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世界胃肠病学杂志（英文版）
世界胃肠病学杂志（英文版）

潘伯荣

周刊

1007-9327

wjg@wjgnet.com

010-85381901-628

100025

北京市朝阳区东四环中路62号楼远洋国际中心D座903室

世界胃肠病学杂志（英文版）/Journal World Journal of GastroenterologyCSCDCSTPCDSCI
查看更多>>主要报道和刊登国内外、特别是我国消化病学者具有创造性的、有较高学术水平的基础和临床研究论文、研究快报等. 对具有中国特色的研究论文, 如食管癌、胃癌、肝癌、大肠癌、病毒性肝炎、幽门螺杆菌、中医中药、中西医结合和基于作者自己研究工作为主的综述性论文, 将优先发表. 读者对象为基础研究或临床研究的消化专业工作者。
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    Adjusting CA19-9 values to predict malignancy in obstructive jaundice: Influence of bilirubin and C-reactive protein

    Gaetano La GrecaMaria SofiaRosario LombardoSaverio Latteri...
    4150-4155页
    查看更多>>摘要：AIM:To find a possible relationship between inflammation and CA19-9 tumor marker by analyzing data from patients with benign jaundice (BJ) and malignant jaundice (MJ).METHODS:All patients admitted for obstructive jaundice,in the period 2005-2009,were prospectively enrolled in the study,obtaining a total of 102 patients.On admission,all patients underwent complete standard blood test examinations including C-reactive protein (CRP),bilirubin,CA19-9.Patients were considered eligible for the study when they presented obstructive jaundice confirmed by instrumental examinations and increased serum bilirubin levels (total bilirubin ＞ 2.0 mg/dL).The standard cut-off level for CA19-9 was 32 U/mL,whereas for CRP this was 1.5 mg/L.The CA19-9 level was adjusted by dividing it by the value of serum bilirubin or by the CRP value.The patients were divided into 2 groups,MJ and BJ,and after the adjustment a comparison between the 2 groups of patients was performed.Sensitivity,specificity and positive predictive values were calculated before and after the adjustment.RESULTS:Of the 102 patients,51 were affected by BJ and 51 by MJ.Pathologic CA19-9 levels were found in 71.7％ of the patients.In the group of 51 BJ patients there were 29 (56.9％) males and 22 (43.1％) females with a median age of 66 years (range 24-96 years),whereas in the MJ group there were 24 (47％) males and 27 (53％) females,with a mean age of 70 years (range 30-92 years).Pathologic CA19-9 serum level was found in 82.3％ of MJ.CRP levels were pathologic in 66.6％ of the patients with BJ and in 49％ with MJ.Bilirubin and CA19-9 average levels were significantly higher in MJ compared with BJ (P =0.000 and P =0.02),while the CRP level was significantly higher in BJ (P =0.000).Considering a CA19-9 cut-off level of 32 U/mL,82.3％ in the MJ group and 54.9％ in the BJ group were positive for CA19-9 (P =0.002).A CA19-9 cut-off of 100 U/mL increases the difference between the two groups:35.3％ in BJ and 68.6％ in MJ (P =0.0007).Adjusting the CA19-9 value by dividing it by serum bilirubin level meant that 21.5％ in the BJ and 49％ in the MJ group remained with a positive CA19-9 value (P =0.003),while adjusting the CA19-9 value by dividing it by serum CRP value meant that 31.4％ in the BJ group and 76.5％ in the MJ group still had a positive CA19-9 value (P =0.000004).Sensitivity,specificity,positive predictive values of CA19-9 ＞ 32 U/mL were 82.3％,45％ and 59.1％; when the cutoff was CA19-9 ＞ 100 U/mL they were,respectively,68.6％,64.7％ and 66％.When the CA19-9 value was adjusted by dividing it by the bilirubin or CRP values,these became 49％,78.4％,69.4％ and 76.5％,68.6％,70.9％,respectively.CONCLUSION:The present study proposes CRP as a new and useful correction factor to improve the diagnostic value of the CA19-9 tumor marker in patients with cholestatic jaundice.
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    Intrahepatic expression of genes related to metabotropic receptors in chronic hepatitis

