目的系统评价抗焦虑或抗抑郁药辅助治疗功能性消化不良(FD)的疗效。方法计算机检索PubMed、EMBASE、Wed of Science、The Cochrane library、CNKI全文数据库、万方数据库以及中国科技期刊数据库,检索时间建库至2015年12月,搜集关于抗焦...目的系统评价抗焦虑或抗抑郁药辅助治疗功能性消化不良(FD)的疗效。方法计算机检索PubMed、EMBASE、Wed of Science、The Cochrane library、CNKI全文数据库、万方数据库以及中国科技期刊数据库,检索时间建库至2015年12月,搜集关于抗焦虑或抗抑郁药治疗FD的随机对照试验(R/CT),采用Stata12.0对纳入的研究进行Meta分析。结果共8项RCT包含886例患者符合入选标准。Meta分析结果显示:与安慰剂相比,抗焦虑或抗抑郁药能够降低消化不良症状总分,差异有统计学意义(SMD=-0.32,95%CI-0.636^-0.004,P=0.047);亚组分析显示,抗焦虑药对FD的治疗效果优于安慰剂(SMD=-0.47,95%CI-0.931^-0.016,P=0.043),而抗抑郁药的疗效与安慰剂相比差异无统计学意义(SMD=-0.23,95%CI-0.646~0.182,P=0.271)。在不良反应方面,抗焦虑或抗抑郁药不良反应发生率较低,与安慰剂相似(OR=1.25,95%CI 0.847~1.847,P=0.261)。结论抗焦虑药可能是治疗FD的有效药物,且较为安全,但抗抑郁药对FD的治疗作用有待进一步的探讨。展开更多
目前,国内尚无关于九价人乳头瘤病毒疫苗导致药物性肝损伤的报道,但这一问题应引起临床医师的高度重视。现报道1例中年女性患者,在接种九价HPV疫苗第二针后出现乏力、纳差、巩膜及皮肤黄染,经护肝、利胆等对症支持治疗后症状好转,但临...目前,国内尚无关于九价人乳头瘤病毒疫苗导致药物性肝损伤的报道,但这一问题应引起临床医师的高度重视。现报道1例中年女性患者,在接种九价HPV疫苗第二针后出现乏力、纳差、巩膜及皮肤黄染,经护肝、利胆等对症支持治疗后症状好转,但临床医生未能及时说服患者完善相关检查进一步排查药物性肝损伤,致患者继续接种第三针,出现肝损慢性化、严重化。经进一步的护肝、利胆、营养支持等对症支持治疗并随访5个月,患者肝脏功能已恢复正常。通过该病例以期提高临床对药物性肝损伤的认知及诊治水平。At present, there is no report on drug-induced liver injury caused by nine-valent human papillomavirus vaccine in China, but this problem should be highly valued by clinicians. It is reported that a middle-aged female patient suffered from fatigue, poor appetite, yellow staining of sclera and skin after the second dose of nine-valent HPV vaccine. After symptomatic support treatment such as protecting the liver and promoting gallbladder function, the symptoms improved, but the clinician failed to persuade the patient to improve the relevant examination in time to further investigate the drug-induced liver injury, resulting in the patient continuing to receive the third dose, resulting in chronic and severe liver damage. After further symptomatic support treatment such as liver protection, choleretic and nutritional support and follow-up for 5 months, the liver function of the patient has returned to normal. Through this case, we hope to improve the clinical cognition, diagnosis and treatment of drug-induced liver injury.展开更多
原发性胆汁性肝硬化(Primary Biliary Cholangitis, PBC)和自身免疫性肝炎(Autoimmune Hepatitis, AIH)是不同的自身免疫性慢性肝病,这2种疾病在同一患者中共存称为重叠综合征。干燥综合征(Sjögren Syndrome, SS)是自身免疫性肝病(...原发性胆汁性肝硬化(Primary Biliary Cholangitis, PBC)和自身免疫性肝炎(Autoimmune Hepatitis, AIH)是不同的自身免疫性慢性肝病,这2种疾病在同一患者中共存称为重叠综合征。干燥综合征(Sjögren Syndrome, SS)是自身免疫性肝病(Autoimmune Liver Disease, AILD)最常并发的肝外自身免疫病。本文报告了一例AIH-PBC重叠综合征合并SS的病例,探讨其临床表现、诊断和治疗策略。Autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC) are two common clinical autoimmune liver diseases, and some patients have both diseases;this feature is called AIH-PBC overlap syndrome. Sjögren syndrome is one of the most common extrahepatic autoimmune diseases among patients with autoimmune liver diseases. This article presents the case report of an elderly female patient who was diagnosed with AIH-PBC overlap syndrome combined with Sjögren syndrome, and discusses its clinical presentation, diagnosis and treatment strategies.展开更多
