中西医结合治疗消化性溃疡临床研究

目的:观察中西医结合治疗幽门螺杆菌(Hp)阳性消化性溃疡的临床疗效。方法:将90例Hp阳性消化性溃疡患者随机分为两组,每组45例。对照组采用雷贝拉唑、阿莫西林、克拉霉素三联疗法,治疗组在对照组基础上给予复方胃宁片,比较两组临床疗效、Hp根除率及不良反应发生率。结果:治疗组有效率、Hp根除率及不良反应发生率与对照组比较,差异均具有统计学意义(P<0.05)。结论:中西医结合治疗Hp阳性消化性溃疡治愈率高,Hp根除率高,临床疗效显著。     

基于根除Hp治疗对胆汁反流性胃炎病人的临床疗效观察

为观察根除幽门螺杆菌(Hp)治疗及艾普拉唑和复方尿囊素联合枳术宽中疗法对胆汁反流性胃炎的治疗效果影响,将171例胆汁反流性胃炎病人进行Hp检测,Hp阳性病人分别给予非根除Hp治疗和根除Hp治疗,Hp阴性病人分别给予非联合枳术宽中和联合枳术宽中治疗。结果显示,治疗后,Hp阳性病人有效率分别为60. 00%和87. 10%,Hp阴性病人有效率分别为64. 70%和91. 53%。对Hp阳性的胆汁反流性胃炎病人,根除Hp治疗疗效优于非根除Hp治疗;对Hp阴性的胆汁反流性胃炎病人,艾普拉唑和复方尿囊素联合枳术宽中疗效优于非联合枳术宽中治疗。     

序贯疗法根除幽门螺杆菌的疗效观察

目的对比序贯疗法与标准三联疗法对幽门螺杆菌的根除率。方法将速尿素酶试验（RUT）和13C尿素呼吸试验（13C-UBT）阳性的患者97例随机分成2组：①治疗组46例,予10 d序贯疗法：第1-5 d予泮托拉唑、阿莫西林治疗,第6-10 d后改为泮托拉唑、克拉霉素、呋喃唑酮治疗。②对照组51例,予常规三联疗法：泮托拉唑、克拉霉素、阿莫西林,疗程7 d。停药4周后行13C-UBT检查,比较Hp的根除率。结果 Hp根除率治疗组为95.65%,对照组为76.47%,2组相比,差异均有统计学意义（P〈0.01）。结论 10 d序贯疗法明显比标准7 d三联疗法有较高的Hp根除率。     

多西环素、阿莫西林、铋剂联合PPI治疗幽门螺杆菌感染的临床效果观察

目的:探讨在幽门螺杆菌(Helicobacter pylori,Hp)感染根治中,多西环素、阿莫西林、铋剂联合质子泵抑制剂(PPI)用药方案的临床效果。方法:选取本院接诊Hp感染患者126例,按照随机数字表法分为A组、B组、C组,各42例。分别给予三组不同的用药方案,A组:多西环素+阿莫西林+铋剂+PPI;B组:左氧氟沙星+阿莫西林+铋剂+PPI;C组:克拉霉素+阿莫西林+铋剂+PPI,观测4周后三组患者的消化性溃疡治疗效果及Hp感染根除效果。结果:A组消化性溃疡治疗总有效率为95.24%,Hp初始根除率为88.10%;B组消化性溃疡治疗总有效率为88.10%,Hp初始根除率为83.33%;C组消化性溃疡治疗总有效率为85.71%,Hp初始根除率为80.95%。A组消化性溃疡治疗总有效率、Hp初始根除率均高于B组和C组(P<0.05),B组与C组消化性溃疡治疗总有效率、Hp初始根除率比较,差异均无统计学意义(P>0.05)。结论:对于目前存在的幽门螺杆菌感染治疗中的抗生素耐药问题,多西环素的组合在提高根除率上展示了新的临床价值。     

