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世界核心医学期刊文摘（胃肠病学分册） 2006年第8期2卷 41-42页

作者： Foucher J. Chanteloup e. Vergniol J. V. De Lédinghen 王顺涛(译) 陈云茹(校) 不详 service d'hépato-gastroentérologie Hoepital Haut Lévéque Avenue Magellan 33604 Pessac France

Background: Transient elastography (FibroScan) is a new, noninvasive, rapid, and reproducible method allowing evaluation of liver fibrosis by measurement of liver stiffness. In cirrhotic patients, liver stiffness measurements range from 12.5 to 75.5 kPa. however, the clinical relevance of these values is unknown. The aim of this prospective study was to evaluate the accuracy of liver stiffness measurement for the detection of cirrhosis in patients with chronic liver disease. Methods: A total of 711 patients with chronic liver disease were studied. Aetiologies of chronic liver diseases were hepatitis C virus or hepatitis B virus infection, alcohol, non-alcoholic steatohepatitis, other, or a combination of the above aetiologies. Liver fibrosis was evaluated according to the MeTAVIR score. Results: Stiffness was significantly correlated with fibrosis stage (r=0.73, p eas under the receiver operating characteristic curve (95% confidence interval) were 0.80 (0.75- 0.84) for patients with significant fibrosis (F >2), 0.90 (0.86- 0.93) for patients with severe fibrosis (F3), and 0.96 (0.94- 0.98) for patients with cirrhosis. Using a cut off value of 17.6 kPa, patients with cirrhosis were detected with a positive predictive value and a negative predictive value (NPV) of 90% . Liver stiffness was significantly correlated with clinical, biological, and morphological parameters of liver disease. With an NPV >90% , the cut off values for the presence of oesophageal varices stage 2/3, cirrhosis Child-Pugh B or C, past history of ascites, hepatocellular carcinoma, and oesophageal bleeding were 27.5, 37.5, 49.1, 53.7, and 62.7 kPa, respectively. Conclusion: Transient elastography is a promising non-invasive method for detection of cirrhosis in patients with chronic liver disease. Its use for the follow up and management of these patients could be of great interest and should be evaluated further.

关键词：肝硬化患者前瞻性研究弹性肝纤维化程度非酒精性脂肪肝慢性肝病患者诊断肝脏硬度纤维化分期 ROC曲线

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Cirrhotic patients and older people

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World Journal of hepatology 2019年第9期11卷 663-677页

作者： Paul Carrier Marilyne Debette-Gratien Jérémie Jacques Véronique Loustaud-Ratti Fédération d’hépatologie Centre Hospitalier Universitaire Dupuytren de LimogesLimoges 87042France Facultéde Médecine et de Pharmacie de Limoges Rue Docteur MarclandLimoges 87042France service de gastroentérologie Centre Hospitalier Universitaire Dupuytren de LimogesLimoges 87042France

The global population is aging,and so the number of older cirrhotic patients is *** patients are characterised by a risk of frailty and comorbidities,and age is a risk factor for mortality in cirrhotic *** incidence of nonalcoholic fatty liver disease as an aetiology of cirrhosis is increasing,while that of chronic viral hepatitis is ***,cirrhosis is frequently *** management of portal hypertension in older cirrhotic patients is similar to that in younger patients,despite the greater risk of treatment-related adverse events of the *** prevalence of hepatocellular carcinoma increases with age,but its treatment is *** transplantation is generally recommended for patientsears of *** the increasing prevalence of cirrhosis in older people,little data are available and few recommendations have been *** review suggests that comorbidities have a considerable impact on older cirrhotic patients.

