Magnetic resonance(MR)imaging plays an important role in the diagnosis and staging of acute and chronic pancreatitis and may represent the best imaging technique in the setting of pancreatitis due to its unmatched sof...Magnetic resonance(MR)imaging plays an important role in the diagnosis and staging of acute and chronic pancreatitis and may represent the best imaging technique in the setting of pancreatitis due to its unmatched soft tissue contrast resolution as well as nonionizing nature and higher safety profile of intravascular contrast media,making it particularly valuable in radiosensitive populations such as pregnant patients,and patients with recurrent pancreatitis requiring multiple follow-up examinations.Additional advantages include the ability to detect early forms of chronic pancreatitis and to better differentiate adenocarcinoma from focal chronic pancreatitis.This review addresses new trends in clinical pancreatic MR imaging emphasizing its role in imaging all types of acute and chronic pancreatitis,pancreatitis complications and other important differential diagnoses that mimic pancreatitis.展开更多
Current understanding of autoimmune pancreatitis (AIP) recognizes a histopathological subtype of the disease to fall within the spectrum of IgG4-related disease. Along with clinical, laboratory, and histopathological ...Current understanding of autoimmune pancreatitis (AIP) recognizes a histopathological subtype of the disease to fall within the spectrum of IgG4-related disease. Along with clinical, laboratory, and histopathological data, imaging plays an important role in the diagnosis and management of AIP, and more broadly, within the spectrum of IgG4-related disease. In addition to the defined role of imaging in consensus diagnostic protocols, an array of imaging modalities can provide complementary data to address specific clinical concerns. These include contrast-enhanced computed tomography (CT) and magnetic resonance (MR) imaging for pancreatic parenchymal lesion localization and characterization, endoscopic retrograde and magnetic resonance cholangiopancreatography (ERCP and MRCP) to assess for duct involvement, and more recently, positron emission tomography (PET) imaging to assess for extra-pancreatic sites of involvement. While the imaging appearance of AIP varies widely, certain imaging features are more likely to represent AIP than alternate diagnoses, such as pancreatic cancer. While nonspecific, imaging findings which favor a diagnosis of AIP rather than pancreatic cancer include: delayed enhancement of affected pancreas, mild dilatation of the main pancreatic duct over a long segment, the “capsule” and “penetrating duct” signs, and responsiveness to corticosteroid therapy. Systemic, extra-pancreatic sites of involvement are also often seen in AIP and IgG4-related disease, and typically respond to corticosteroid therapy. Imaging by CT, MR, and PET also play a role in the diagnosis and monitoring after treatment of involved sites.展开更多
Tumors and cancers of the gastrointestinal tract and pancreas are commonly derived from precursor lesions so that understanding the physiological, cellular, and molecular mechanisms underlying the pathogenesis of prec...Tumors and cancers of the gastrointestinal tract and pancreas are commonly derived from precursor lesions so that understanding the physiological, cellular, and molecular mechanisms underlying the pathogenesis of precursor lesions is critical for the prevention and treatment of those neoplasms. Pancreatic neuroendocrine tumors(PNETs) can also be derived from precursor lesions. Pancreatic α cell hyperplasia(ACH), a specific and overwhelming increase in the number of α cells, is a precursor lesion leading to PNET pathogenesis. One of the 3 subtypes of ACH, reactive ACH is caused by glucagon signaling disruption and invariably evolves into PNETs. In this article, the existing work on the mechanisms underlying reactive ACH pathogenesis is reviewed. It is clear that the liver secretes a humoral factor regulating α cell numbers but the identity of the liver factor remains elusive. Potential approaches to identify the liver factor are discussed.展开更多