益生菌联合含铋剂四联疗法根除幽门螺杆菌感染的疗效观察

目的:观察益生菌联合含铋剂四联疗法根除幽门螺杆菌感染的疗效。方法:收集150例幽门螺旋杆菌(Helicobacter pylori,Hp)阳性的患者,按照随机数字表法分为三组,每组各50例。A组:标准四联疗法,艾司奥美拉唑(20 mg,2次/d)、克拉霉素(0.5 g,2次/d)、阿莫西林(1 g,2次/d)、枸橼酸铋钾(0.2 g,2次/d)疗程14 d;B组标准四联疗法联合益生菌,疗程14 d;C组标准四联疗法治疗14 d结束后服用益生菌2周,疗程28 d。比较三组患者的临床症状评分、Hp根除情况、不良反应发生情况。结果:治疗前,三组患者的临床症状评分比较,差异均无统计学意义(P>0.05)。治疗后,三组患者的临床症状评分均显著低于治疗前(P<0.05),且B组、C组患者的临床症状评分均显著低于A组(P<0.05),但B组、C组患者的临床症状评分比较差异无统计学意义(P>0.05)。B组、C组患者的Hp根除率92.0%、96.0%均显著高于A组84.0%(P<0.05),但B组、C组患者的Hp根除率比较差异无统计学意义(P>0.05)。B组、C组患者的不良反应发生率16.0%、20.0%均显著低于A组34.0%(P<0.05),但B组、C组患者的不良反应发生率比较差异无统计学意义(P>0.05)。结论:益生菌联合含铋剂四联疗法根除幽门螺杆菌感染的疗效较单独含铋剂四联疗法显著,更能有效改善患者临床症状,提升患者HP根除率,降低患者不良反应发生率,值得推广。     

埃索美拉唑镁肠溶片四联疗法根除幽门螺杆菌感染的效果分析

目的:探讨埃索美拉唑镁肠溶片、阿莫西林、克拉霉素、胶体果胶铋四联疗法根除幽门螺杆菌(Helicobacter pylori,H.pylori)的疗效和安全性。方法:178例H.pylori阳性患者随机数字表法分成两组:观察组予以埃索美拉唑镁肠溶片40 mg,阿莫西林1000 mg,克拉霉素500 mg,胶体果胶铋220 mg,2次/d,连续应用14 d;对照组予以奥美拉唑20 mg,左氧氟沙星片500 mg,甲硝唑400 mg,2次/d,连续应用7 d。两组总观察周期为6周,结束后两组患者均采用可对胃内幽门螺杆菌感染做半定量评估的13C-尿素呼气试验检测Hp,记录Hp根除率及药物不良反应,消化性溃疡患者复查胃镜确定溃疡愈合情况,比较分析两组患者的临床疗效及安全性。结果:观察组Hp根除率、不良反应发生率分别为根除率92.13%(82/89)、10.11%(9/89),对照组Hp根除率、不良反应发生率分别为77.5%(69/89)、20.22%(18/89),观察组Hp根除率高于对照组、不良反应发生率低于对照组,比较差异有统计学意义(P<0.05)。观察组症状缓解的总有效率、溃疡愈合率分别为89.88%(80/89)、96.67%(58/60),对照组分别为88.76%(79/89)、96.61%(57/59),两组比较差异无统计学意义。结论:以埃索美拉唑,胶体果胶铋为核心的标准四联疗法根除H.pylori的方案与三联方案相比根除率高,不良反应少,值得推广。     

口腔幽门螺杆菌感染与胃幽门螺杆菌感染的相关性研究

目的:探讨口腔幽门螺杆菌感染与胃幽门螺杆菌感染的关系,评价根除幽门螺杆菌治疗对口腔幽门螺杆菌感染及胃幽门螺杆菌感染的影响。方法:采用唾液测定幽门螺杆菌抗原技术(HPS)与14C尿素呼气试验(14C-UBT)同时测试的方法,选取有上消化道症状来消化科门诊初诊的患者、经证实有胃Hp感染且根除治疗后4周复查的患者及无任何消化道症状的健康志愿者分别进行检测。结果:上述三组入选对象均有较高HPS阳性检出率,分别为78.57%、79.83%和76.74%,三组比较差异无统计学意义(字2=0.46,P>0.05),14C-UBT阳性检出率,三组患者分别为51.79%、34.45%、23.26%,三组比较差异有统计学意义,初诊患者高于抗Hp治疗后患者和健康志愿者,(字2=8.32,字2=9.18,P<0.05);在14C-UBT阳性患者中HPS阳性检出率,三组患者分别为82.76%、90.24%、90.00%,三组间比较差异无统计学意义(P>0.05)。结论:口腔中有较高的Hp检出率,胃Hp感染患者中大多存在口腔Hp感染。Hp根除治疗对杀灭胃内Hp有一定疗效,对口腔Hp感染几乎无效。     

