卷 81, 编号 2 (2009)
- 年: 2009
- 文章: 22
- URL: https://journals.rcsi.science/0040-3660/issue/view/1718
Editorial article
Development of theory on intestinal dysfunction in the XXI century
Terapevticheskii arkhiv. 2009;81(2):5-10
5-10
Gastrointestinal symptoms in adult population of Novosibirsk city: prevalence and risk factors
摘要
Aim. To study prevalence of dyspepsia symptoms, gastroesophageal reflux (GER) and irritable bowel syndrome (ICS) in city population and to detect relevant risk factors.
Material and methods. Gastrointestinal symptoms were investigated with a validated questionnaire Bowel Disease Questionnaire and dyspepsia, GER, ICS syndromes were identified in a representative sample of adult Novosibirsk population (1040 patients, 492 males and 548 females aged 45-69 years). Risk factors were studied by social-demographic and antropometric parameters, smoking, drinking and administration of nonsteroidal anti-inflammatory drugs (NSAD). Depression was assessed by CESD questionnaire. Helicobacter pylori infection and the level of pepsinogen I were studied with enzyme immunoassay Biohit GastroPanel (Biohit, Finland).
Results. Incidence of dyspepsia was 38%, GER - 30%, ICS - 19%. One of the illnesses was found in 56% cases, combination of the conditions - in 24%. Females had dyspepsia and ICS much more frequently. Social-demographic parameters (age, marital status, education, labor activity), alcohol consumption, intake of NSAD, Helicobacter pylori infection had no significant effect on the incidence of gastrointestinal symptoms. GER occurred more frequently in smoking males. Overweight was characteristic both for GER males and females. Severe depression was associated with the risk of dyspepsia and ICS both in females and males. Hyperpepsinogenemia increased the rate of GER detection in males and dyspepsia in females.
Conclusion. Dyspepsia, GER and ICS were seen in 50% adult population and often combine, but the risk factors differ. Some of the latter can be modified and prevented.
Terapevticheskii arkhiv. 2009;81(2):11-16
11-16
Clinico-morphological variants of gastric mucosa atrophy
摘要
Aim. To characterize clinicomorphological manifestations of atrophic process (AP) in gastric mucosa (GM) in chronic atrophic gastritis (CAG) associated and not associated with Helicobacter pylori infection.
Material and methods. Clinicoendoscopic and pathomorphological (light microscopy of gastric biopsies, 6 point scale assessment of dysregeneratory alterations) investigations were made in 98 patients aged 16 to 68 years. H.pylori-negative CAG was diagnosed in 52 of them, H.pylori-positive one in 46 patients (groups 1 and 2, respectively).
Results. A comparative clinicomorphological analysis has identified 2 variants of AP morphogenesis in GM. Variant 1 is not associated with H.pylori but associated with a combined action of several endogenic risk factors of chronic gastritis or failure of regeneration, with diffuse or diffuse-focal changes with initial prevalence of dysregeneratory changes in a fundal stomach manifesting as a trend to atrophy of the glands. Clinically, this variant is characterized by longer disease, frequent systemic atrophic lesions of gastrointestinal mucosa, prevalent complaints of dyspeptic pain. Variant 2 is associated with a combined action of endo- and exogenic factors, H.pylori infection in particular, pathogenetic components of "chemical" gastritis (duodenogastric reflux, malnutrition), prevalence of dysregeneratory and sclerotic alterations in the antral stomach.
Conclusion. GM atrophy is characterized by a significant frequency of concomitant endocrinopathies, undifferentiated connective tissue dysplasia, systemic lesions, structurally - by multidirectional disorders of proliferation and differentiation. First of all, it is the result of impaired regulation of regenerative processes. AP polyetiology and different morphogenetic variants in GM suggest necessity of both individual diagnostic algorithm and pathogenetically sound therapy in each individual case.
Terapevticheskii arkhiv. 2009;81(2):17-23
17-23
Psychoemotional and humoral changes in patients with combined reflux disorders
摘要
Aim. To investigate disorders of psychoemotional functions, humoral regulation (substance P) and duodenal motility (DM) in patients with combined refluxes for their differential correction.
Material and methods. A total of 60 patients with gastroesophageal and duodenogastric refluxes were examined.
