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Objective To evaluate the value of serum soluble transferrin receptor ( sTFR) and sTFR-ferritin index (sTFR/LogSF) in diagnosing iron deficiency anemia ( IDA) with inflammatory bowel disease ( IBD) . Methods 161 patients with diagnosis of IBD was continuous collected, including 81 cases of Crohn's disease ( CD) and 80 cases of ulcerative colitis( UC) . Drawing venous blood to check complete blood count, iron metabolism, CRP, folic acid and vitamin B12 (VitB12) in the next morning with an empty stomach. According to the WHO anemia diag-nostic criterion, patients were divided into anemia group and non anemia group. The incidence and etiology of IBD were analysed. All patients with IBD were divided into iron deficiency anemia group and non iron deficiency group based on SF. Receiver-operating characteristic curve ( ROC curve) were applied to evaluate the value of sTFR and sTFR/LogSF in diagnosis of IDA with IBD. All the cases were followed till the endpoint of the study, lasted for 12 months at least. Results The incidence of IBD combined with anemia was 62. 1% (100/161), among which IDA and ACD hold up to 40. 0 % (40/100) and 14. 0% (14/100) respectively, while the mix of IDA and ACD ac-count for 26. 0% (26/100), and 10. 0% (10/100) was taken by lack of folic acid and VitB12. The level of sTFR and sTFR/LogSF in IDA group were obviously higher than those in non IDA group,and this difference was statisti-cally significant (U=655. 5,306. 0,P ＜0. 001). The AUC of sTFR/LogSF (0. 937) was higher than the AUC (0. 865) of sTFR. High sTfR levels ( ＞4. 7 mg/L) had a sensitivity of 77. 5% and a specificity of 86. 0%, whereas high sTfR/LogSF ( ＞2. 8) had a sensitivity of 87. 5% and a specificity of 90. 9% for the diagnosis of IDA. Both sTFR and sTFR/LogSF index were not correlated with CRP levels (r=0. 042,0. 958, P＞0. 05). Con-clusion The incidence of IBD combined anemia is high,among which IDA is common. By detecting serum sTFR/LogSF and sTfR,the diagnosis of IBD combined IDA may be more accurate.
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Objective To investigate the cumulative effective dose (CED) of ionizing radiation received by patients with Crohn's disease(CD) and to identify the risk factors associated with high levels of radiation in patients with Crohn's disease. Methods A total of 230 patients were enrolled. The classification of CD was according to the Montreal standards, and the CED of each patient was calculated retrospectively based on standards tables. High levels of radiation was defined as no less than 50 mSv CED. Patients who accepted no less than 50 mSv CED were assigned to high level of the radiation group, and those who accepted simultaneously less than 50 mSv CED were assigned to the control group. The risk factors for patients associating with high levels of radiation were analyzed by Logistic regression. Results CT enterography and abdominopelvic CT accounted for 52. 1％ and 39. 6％, respectively, and add up to 91. 7％ of total CED. The mean CED received per patient was 34. 07 mSv (95％ CI:30. 845～37. 304), and 51 patients (22. 2％ of total patients) with CD were exposed to no less than 50 mSv CED. Patients with long disease duration, surgical intervention, ileal location, stricturing or penetrating pattern received a higher dose of radiation. In a Logistic regression, stricturing or penetrating pattern(OR =3. 711, 95％ CI:2. 239 ～ 6. 151, P ＜0. 001) and the requirement for azathioprine (OR =4. 218, 95％ CI: 1. 221 ～14. 579,P=0. 023) were independent risk factors for the high levels of radiation in CD. Conclusion More than one in five of patients with CD are exposed to high levels of ionizing radiation, mainly caused by CT examination. Stricturing or penetrating pattern and the usage of azathioprine are independent risk factors for the high levels exposure of radiation in CD patients. During the clinical management and follow-up, it is important to either monitor the effective dose received per patient, minimizing unnecessary CT examination, or to transform to use no radiation imaging examination, such as MR enterography.