以雷贝拉唑为基础的序贯疗法根除幽门螺杆菌的疗效评估

目的:比较以雷贝拉唑、阿莫西林、克拉霉素、呋喃唑酮组成的10 d序贯疗法与奥美拉唑+阿莫西林+呋喃唑酮组成的10 d标准三联疗法根除幽门螺杆菌(Hp)的疗效和安全性。方法:160例Hp感染活动性消化性溃疡患者随机分为治疗组和对照组,每组80例。治疗组为序贯疗法组:给予雷贝拉唑10 mg/次、阿莫西林1000 mg/次,2次/d,服用5 d,5 d后口服雷贝拉唑10 mg/次、克拉霉素500 mg/次、呋喃唑酮100 mg/次,2次/d,再服用5 d,10 d后使用雷贝拉唑10 mg/次,1次/d,续服3周。对照组为标准三联疗法组:第1~10天给予奥美拉唑20 mg/次、阿莫西林1000 mg/次、呋喃唑酮100 mg/次,2次/d,第11~31天服用奥美拉唑20 mg/次,1次/d。治疗结束后4周复查胃镜,行快速尿素酶试验和14C尿素呼气试验测定Hp,评估疗效及安全性。结果:156例患者按方案完成治疗。治疗组按ITT分析Hp根除率为92.50%(74/80),明显高于对照组的78.75%(63/80),差异有统计学意义(χ2=19.262,P<0.01)。治疗组按PP分析Hp根除率为94.87%(74/78),明显高于对照组的80.77%(63/78),差异有统计学意义(χ2=15.566,P<0.01)。治疗组和对照组的不良反应发生率分别为18.75%(15/80)和22.50%(18/80),比较差异无统计学意义(P>0.05)。结论:雷贝拉唑、阿莫西林、呋喃唑酮、克拉霉素组成的10 d序贯治疗方案较奥美拉唑、阿莫西林、呋喃唑酮组成的标准三联10 d治疗方案更加能有效根除Hp,取得了很高的Hp根除率,治疗效果佳,个体差异小,不良反应发生率低,患者依从性好,值得临床上推广应用。     

理中活血汤联合幽门螺杆菌根除疗法治疗慢性萎缩性胃炎癌前病变46例临床观察

目的观察理中活血汤联合幽门螺杆菌(Hp)根除疗法治疗慢性萎缩性胃炎(CAG)癌前病变的临床疗效。方法将92例CAG癌前病变患者随机分为2组,对照组46例予Hp根除治疗,治疗组46例在对照组治疗方法的基础上给予理中活血汤治疗,2组疗程均为2周,观察2组的临床疗效、主要症候变化及病理疗效情况。结果治疗组总有效率为84.78%,对照组为69.57%,2组比较差异有统计意义(P<0.05);治疗后2组主症积分、次症积分及总积分均显著降低,差异有统计意义(P<0.05),且治疗组治疗后降低更明显,差异有统计意义(P<0.05);治疗后治疗组胃黏膜萎缩、肠上皮化生、异型增生总有效率均高于对照组,且胃黏膜萎缩和肠上皮化生总有效率差异有统计意义(P<0.05);治疗组Hp根除率为91.30%,对照组为73.91%,2组比较差异有统计意义(P<0.05)。结论理中活血汤联合Hp根除治疗不仅能改善CAG癌前病变患者的临床症状,而且对其癌前病变也有治疗作用。     

中西医结合分阶段治疗Hp相关性胃炎的临床经验

Hp耐药性增加、根治率下降等致Hp相关性胃炎的症状反复,久治不愈。迟莉丽教授采用西医辨病、中医辨证,分三阶段中西医结合治疗本病多获效验。第一阶段当以调理脾胃功能为要,兼加驱邪,中医辨证予清热化湿、疏肝和胃、化瘀通络、温中健脾、益气养阴;第二阶段运用标准三联或四联疗法彻底根除Hp;第三阶段益气养阴或温中补虚,健运脾胃,防病反复。     

系统性硬化症与肠道菌群的关系

肠道菌群对人类健康和疾病有着深远影响。不仅肠道菌群能影响宿主免疫系统发育,免疫系统本身也能改变肠道菌群。目前发现肠道菌群参与了多种自身免疫性疾病。研究发现,系统性硬化症(systemic sclerosis,SSc)患者肠道菌群紊乱较常见,胃肠道易受累,且其中一些特定菌属与SSc患者胃肠道受累严重程度相关。本文对SSc患者肠道菌群变化特点、肠道菌群与SSc消化系统运动障碍和纤维化的关系以及治疗方案等方面进行系统阐述。     