    Andrzej Cie(s)la,Maciej Ku(s)mider,Agata Faron-GóreckaMarta Dziedzicka-Wasylewska...
    4156-4161页
    查看更多>>摘要：AIM:To screen for genes related to metabotropic receptors that might be involved in the development of chronic hepatitis.METHODS:Assessment of 20 genes associated with metabotropic receptors was performed in liver specimens obtained by punch biopsy from 12 patients with autoimmune and chronic hepatitis type B and C.For this purpose,a microarray with low integrity grade and with oligonucleotide DNA probes complementary to target transcripts was used.Evaluation of gene expression was performed in relation to transcript level,correlation between samples and grouping of clinical parameters used in chronic hepatitis assessment.Clinical markers of chronic hepatitis included alanine and aspartate aminotransferase,γ-glutamyltranspeptidase,alkaline phosphatase and cholinesterase activity,levels of iron ions,total cholesterol,triglycerides,albumin,glucose,hemoglobin,platelets,histological analysis of inflammatory and necrotic status,fibrosis according to METAVIR score,steatosis,as well as anthropometric body mass index,waist/hip index,percentage of adipose tissue and liver size in ultrasound examination.Gender,age,concomitant diseases and drugs were also taken into account.Validation of oligonucleotide microarray gene expression results was done with the use of quantitative real-time polymerase chain reaction (qRT-PCR).RESULTS:The highest (0.002 ＜ P ＜ 0.046) expression among genes encoding main components of metabotropic receptor pathways,such as the a subunit of G-coupled protein,phosphoinositol-dependent protein kinase or arrestin was comparable to that of angiotensinogen synthesized in the liver.Carcinogenesis suppressor genes,such as chemokine ligand 4,transcription factor early growth response protein 1 and lysophosphatidic acid receptor,were characterized by the lowest expression (0.002 ＜ P ＜ 0.046),while the factor potentially triggering hepatic cancer,transcription factor JUN-B,had a 20-fold higher expression.The correlation between expression of genes of protein kinases PDPK1,phosphoinositide 3-kinase and protein kinase A (Spearman's coefficient range:0.762-0.769) confirmed a functional link between these enzymes.Gender (P =0.0046) and inflammation severity,measured by alanine aminotransferase activity (P =0.035),were characterized by diverse metabotropic receptor gene expression patterns.The Pearson's coefficient ranging from-0.35 to 0.99 from the results of qRT-PCR and microarray indicated that qRT-PCR had certain limitations as a validation tool for oligonucleotide microarray studies.CONCLUSION:A microarray-based analysis of hepatocyte metabotropic G-protein-related gene expression can reveal the molecular basis of chronic hepatitis.
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    Growth inhibitory effects of Phyllanthus niruri extracts in combination with cisplatin on cancer cell lines

    Raimundo Fernandes de Araújo JúniorLuiz Alberto Lira SoaresCínthia Raquel da Costa PortoRanniere Gurgel Furtado de Aquino...
    4162-4168页
    查看更多>>摘要：AIM:To investigate the cytotoxic effects of spray-dried extracts of Phyllanthus niruri in combination with cisplatin on two cancer cell lines.METHODS:Colorectal carcinoma (HT29) and human hepatocellular carcinoma (HepG2) cells were treated with spray-dried extracts of Phy//anthus niruri (SDEPN) either alone or in combination with cisplatin at different concentrations (0.5 mg/mL and 1 mg/mL) for 4 h and 24 h.To verify and quantify cancer cells treated with these products as well as identify the cell cycle stage and cell viability,we stained the cells with propidium iodide and assessed them by flow cytometry.The percentage of cells in different cell cycle phases was quantified and data were expressed as histograms.Significant differences between groups were determined using analysis of variance and Bonferroni's test,as indicated.A value of P ＜ 0.05 was considered to be statistically significant.RESULTS:SDEPN had significantly different cytotoxic effects on HT29 (2.81 ± 0.11 vs 3.51 ± 1.13,P ＞ 0.05) and HepG2 (5.07 ± 0.3 vs 15.9 ± 1.04,P ＜0.001) cells when compared to control cells for 4 h.SDEPN also had significantly different cytotoxic effects on HT29 (1.91 ± 0.57 vs 4.53 ± 1.22,P ＞ 0.05) and HepG2 (14.56 ± 1.6 vs 35.67 ± 3.94,P ＜ 0.001) cells when compared to control cells for 24 h.Both cell lines were killed by cisplatin in a dose-dependent manner compared to control cells (HepG2 cells for 4 h:10.78 ± 1.58 vs 53.89 ± 1.53,P ＜ 0.001; 24 h:8.9 ± 1.43 vs 62.78 ± 1.87,P ＜ 0.001 and HT29 cells for 4 h:9.52 ± 0.913 vs 49.86 ± 2.89,P ＜ 0.001; 24 h:11.78 ± 1.05 vs 53.34 ± 2.65,P ＜ 0.001).In HT29 cells,pretreatment with SDEPN and subsequent treatment with cisplatin resulted in a greater number of cells being killed (12.78 ± 1.01 vs 93.76 ± 1.6,P ＜ 0.001).HepG2 cells showed significant cell killing with treatment with SDEPN when combined with cisplatin (12.87±2.78 vs 78.8 ± 3.02,P ＜ 0.001).CONCLUSION:SDEPN is selectively toxic against two cancer cell lines.Moreover,SDEPN in combination with cisplatin induces a synergistic increase in the cell death of both HT29 and HepG2 cells.
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    Sensitivity of the suspected blood indicator: An experimental study