1例以腹泻为主要表现的肠气囊肿症(pneumatosis cystoides intestinalis, PCI)患者,患者既往糖尿病20余年,一直在规律服用“阿卡波糖”降糖治疗,完善腹部影像学及内镜检查后明确诊断为肠气囊肿症。采用调整降糖方案、高压氧疗2次/天(共5...1例以腹泻为主要表现的肠气囊肿症(pneumatosis cystoides intestinalis, PCI)患者,患者既往糖尿病20余年,一直在规律服用“阿卡波糖”降糖治疗,完善腹部影像学及内镜检查后明确诊断为肠气囊肿症。采用调整降糖方案、高压氧疗2次/天(共5天)、抑酸保护胃黏膜、调节肠道菌群等支持治疗后患者腹泻、腹痛好转。半年后返院复查肠镜未见异常。肠气囊肿症是临床上一种少见的疾病,其临床表现多样,无特异性,为提高临床医生对本病的认识水平,笔者总结了1例以腹泻为主要表现的肠气囊肿症的诊治经过,现报道如下。A patient with diarrhea as the main manifestation of pneumatosis cystoides intestinalis (PCI), who has had diabetes for more than 20 years, has been taking acarbose as hypoglycemic therapy regularly. She was diagnosed with pneumatosis cystoides intestinalis after abdominal imaging and endoscopic examination. The patient’s diarrhea and abdominal pain were improved after treatment with adjusted hypoglycemic regimen, hyperbaric oxygen therapy twice a day (5 days in total), acid inhibition to protect gastric mucosa, and regulation of intestinal flora. Six months later, she returned to the hospital and rechecked the colonoscopy. Pneumatosis cystoides intestinalis is a rare disease in the clinic, and its clinical manifestations are diverse and non-specific. In order to improve the understanding level of clinicians, the author summarized the diagnosis and treatment of 1 case of pneumatosis cystoides intestinalis with diarrhea as the main manifestation, and reported as follows.展开更多
腹膜炎是全球重症监护病房患者败血症的第二大死亡原因,脓毒血症的早期预测对于及时干预并最终改善预后至关重要。本研究基于新型的机器学习算法,建立并验证腹膜炎患者发展为脓毒血症的预测模型,研究结果提示机器学习模型可以成为预测...腹膜炎是全球重症监护病房患者败血症的第二大死亡原因,脓毒血症的早期预测对于及时干预并最终改善预后至关重要。本研究基于新型的机器学习算法,建立并验证腹膜炎患者发展为脓毒血症的预测模型,研究结果提示机器学习模型可以成为预测腹膜炎患者预测脓毒血症的可靠工具,并且,随机森林算法模型具有最佳的预测性能,这种机器学习方法可用于帮助临床医生对于高风险因素的认识并早期干预以降低死亡率。Peritonitis is the second leading cause of sepsis-related mortality in intensive care unit (ICU) patients worldwide. Early prediction of sepsis is critical for timely intervention and ultimately improving prognosis. This study established and validated a predictive model for the development of sepsis in peritonitis patients using novel machine learning algorithms. The findings suggest that machine learning models can be a reliable tool for predicting sepsis in peritonitis patients. Among them, the random forest algorithm model showed the best predictive performance. This machine learning approach can help clinicians recognize high-risk factors and intervene early to reduce mortality.展开更多