AIM: To evaluate the effect of dietary cholesterol and serum total cholesterol(TC) on the risk of pancreatic cancer. METHODS: A literature search was performed up to June 2014 in Pub Med, EMBASE, China National Knowle...AIM: To evaluate the effect of dietary cholesterol and serum total cholesterol(TC) on the risk of pancreatic cancer. METHODS: A literature search was performed up to June 2014 in Pub Med, EMBASE, China National Knowledge Infrastructure and China Biology Medicalliterature database for relevant articles published in English or Chinese. Pooled relative risks(RRs) with 95% confidence intervals(CIs) were calculated with a random-effects model. RESULTS: We included 14 published articles with 439355 participants for dietary cholesterol, and 6 published articles with 1805697 participants for serum TC. For the highest vs lowest category of dietary cholesterol, the pooled RR(95%CI) of pancreatic cancer was 1.308(1.097-1.559). After excluding two studies(RR > 3.0), the pooled RR(95%CI) was 1.204(1.050-1.380). In subgroup analysis stratified by study design, the pooled RRs(95%CIs) were 1.523(1.226-1.893) for case-control studies and 1.023(0.871-1.200) for cohort studies. The association of dietary cholesterol with the risk of pancreatic cancer was significant for studies conducted in North America [1.275(1.058-1.537)] and others [2.495(1.565-3.977)], but not in Europe [1.149(0.863-1.531)]. No significant association [1.003(0.859-1.171)] was found between the risk of pancreatic cancer and serum TC. CONCLUSION: Dietary cholesterol may be associated with an increased risk of pancreatic cancer in worldwide populations, except for Europeans. The results need to be confirmed further.展开更多
AIM: To assess the diagnostic accuracy of computed tomographic venography(CTV) for splanchnic vein thrombosis(SVT) detection in necrotizing acute pancreatitis(AP) patients.METHODS:Forty-three patients with necrotizing...AIM: To assess the diagnostic accuracy of computed tomographic venography(CTV) for splanchnic vein thrombosis(SVT) detection in necrotizing acute pancreatitis(AP) patients.METHODS:Forty-three patients with necrotizing AP who underwent both CTV and digital subtraction angiography(DSA)within 3 d were analyzed in this retrospective comparative study.All CTV procedures were performed with a dual-source CT scanner.The presence and location of SVT were determined via blinded imaging data analyses.RESULTS:According to the DSA results,17(39.5%)of the total 43 patients had SVT.The sensitivity,specificity,positive and negative predictive values of CTV for SVT detection were 100%(95%CI:77.1%-100%),92.3%(95%CI:73.4%-98.7%),89.5%(95%CI:65.5%-98.2%)and 100%(95%CI:82.8%-100%),respectively.CONCLUSION:CTV is an effective examination for SVT detection in patients with necrotizing AP with high positive and negative predictive values.展开更多
Acute mediastinitis is a fatal disease that usually originates from esophageal perforation and surgical infection.Rare cases of descending necrotizing mediastinitis can occur following oral cavity and pharynx infectio...Acute mediastinitis is a fatal disease that usually originates from esophageal perforation and surgical infection.Rare cases of descending necrotizing mediastinitis can occur following oral cavity and pharynx infection or can be a complication of pancreatitis.The most common thoracic complications of pancreatic disease are reactive pleural effusion and pneumonia,while rare complications include thoracic conditions,such as pancreaticopleural fistula with massive pleural effusion or hemothorax and extension of pseudocyst into the mediastinum.There have been no reports of acute mediastinitis originating from pancreatitis in South Korea.In this report,we present the case of a 50-year-old female suffering from acute mediastinitis with pleural effusion arising from recurrent pancreatitis that improved after surgical intervention.展开更多