Results. Patients with reflux disorders had more frequent and severe neurotic reactions. Humoral changes are associated with characteristics of psychoemotional regulation. The risk of subnormal levels of the substance P rises substantially in changes in the scales of anxiety, neurotic depression, hysterical reaction and autonomic disorders. Segmental duodenal motility regresses with lowering of plasmic levels of substance P.
Conclusion. Patients with combined reflux disorders have psychoemotional disorders, abnormal humoral regulation and duodenal motility necessitating a differential approach to treatment of such patients.
Terapevticheskii arkhiv. 2009;81(2):24-26
24-26
How to raise efficacy of gastroesophageal reflux disease treatment
摘要
Aim. To specify dysfunction of the stomach and duodenum in gastroesophageal reflux disease (GRD) to offer more effective pathogenetic pharmacotherapy of GRD.
Material and methods. Fibroesophagogastroduodenoscopy with further assessment of esophageal mucosa condition by Savary-Miller, intragastric pH-metry, dynamic gastroscintigraphy and electrogastrography were made in 150 GRD patients.
Results. GRD patients were found to have significant disturbances of a motor-evacuatory function of the gastroduodenal complex. Addition of domperidon and mebeverin to routine combined treatment of GRD raises clinical efficacy of GRD treatment and promotes recovery of gastric and duodenal function though therapeutic efficacy of the above drugs depended on concomitant pathology.
Conclusion. Domperidon and mebeverin addition to combined treatment of GRD makes this treatment more effective.
Terapevticheskii arkhiv. 2009;81(2):27-29
27-29
Outpatient ronkoleukin treatment of gastric ulcer associated with Helicobacter pylori
摘要
Aim. To determine clinicoimmunological and microbiological efficacy of ronkoleukine in the treatment of Helicobacter pylori-associated gastric ulcer (GU).
Material and methods. A total of 108 H. pylori-associated GU were randomized into two groups. Patients of group 2 received standard 3 or 4 component therapy including proton pump inhibitor and two antibiotics (amoxicillin and clarithromycin). Patients of group 1 received the same treatment but antibiotics were replaced for recombinant interleukine-2 ronkoleukine (Biotech, Russia) which was delivered via gastroscope and injected submucously along the periphery of the ulcer defect in 4-6 points in a dose 0.1 mg; 0.4 mg of the drug was simultaneously injected intravenously. The procedure was made 3 times with a 72 hour interval.
Results. One month after the treatment H. pylori eradication was 81.5 and 95.4% in groups 1 and 2, respectively. Mean duration of ulcer epithelization was 35.23 ± 1.58 and 10.79 ± 0.46 days, respectively.
Conclusion. Clinically and pathogenetically sound method of H. pylori-associated GU with application of systemic and local (paraulcer) immunotropic ronkoleukine therapy is more cost and immunologically effective than standard treatment and can be used both in hospital and outpatient setting.
Terapevticheskii arkhiv. 2009;81(2):30-35
30-35
Long- and short-term results of staged treatment of ulcer patients engaged in oil production
摘要
Aim. To determine clinical and cost-effect efficacy of staged (hospital-day hospital-outpatient clinic) treatment and rehabilitation of patients with ulcer disease (UD).
Material and methods. Of 160 patients with duodenal ulcer 80 patients (controls) received treatment in hospital and 80 patients (the study group) were treated in hospital and day hospital. Efficacy of the treatment was assessed by clinical data, results of device and cost-effect investigations.
Results. Clinical and endoscopic remission of duodenal ulcer was achieved for the same time in both the groups. The cost of the treatment of 1 patient was 23393 and 21163 rub in the controls and in the study group, respectively. Therefore, treatment in a day hospital reduced cost of the treatment. Later, the remission was consolidated by active follow-up in an outpatient clinic.
Conclusion. Staged treatment of UD provides good therapeutic and economic effects compared to hospital treatment.
Terapevticheskii arkhiv. 2009;81(2):36-38
36-38
Postinfection irritable bowel syndrome
摘要
Aim. To characterize pathogenesis, clinicolaboratory criteria and treatment of postinfection irritable bowel syndrome (PICS).