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Objective To evaluate the value of fecal calprotectin (FC) and stool lactoferrin (SL) for detecting endoscopic activity and monitoring postoperative recurrence of Crohn disease.Methods Publications in Pubmed,Embase,Science Direct,Springer Link,CBM,Cnki,Wan fang and VIP database before January 1 st 2016 were searched manually.Papers were screened according to inclusion and exclusion criteria.Quality assessment was conducted by QUADAS-2 scale.Meta-Disc 1.4 was used to analyze the heterogeneity of included articles.The pooled sensitivity,specificity,positive likelihood,negative likelihood were calculated respectively and the SROC curve was drawn.Stata 12.0 was used to assess the publication bias.Results A total of 19 papers in English language were included.The pooled sensitivities of FC,SL in detecting endoscopic activity and FC in monitoring postoperative recurrence of Crohn disease were 86％ (95％ CI:84％-88％),72％ (95 ％ CI:66％-79％),80％ (95％ CI:75％-84％),respectively.The specificities were 71％ (95％CI:67％-75％),84％ (95％ CI:74％-91％),65％ (95％ CI:59％-70％),respectively.The areas under the SROC curve were 0.865 6,0.834 6,0.811 0 respectively.The cut-off values of FC in detecting endoscopic activity of Crohn disease were set to ＜ 100 μg/g,100-＜200 μg/g or ≥ 200 μg/g with the area under the SROC curve being 0.898 7,0.788 8,0.888 8,respectively.The cut-off values of FC in monitoring postoperative recurrence of Crohn disease were set to 100-＜ 150 μg/g,150-＜200 μg/g or ≥ 200 μg/g with the areas under the SROC curve being 0.677 4,0.859 4 and 0.759 5,respectively.Conclusion FC and SL have higher diagnostic efficiency than C-reaction protein and are worthy of clinical promotion in detecting endoscopic activity and monitoring postoperative recurrence of Crohn disease.However,endoscopy cannot be replaced.
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OBJECTIVE:To explore the clinical related factors of leucopenia induced by azathioprine in the treatment of inflam-matory bowel disease (IBD). METHODS:Clinical information of 114 IBD patients were collected from our hospital during Jan. 2013-Mar. 2015. Steady concentration of AZA metabolite 6-thioguanine(6-TGNs)in red blood cell was determined by HPLC. The correlation of patient’s gender,age,diseases,AZA daily dose and blood concentration of 6-TGNs with leucopenia induced by AZA were investigated. The optimal critical value of leucopenia could be predicted with ROC curves. RESULTS:Among 114 IBD patients,40 patients suffered from leucopenia(35.1%). There was no statistical significance in the proportion of leucopenia among patients with different age,gender,diseases and AZA daily dose(P>0.05). There was statistical significance in the proportion of leucopenia among patients with different concentrations of 6-TGNs(P291.04 pmol/(8 × 108)RBC. CONCLUSIONS:AZA induced leucopenia may be related to the concentration of 6-TGNs in red blood cell of IBD patients,and high concentration of 6-TGNs is risk factors of leucopenia. Clinicians can provide AZA individual treatment for IBD patient to reduce the occurrence of leucopenia according to routine blood test and the concentra-tion of 6-TGNs.
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Objective To evaluate the efficacy and safety of Houpu Paiqi mixture in treatment of functional dyspepsia (FD)with abdominal distension symptom.Methods From July 2014 to June 2015 , in nine centers,a total of 162 FD patients with abdominal distension symptom and met Rome Ⅲpostprandial distress syndrome (PDS)diagnostic criteria were enrolled.All patients were randomly divided into trial group and control group,81 patients in either group.The patients of trial group and control group took Houpu Paiqi mixture or placebo,respectively,25 mL per time,twice daily,and both the courses of treatment were two weeks.Before and after the treatment,the improvement of main symptoms,total clinical efficacy rate and efficacy of traditional medicine between two groups were compared.Chi square test,Fisher exact probability method and Wilcoxon test were performed for statistical analysis.Results According to the results of per-protocol (PP)analysis,the total efficacy rate of trial group and control group was 69.4% (50/72)and 59.2% (42/71),respectively,and there was no statistically significant difference in total efficacy rate between the two groups (χ2 =1 .650,P =0.199 ). And there was no statistically significant difference in the improvement of PDS main symptoms(postprandial fullnessand early satiety)between the two groups (56.3% ±27.9% vs 54.4% ±32.1%,t =0.606,P =0.727 ).For those with baseline symptom score over 14,median early satiety score of trial group after the treatment was 0,which was lower than that of control group,and the difference was statistically significant (Z =-2.370,P =0.018).The total efficacy rate of traditional medicine of trial group was 80.8% (59/73 )and that of control group was 72.0% (54/75 ),and the difference was not statistically significant (χ2 = 0.676,P =0.411 ).Conclusion Houpu Paiqi mixture has certain efficacy in FD with abdominal distension,and could be used for the treatment of PDS-predominant FD.