关键词： Liver cirrhosis Portal hypertension Liver cancer Liver transplantation Old age Older elderly

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结肠镜检查期间患者自控镇痛的重要性:一项前瞻性、随机、对照研究结果

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世界核心医学期刊文摘（胃肠病学分册） 2006年第5期2卷 31-32页

作者： Crepeau T. Poincloux L. Bonny C. 张欣 service d'hépato-gastroentérologie Centre Hospitalier d‘Alès 811 avenue Docteur Jean Gaubert 30100 Alès

Background-In France, general anesthesia is given to more than 90% of patients undergoing colonoscopy although in several countries sedation is limited to intolerant patients. This study was carried out to determine whether Patient-Controlled Sedation (PCS) could provide a lighter sedation than general anesthesia adapted to the patient’ s individual requirement. Methods-Patients aged from 18 to 80 scheduled for elective colonoscopy were prospectively randomized to receive either standard sedation (control group) or patient-controlled-sedation (PCS). In the control group, patients received a continuous infusion of propofol. Patients in the PCS group were connected to an infusion pump containing propofol and self-administered 20 mg boluses as often as they required. An anesthetist was present throughout the procedure. Patient satisfaction measured on a visual analog scale four hours after colonoscopy was the main outcome criterion. Results-From December 2002 to September 2003, 402 patients underwent elective colonoscopy, 173 of them were eligible and were asked to participate in the study. Seventy-two gave their informed consent and were prospectively randomized. The patients’ mean satisfaction scores were not statistically different between the two groups: 84.7 mm (PCS group) vs. 91.5mm(control group); P = 0.24. Mean doses of propofol (60 mg vs. 248 mg; P epth of sedation and time before discharge (1.75 hours vs. 4.45 hours) were significantly lower for patients in the PCS group; nine of them (25.7% ) did not use the pump and had total colonoscopy without sedation. There were no statistically significant differences between the two groups regarding total duration of colonoscopy (19.4 min (PCS) vs. 18 min (control)) difficulty and therapeutic procedures (biopsy or polypectomy). Two weeks after the procedure, 96.5% of patients in the PCS group were willing to repeat the examination under the same conditions vs. 72.5% of patients in the control group (P = 0.0

关键词：患者自控镇痛结肠镜检查对照研究随机全身麻醉知情同意书镇痛方法持续输注视觉模拟 PCS

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慢性酒精性胰腺炎合并十二指肠壁囊性营养不良的临床特征、诊断步骤及疗效观察:一项包含23例患者的回顾性、多中心研究

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世界核心医学期刊文摘（胃肠病学分册） 2006年第11期2卷 15-16页

作者： Jouannaud V. Coutarel P. Tossou h. J.-F. Cadranel 王顺涛 service d'hépato-gastroentérologie et de Diabétologie Centre Hospitalier Laёnnec BP 72 60109 Creil Cedex

Aim of the study -The aim of this retrospective multicenter study was to collect data from patients with chronic alcoholic pancreatitis and cystic dystrophy of the duodenal wall in order to better understand the outcome after medical, endoscopic and/or surgical treatment. Patients and methods-The data from medical records of 23 patients consecutively seen in ten primary referral centers from January 1990 to July 2004 were studied. Clinical, biological, and endoscopic features as well as imaging findings were recorded. Response to treatment was noted. Results -Twenty-three patients (20 men), aged 45 years (range: 30-66),with chronic alcohol intake, cystic dystrophy of the duodenal wall, and previously known (N = 14) or simultaneously diagnosed (N = 9) chronic pancreatitis were included. Symptoms most frequently encountered were abdominal pain (N = 22) and weight loss (N = 16). An abdominal ultrasound was available for 10 patients, abdominal computed tomography for 22, upper endoscopy for 18, and endoscopic ultrasonography for 22. endoscopic ultrasonography enabled diagnosis of cystic dystrophy of the duodenal wall in 19/22 patients. Six patients were symptom-free after alcohol withdrawal. Seven patients received octreotide 200 to 400 μg per day, 5 of whom subsequently underwent surgery (71%). Fourteen patients out of 23 were operated on (61%), 11 of whom underwent pancreaticoduodenectomy and remained symptom-free for 47 months follow-up. Mean follow-up was 56 months (range: 2-78) for non surgical patients (39%) and 47 months (range: 12-108)-for surgical patients (61%). Conclusion -Cystic dystrophy of the duodenal wall complicating chronic alcoholic pancreatitis may be the revealing sign of pancreatitis. endoscopic ultrasongraphy is the most reliable imaging method for diagnosis. Pancreaticoduodenectomy is the most frequently employed definitive treatment.