    Sung Chul ParkHoon Jai ChunEun Sun KimBora Keum...
    4169-4174页
    查看更多>>摘要：AIM:To investigate whether suspected blood indicator (SBI) in capsule endoscopy (CE) is affected by background color and capsule passage velocity.METHODS:Experimental models of the small intestine constructed from paper in a variety of colors were used to simulate the background colors observed in CE images.The background colors studied included very pale yellow,yellow,very pale magenta,light grayish pink,burnt sienna,and deep and dark brown,and red spots were attached inside them.An endoscopic capsule was manually passed through the models.The rate of detection of the red spots by the SBI was evaluated based on the colors of the models and the capsule passage velocities (0.5 cm/s,1 cm/s,and 2 cm/s).RESULTS:The rate of detection of the red spots by the SBI differed significantly according to the background color of the model (P ＜ 0.001).Detection rates were highest for backgrounds of very pale magenta,burnt sienna,and yellow,in that order.They were lowest for backgrounds of dark brown and very pale yellow.The rate of detection of red spots by the SBI tended to decrease at rapid capsule passage velocities (1-2 cm/s) compared to slow velocities (0.5 cm/s) for backgrounds of very pale yellow (P =0.042),yellow (P =0.001),very pale magenta (P =0.002),and burnt sienna (P =0.001).No significant differences in the rate of detection were observed according to velocity for light grayish pink (P =0.643) or dark brown (P =0.396).CONCLUSION:SBI sensitivity was affected by background color and capsule passage velocity in the models.These findings may facilitate the rapid detection of bleeding lesions by CE.
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    Impact of surgical volume on nationwide hospital mortality after pancreaticoduodenectomy

    Chul-Gyu KimSungho JoJae Sun Kim
    4175-4181页
    查看更多>>摘要：AIM:To evaluate the impact of surgical volume on nationwide hospital mortality after pancreaticoduodenectomy (PD) for periampullary tumors in South Korea.METHODS:Periampullary cancer patients who underwent PD between 2005 and 2008 were analyzed from the database of the Health Insurance Review and Assessment Service of South Korea.A total of 126 hospitals were divided into 5 categories,each similar in terms of surgical volume for each category.We used hospital mortality as a quality indicator,which was defined as death during the hospital stay for PD,and calculated adjusted mortality through multivariate logistic models using several confounder variables.RESULTS:A total of eligible 4975 patients were enrolled in this study.Average annual surgical volume of hospitals was markedly varied,ranging from 215 PDs in the very-high-volume hospital to ＜ 10 PDs in the verylow-volume hospitals.Admission route,type of medical security,and type of operation were significantly different by surgical volume.The overall hospital mortality was 2.1％ and the observed hospital mortality by surgical volume showed statistical difference.Surgical volume,age,and type of operation were independent risk factors for hospital death,and adjusted hospital mortality showed a similar difference between hospitals with observed mortality.The result of the HosmerLemeshow test was 5.76 (P =0.674),indicating an acceptable appropriateness of our regression model.CONCLUSION:The higher-volume hospitals showed lower hospital mortality than the lower-volume hospitals after PD in South Korea,which were clarified through the nationwide database.
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    Diabetes but not insulin is associated with higher colon cancer mortality