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Objective To evaluate the role of serum immunoglobulin G4 (IgG4) in differentiating autoimmune pancreatitis (AIP) from pancreatic cancer(PC).Methods The database,including Medline,EMBASE,Science Direct,Springer link,CBM,Wanfang,VIP and Cnki were searched by computer and the publication date was before April 1,2015.The studies on evaluating the accuracy of IgG4 in differentiating AIP from PC were screened and selected according to strict determined inclusion and exclusion criteria.Quality assessment was made by QUADAS scale.The publication bias were assessed by Stata12.0 software.The heterogeneity of included articles,calculate the pooled sensitivity,specificity,positive likelihood,negative likelihood were anylyzed by Meta-Disc1.4 software,respectively,and draw the summary ROC (SROC) curve.Results A total of 13 English articles were included and 1403 patients were involved.The pooled sensitivity was 74％ (95％ CI 70％ ～ 78％),the pooled specificity was 93％ (95％ CI 91％ ～ 95％),the positive likelihood ratio was 10.74 (95％ CI 7.16 ～ 16.11),the negative likelihood ratio was 0.25 (95％ CI 0.17 ～0.35) and the area under SROC curve was 0.9340.Conclusions IgG4 has high diagnostic efficacy but low misdiagnosis rate in differentiating AIP from PC,which can be used as one of early diagnostic markers for AIP.
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Objective To explore the risk factors associated with surgery and postoperative recurrence in patients with Crohn's disease (CD).Methods A total of 183 patients diagnosed as CD from January 2008 to December 2013 were enrolled.Forty-six patients after surgery were assigned to surgery group,and 137 non-surgical CD patients were assigned to control group.All the patients were followed up until the endpoint of the study or death,and the follow-up period was at least 12 months.Typing was according to the Montreal classification.The risk factors associated with surgery and postoperative recurrence were analyzed by Logistic regression.Results The surgery rate of CD patients was 25.1 ％ (46/183),the postoperative clinical recurrence rate of surgery group was 39.1％ (18/46),and the recurrence time was 20 months (7～42 months).Before surgery,the rate of definite diagnosis of CD was only 13.0％ (6/46).Stricture (odd ratio (OR)=5.836,95％ confidence interval (CI) 2.199 to 15.487,P＜0.01) and penetration (OR=25.706,95％oo CI 7.091 to 93.190,P＜0.01) were independent risk factors for the surgery.Furthermore,perianal disease(OR=23.550,95％CI 1.311 to 422.912,P=0.032) and lack of prophylaxes treatment after surgery (OR=58.701,95％CI 1.803 to 1 991.000,P=0.022) were independent risk factors for postoperative clinical recurrence.Conclusions Stricture and penetration are risk factors for surgery.Perianal disease and lack of prophylaxes treatment after surgery are risk factors for postoperative clinical recurrence.
