非溃疡性消化不良患者血浆及胃窦粘膜一氧化氮含量的变化

目的:探讨非溃疡性消化不良(NUD)患者血浆及胃窦粘膜中一氧化氮(NO)含量有无变化以及它在NUD疾病过程中的可能作用和临床意义。方法:应用亚硝酸盐法测定31例NUD患者血浆NO含量,其中12例患者胃液体排空延迟(NUD_2组),19例患者胃液体排空正常(NUD_1组);再用NADPH—黄递酶组织化学方法结合彩色图像分析系统测定这些患者胃窦粘膜NO含量,并以14例相当的正常人作对照。结果:NUD_2组患者血浆NO含量明显高于NUD_1组及对照组(P<0.01);胃窦粘膜中NO含量NUD_2组亦显著高于NUD_1组及对照组(P<0.01)。西沙必利使NUD患者胃液体排空功能及临床症状改善,也使其血浆和胃窦粘膜中NO含量明显升高(P<0.01)。结论NO含量升高与胃液体排空延迟相关,NO在NUD的疾病过程中可能有一定的作用。     

老年冠心病患者血浆心肌营养素-1与心功能的关系

目的 探讨老年冠心病患者血浆心肌营养素-1(CT-1)与心功能的关系及其临床意义.方法 应用酶联免疫吸附测定法(ELISA)测定老年冠心病患者54例(NYHAⅠ级11例,NYHA Ⅱ级16例,Ⅲ级16例,Ⅳ级11例)血浆CT-1、脑钠素(BNP)水平,通过超声心动图检查测定左室射血分数(LVEF).结果 老年冠心病患者血浆CT-1水平随心功能下降而升高.其中NYHAⅣ级患者为(249.95±53.529)pg/ml,Ⅲ级患者为(159.67±50.159)pg/ml,Ⅱ级患者为(108.70±39.241)pg/ml,NYHAⅠ级为(70.66±29.021)pg/ml,各组CT-1水平差异具有统计学意义(F＝35.144,P＜0.01),组间比较亦有统计学意义(P＜0.05或P＜0.01).Spearman直线相关分析显示老年冠心病患者血浆CT-1水平与心功能分级相关(r=0.805,P＜0.01);Pearson直线相关分析显示冠心病组血浆CT-1水平与血浆BNP水平相关(r=0.819,P＜0.01),与LVEF值负相关(r=-0.678,P＜0.01).通过绘制CT-1的ROC曲线,CT-1在ROC曲线下的面积为0.882,95%的可信区间为0.789～0.974,曲线下面积差异有统计学意义(P＜0.01).结论 老年冠心病患者血浆CT-1水平随心功能下降而升高,且与BNP、NYHA分级、LVEF具有较好的相关性.联合检测老年冠心病患者血浆CT-1、BNP浓度有助于判断冠心病预后.     

慢性乙型重型肝炎患者外周血树突状细胞核因子-κB及其激活因子的表达及意义

目的 探讨慢性乙型重型肝炎(CSHB)患者外周血单个核细胞衍生的树突状细胞核因子(NF)-κB、肿瘤坏死因子(TNF)α、白细胞介素(IL)-6与疾病严重程度及预后的相关性.方法 采集37例CSHB患者、20例慢性乙型肝炎(CHB)患者和20例健康对照者的外周血,分为CSHB组、CHB组与对照组并分别用密度梯度离心法分离外周血单个核细胞,用免疫磁珠细胞分选法获得纯化的单核细胞,体外培养6 d为未成熟的树突状细胞,用聚肌胞刺激48 h为成熟的树突状细胞(mDC).用实时定量PCR检测mDC NF-κB p50表达;用酶联免疫吸附试验测定培养mDC上清液中TNF α、IL-6的分泌水平.两组间比较采用t检验,3组间比较采用One-Way ANOVA分析法,相关分析采用直线相关分析法.结果 3组研究对象mDC表达NF-κB p50,表达量CSHB组为2.63±0.94、CHB组为2.03±0.39、对照组为1.41±0.40,3组比较,F=19.01,P<0.01,差异有统计学意义.mDC分泌TNF α,CSHB组、CHB组、对照组分别为(15 317.69±4124.90)pg/ml、(9670.29±3654.68)pg/ml、(6547.43±1027.20)pg/ml,3组比较,F=45.77,P<0.01,差异有统计学意义; IL-6分泌量分别为(1423.78±375.14)pg/ml、(862.68±93.68)pg/ml、(567.26±167.04)pg/ml,3组比较,F=67.60,P<0.01,差异有统计学意义.3组研究对象mDCNF-κB p50表达与TNF α、IL-6水平呈正相关(r=0.52,P<0.01;r=0.65,P<0.01).CSHB组mDC表达TNF α、IL-6与凝血酶原活动度呈负相关(r=-0.41,P=0.01;r=-0.40,P=0.01),与ALT、总胆红素、HBV DNA无相关性(r=-0.03,P=0.85,r=0.01,P=0.93,r=0.01,P=0.95;r=-0.09,P=0.58,r=0.16,P=0.34,r=0.09,P=0.59).CSHB 存活组与死亡组mDC表达TNF α、IL-6差异无统计学意义(t=0.42,P=0.67;t=0.76,P=0.45).结论 CSHB患者树突状细胞衍生的NF-κB及其激活产物TNF α、IL-6表达增加,可能与CSHB疾病严重程度相关.     