A pancreatic pseudocyst(PPC)is a collection of pancreatic fluid enclosed by a non-epithelialized,fibrous or granulomatous wall.Endoscopic pancreatic pseudocyst drainage(PPD)has been widely used clinically to treat PPC...A pancreatic pseudocyst(PPC)is a collection of pancreatic fluid enclosed by a non-epithelialized,fibrous or granulomatous wall.Endoscopic pancreatic pseudocyst drainage(PPD)has been widely used clinically to treat PPCs.The success and complications of endoscopic PPD are comparable with surgical interventions.Stent displacement is a rare complication after endoscopic PPD.Almost all the complications of endoscopic PPD have been managed surgically,and there is rare report involving the endoscopic treatment of intraperitoneal stent displacement.We report here a case of stent displacementafter endoscopic ultrasound-and fluoroscopy-guided PPD in a 41-year-old female patient with a PPC in the tail of the pancreas.The endoscopic treatment was successfully performed to remove the displaced stent.The clinical course of the patient was unremarkable.The cyst had significantly reduced and disappeared by 12 wk.We found that both endoscopic ultrasound and fluoroscopy should be used during endoscopic PPD to avoid stent displacement.The displaced stent can be successfully treated by endoscopic removal.展开更多
Objective To understand the relationship among congenital choledochal c yst, anomalous junction of pancreaticobiliary duct (AJPBD) and pancreatitis Methods 25 children with choledochal cyst treated in our hospital w...Objective To understand the relationship among congenital choledochal c yst, anomalous junction of pancreaticobiliary duct (AJPBD) and pancreatitis Methods 25 children with choledochal cyst treated in our hospital were included in this study Their ages ranged from 2 months to 14 years Intraoperative cho la ngiography was performed in 24 children Pancreatic samples obtained from the h e ad and body of the pancreas at operation were observed under light and electron microscope Serum amylase was analyzed one week before and after operation resp e ctively Bile amylase in the cyst and gallbladder was measured at operation Results The incidence of AJPBD was 70%. Inflammatory cell infiltration and fibro us hyperplasia were seen in the pancreatic specimens of 5 children, of whom 4 ha d AJPBD No ultrastructural changes were found in 2 children without AJPBD, whi l e different changes were seen in 6 with AJPBD, including those showing no pathol ogical changes under light microscope All the changes became more severe as th e age of the patient increased The bile and serum amylase levels were higher in children with AJPBD than those without AJPBD ( P <005) Conclusion Congenital choledochal cyst has a close relationship with AJ PBD and pancreatitis Pancreatic pathological changes have a long and chronic c o urse from ultrastructural changes to macroscopic changes for the developing of p ancreatitis展开更多
S100A12 plays a key role in regulating the inflammation.It is mainly expressed in neutrophils.In early acute pancreatitis,neutrophils are activated and release a large number of cytokines and inflammatory medium—this...S100A12 plays a key role in regulating the inflammation.It is mainly expressed in neutrophils.In early acute pancreatitis,neutrophils are activated and release a large number of cytokines and inflammatory medium—this is a central link of the systemic inflammatory response caused by severe acute pancreatitis.S100A12 could real-timely reflect the severity of acute pancreatitis and can be used for monitoring the development and prognosis of the disease.展开更多