    Chin-Hsiao Tseng
    4182-4190页
    查看更多>>摘要：AIM:To evaluate whether diabetic patients had a higher risk of colon cancer mortality and its associated risk factors.METHODS:The sex-specific crude and age-standard-ized (to the 2000 World Health Organization population) mortality rates of colon cancer in the Taiwanese general population were first calculated from 1995 to 2006.The trends were evaluated by linear regression.A total of 113 347 diabetic men and 131 573 diabetic women aged ≥ 25 years at recruitment from 1995 to 1998 were followed up until the end of 2006.Age/sexspecific colon cancer mortality rate ratios were calculated comparing the mortality rates of the diabetic patients with the average mortality rates of the general population within 12 years (1995-2006).A sub-cohort of diabetic patients (42 260 men and 49 405 women) was interviewed using a baseline questionnaire and Cox's regression was used to evaluate the risk factors for colon cancer mortality in these diabetic patients.RESULTS:The crude and age-standardized trends of colon cancer mortality from 1995 to 2006 increased significantly for both sexes in the general population.A total of 641 diabetic men and 573 diabetic women died of colon cancer,with a mortality rate of 74.4 and 54.3 per 100 000 person-years,respectively.Mortality rate ratios [95％ confidence intervals (CIs)] showed a significantly higher risk of mortality from colon cancer for the diabetic patients compared to the general population,with the magnitude increasing with decreasing age:1.65 (1.40-1.95),2.01 (1.78-2.27),2.75 (2.36-3.21) and 5.69 (4.65-6.96) for ≥ 75,65-74,55-64 and 25-54 years old,respectively,for men; and 1.46 (1.24-1.72),2.09 (1.84-2.38),2.67 (2.27-3.14) and 3.05 (2.29-4.06),respectively,for women.Among the sub-cohort of diabetic patients who had been interviewed with the baseline questionnaire,including information on age,sex,diabetes duration,diabetes type,body mass index,smoking,insulin use and area of residence,age and smoking were significantly predictive for colon cancer mortality,with respective adjusted hazard ratios (HRs) (95％ CIs) of 1.077 (1.066-1.088) and 1.384 (1.068-1.792).Diabetes duration became a significant factor when those who died of colon cancer within 5 years of diabetes diagnosis were excluded to minimize the possible contamination of diabetes caused by incipient colon cancer,with an adjusted hazard ratio of 1.021 (1.007-1.034).Sex,diabetes type,insulin use,body mass index and area of residence were not significant predictors for colon cancer mortality in the diabetic patients.Although insulin use was categorized into subgroups of duration of use (non-users and users ＜ 5 years,5-9 years and ≥ 10 years),none of the HRs for colon cancer mortality was significant with regards to different durations of insulin use.CONCLUSION:Colon cancer mortality is increasing in Taiwan.A higher risk is observed in diabetic patients.Smoking,but not insulin use,is a modifiable risk factor.
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    Role of body mass index in colon cancer patients in Taiwan

    Chih-Chien ChinYi-Hung KuoChien-Yuh YehJinn-Shiun Chen...
    4191-4198页
    查看更多>>摘要：AIM:To determine the effect of body mass index (BMI) on the characteristics and overall outcome of colon cancer in Taiwan.METHODS:From January 1995 to July 2003,2138 patients with colon cancer were enrolled in this study.BMI categories (in kg/m2) were established according to the classification of the Department of Health of Taiwan.Postoperative morbidities and mortality,and survival analysis including overall survival (OS),diseasefree survival (DFS),and cancer-specific survival (CSS) were compared across the BMI categories.RESULTS:There were 164 (7.7％) underweight (BMI ＜ 18.5 kg/m2),1109 (51.9％) normal-weight (BMI =18.5-23.9 kg/m2),550 (25.7％) overweight (BMI =24.0-26.9 kg/m2),and 315 (14.7％) obese (BMI ≥27 kg/m2) patients.Being female,apparently anemic,hypoalbuminemic,and having body weight loss was more likely among underweight patients than among the other patients (P ＜ 0.001).Underweight patients had higher mortality rate (P =0.007) and lower OS (P ＜ 0.001) and DFS (P =0.002) than the other patients.OS and DFS did not differ significantly between normal-weight,overweight,and obese patients,while CSS did not differ significantly with the BMI category.CONCLUSION:In Taiwan,BMI does not significantly affect colon-CSS.Underweight patients had a higher rate of surgical mortality and a worse OS and DFS than the other patients.Obesity does not predict a worse survival.
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    Oxymatrine liposome attenuates hepatic fibrosis via targeting hepatic stellate cells