关键词：十二指肠壁诊断步骤慢性胰腺炎超声内镜影像学结果首次就诊奥曲肽影像学诊断无症状经戒

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奥沙利铂联合氟尿嘧啶二线治疗晚期胰腺癌:Ⅱ期临床试验结果

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世界核心医学期刊文摘（胃肠病学分册） 2006年第12期2卷 31-32页

作者： Mitry e. DucreuxM. Ould-KaciM. 成虹 service d'hépato-gastroentérologie et Oncologie Digestive CHU Amoroise Paré9avenue Charles de Gaulle92100 BoulogneFrance

Background-The efficacy and benefit of second-line chemotherapy in advanced pancreatic adenocarcinoma has never been demonstrated although it is regularly *** and methods-A randomized phase II study evaluating oxaliplatin alone(OXA) ,infusional 5-fluorouracil alone(5-FU) and an oxaliplatin/infusional 5-FU combination(OXFU) in untreated advanced pancreatic adenocarcinoma has been *** this trial,a second-line treatment with the OXFU regimen(OXA 130 mg/m2 2-h intravenous(i.v.) infusion combined with 5-FU(1000 mg/m2/day,continuous i.v.,days 1-4) ,every 3 weeks) was offered to patients progressing after single agent ***-eighteen out of 32 patients(12 males,median age 57 years) treated in the single agent arms received the OXFU combination in second-line *** performance status was at least 2 in 61% of the *** was no objective response and 3 patients(17%) had a disease *** time to progression from the start of second-line treatment was 0.9 *** overall survival was 4.9 months from the start of front-line therapy and 1.3 months from the start of second-line ***-The results of this trial bring arguments to support a modest value of second-line chemotherapy for advanced pancreatic adenocarcinoma.

关键词：晚期胰腺癌尿嘧啶二线治疗 Ⅱ期临床试验联合方案随机临床研究存活期

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Frequency of Viral Replication Markers in Chronic hBV Carriers in N’Djamena, Chad

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Open Journal of gastroenterology 2022年第10期12卷 271-277页

作者： Ali Mahamat Moussa Mayanna habkreo Adawaye Chatté Borde emmanuel Adoum Abdelrazack Fouda Bessimbaye Nadlaou service de Médecine Interne et gastroentérologie CHU La Référence Nationale de N’Djamena N’Djamena Tchad Département des Sciences Biomédicales et Pharmaceutiques Faculté des Sciences de la Santé Humaine Université de N’Djamena N’Djamena Tchad Programme National de Lutte Contre le VIh/IST/hépatite Ministère de la Santé Publique N’Djamena Tchad

Introduction: According to the WhO, Chad is located in an area of high endemicity for hepatitis B virus (hBV). The aim of this study was to analyze the virological profiles of chronic hBV carriers. Materials and Method: This was a retrospective and analytical study including outpatients with chronic hBV of any age received in Department of Internal Medicine and gastroenterology of National General Reference hospital of N’Djamena from 2013 to 2017. Results: During the study period, 401 chronic hepatitis B virus carriers (mean age was 35 years ± 11 years with sex ratio of 3.26) were seen in outpatient clinic with a frequency of 3.34% (401/11,988). hBeAg (+) patients were 12.8% and hBeAg negative 87.2%. hBeAg-negative patients were significantly older (p = 0.000) than those with hBeAg (+). The mean hBV-DNA level was higher in hBeAg (+) patients. The hBV-DNA level in hBeAg-positive patients was higher than in hBeAg-negative patients with a significant difference (p = 0.043). The mean ALT level was 45 IU/L in hBeAg (−) patients. It was 49 in hBeAg (+) patients. Conclusion: hBeAg (−) chronic hepatitis B is the most predominant form in our study. This observation is important because it can help to adapt the management strategies.