Material and methods. The examination including histological study of the small and large intestine mucosa, polymerase chain reaction (PCR), coagglutination reaction using shigella, salmonella, yersinia, campilobacter jejuni diagnosticums, indirect hemagglutination reaction for identification of antibodies to these agents in the blood serum was conducted in 750 patients with PICS. Fecal seeding on selective media was made as well as the respiratory test for bacterial growth in the small intestine. Immune status was studied with laser cytometry, chemiluminescence, immunodiffusion, immunofluorescence, flow laser cytofluorometry. Personality profile was assessed by MMPI.
Results. PICS was diagnosed in 599 (79.9%) of 750 patients. Most of them had diarrhea, abnormal fecal microflora, antigens of acute intestinal infection agents in circulating immune complexes of the serum and coprofiltrates. Immune system was characterized by low phagocytic activity, attenuation of cell and humoral immunity. Etiotropic and pathogenetic treatment including intestinal antiseptics, probiotics and immunomodulators produced persistent remission during a year in 79.3% PICS patients.
Conclusion. PICS is described which differs from ICS by registration of markers of acute intestinal infections in biological media, bacterial overgrowth in the small intestine and dysbiosis in the large intestine, immunodeficiency. A positive response was observed to treatment with intestinal anticeptic and enterosorbent drugs, probiotics and immunomodulators.
Terapevticheskii arkhiv. 2009;81(2):39-44
39-44
Prognosis for patients with chronic diseases of the liver in formulating indications to orthotopic liver transplantation
摘要
Aim. To analyse a clinical course of hepatic cirrhosis of various etiology in potential recipients of donor liver; to formulate symptom complex which determines life span prognosis in patients with chronic diffuse diseases of the liver (CDDL).
Material and methods. We studied 74 recipients of the liver (73 adults aged 15-58 years and 1 boy aged 13 years, mean age at liver transplantation 27.04 ± 1.5 years, 41% males, 59% females). Orthotopic transplantation of the liver (OTL) was made from a live relative donor. All the patients have undergone clinical, biochemical, immunological, virological, ultrasonic, x-ray and other examinations. Severity of the patients condition was assessed according to the Child-Pugh classification. Indications to transplantation of the liver were formulated basing on the syndromal approach.
Results. Asthenic syndrome was diagnosed in 34, pruritus - in 25, articular syndrome - in 11, jaundice - in 43, hepatomegaly - in 40, splenomegaly - in 65, ascitis - in 26, peripheral edema - in 8, esophageal varicose veins - in 66, encephalopathy - in 5 patients. Main syndrome manifestations of CDDL involved in formulating indications for liver transplantation consisted in the syndrome of liver cell insufficiency (diagnosed in 77% cases), syndrome of portal hypertension (detected in 100% cases), edemo-ascitic syndrome (41% cases), cholestasis syndrome (95% cases), autoimmune cytopenia syndrome (77% cases), hepatorenal syndrome (5.4%). Most of potential recipients who had liver transplantation were classified as having class B and C by Child-Pugh (66.3%), but often indications for OTL were considered in terms of a combination of various syndromes significant for life prognosis in each patient and in terms of urgency of OTL performance.
Conclusion. In determination of indications for OTL syndromal approach seems most adequate. Main syndromes influencing primarily on OTL decision making are portal hypertension with consideration of esophageal varicose veins, syndrome of hepatic cell deficiency, edemoascytic syndrome, hepatorenal syndrome, syndrome of autoimmune cytopenia and cholestasis.
Terapevticheskii arkhiv. 2009;81(2):45-49
45-49
Regulators of fibrinolysis in chronic viral pathology of the liver
摘要
Aim. To investigate a clinicopathogenetic role of fibrinolysis regulators in chronic viral hepatitis (CVH) and viral cyrrhosis of the liver (CL).
Material and methods. Seventy patients entered the study: 10 patients with CVH B, 33 - with CVH C, 6 - with CVH D, 21 - with viral CL (HCV-associated in 14 cases and HBV-associated in 7 cases. A concentration and activity of tissue plasminogen activator (TPA), the level of plasminogen-1 activator inhibitor (PAI-1) in blood plasma were estimated with enzyme immunoassay (Technoclone GmbH, Austria). PAI-1/TPA was estimated.