2010229 Expression and significance of phosphtidylinositol 3-kinase/protein kinase B signal transduction pathway in severe acute pancrceatitis-associated lung injury. KANG Xin(康新),et al. Dept Emerg Med,Zhongshan Hos...2010229 Expression and significance of phosphtidylinositol 3-kinase/protein kinase B signal transduction pathway in severe acute pancrceatitis-associated lung injury. KANG Xin(康新),et al. Dept Emerg Med,Zhongshan Hosp,Dalian Univ, Dalian 116001.Natl Med J China 2010;90(11):732-777.展开更多
目的探讨新诊断2型糖尿病(type 2 diabetes mellitus,T2DM)患者基线血钾水平对胰岛素抵抗指数(ho⁃meostasis model assessment for insulin resistance,HOMA-IR)及处置指数(disposition index at 120 minutes,DI120)的影响,分析血钾与...目的探讨新诊断2型糖尿病(type 2 diabetes mellitus,T2DM)患者基线血钾水平对胰岛素抵抗指数(ho⁃meostasis model assessment for insulin resistance,HOMA-IR)及处置指数(disposition index at 120 minutes,DI120)的影响,分析血钾与糖代谢指标的相关性。方法回顾性选取2024年1—12月湛江南油医院收治的新诊断86例T2DM患者的临床资料。根据基线血钾水平分为两组:血钾正常组(3.5~5.0 mmol/L,n=30)和血钾异常组(<3.5 mmol/L或>5.0 mmol/L,n=56)。收集基线特征、电解质、糖代谢及肾功能指标进行单因素分析,以连续变量形式纳入多因素Logistic回归分析血钾水平对HOMA-IR和DI120的影响。结果血钾异常组与血钾正常组的HOMA-IR、DI120、eGFR水平对比,差异均有统计学意义(P均<0.05)。多因素Logistic回归分析结果显示,HOMA-IR、eGFR和DI120是血钾异常的独立影响因素(P均<0.05)。结论新诊断T2DM患者中,血钾异常是胰岛素抵抗加重和早期胰岛素分泌功能受损的独立危险因素。维持血钾稳态,特别是预防和纠正血钾异常,可能成为改善患者糖代谢状况的新靶点。展开更多
目的:检测Hippo-YAP信号通路中主要效应蛋白Yes相关蛋白(Yes-associated protein,YAP)在正常胰腺组织和胰腺癌组织中的表达,探讨其表达强度与临床病理因素之间的关系及意义.方法:应用免疫组织化学EnVision法测定Hippo信号通路中YAP蛋白...目的:检测Hippo-YAP信号通路中主要效应蛋白Yes相关蛋白(Yes-associated protein,YAP)在正常胰腺组织和胰腺癌组织中的表达,探讨其表达强度与临床病理因素之间的关系及意义.方法:应用免疫组织化学EnVision法测定Hippo信号通路中YAP蛋白在45例胰腺癌及15例正常胰腺组织中的表达,应用RT-PCR方法检测YAP mRNA在45例胰腺癌及15例正常胰腺组织中的表达.结果:胰腺癌组织中YAP蛋白主要表达于胰腺导管上皮细胞,45例胰腺癌组织中YAP的阳性表达率为93.33%(42/45),15例正常胰腺组织中YAP阳性表达率为26.67%(4/15),两组间的表达差异具有统计学意义(2=27.95,P<0.01).在胰腺癌组织中YAP的表达与肿瘤分化程度密切相关(P=0.048),与年龄、性别、吸烟、饮酒、肥胖、糖耐量异常、糖尿病、慢性胰腺炎及临床分期等无关(P值分别是0.577、0.565、0.541、0.224、1.000、0.542、0.555、0.571、0.926).胰腺癌患者血清CA19-9水平与胰腺癌组织中YAP阳性程度呈正相关.YAP m R N A在胰腺癌组织中的表达较正常胰腺组织明显升高(0.3682±0.0783 vs 0.0394±0.0091,P<0.01).结论:Hippo-YAP通路可能在胰腺癌的发生、发展中发挥重要作用.并有可能成为胰腺癌治疗中新的靶点.展开更多
目的探讨双胆总管(double common bile duct,DCBD)变异在肝胆外科手术中的意义。方法分析笔者所在医院2010年7～12月期间收治的2例DCBD变异患者的临床资料,同时复习了DCBD的相关文献。结果 2例病例中1例在行腹腔镜胆囊切除术时误判右肝...目的探讨双胆总管(double common bile duct,DCBD)变异在肝胆外科手术中的意义。方法分析笔者所在医院2010年7～12月期间收治的2例DCBD变异患者的临床资料,同时复习了DCBD的相关文献。结果 2例病例中1例在行腹腔镜胆囊切除术时误判右肝管为胆囊管而将其横断;另一例于术中经胆道造影及胆道镜检查证实为DCBD,因合并胆总管囊肿、胆胰管汇合异常(anomalous pancreaticobiliary ductal junction,APBDJ)及原发性肝内外胆管结石而行手术治疗。2例均为Ⅴb型DCBD。复习DCBD英文文献32篇,自1932年始共报道DCBD病例100例,其中以Ⅱ型和Ⅲ型最常见,Ⅴ型DCBD仅报道10例。自1994～2012年中文文献25篇,共收集DCBD 27例,其中以Ⅴ型最常见。本组2例为Ⅴb型DCBD。副胆总管(accessory common bile duct,ACBD)最常见开口于十二指肠、胃及胰管,常见合并症包括结石、APBDJ、胆总管囊肿、肿瘤等。结论 DCBD是极少见的肝外胆管解剖变异,常伴有胆管结石以及胆总管囊肿、APBDJ等其他胆道解剖异常,并潜在致癌的可能;增加了医源性胆管损伤的风险和胆道手术的复杂性,必须引起肝胆外科医师的高度重视。展开更多
文摘Magnetic resonance(MR)imaging plays an important role in the diagnosis and staging of acute and chronic pancreatitis and may represent the best imaging technique in the setting of pancreatitis due to its unmatched soft tissue contrast resolution as well as nonionizing nature and higher safety profile of intravascular contrast media,making it particularly valuable in radiosensitive populations such as pregnant patients,and patients with recurrent pancreatitis requiring multiple follow-up examinations.Additional advantages include the ability to detect early forms of chronic pancreatitis and to better differentiate adenocarcinoma from focal chronic pancreatitis.This review addresses new trends in clinical pancreatic MR imaging emphasizing its role in imaging all types of acute and chronic pancreatitis,pancreatitis complications and other important differential diagnoses that mimic pancreatitis.