    Ning-Li ChaiQiang FuHui ShiChang-Hao Cai...
    4199-4206页
    查看更多>>摘要：AIM:To investigate the potential mechanism of ArgGly-Asp (RGD) peptide-labeled liposome loading oxymatrine (OM) therapy in CCl4-induced hepatic fibrosis in METHODS:We constructed a rat model of CCl4-induced hepatic fibrosis and treated the rats with different formulations of OM.To evaluate the antifibrotic effect of OM,we detected levels of alkaline phosphatase,hepatic histopathology (hematoxylin and eosin stain and Masson staining) and fibrosis-related gene expression of matrix metallopeptidase (MMP)-2,tissue inhibitor of metalloproteinase (TIMP)-1 as well as type Ⅰ procollagen via quantitative real-time polymerase chain reaction.To detect cell viability and apoptosis of hepatic stellate cells (HSCs),we performed 3-(4,5)-dimethylthiahiazo(-z-y1)-3,5-diphenytetrazoliumromide assay and flow cytometry.To reinforce the combination of oxymatrine with HSCs,we constructed fluorescein-isothiocyanate-conjugated Arg-Gly-Asp peptide-labeled liposomes loading OM,and its targeting of HSCs was examined by fluorescent microscopy.RESULTS:OM attenuated CCl4-induced hepatic fibrosis,as defined by reducing serum alkaline phosphatase (344.47 ± 27.52 U/L vs 550.69 ± 43.78 U/L,P ＜ 0.05),attenuating liver injury and improving collagen deposits (2.36％ ± 0.09％ vs 7.70％ ± 0.60％,P ＜ 0.05) and downregulating fibrosis-related gene expression,that is,MMP-2,TIMP-1 and type Ⅰ procollagen (P ＜ 0.05).OM inhibited cell viability and induced apoptosis of HSCs in vitro.RGD promoted OM targeting of HSCs and enhanced the therapeutic effect of OM in terms of serum alkaline phosphatase (272.51 ± 19.55 U/L vs 344.47 ± 27.52 U/L,P ＜ 0.05),liver injury,collagen deposits (0.26％ ± 0.09％ vs 2.36％ ± 0.09％,P ＜ 0.05) and downregulating fibrosis-related gene expression,that is,MMP-2,TIMP-1 and type Ⅰ procollagen (P ＜ 0.05).Moreover,in vitro assay demonstrated that RGD enhanced the effect of OM on HSC viability and apoptosis.CONCLUSION:OM attenuated hepatic fibrosis by inhibiting viability and inducing apoptosis of HSCs.The RGD-labeled formulation enhanced the targeting efficiency for HSCs and the therapeutic effect.
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    X-ray repair cross-complementing group 1 polymorphisms and hepatocellular carcinoma: A meta-analysis