Results. Increased TPA, PAI-1 concentrations and TPA activity in plasma with maximal values in CL were found. Most severe imbalance in the system of fibrinolysis regulators occurs in poor-prognosis cirrhosis and decompensated portal hypertension. High TPA concentration and activity in CL have a positive correlation with the Child-Pugh index, while low PAI-1/TPA correlates negatively with this index.
Conclusion. TPA and PAI-1 correlations with hemorrhagic manifestations and prognosis of the disease suggest an essential clinical role of fibrinolysis regulators in chronic viral pathology of the liver.
Terapevticheskii arkhiv. 2009;81(2):50-53
50-53
Lipoprotein(a) - a new independent cholelithiasis risk factor?
摘要
Aim. To study the level of lipoprotein(a) - Lp(a) in the blood serum and incidence of isoforms of apolipoprotein(a) - apo(a) in males and females with cholelithiasis and free of it in population of Novosibirsk; to assess possible correlations between Lp(a) level in the blood, apo(a) isoforms and bile lithogenicity in females with cholesterol cholelithiasis.
Material and methods. Examination of the representative samples of 870 females aged 25-64 years and 405 males aged 35-54 years has detected cholelithiasis in 91 females and 19 males.
Results. Serum levels of Lp(a) are associated with cholelithiasis. Risk of the latter in males (Lp(a) > 28 mg/dl) and females (Lp(a) > 24 mg/dl) is estimated. It is confirmed that isoforms of apo(a) B, S1 and S2 in females and isoforms of apo(a) B, S2 in males with cholelithiasis occur much more frequently than in individuals free of cholelithiasis while isoform apo(a) S4 is rare. Females with cholesterol cholelithiasis have positive correlation between blood Lp(a) levels, the presence of isoforms apo(a) B, S1 and bile lithogenicity.
Conclusion. Males and females with cholelithiasis have more frequent high concentrations of Lp(a) (> 30 mg.dl) while low levels (0-5 mg/dl) are rare. There is a correlation between blood levels of Lp(a), apo(a) isoforms, bile lithogenicity in females with cholesterol cholelithiasis.
Terapevticheskii arkhiv. 2009;81(2):54-56
54-56
Effects of laser reflex therapy on a motor function of the gall bladder and physical properties of bile in patients with chronic acalculous cholecystitis
摘要
Aim. To study effects of laser puncture in combined treatment of chronic non-calculous cholecystitis on motor function of the gallbladder, bile physical characteristics and clinical symptoms.
Material and methods. 73 patients with chronic non-calculous cholecystitis were divided into two groups: 35 patients received standard therapy alone (control group) and 38 patients were exposed to laser puncture as a component of combined treatment.
Results. Laser radiation on acupuncture points has a positive therapeutic result, i.e. shorter clinical symptoms, correction of motor function of the gallbladder and bile physical characteristics.
Conclusion. Laser puncture is an effective method of acalculous cholecystitis treatment and can be included in relevant combined schemes.
Terapevticheskii arkhiv. 2009;81(2):57-61
57-61
Clinical features of different variants of excretory pancreatic insufficiency
摘要
Aim. To analyse course of excretory pancreatic insufficiency (EPI) of pancreatic and not origin as well as factors associated with its development.
Material and methods. A total of 139 patients with chronic pancreatitis or malabsorption were examined. The pancreatic function was assessed by the results of elastase test - concentration of pancreatic elastase 1 in the feces. EPI was detected in 57 patients (fecal pancreatic elastase 1 under 200 mcg/g); 38 patients had chronic pancreatitis and absolute EPI, 19 patients had relative EPI (the elastase was low, pancreatic pathology was absent, but other gastroenterological diseases were present - enteropathy, Crohns disease, previous surgery).
Results. Pancreatic insufficiency in patients with pancreatitis was 36.5%. It was associated with the disease duration. Diarrhial and asthenic syndromes, normal or low lipase levels in the serum were found. Patients with relative insufficiency were significantly younger, had shorter disease duration, more frequent diarrhea, were thinner. Correction of diarrheal syndrome was more successful in patients with absolute insuffuiciency. Pancreatic elastase concentration in the feces persisted for a year in patients with absolute EPI and normalized in patients with enteropaties after etiotropic and pathogenetic therapy.