文摘Current understanding of autoimmune pancreatitis (AIP) recognizes a histopathological subtype of the disease to fall within the spectrum of IgG4-related disease. Along with clinical, laboratory, and histopathological data, imaging plays an important role in the diagnosis and management of AIP, and more broadly, within the spectrum of IgG4-related disease. In addition to the defined role of imaging in consensus diagnostic protocols, an array of imaging modalities can provide complementary data to address specific clinical concerns. These include contrast-enhanced computed tomography (CT) and magnetic resonance (MR) imaging for pancreatic parenchymal lesion localization and characterization, endoscopic retrograde and magnetic resonance cholangiopancreatography (ERCP and MRCP) to assess for duct involvement, and more recently, positron emission tomography (PET) imaging to assess for extra-pancreatic sites of involvement. While the imaging appearance of AIP varies widely, certain imaging features are more likely to represent AIP than alternate diagnoses, such as pancreatic cancer. While nonspecific, imaging findings which favor a diagnosis of AIP rather than pancreatic cancer include: delayed enhancement of affected pancreas, mild dilatation of the main pancreatic duct over a long segment, the “capsule” and “penetrating duct” signs, and responsiveness to corticosteroid therapy. Systemic, extra-pancreatic sites of involvement are also often seen in AIP and IgG4-related disease, and typically respond to corticosteroid therapy. Imaging by CT, MR, and PET also play a role in the diagnosis and monitoring after treatment of involved sites.
基金Supported by National Cancer Institute of the National Institutes of Health,No.R00CA138914(YT)National Natural Science Foundation,No.81372216(YT)
文摘Tumors and cancers of the gastrointestinal tract and pancreas are commonly derived from precursor lesions so that understanding the physiological, cellular, and molecular mechanisms underlying the pathogenesis of precursor lesions is critical for the prevention and treatment of those neoplasms. Pancreatic neuroendocrine tumors(PNETs) can also be derived from precursor lesions. Pancreatic α cell hyperplasia(ACH), a specific and overwhelming increase in the number of α cells, is a precursor lesion leading to PNET pathogenesis. One of the 3 subtypes of ACH, reactive ACH is caused by glucagon signaling disruption and invariably evolves into PNETs. In this article, the existing work on the mechanisms underlying reactive ACH pathogenesis is reviewed. It is clear that the liver secretes a humoral factor regulating α cell numbers but the identity of the liver factor remains elusive. Potential approaches to identify the liver factor are discussed.
文摘AIM: To evaluate the effect of dietary cholesterol and serum total cholesterol(TC) on the risk of pancreatic cancer. METHODS: A literature search was performed up to June 2014 in Pub Med, EMBASE, China National Knowledge Infrastructure and China Biology Medicalliterature database for relevant articles published in English or Chinese. Pooled relative risks(RRs) with 95% confidence intervals(CIs) were calculated with a random-effects model. RESULTS: We included 14 published articles with 439355 participants for dietary cholesterol, and 6 published articles with 1805697 participants for serum TC. For the highest vs lowest category of dietary cholesterol, the pooled RR(95%CI) of pancreatic cancer was 1.308(1.097-1.559). After excluding two studies(RR > 3.0), the pooled RR(95%CI) was 1.204(1.050-1.380). In subgroup analysis stratified by study design, the pooled RRs(95%CIs) were 1.523(1.226-1.893) for case-control studies and 1.023(0.871-1.200) for cohort studies. The association of dietary cholesterol with the risk of pancreatic cancer was significant for studies conducted in North America [1.275(1.058-1.537)] and others [2.495(1.565-3.977)], but not in Europe [1.149(0.863-1.531)]. No significant association [1.003(0.859-1.171)] was found between the risk of pancreatic cancer and serum TC. CONCLUSION: Dietary cholesterol may be associated with an increased risk of pancreatic cancer in worldwide populations, except for Europeans. The results need to be confirmed further.