    Tian XieZhen-Guang WangJing-Lei ZhangHui Liu...
    4207-4214页
    查看更多>>摘要：AIM:To perform a systematic meta-analysis to investigate the association between X-ray repair crosscomplementing group 1 (XRCC1) polymorphisms and hepatocellular carcinoma (HCC) risk.METHODS:Relevant studies extracted from PubMed,Embase,Wanfang,VIP and the Chinese National Knowledge Infrastructure databases up to March 2012 were included in the study.Stata software,version 11.0,was used for the statistical analysis.The odds ratios (ORs) and 95％ confidence interval (CI) of the XRCC1 polymorphisms in HCC patients were analyzed and compared with healthy controls.The meta-analysis was performed using fixed-effect or random-effect methods,depending on the absence or presence of significant heterogeneity.RESULTS:Eleven studies with 2075 HCC cases and 2604 controls met our eligibility criteria (four studies,888 cases and 938 controls for Arg194Trp,four studies,858 cases and 880 controls for Arg280His,and nine studies,1845 cases and 2401 controls for Arg399Gln).The meta-analysis revealed no associations between the Arg194Trp and Arg399Gln polymorphisms of the XRCC1 gene and HCC risk under all contrast models (codominant,dominant and recessive models) in the overall analysis and sensitivity analysis (the studies with controls not in the Hardy-Weinberg equilibrium were excluded).For XRCC1 Arg280His polymorphism,the overall analysis revealed the significant association between the His/His genotype and the increased risk of HCC (His/His vs Arg/Arg model,OR:1.96,95％ CI:1.03-3.75,P =0.04).However,sensitivity analysis showed an altered pattern of result and non-significant association (OR:2.06,95％ CI:0.67-6.25,P =0.20).The heterogeneity hypothesis test did not reveal any heterogeneity,and Begg's and Egger's tests did not find any obvious publication bias.CONCLUSION:The XRCC1 Arg194Trp and Arg399Gln polymorphisms are not associated with HCC risk.More rigorous association studies are needed to verify the involvement of XRCC1 Arg280His polymorphism in HCC susceptibility.
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    Metabolic syndrome and gallstone disease

    Li-Ying ChenQiao-Hua QiaoShan-Chun ZhangYu-Hao Chen...
    4215-4220页
    查看更多>>摘要：AIM:To investigate the association between metabolic syndrome (MetS) and the development of gallstone disease (GSD).METHODS:A cross-sectional study was conducted in 7570 subjects (4978 men aged 45.0 ± 8.8 years,and 2592 women aged 45.3 ± 9.5 years) enrolled from the physical check-up center of the hospital.The subjects included 918 patients with gallstones (653 men and 265 women) and 6652 healthy controls (4325 men and 2327 women) without gallstones.Body mass index (BMI),waist circumference,blood pressure,fasting plasma glucose (FPG) and serum lipids and lipoproteins levels were measured.Colorimetric method was used to measure cholesterol,high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C).Dextrose oxidizing enzyme method was used to measure FPG.Subjects were asked to complete a questionnaire that enquired about the information on demographic data,age,gender,histories of diabetes mellitus,hypertension,and chronic liver disease and so on.Metabolic syndrome was diagnosed according to the Adult Treatment Panel Ⅲ (ATP Ⅲ) criteria.Gallstones were defined by the presence of strong intraluminal echoes that were gravity-dependent or attenuated ultrasound transmission.RESULTS:Among the 7570 subjects,the prevalence of the gallstone disease was 12.1％ (13.1％ in men and 10.2％ in women).BMI,waist circumference,systolic blood pressure,diastolic blood pressure,fasting blood glucose and serum triglyceride (TG) in cases group were higher than in controls,while serum high-density lipid was lower than in controls.There were significant differences in the waist circumference,blood pressure,FPG and TG between cases and controls.In an ageadjusted logistic regression model,metabolic syndrome was associated with gallstone disease.The age-adjusted odds ratio of MetS for GSD in men was 1.29 [95％confidence interval (CI),1.09-1.52; P =0.0030],and 1.68 (95％ CI,1.26-2.25; P =0.0004) in women; the overall age-adjusted odds ratio of MetS for GSD was 1.42 (95％ CI,1.23-1.64; P ＜ 0.0001).The men with more metabolic disorders had a higher prevalence of gallstone disease,the trend had statistical significance (P ＜ 0.0001).The presence of 5 components of the MetS increased the risk of gallstone disease by 3.4 times (P ＜ 0.0001).The prevalence of GSD in women who had 5 components of MetS was 5 times higher than in those without MetS component.The more the components of MetS,the higher the prevalence of GSD (P ＜ 0.0001).The presence of 5 components of the MetS increased the risk of gallstone disease by 4.0 times.CONCLUSION:GSD appears to be strongly associated with MetS,and the more the components of MetS,the higher the prevalence of GSD.
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