关键词： Chronic hepatitis B epidemiology hBeAg Viral Replication Ndjamena Chad

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Role of immunosuppression and tumor differentiation in predicting recurrence after liver transplantation for hepatocellular carcinoma: A multicenter study of 412 patients

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World Journal of gastroenterology 2006年第45期12卷 7319-7325页

作者： Thomas Decaens Franoise Roudot-Thoraval Solange Bresson-hadni Carole Meyer Jean Gugenheim Francois Durand Pierre-henri Bernard Olivier Boillot Philippe Compagnon Yvon Calmus Jean hardwigsen Christian Ducerf Georges Philippe Pageaux Sébastien Dharancy Olivier Chazouillères Daniel Cherqui Christophe Duvoux service d'hépatologie et de gastroentérologie AP-HP Hpital Henri Mondor Créteil Unité INSERM 581 France Département de Santé Publique AP-HP Hpital Henri Mondor Créteil France service d’hépatologie Hpital Jean Minjoz Besanon France service de Transplantation Hpital HautefeuilleStrasbourg France service de Chirurgie Digestive Hpital L’Ar-chet 2 Nice France service d’hépatologie AP-HP Hpital Beau-jon Clichy France service d’hépatologie et de gastroentéro-logie H?pital Pellegrin Bordeaux France service de Chirurgie Digestive Hpital Edouard Herriot Lyon France service de Chirurgie Digestive Hpital Ponchaillou Rennes France service de Chirurgie Digestive AP-HP HpitalCochin Paris France service de Chirurgie Digestive Hpital laConception Marseille France service de Chirurgie Digestive Hpital de laCroix Rousse Lyon France Fédération Médico-Chirurgicale deMaladies de l’Appareil Digestif Hpital Saint-Eloi MontpellierFrance service d’hépatologie et de gastroentérologie H?pital Claude Huriez Lille France service d’hépatologie AP-HP Hpital SAntoine Paris France service de Chirurgie Générale et Digestive APHP Hopital Henri Mondor Créteil France

AIM: To assess pre-orthotopic liver transplantation (OLT) factors that could be evaluated pre-operatively or con- trolled post-operatively associated with hepatocellular carcinoma (hCC) recurrence and disease-free survival after liver transplantation (LT).MeThODS: Four hundred and twelve patients trans- planted for hCC between 1988 and 1998 in 14 French centers, who survived the postoperative period were studied. Kaplan Meier estimates were calculated for 24 variables potentially associated with recurrence of hCC. Uni- and multivariate analyses were conducted to iden- tify independent predictors of recurrence. ReSULTS: Overall 5-year disease-free survival was 57.1%. By univariate analysis, variables associated with disease-free survival were: presence of cirrhosis (P = 0.001), etiology of liver disease (P = 0.03), α fetoprotein level ( 2000; P 2N; P = 0.02), the number of nodules (1, 2-3 or ≥ 4; P = 0.02), maximal diameter of the largest nodule ( 5 cm; P he sum of the diameter of the nodules (10 cm; P eoperative portal thrombosis (P eri-operative treatment of the tumor (P = 0.002) and chemoembolization (P = 0.03), tumor differentiation (P = 0.01), initial type of calcineurin inhibitor (P = 0.003), the use of antilymphocyte antibodies (P = 0.02), rejection episodes (P = 0.003) and period of LT (P e analysis, 6 variables were independently associated with hCC recurrence: maximal diameter of the largest nodule (P e of LT (P erentiation (P e of anti-lymphocyte antibody (ATG) or anti-CD3 antibody (OKT3) (P = 0.005), preoperative portal thrombosis (P = 0.06) and the number of nodules (P = 0.06). CONCLUSION: This study identif ies immunosuppression, through the use of ATG or OKT3, as a predictive factor of tumor re

关键词：免疫抑制肝细胞癌肝移植分化

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FOLFIRI regimen in metastatic pancreatic adenocarcinoma resistant to gemcitabine and platinum-salts

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World Journal of gastroenterology 2012年第33期18卷 4533-4541页