文摘AIM: To assess the diagnostic accuracy of computed tomographic venography(CTV) for splanchnic vein thrombosis(SVT) detection in necrotizing acute pancreatitis(AP) patients.METHODS:Forty-three patients with necrotizing AP who underwent both CTV and digital subtraction angiography(DSA)within 3 d were analyzed in this retrospective comparative study.All CTV procedures were performed with a dual-source CT scanner.The presence and location of SVT were determined via blinded imaging data analyses.RESULTS:According to the DSA results,17(39.5%)of the total 43 patients had SVT.The sensitivity,specificity,positive and negative predictive values of CTV for SVT detection were 100%(95%CI:77.1%-100%),92.3%(95%CI:73.4%-98.7%),89.5%(95%CI:65.5%-98.2%)and 100%(95%CI:82.8%-100%),respectively.CONCLUSION:CTV is an effective examination for SVT detection in patients with necrotizing AP with high positive and negative predictive values.
文摘Acute mediastinitis is a fatal disease that usually originates from esophageal perforation and surgical infection.Rare cases of descending necrotizing mediastinitis can occur following oral cavity and pharynx infection or can be a complication of pancreatitis.The most common thoracic complications of pancreatic disease are reactive pleural effusion and pneumonia,while rare complications include thoracic conditions,such as pancreaticopleural fistula with massive pleural effusion or hemothorax and extension of pseudocyst into the mediastinum.There have been no reports of acute mediastinitis originating from pancreatitis in South Korea.In this report,we present the case of a 50-year-old female suffering from acute mediastinitis with pleural effusion arising from recurrent pancreatitis that improved after surgical intervention.
文摘A pancreatic pseudocyst(PPC)is a collection of pancreatic fluid enclosed by a non-epithelialized,fibrous or granulomatous wall.Endoscopic pancreatic pseudocyst drainage(PPD)has been widely used clinically to treat PPCs.The success and complications of endoscopic PPD are comparable with surgical interventions.Stent displacement is a rare complication after endoscopic PPD.Almost all the complications of endoscopic PPD have been managed surgically,and there is rare report involving the endoscopic treatment of intraperitoneal stent displacement.We report here a case of stent displacementafter endoscopic ultrasound-and fluoroscopy-guided PPD in a 41-year-old female patient with a PPC in the tail of the pancreas.The endoscopic treatment was successfully performed to remove the displaced stent.The clinical course of the patient was unremarkable.The cyst had significantly reduced and disappeared by 12 wk.We found that both endoscopic ultrasound and fluoroscopy should be used during endoscopic PPD to avoid stent displacement.The displaced stent can be successfully treated by endoscopic removal.
文摘Objective To understand the relationship among congenital choledochal c yst, anomalous junction of pancreaticobiliary duct (AJPBD) and pancreatitis Methods 25 children with choledochal cyst treated in our hospital were included in this study Their ages ranged from 2 months to 14 years Intraoperative cho la ngiography was performed in 24 children Pancreatic samples obtained from the h e ad and body of the pancreas at operation were observed under light and electron microscope Serum amylase was analyzed one week before and after operation resp e ctively Bile amylase in the cyst and gallbladder was measured at operation Results The incidence of AJPBD was 70%. Inflammatory cell infiltration and fibro us hyperplasia were seen in the pancreatic specimens of 5 children, of whom 4 ha d AJPBD No ultrastructural changes were found in 2 children without AJPBD, whi l e different changes were seen in 6 with AJPBD, including those showing no pathol ogical changes under light microscope All the changes became more severe as th e age of the patient increased The bile and serum amylase levels were higher in children with AJPBD than those without AJPBD ( P <005) Conclusion Congenital choledochal cyst has a close relationship with AJ PBD and pancreatitis Pancreatic pathological changes have a long and chronic c o urse from ultrastructural changes to macroscopic changes for the developing of p ancreatitis
文摘S100A12 plays a key role in regulating the inflammation.It is mainly expressed in neutrophils.In early acute pancreatitis,neutrophils are activated and release a large number of cytokines and inflammatory medium—this is a central link of the systemic inflammatory response caused by severe acute pancreatitis.S100A12 could real-timely reflect the severity of acute pancreatitis and can be used for monitoring the development and prognosis of the disease.
文摘2010229 Expression and significance of phosphtidylinositol 3-kinase/protein kinase B signal transduction pathway in severe acute pancrceatitis-associated lung injury. KANG Xin(康新),et al. Dept Emerg Med,Zhongshan Hosp,Dalian Univ, Dalian 116001.Natl Med J China 2010;90(11):732-777.