Terapevticheskii arkhiv. 2009;81(2):62-64
62-64
Etiology and pathogenesis of duodenal mucosa lesion in chronic pancreatitis
摘要
Aim. To measure content of neuromediators (acetylcholine - Ach, serotonin - 5-NT) and gastrointestinal hormones (cholecystokinine - CCK and secretin) in the blood serum of patients with chronic pancreatitis (CP); to study protective properties of the mucus in the duodenum in CP.
Material and methods. CCK and secretin concentrations were estimated by enzyme immunoassay, Ach and 5-NT were measured biochemically basally and after standard meal in 65 CP patients and in the control group. Proteolytic activity of the mucus was assessed by Ansons method. An inhibitory property of the mucus was studied by residual proteolytic activity of pepsine after its incubation with mucus.
Results. In AP patients the response of biologically active substrates to standard meal changed: 5-NT concentration rose from 0.40 ± 0.07 to 0.55 ± 0.05 mcg/ml (p < 0.05) while Ach dropped from 1.7 ± 0.3 to 1.6 ± 0.3 mmol/l (p > 0.05). BP patients responded to the standard meal with 5-HT concentration rise from 0.28 ± 0.04 to 0.43 ± 0.05 mcg/ml (p < 0.05), Ach changed insignificantly (from 1.5 ± 0.12 to 1.45 ± 0.21 mmol/l, p > 0.05, reslectively). CCK after standard meal significantly rose both in AP and BP. AP and BP patients had strong direct correlation between concentrations of 5-HT and CCK (r = 0.875439) and weak negative correlation with Ach level (r = -0.2209). In AP and BP patients secretin level weakly negatively correlated both with 5-NT and Ach levels (r = -0.4839 and r = -0.33207, respectively). Reduction of secretin secretion diminished secretion of bicarbonates and mucus with simultaneous change in the quality of mucous gel.
Conclusion. In CP of various etiology there are changes in the level and proportions of neuromediators and hormones causing alterations in the regulation system. These disorders correlate with disturbances in pancreatic excretory function and destructive tissue changes. Bicarbonates secretion decreases and changes quality of the secreted mucus.
Terapevticheskii arkhiv. 2009;81(2):65-67
65-67
Autoimmune reactions in gastrointestinal diseases
摘要
Aim. To examine content, diagnostic and prognostic role of autologous antibodies in gastrointestinal diseases (GID).
Material and methods. Enzyme immunoassay was used to measure content of autologous antibodies to N+/K+ATPase (Aab) of gastric parietal cells, mitochondria, microsomes, tissue transglutaminase in blood serum of 196 patients with gastric, gallbladder, small and large intestinal diseases. Aab relations with heterologous antibodies were studied with kits provided by Bektor-Best (Novosibirsk), DRG-Diagnostics, Orgentec (Germany) and others.
Results. In GID high circulation of Aab to parietal cells (Ab-PC) was detected in 42% cases, mean content being 217 ± 32.4 U/ml, 10 U/ml in the control. Maximal concentration (180 = 340 U/ml) occurred in hepatic cirrhosis, celiac disease, atrophic gastritis. In exacerbations of pancreatictis, colelithiasis and duodenal ulcer ab-PC concentration was 190-210 U/ml, in remission - 6-12 U/ml. Minimal concentration (8-38 U/ml) was seen in polyps, gastric cancer, nonspecific ulcerative colitis. For primary biliary cirrhosis more typical was high Aab concentration to mitochondria (in 83%; 200 U.ml), for autoimmune hepatitis - Aab to microsomes (in 81%; 170 U/ml), in celial disease - Aab to tissue transglumaminase (93%, 75 U/ml). High autoantibodies concentration in GID is accompanied with overcirculation of heteroantibodies to infectious-toxic agents confirming their role in development of autoimmune processes.
Conclusion. GID are associated with high circulation of autologous antyibodies - markers of systemic humoral autoimmune reactions differing in duration, severity, site of lesion, form, stage, disease duration. Maximal detection rate and concentration of serum autologous antibodies were observed in hepatic cyrrhosis, active hepatitis, celiac disease, atrophic gastritis, exacerbations of cholelithiasis, ulcer, pancreatitis. Estimation of Aab concentration is essential for diagnosis, prognosis of autoimmune diseases, it reflects intensity and duration of autoimmune reactions in GID.