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Objective To explore the clinical characteristics and medicine treatment of patients with severe ulcerative colitis (UC),the efficacy of rescue treatment in patients with glucocorticoid (GCS) resistant severe UC,and the clinical risk factors in patients with GCS-refractory severe UC.Methods From January 2001 to December 2012,clinical,laboratory,endoscopy,imaging data and medication of treatment of 106 patients with severe UC were retrospectively analyzed.Then the patients were followed up,and the clinical efficacy and under endoscopic presentation of Mayo score were evaluated.Logistic regression analysis was performed to analyze the high risk factor of GCS-refractory severe UC.Results Among 106 patients with severe UC,95 were chronic relapse type accounting for 89.6 ％.The percentage of patients with defecation times over six was 73.6％ (78/106),with severe purulent bloody stool was 51.0％ (54/106),and with moderately or severe abdominal pain was 83.0％ (88/106).The percentage of diffuse colon type was 83.0％ (88/106),endoscopic presentation of Mayo score over two was 87.7％ (93/106).Hemoglobin decreased in 65.1％ (69/106) patients,blood platelet increased in 48.1％ (51/106) patients,C-reaction protein elevated in 88.7％ (94/106) patients,and hypoalbuminemia decreased in 42.5％ (45/106) patients.Account to 89.6％ (95/106) of patients with severe UC received GCS treatment,and the percentage of induced remission was 64.2％ (61/95),effective rate was 16.8％ (16/95),and ineffective rate was 18.9％ (18/95).The percentage of GCS refractory was 35.8％(34/95).There were 23 patients with GCS resistance and 11 patients with GCS dependence.Ten patients with GCS resistant severe UC accepted medicine rescue therapy.Five cases were treated with cyclosporin A,of which two cases induced remission,one case was effective,and two cases were ineffective.Another five cases were treated with infliximab,of which three cases induced remission,and two cases were ineffective.The results of Logistic regression analysis showed that severe anemia (OR=6.750,95％CI:2.656 to 17.152,P＜0.01),elevated blood platelets (OR=4.032,95％CI:1.226 to 13.261,P=0.015) and albumin level less than 25 g/L (OR =3.022,95 ％ CI:1.236 to 7.390,P =0.022) were risk factors of GCS-refractory severe UC.Conclusions GCS resistant or dependent occurred in part of patients with severe UC.Patients with G-CS resistant severe UC receive rescue treatment of cyclosporin A or infliximab.Severe anemia,elevated blood platelets,albumin less than 25 g/L may be clinical predicting factors in patients with GCS-refractory severe UC.
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Objective To investigate clinical characteristics and outcome of patients with liver cirrhosis complicated with diabetes,and to explore the differences of clinical characteristics and prognosis between hepatogenous diabetes (HD) and type 2 diabetes mellitus (T2DM).Methods From November 2010 to April 2012,246 patients with liver cirrhosis were collected and divided into liver cirrhosis complicated with diabetes (LC-DM) group (n=72) and liver cirrhosis without diabetes (LC) group (n=174).LC-DM group was then sub-divided into HD group (n=33) and T2DM group (n =39).All the patients were followed up until death or the study endpoint.The clinical characteristics,prognosis and indicators of glucose metabolism were compared and analyzed.Oral glucose tolerance test and insulin C-peptide release test were conducted in part of patients in LC-DM group.Student t test was performed for mean comparison between two groups.Chi-square test was used for count data and rate comparison between two groups.The death related factors of liver cirrhosis were analyzed by Logistic regression analysis.Results The percentage of alcoholic liver cirrhosis of LC-DM group was 18.1 ％ (13/72),which was higher than that of LC group (6.9％,12/ 174) and the difference was statistically significant (x2=6.946,P=0.008).In HD group,the percentage of patients with diabetes family history was 9.1％ (3/33),which was lower than that of T2DM group (30.8％,12/39),the percentage of alcoholic liver cirrhosis was 30.3％ (10/33),which was higher than that of T2DM group (7.7％,3/39),the total bilirubin level ((43.4±57.7) μmol/L) was higher than that of T2DM group ((22.6 ± 13.3) μmol/L),the total cholesterol level ((3.3 ±1.2) mmol/L) was lower than that of T2DM group ((4.0±1.6) mmol/L),and the differences were statistically significant (x2=5.093 and 6.177,t=2.178 and 2.014,P=0.024,0.013,0.033 and 0.048).The duration of hospitalization,Chiid-Pugh score,the incidence of upper gastrointestinal bleeding,the incidence of hepatic encephalopathy,electrolyte disturbances and mortality of LC-DM group were all higher than those of LC group and the differences were statistically significant(t=2.389 and 2.270,x2 =6.496,5.572,5.194,19.646,all P＜0.05),and there was no significant difference between HD group and T2DM group(all P＞0.05).The blood glucose levels of HD group at different time point (0,30,60,120,180 min) were all lower than those of T2DM group and the differences were statistically significant (t=3.175,2.345,3.444,3.090,3.542,all P＜0.05).The fasting insulin level of HD group was close to that of T2DM group,the insulin levels of HD group at other time point (30,60,120,180 min) were all higher than those of T2DM group and the differences were statistically significant (t =3.084,2.881,3.648,2.840,all P＜ 0.05).There was obvious hyperinsulinemia in HD group.At 0,30,60,120,180 min,C-peptide level of HD group was at normal levels,and which of T2DM group was lower than normal.Child-Pugh grade C was an independent predictor factor of death in patients with liver cirrhosis (OR =3.056,95 ％ CI:1.268 ～ 7.346,P=0.013).Conclusions Compared with liver cirrhosis patients without diabetes,the liver function of patients complicated with diabetes was worse,and the incidence of complication and mortality was higher.However there was no significant difference between HD group and T2DM group.