文摘目的探讨新诊断2型糖尿病(type 2 diabetes mellitus,T2DM)患者基线血钾水平对胰岛素抵抗指数(ho⁃meostasis model assessment for insulin resistance,HOMA-IR)及处置指数(disposition index at 120 minutes,DI120)的影响,分析血钾与糖代谢指标的相关性。方法回顾性选取2024年1—12月湛江南油医院收治的新诊断86例T2DM患者的临床资料。根据基线血钾水平分为两组:血钾正常组(3.5~5.0 mmol/L,n=30)和血钾异常组(<3.5 mmol/L或>5.0 mmol/L,n=56)。收集基线特征、电解质、糖代谢及肾功能指标进行单因素分析,以连续变量形式纳入多因素Logistic回归分析血钾水平对HOMA-IR和DI120的影响。结果血钾异常组与血钾正常组的HOMA-IR、DI120、eGFR水平对比,差异均有统计学意义(P均<0.05)。多因素Logistic回归分析结果显示,HOMA-IR、eGFR和DI120是血钾异常的独立影响因素(P均<0.05)。结论新诊断T2DM患者中,血钾异常是胰岛素抵抗加重和早期胰岛素分泌功能受损的独立危险因素。维持血钾稳态,特别是预防和纠正血钾异常,可能成为改善患者糖代谢状况的新靶点。
文摘目的:检测Hippo-YAP信号通路中主要效应蛋白Yes相关蛋白(Yes-associated protein,YAP)在正常胰腺组织和胰腺癌组织中的表达,探讨其表达强度与临床病理因素之间的关系及意义.方法:应用免疫组织化学EnVision法测定Hippo信号通路中YAP蛋白在45例胰腺癌及15例正常胰腺组织中的表达,应用RT-PCR方法检测YAP mRNA在45例胰腺癌及15例正常胰腺组织中的表达.结果:胰腺癌组织中YAP蛋白主要表达于胰腺导管上皮细胞,45例胰腺癌组织中YAP的阳性表达率为93.33%(42/45),15例正常胰腺组织中YAP阳性表达率为26.67%(4/15),两组间的表达差异具有统计学意义(2=27.95,P<0.01).在胰腺癌组织中YAP的表达与肿瘤分化程度密切相关(P=0.048),与年龄、性别、吸烟、饮酒、肥胖、糖耐量异常、糖尿病、慢性胰腺炎及临床分期等无关(P值分别是0.577、0.565、0.541、0.224、1.000、0.542、0.555、0.571、0.926).胰腺癌患者血清CA19-9水平与胰腺癌组织中YAP阳性程度呈正相关.YAP m R N A在胰腺癌组织中的表达较正常胰腺组织明显升高(0.3682±0.0783 vs 0.0394±0.0091,P<0.01).结论:Hippo-YAP通路可能在胰腺癌的发生、发展中发挥重要作用.并有可能成为胰腺癌治疗中新的靶点.
文摘目的探讨双胆总管(double common bile duct,DCBD)变异在肝胆外科手术中的意义。方法分析笔者所在医院2010年7～12月期间收治的2例DCBD变异患者的临床资料,同时复习了DCBD的相关文献。结果 2例病例中1例在行腹腔镜胆囊切除术时误判右肝管为胆囊管而将其横断;另一例于术中经胆道造影及胆道镜检查证实为DCBD,因合并胆总管囊肿、胆胰管汇合异常(anomalous pancreaticobiliary ductal junction,APBDJ)及原发性肝内外胆管结石而行手术治疗。2例均为Ⅴb型DCBD。复习DCBD英文文献32篇,自1932年始共报道DCBD病例100例,其中以Ⅱ型和Ⅲ型最常见,Ⅴ型DCBD仅报道10例。自1994～2012年中文文献25篇,共收集DCBD 27例,其中以Ⅴ型最常见。本组2例为Ⅴb型DCBD。副胆总管(accessory common bile duct,ACBD)最常见开口于十二指肠、胃及胰管,常见合并症包括结石、APBDJ、胆总管囊肿、肿瘤等。结论 DCBD是极少见的肝外胆管解剖变异,常伴有胆管结石以及胆总管囊肿、APBDJ等其他胆道解剖异常,并潜在致癌的可能;增加了医源性胆管损伤的风险和胆道手术的复杂性,必须引起肝胆外科医师的高度重视。