目的研究5-羟色胺受体基因启动子区(5-HTTLPR)多态性与功能性消化不良(FD)发病之间的关系,为疾病提供临床治疗信息。方法计算机检索PubMed、EMbase、Web of Science、中国生物医学文献数据库、CNKI、万方等数据库,检索截止时间至2018年5...目的研究5-羟色胺受体基因启动子区(5-HTTLPR)多态性与功能性消化不良(FD)发病之间的关系,为疾病提供临床治疗信息。方法计算机检索PubMed、EMbase、Web of Science、中国生物医学文献数据库、CNKI、万方等数据库,检索截止时间至2018年5月18日,筛选5-HTTLPR基因多态性与FD发病相关研究,运用Stata 12.0软件进行Meta分析。结果共纳入6篇研究,S(短)及L(长)等位基因组成5种遗传模型。SS+LS vs LL模型与FD发病风险相关(OR=0.50,95%CI:0.25～0.98),其余遗传模型与FD发病无关(SS vs LL+LS:OR=1.02,95%CI:0.70～1.50;SS vs LL:OR=1.01,95%CI:0.68～1.50;SS vs LS:OR=1.08,95%CI:0.70～1.68;S vs L:OR=0.96,95%CI:0.81～1.14),亚洲人群SS+LS vs LL模型与FD发病风险相关(OR=0.53,95%CI:0.29～0.97),其余模型未见明显相关,高加索人群各遗传模型与FD发病风险无关。剔除一篇文章后,无论汇总结果还是亚组分析均提示各遗传模型与FD发病风险无明显相关。结论无论在亚洲还是高加索人群中,5-HTTLPR基因多态性与FD发病风险无明显相关。展开更多
文摘目前,国内尚无关于九价人乳头瘤病毒疫苗导致药物性肝损伤的报道,但这一问题应引起临床医师的高度重视。现报道1例中年女性患者,在接种九价HPV疫苗第二针后出现乏力、纳差、巩膜及皮肤黄染,经护肝、利胆等对症支持治疗后症状好转,但临床医生未能及时说服患者完善相关检查进一步排查药物性肝损伤,致患者继续接种第三针,出现肝损慢性化、严重化。经进一步的护肝、利胆、营养支持等对症支持治疗并随访5个月,患者肝脏功能已恢复正常。通过该病例以期提高临床对药物性肝损伤的认知及诊治水平。At present, there is no report on drug-induced liver injury caused by nine-valent human papillomavirus vaccine in China, but this problem should be highly valued by clinicians. It is reported that a middle-aged female patient suffered from fatigue, poor appetite, yellow staining of sclera and skin after the second dose of nine-valent HPV vaccine. After symptomatic support treatment such as protecting the liver and promoting gallbladder function, the symptoms improved, but the clinician failed to persuade the patient to improve the relevant examination in time to further investigate the drug-induced liver injury, resulting in the patient continuing to receive the third dose, resulting in chronic and severe liver damage. After further symptomatic support treatment such as liver protection, choleretic and nutritional support and follow-up for 5 months, the liver function of the patient has returned to normal. Through this case, we hope to improve the clinical cognition, diagnosis and treatment of drug-induced liver injury.
文摘原发性胆汁性肝硬化(Primary Biliary Cholangitis, PBC)和自身免疫性肝炎(Autoimmune Hepatitis, AIH)是不同的自身免疫性慢性肝病,这2种疾病在同一患者中共存称为重叠综合征。干燥综合征(Sjögren Syndrome, SS)是自身免疫性肝病(Autoimmune Liver Disease, AILD)最常并发的肝外自身免疫病。本文报告了一例AIH-PBC重叠综合征合并SS的病例,探讨其临床表现、诊断和治疗策略。Autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC) are two common clinical autoimmune liver diseases, and some patients have both diseases;this feature is called AIH-PBC overlap syndrome. Sjögren syndrome is one of the most common extrahepatic autoimmune diseases among patients with autoimmune liver diseases. This article presents the case report of an elderly female patient who was diagnosed with AIH-PBC overlap syndrome combined with Sjögren syndrome, and discusses its clinical presentation, diagnosis and treatment strategies.