Terapevticheskii arkhiv. 2009;81(2):68-70
68-70
A morphometric analysis of the nuclei and nucleoli in tumor cells in lymphogranulomatosis, diffuse large B-cell lymphoma and anaplastic large cell lymphoma
摘要
Aim. To make a comparative morphometric analysis of the nuclei and nucleoli of tumor cells in lymphogranulomatosis (LGM), diffuse large B-cell lymphoma (DLBCL) and anaplastic large cell lymphoma (ALCL) for differential diagnosis of these lymphomas.
Material and methods. Biopsy material (lymph node biopsies) was frozen in hexan, fixed and stained, then microscopic pictures were made.
Results. Mean area of tumor cell nuclei in LGM was 97.25 ± 68.77 mcm2, in DLBCL and ALCL - 55.89 ± 20.13 mcm2 and 70.31 ± 34.64 mcm2, respectively. The area differences were significant (p < 0.001). Hodgkins and Berezovsky-Rid-Sternberg cell bucleoli area was the largest (11.44 ± 7.83 mcm2). The nucleoli of the former are larger than those of the latter. Mean area of the nucleoli in DLBCL was 3.05 ± 1.58, in ALCL - 5.53 ± 4.94 mcm2. The differences are significant (p < 0.001).
Conclusion. Nucleoli in Hodgkins cells are significantly larger than those in the tumor cells in ALCL and DLBCL and the nucleoli with the area more than 12 mcm2 can be used in differential diagnosis between LGM and DLBCL but not between LGM and ALCL.
Terapevticheskii arkhiv. 2009;81(2):71-74
71-74
Combined antihypertensive treatment in hypertensive patients and type 2 diabetes mellitus
摘要
Aim. To investigate antihypertensive efficacy, effects on endothelial, diastolic function of the left ventricule and metabolism of combination of ACE inhibitor quinapril (accupro) with diuretic indapamide SR in patients with hypertension of the second-third degree and type 2 diabetes mellitus (DM) and free of DM.
Material and methods. Outpatient treatment was given to 60 patients with AH (mean age 55.3 ± 9.6 years) in combination with mild or moderate DM (group 1) and free of DM (group 2). The patients were observed for 12 weeks. Clinical and biochemical blood tests, ECG, echo-CG, measurements of blood pressure were made in all the patients.
Results. Quinapril course (mean dose 23.3 ± 9.8 mg/day) in combination with indapamide (1.5 mg/day) produced a complete hypotensive effect in group 1 (23 patients,76.7%), in group 2 - 25 (83.3%). DM patients demonstrated reduction of fasting and postprandial glycemia and cholesterol, time of isovolumic relaxation reduced in group 1 by 9.1%, in group 2 by 19.8% (p < 0.01). Left ventricular diastolic function improved, endothelium-dependent vasodilation in diabetics rose by 40%, non-endothelium-dependent - by 21.8%, in hypertensive patients free of DM - by 51.9 and 43.2%, respectively.
Conclusion. Combination of quinapril with indapamide produces a significant antihypertensive effect in patients with AH of degree II-III associated with type 2 DM, improves carbohydrate and lipid metabolism, left ventricular diastolic function.
Terapevticheskii arkhiv. 2009;81(2):75-79
75-79
Endoscopic methods of investigation in gastroenterology
Terapevticheskii arkhiv. 2009;81(2):80-82
80-82
Spontaneous bacterial peritonitis: pathogenesis problems
Terapevticheskii arkhiv. 2009;81(2):83-86
83-86
Gastrointestinal hormones in clinical gastroenterology
Terapevticheskii arkhiv. 2009;81(2):87-89
87-89
Unsolved problems of enteropathy induced by nonsteroidal anti-inflammatory drugs
Terapevticheskii arkhiv. 2009;81(2):90-92
90-92
The VIII Congress of Gastroenterology Society of Russia
Terapevticheskii arkhiv. 2009;81(2):93-93
93-93