with chronic renal failure, 13 cases at pre and post introduction of hemodialysis and 40 cases at pre and post hemodialysis of maintenance hemodialysis with 38 normal controls were investigated. The plasminogen activator of untreated chronic renal failure was lower than controls, yet increased with the introduction of hemodialysis. On the other hand the antiplasmin was lowered with the introduction. In cases with maintenance hemodialysis, the plasminogen activator was lower than controls, but was elevated with hemodialysis. The level of antiactivator was higher in uremia of either pre or post hemodialysis than controls. The levels of alpha 2-macroglobulin and alpha 1-antitrypsin were reduced at prehemodialysis state comparing to controls, and yet, increased with hemodialysis, respectively. The low molecular weight antiplasmin and antiactivator, molecular weight below 30,000 were separated with Sephadex G-50 gel filtration of plasma. The low molecular weight fibrinolysis inhibitors of plasma with untreated uremia were elevated comparing to controls, but decreased with the hemodialysis. The removable fibrinolytic inhibitors were indicated, however, the ratio of the low molecular weight fibrinolytic inhibitors to the total fibrinolytic inhibitors were little.