文摘1例以腹泻为主要表现的肠气囊肿症(pneumatosis cystoides intestinalis, PCI)患者,患者既往糖尿病20余年,一直在规律服用“阿卡波糖”降糖治疗,完善腹部影像学及内镜检查后明确诊断为肠气囊肿症。采用调整降糖方案、高压氧疗2次/天(共5天)、抑酸保护胃黏膜、调节肠道菌群等支持治疗后患者腹泻、腹痛好转。半年后返院复查肠镜未见异常。肠气囊肿症是临床上一种少见的疾病,其临床表现多样,无特异性,为提高临床医生对本病的认识水平,笔者总结了1例以腹泻为主要表现的肠气囊肿症的诊治经过,现报道如下。A patient with diarrhea as the main manifestation of pneumatosis cystoides intestinalis (PCI), who has had diabetes for more than 20 years, has been taking acarbose as hypoglycemic therapy regularly. She was diagnosed with pneumatosis cystoides intestinalis after abdominal imaging and endoscopic examination. The patient’s diarrhea and abdominal pain were improved after treatment with adjusted hypoglycemic regimen, hyperbaric oxygen therapy twice a day (5 days in total), acid inhibition to protect gastric mucosa, and regulation of intestinal flora. Six months later, she returned to the hospital and rechecked the colonoscopy. Pneumatosis cystoides intestinalis is a rare disease in the clinic, and its clinical manifestations are diverse and non-specific. In order to improve the understanding level of clinicians, the author summarized the diagnosis and treatment of 1 case of pneumatosis cystoides intestinalis with diarrhea as the main manifestation, and reported as follows.
文摘腹膜炎是全球重症监护病房患者败血症的第二大死亡原因,脓毒血症的早期预测对于及时干预并最终改善预后至关重要。本研究基于新型的机器学习算法,建立并验证腹膜炎患者发展为脓毒血症的预测模型,研究结果提示机器学习模型可以成为预测腹膜炎患者预测脓毒血症的可靠工具,并且,随机森林算法模型具有最佳的预测性能,这种机器学习方法可用于帮助临床医生对于高风险因素的认识并早期干预以降低死亡率。Peritonitis is the second leading cause of sepsis-related mortality in intensive care unit (ICU) patients worldwide. Early prediction of sepsis is critical for timely intervention and ultimately improving prognosis. This study established and validated a predictive model for the development of sepsis in peritonitis patients using novel machine learning algorithms. The findings suggest that machine learning models can be a reliable tool for predicting sepsis in peritonitis patients. Among them, the random forest algorithm model showed the best predictive performance. This machine learning approach can help clinicians recognize high-risk factors and intervene early to reduce mortality.
文摘目的研究5-羟色胺受体基因启动子区(5-HTTLPR)多态性与功能性消化不良(FD)发病之间的关系,为疾病提供临床治疗信息。方法计算机检索PubMed、EMbase、Web of Science、中国生物医学文献数据库、CNKI、万方等数据库,检索截止时间至2018年5月18日,筛选5-HTTLPR基因多态性与FD发病相关研究,运用Stata 12.0软件进行Meta分析。结果共纳入6篇研究,S(短)及L(长)等位基因组成5种遗传模型。SS+LS vs LL模型与FD发病风险相关(OR=0.50,95%CI:0.25～0.98),其余遗传模型与FD发病无关(SS vs LL+LS:OR=1.02,95%CI:0.70～1.50;SS vs LL:OR=1.01,95%CI:0.68～1.50;SS vs LS:OR=1.08,95%CI:0.70～1.68;S vs L:OR=0.96,95%CI:0.81～1.14),亚洲人群SS+LS vs LL模型与FD发病风险相关(OR=0.53,95%CI:0.29～0.97),其余模型未见明显相关,高加索人群各遗传模型与FD发病风险无关。剔除一篇文章后,无论汇总结果还是亚组分析均提示各遗传模型与FD发病风险无明显相关。结论无论在亚洲还是高加索人群中,5-HTTLPR基因多态性与FD发病风险无明显相关。