呼吸道标本病原学检测对曲霉菌诊断的价值

目的：探讨呼吸道标本直接涂片和培养对曲霉菌诊断的价值。方法将85例呼吸道标本（痰液、肺泡灌洗液）培养曲霉菌阳性患者按曲霉菌感染及曲霉菌定植诊断标准分为曲霉菌感染组（30例）和曲霉菌定植组（55例）。均采用卡方检验和二分类Logistic回归分析细菌培养联合标本直接革兰染色对区别曲霉菌感染和定植的诊断意义。结果85例呼吸道合格标本曲霉菌培养和直接涂片阳性中,30例与临床诊断相符,符合率为35．2％。曲霉菌感染组镜下和培养检出正常菌群均显著低于定植组、曲霉菌检出次数显著高于定植组（均P＜0．05）。2组镜下WBC浸润量、菌丝检出比较差异均无统计学意义（P＝0．408,P＝0．831）。经多因素Logistic回归分析示：曲霉菌检出次数、无正常菌群定植（包括镜下和培养均无正常菌群）对曲霉菌病诊断有统计学意义（P＜0．05）;激素使用、糖尿病、呼吸衰竭及血液系统疾病是其疾病发生的主要影响因素。在曲霉菌培养阳性基础上,镜下未见正常菌群对诊断灵敏度为83．3％,阴性预测值均达83．9％,培养未见正常菌群诊断灵敏度为86．7％、阴性预测值为89．4％,但特异度和阳性预测值均低于60．0％;两者联合诊断曲霉菌感染的特异度可提高到66．4％,阳性预测值可为53．9％。三者联合检测（镜下和培养未见正常菌群与检出次数）能提高曲霉菌诊断的特异度（92．0％）和阳性预测值（71．0％）。结论在标本合格条件下曲霉菌检出阳性时,呼吸道标本直接涂片及培养出正常菌群对区分曲霉菌定植与感染具有诊断价值。     

3种方法检测口腔中幽门螺杆菌的效果

目的比较快速尿素酶、多聚酶链反应（PCR）及细菌培养法检测胃炎或消化性溃疡患者口腔中的幽门螺杆菌（Hp）的效果。方法选取经胃镜证实为慢性胃炎或消化性溃疡的患者50例,在磨牙区刮取3份龈下菌斑,分别采用快速尿素酶、PCR、细菌培养法测定Hp。结果快速尿素酶、PCR、细菌培养法的Hp阳性率分别为80%、64%、26%,3种方法比较差异有统计学意义（P〈0.05）。结论快速尿素酶、PCR、细菌培养法检测口腔中Hp有明显差异性,其中PCR法不仅特异敏感,而且速度较快、准确率高,是县及县以上医院较好的检测口腔中Hp的方法。     

The pre-Hispanic landscape of the Cerro de Montevideo (Uruguay) in the sixteenth century: first eco-historical study based on biogeography of vegetation and arachnids,historiography and other evidence

The Cerro de Montevideo is a symbolic reference of Uruguay that currently presents an artificialised landscape with environmental deterioration. We used combined techniques including documentary analysis, cartography, remote sensing, biogeographical relict biota, digital recreation and estimated valuation of visual fragility to characterise its pre-Hispanic ecological landscape: a grassy matrix with large patches and corridors of grasslands and woody vegetation, with an estimated intermediate-level visual fragility. The physiognomic changes would have initiated since ca. 1520, much earlier than was formerly proposed (1851), due to supply of firewood from native forests to vessels and livestock introduction by Europeans. Landscape artificialisation by urbanisation and industrialisation was intensified since 1870. Environmental degradation has increased since 1930. For the first time, cryptozoic arachnofauna, visual fragility and digital satellite photographic recreations were included in an historical landscape study. In addition, Dorstenia brasiliensis was found to be the first known identified plant for the Uruguayan flora.     