作者： Cindy Neuzillet Olivia hentic Benot Rousseau Vinciane Rebours Léla Bengrine-Lefèvre Franck Bonnetain Philippe Lévy eric Raymond Philippe Ruszniewski Christophe Louvet Pascal hammel service de gastroentérologie-Pancréatologie Hpital Beaujon 100 Boul-evard du Général Leclerc 92110 Clichy La Garenne AP-HP France service d'Oncologie Médicale Hpital Saint Antoine 184 Rue du Faubourg Saint-Antoine 75012 Paris AP-HP France Unité de Biostatistique et d'epidémiologie eA 4184 Centre Georges Franois Leclerc 1 Rue du Pr Marion 21079 Dijon France service d'Oncologie Médicale Hpital Beau-jon 100 Boulevard du Général Leclerc 92110 Clichy La Garenne AP-HP France Département d'Oncologie Médicale Institut Mutualiste Montsouris 42 Boulevard Jourdan 75014 Paris France

AIM: To evaluate the efficacy and safety of the FOLFIRI regimen in patients with metastatic pancreatic adenocarcinoma (PAC) after the failure of gemcitabine and platinum salts. MeThODS: All consecutive patients with histologically confirmed, metastatic PAC and World health Organiza-tion performance status (PS) ≤ 2 received FOLFIRI-1 [irinotecan 180 mg/m2 on day 1 and leucovorin 400 mg/m2 followed by 5-fluorouracil (5-FU) 400 mg/m2 bolus, then 5-FU 2400 mg/m2 as a 46-h infusion, biweekly] or FOLFIRI-3 (irinotecan 100 mg/m2 on day 1 and leucovorin 400 mg/m2, then 5-FU 2400 mg/m2 as a 46-h infusion and irinotecan 100 mg/m2 repeated on day 3, biweekly) after failure of gemcitabine and platinum-based chemotherapies as a systematic policy in two institutions between January 2005 and May 2010. Tumor response, time to progression (TTP), overall survival rate (OS) and grade 3-4 toxicities were retrospectively studied. Subgroup analyses were performed to search for prognostic factors. ReSULTS: Sixty-three patients (52.4% male, median age 59 years) were analyzed. Among them, 42.9% were PS 0, 38.1% were PS 1 and 19.0% were PS 2. Fifty one patients (81.0%) had liver metastases. Before the FOLFIRI regimen, patients had received 1 line (n = 19), 2 lines (n = 39) or 3 lines (n = 5) of chemotherapy. Median TTP obtained with the line before FOLFIRI was 3.9 mo (95% CI: 3.4-5.3 mo). A total of 480 cycles was completed (median: 6 cycles, range: 1-51 cycles). The main reason for discontinuing FOLFIRI was tumor progression (90.3%). Tumor control was achieved in 25 patients (39.7%) (partial response: n = 5, stable disease: n = 20) with FOLFIRI. Median TTP was 3.0 mo (95% CI: 2.1-3.9 mo) and median OS was 6.6 mo (95% CI: 5.3-8.1 mo). Dose adaptation was required in 36 patients (57.1%). Fifteen patients (23.8%) had grade 3-4 toxicities, mainly hematological (n = 11) or digestive (n = 4). Febrile neutropenia occurred in 3 patients. There was no toxic death. PS 2 was significantly associated w

关键词：转移性胰腺癌铂盐治疗 5-FU 亚叶酸钙中性粒细胞 TTP

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内镜下绒毛萎缩作为伴有消化不良症状的乳糜泻患者的标志是无效的

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世界核心医学期刊文摘（胃肠病学分册） 2006年第12期2卷 25-26页

作者： Lecleire S. Di Fiore F. Antoniette M. 宋平 service d'hé pato-gastroenté rologie et de Nutrition CHU Charles Nicolle1 Rue de Germont76031 RouenFrance Dr.