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Objective To screen the prevalence of nutritional risk in cirrhotic inpatients by Nutritional Risk Screening 2002 (NRS 2002) and explore the relationship between nutritional risks and outcomes.Methods NRS 2002 was used to identify the nutritional risk of 200 cirrhotic inpatients between May 2010 and May 2011.The Child-Turcotte-Pugh (CTP) grade,fatality,complications,and length of stay within 6 months were followed up to explore the relationship between nutritional risks and outcomes.Results The prevalence of nutritional risk screened by NRS 2002 was 53.5％ in cirrhotic patients.The prevalence of nutritional risk was 39.0％,59.4％,and 60.0％ respectively in patients with CTP grade A,B,and C (P =0.029).Compared with those without nutritional risks,patients with nutritional risks had significantly higher incidences of complications and fatality (P =0.000 and 0.013) and longer hospital stay (P =0.001).Conclusion The nutritional risk increases along with the CTP grade.Patients with nutritional risks tend to have poorer outcomes.The influence of nutrition support on the outcome of patients with liver diseases needs further research.
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Objective To investigate recurrence of colorectal adenoma (CRA)after polypectomies and colonoscopic surveillance,and to explore risk factors related to CRA recurrence.MethodsFrom June 2005 to December 2009,in the Fist Affiliated Hospital of Anhui Medical University,the clinical data of 283 hospitalized patients who underwent CRA polypectomy and met the study criteria were collected and followed up.The recurrence rate of CRA after polypectomies,the relationship between colonoscopic surveillance interval and CRA recurrence and risk factors related to recurrence were analyzed.The colonoscopic surveillance interval,frequency and the reason for no colonoscopic surveillance were also analyzed.ResultsA total of 235 post-polypectomies CRA patients were successfully followed up,the follow-up rate was 83.0％ (235/283).The shortest follow-up period was 12 months and the longest was 66 months,the median follow-up time was (35.1 ± 14.2)months.A total of 115 patients were underwent colonoscopic surveillances,the surveillance rate was 49.4％ (115/233).The recurrence rate was 45.0％ (50/111) in colonoscopic surveillance group.A total of 118 patients were without colonoscopic surveillances.Age over 60 years,body mass index over 25 kg/m2 and multiple adenomas (≥ 2) were significantly related with CRA recurrence,and the difference was statistical significant (P＜ 0.05).The rate of awareness that CRA needed regular surveillance group without surveillonce was significantly lower than that of group with surveillance.(P＜0.01).ConclusionThe recurrence rate of CRA after polypectomies is high.Age,high body mass index and multiple adenomas are predicted independent risk factors for CRA recurrence.Lacking awareness of the importance of regular surveillances after polypectomies is the main reason for low colonoscopic surveillance rate after polypectomies in our hospital.