大承气汤联合电针在治疗肝移植术后腹内高压中的应用效果

目的探讨大承气汤联合电针在治疗肝移植术后腹内高压中的应用效果。方法将53例肝移植术后腹内高压（腹内压≥1.330kPa）患者按随机数字表法分为2组：对照组26例采用胃肠减压,静脉营养支持,纠正水、电解质紊乱和酸碱平衡,静脉泵入生长抑素抑制肠液分泌,合理应用抗生素控制感染等常规治疗;治疗组27例在常规治疗基础上采用大承气汤联合电针治疗。治疗1周,比较2组临床效果及腹内压变化情况。结果治疗1周后治疗组有效27例,有效率为100.0%,对照组有效23例,有效率为88.5%,治疗组有效率显著高于对照组（P〈0.05）。治疗组治疗后1-7d腹内压明显低于对照组（P〈0.01）。结论在常规治疗基础上运用大承气汤联合电针治疗肝移植术后腹内高压是一种促进肝移植术后腹胀患者肠蠕动,降低腹内压,减轻腹胀的安全有效方法。     

从“拯救Sepsis运动”指南变迁看血流动力学的巨变

血流动力学治疗是Sepsis救治必不可少的内容。从2004年开始,"拯救Sepsis运动(Surviving Sepsis Campaign,SSC)"指南先后经历了4次变迁,每一次变迁均是前期基础上的进一步完善。在SSC指南的变迁过程中,血流动力学治疗策略的制定和实施发生着重要改变。临床对于Sepsis血流动力学治疗认识的逐步深刻也是血流动力学巨变的过程,有利于治疗调控更为精准。     

Making the Cape Floral Kingdom: the discovery and defence of indigenous flora at the Cape ca. 1890-1939

The colonial elite in the south-western Cape were historically aficionados of exotic flora and disdainful of the region's indigenous vegetation. This changed rapidly in the half century after ca. 1890 with the indigenization of botanical science and the emergence of a distinctive Cape botany, practised and patronized by the Cape Town patriciate. The botanists' re-imagining of the indigenous flora as the 'Cape Floral Kingdom', an ancient and endangered flora without equal anywhere in the world, served ideological and practical purposes for their sponsors. Floral nativism provided both a sense of identity for an emerging White settler nationalism and a justification for evicting the underclass from the commons and their conversion into a preserve for patrician leisure and contemplation. The political realignments of Union, however, left the Cape Town patriciate isolated and forced them to seek a broader popular audience among the urban middle classes of the region and United Kingdom. By the eve of the Second World War, identification with the indigenous Cape flora had become a mark of class, ethnic and regional identity for the old imperial urban, English-speaking middle class marooned in a new nation state governed by rural, Afrikaans republicanism.     

Floristic Study of Vascular Plants in Typical Plant Communities in the Middle and Upper Reaches of the Yarlung Zangbo River

[Objective] Species composition and flora of vascular plants in the middle and upper reaches of the Yarlung Zangbo River were analyzed, to provide scientific basis for the estimation and protection of plant diversity, construction of ecological security shelter for the Tibetan Plateau.[Methods] In the middle and upper reaches of the Yarlung Zangbo River, quadrat(line transect) method was applied to investigate the phytocoenoses in sample plots, and relative literature was used to analyze the floristic composition and floristic element of vascular plants in the middle and upper reaches of the Yarlung Zangbo River.[Results](1) There are 96 species(including subspecies and variations), 69 genera of 35 vascular plant families, accounting for 16.83%, 5.48%,1.66% and 11.63%, 2.02%, 0.31% of total vascular plant families, genera and species in Tibet and China.(2) There are 24 monotypic-genus families, accounting for 68.57% of the total family number in the local area; 22 monotypic-species families, accounting for 62.86% of the total family number in the local area.Local flora shows the characteristics of ancient relict, such as Euphorbiaceae, Rubiaceae, Liliaceae and Ranunculaceae, they are all ancient primitive groups of the third flora and the fourth flora.(3) Local vascular plant genera fall into 10 areal types and 8 variations.(4) Temperate elements are much more than tropical elements, R/T is 0.19, indicating that vascular plants have typical temperate nature and residual tropical nature.There are only a few endemic genera, but more endemic species to the local area, and these species are closely related, of which there are some transitional species, indicating that local flora is too young to experience more differentiation and specialization.(5) There are 24 Chinese endemic species, accounting for 25% of total number of species in the local area; among which there are 12 endemic species to Tibet, accounting for 50% of endemic species to China, 12.5% of total number of species in the local area.Four key wild plant species are included in the second batch of national key protection.[Conclusions](1) There are scarce plant groups in the local area.(2) Among the obvious advantages, single-genus(species) families possess the absolute advantage, and the flora has ancient origins.(3) The local flora has diversified distribution types, and the complicated geographical elements.(4) Temperate species possess obvious advantages, and the flora is young.(5) Rich unique and rare species have high species diversity protection and research value.