Background and study aims:Celiac disease can manifest with nonspecific symptoms,including functional gastrointestinal disorders such as *** aim of our study was to assess the usefulness of duodenal endoscopic markers of villous atrophy for the selection of dyspeptic patients for histological *** and methods:esophagogas troduodenoscopy was performed in dyspeptic patients,in patients considered to be at risk of having celiac disease,and in healthy *** least three duodenal biopsies were performed for histological assessment of villous atrophy in all patients and *** looked for the following four duodenal endoscopic markers of celiac disease:reduction in the number of folds,scalloping of folds,mosaic-pattern mucosa,and nodular ***:A total of 175 people were enrolled(75 patients with dyspepsia;75 patients who were “ at risk” of having celiac disease;and 25 healthy volunteers,or “ controls”) .Of the dyspeptic patients,four had endoscopic markers of celiac disease with no histologically confirmed villous atrophy,while one patient without endoscopic markers was found to have Marsh type I villous *** the patients at risk of having celiac disease,16 had at least one endoscopic marker and 10/16 were found to have histological villous *** this group,the sensitivity and specificity of the endoscopic markers were 100% and 90.8% respectively.“ At-risk” patients with two or more endoscopic markers all had histologically confirmed villous *** endoscopic markers nor villous atrophy were found in any of the control ***:Additional endoscopic markers are valuable for diagnosis in patients with clinical symptoms suggestive of celiac *** contrast,endoscopic markers of villous atrophy are not useful for selecting a subgroup of dyspeptic patients for screening for celiac disease by duodenal histological *** patients should be screened using other protocols.

关键词：乳糜泻消化不良症状肠功能紊乱非特异性症状活组织检查评估应用特异度

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大剂量α-干扰素诱导与二期利巴韦林联合疗法在未经治疗的慢性丙肝患者中的应用:一项多中心、随机、对照试验

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世界核心医学期刊文摘（胃肠病学分册） 2006年第11期2卷 14-15页

作者： Wartelle-Bladou C. Arpurt J.-P. Renou C. 王顺涛 Centre hospitalier du Pays d'Aix Service d'Hépato-Gastroentérologie Avenue des Tamaris 13616 Aix en Provence Cedex France

Objectives -To evaluate in naive patients with chronic hepatitis C 1 -the efficacy and safety of one month interferon alpha (IFN-α) induction regimen; 2-the potential virological benefit of a secondary adjunction of ribavirin among hCV-RNA negative patients after 20 weeks of IFN therapy,with or without an initial 4-week IFN induction. Material and methods -151 naive hCV-RNA positive patients presenting with biopsy-proven chronic hepatitis C and elevated ALT were randomised in a 2∶1 ratio in two arms: IFN-α3 MU thrice a week (tiw) for 24 weeks (non-induced patients); IFN-α6 MU daily for two weeks, then 3 MU daily for two weeks then 3 MU tiw for 20 weeks (induced patients). At week 24, hCV-RNA negative patients were randomised to receive in addition or not ribavirin 1-1.2 g daily for 24 additional weeks. Induction efficacy was assessed on the early viral response (eVR) defined as undetectable hCV RNA at week 4 then week 20. Ribavirin efficacy was assessed on the proportion of maintained complete response until the end of follow-up, 24 weeks after discontinuation of treatment. Data were analysed on an intent-to-treat basis. Results -efficacy of IFN-αinduction: 104 patients were randomised to the non-induction group, 47 to the induction group. Gender, age, genotype distribution and hCV viral load at baseline did not differ significantly between the two groups. There was one treatment discontinuation because of adverse events in induced patients versus four in non-induced patients (P > 0.05). The 4 week eVR was significantly greater in induced patients in patients with hCV genotype 1, 4 or 5 (47%vs 12%, P = 0.0002) only. There was no impact of induction in patients with hCV genotype 2 or 3. efficacy of ribavirin: at week 24, 28 and 26 hCV-RNA negative patients were randomised to addition of ribavirin or not, respectively. Patients randomised to secondary additive ribavirin were more often hCV-RNA negative at the end of follow-up than patients treated with IFN-αalone: 18/

关键词：慢性丙肝 α-干扰素联合疗法对照试验病毒学应答慢性丙型肝炎阴性患者诱导组应答率复发率

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