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Objective To explore the clinical correlation of the variation of plasma homocysteine (HCY), melatonin (MLT) and ulceative colitis (UC). Methods The clinical data of 112 UC patients was collected, and 110 normal healthy persons as control. The level of plasma HCY and MLT was detected by high pressure liquid chromatography-fluorescence detection (HPLC-FD) method. The level of plasma folate ( FA) and vitamin B12 was detected by enzyme-linked immunosorbent assay (ELISA) method. The correlation of these four indexes and UC was analyzed. Results The serum level of HCY in UC patients was significantly higher than that in normal healthy persons [(11. 27± 7.26) μmol/L vs (8. 19±4. 81) μmol/L, P = 0. 000]. The serum level of MLT in UC patients was significantly lower than that in normal healthy persons [(49. 06 + 31. 40) pg/ml vs (64. 28±41. 16) pg/ml,P=0. 008]. The serum level of FA in UC patients was significantly lower than that in normal healthy persons [(7. 64 + 1.95) nmol/L vs (9. 14 + 1.23) nmol/L, P = 0. 005]. The serum level of vitamin B12 in UC patients was significantly lower than that in normal healthy persons [(108. 64 ±32. 22) pmol/L vs (112. 64±33. 33) pmol/L, P = 0. 004]. There was no correlation between plasma HCY, MLT and UC disease activity degree, range, disease duration, erythrocyte sedimentation rate (ESR), or C reactive protein (CRP) in UC patients. There was no significant correlation between MLT and HCY in UC patients. Conclusions The serum level of HCY is higher in UC patients than that in normal control, and MLT is lower than that in normal control. However there is no significant correlation between them.
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Objective To investigate the accuracy of prognosis risk assessment and clinical applicability of Rockall (RS) and Blatchford scoring system (BRS) for acute nonvariceal upper gastrointestinal bleeding (ANVUGIB). Methods From January 2009 to December 2009, the clinical date 195 ANVUGIB patients who met the standards with complete information and treated in The First Affiliated Hospital of Anhui Medical University were recorded. Each patient's scores of RS and BRS were calculated for risk stratification. Patients were followed up for 30 days after discharged.Death or the prognosis of disease in 30 days after discharged was considered as clinical study endpoints.Checked prognostic capacity of these two scoring system. Results In the 195 patients, there were 150 years, mean age was 53.97±18.34 years. 90 patients' age was over sixty (elderly group), 105 less than sixty (non-elderly group). 182 patients survived (93.3%), while 13 dead (6.7%). In survival patients, 11were re-bleeding (5.6 %). Mortality ( 12.2 %, 11/90), the percentage of patients with comorbidities (43.3%, 39/90) and taking aspirin (24. 4%, 22/90) were higher in elderly patients than non-elderly patients (1.9%, 2/105; 16.2%, 17/105; 11.4%, 12/105 respectively)(P＜0.05).The AUC of RS in predicting risk of death was 0.742 (P=0.004) and re-bleeding was 0.469 (P=0.101). For BRS score system, the AUC of predicting risk of death was 0. 493 (P= 0. 067)and rebleeding was 0.341(P=0.092). The RS score was positively correlated with length of hospital stay,however there was no statistically significant between BRS score and length of hospital stay.Conclusion RS score system was good at predicting the risk of death, and the score was positively correlated with length of hospital stay. While it was poor in predicting the risk of re-bleeding. BRS performed poorly in predicting the risk of both death and re-bleeding, so it was not suitable for predicting the risk of hospitalized patients.
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Objective To evaluate mechanical radial scanning endoscopic ultrasonography (EUS) for preoperative tumor and lymph node ( TN ) staging of esophageal cancer. Methods From January 2010 to June 2010, a total of 60 patients with esophageal cancer underwent preoperative staging with mechanical radial scanning EUS. The findings of EUS were compared with postoperative pathological outcomes. Results EUS accurately predicted T stage in 80 % of cases and N stage in 71% cases. Sensitivities to T1 , T2 , T3 and T4 were 75% , 100% , 96% and 50% , respectively, and those to N0 and N1 were 55% and 100% , respectively. With exclusion of 11 patients with un-passable lesions, the accurate rate of EUS in T staging of focal and advanced cancers was 90% ( 44/49 ). Conclusion Mechanical radial scanning EUS can accurately predict T and N stages in preoperative patients with esophageal cancer, which also exhibits high differential accuracy in focal and advanced esophageal cancer.
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Purpose:To investigate the relationship between expression of COX-2,VEGF in gastric carcinoma and its prognostic significance.Methods:281 patients with early and middle stage of gastric carcinoma were followed up. Expression of COX-2 and VEGF was examined by immunohistochemistry in 232 archival paraffinembedded tissue specimens.Results:The MVD value was much higher in COX-2(+) group and VEGF(+) group than that in COX-2(-) group and VEGF(-) group ( P