血浆脑钠肽水平与首发急性脑梗死预后的关系

目的 探讨脑钠肽(brain natriuretic peptide,BNP)对急性脑梗死患者的预后价值.方法 纳入65例首发急性脑梗死患者和32名正常对照者.病例组神经功能缺损采用中国卒中量表(Chinese Stroke Scale,CSS)评价.血浆BNP浓度采用荧光免疫定量法检测.病例组死亡和复发性卒中事件进行随访.比较事件组与非事件组血浆BNP浓度,分析血浆BNP浓度与预后不良的关系.结果 急性腩梗死患者血浆BNP浓度为(238.7±131.6)pg/ml,显著高于健康对照组的(38.7±23.8)pg/ml(P<0.01).随访期间有9例(13.8%)患者死亡,8例(12.3%)复发非致死性卒中.死亡/复发性卒中事件组患者基线血浆BNP浓度为(304.0±134.9)pg/ml,显著高于非事件组的(214.4±120.9)pg/ml(P<0.01).血浆NBP浓度与CSS评分之间存在显著相火性(r=-0.359,P<0.05).对各种危险凶素进行多变量分析表明,BNP水平(OR=3.5,95%CI 2.1～5.8;P<0.01)、高龄(OR=4.1,95%CI 1.7～9.2;P<0.01)和CSS评分(OR=2.6,95%CI 1.6-4.3;P<0.01)均为转归不良的独立预测因素.结论 血浆BNP水平升高是急性脑梗死患者近期死亡和复发的独立预测因素.     

白介素13和一氧化氮在溃疡性结肠炎的作用及意义

目的 探讨溃疡性结肠炎(UC)患者白介素13(IL13)和一氧化氮(NO)的作用和相互关系。方法 采用硝酸还原法和ELIAS分别检测血清NO浓度和血浆IL-13浓度。结果 31例UC患者和30例健康人血浆IL-13(pg/ml)(16.65±3.38 vs 25.83±3.59)或血清NO浓度(μml/L)(66.65±8.38 vs 59.83±8.59)比较,差异有显著性(P<0.05)。活动期(21例)和静止期(10例)UC患者血浆IL-13浓度(pg/ml)(12.03±3.72 vs 18.67±4.22)或血清NO浓度(μml/L)(69.03±8.72 vs 61.67±4.92)比较,差异有显著性(P<0.05)。轻、中、重度活动期UC血浆IL-13浓度(pg/ml)(13.35±2.98,8.12±1.56,4.57±1.36)或血清NO浓度(μml/L)(60.35±4.98,69.12±6.56,77.57±5.76)相互间比较,差异有显著性(P<0.05)。UC患者血清C-RP浓度与血浆IL-13呈负相关(r=-0.598.P<0.01),而与血清NO浓度呈正相关(r=0.799,P<0.01)。血清NO浓度和血浆IL-13浓度呈负相关(r=-0.632,P<0.01)。结论血浆IL-13和血清NO可作为判断UC患者病变严重程度和复发的指标之一。IL-13可能参与肠粘膜上皮细胞内调节NO产生的机制。     

高血压不同并发症患者血浆内皮素变化及辛伐他汀干预对其影响

目的 了解原发性高血压(EH)不同合并症患者血浆内皮素(ET)浓度的变化及辛伐他汀干预对其影响.方法 入选EH患者149例,根据合并症的不同分为单纯EH组44例,EH合并左心室肥厚(EH-LVH)组40例,EH合并心房颤动(EH-AF)组36例,EH合并腔隙性脑梗死(EH-LI)组29例,同时选择30例健康体检者作为对照.149例EH患者按血压水平随机分为常规治疗组(主要应用钙拮抗剂、血管紧张素转换酶抑制剂、利尿剂、β受体阻滞剂等药治疗8周)和辛伐他汀干预组(常规治疗+辛伐他汀40 mg/d),药物治疗前后检测血浆内皮素.结果 (1)EH组ET浓度高于对照组[(71.42±6.62)pg/ml对(45.52±8.28)pg/ml,P<0.01]并与血压升高程度呈正相关(r=0.746,P<0.001),EH-LVH组、EH-AF组、EH-LI组ET浓度均高于EH组[(97.67±10.53)pg/ml、(102.15±12.96)pg/ml、(103.49±9.91)pg/ml对(71.42±6.62)pg/ml,P<0.01],ET浓度变化均与血压升高程度呈正相关(r=0.671,r=0.592,r=0.530,P均<0.001).(2)EH-AF组左心房内径与ET浓度呈正相关(r=0.684,P<0.001);EH-LVH组的左心室质量指数与ET浓度呈正相关(r=0.545,P<0.001).(3)EH-LVH组、EH-AF组、EH-LI组的3级高血压所占的百分比均高于EH组.(4)EH 3级辛伐他汀干预组治疗后血压水平较常规治疗组下降更为显著(P<0.05).(5)EH 2级辛伐他汀干预组治疗后ET水平较常规治疗组显著降低(P<0.05),EH 3级辛伐他汀干预组和常规治疗组治疗后ET水平均显著降低(P<0.05),但辛伐他汀干预组下降更为显著(P<0.05).结论 ET水平与EH的严重程度呈正相关,辛伐他汀干预能更显著降低EH患者ET水平和EH3级患者的血压,提示对EH患者在使用降压药物控制血压的同时合用他汀类药物可能更有益.     

NIDDM患者血清胃泌素,血浆胃动素,生长抑素的浓度变化及意义

采用放射免疫法对19例NIDDM患者及20例正常对照组在空腹状态下进行了血清胃泌素、血浆胃动素及生长抑素的测定。结果显示，患者组胃泌素、胃动素及生长抑素的浓度分别为138.09±29.68pg／ml、659.84±145．95pg／ml及29.72±8.93pg／ml，对照组分别为90．86±15.76pg／ml、543.52±114．06pg／ml及54．21±12．51pg／ml，两组比较均有显著性差异（P＜0．05）。提示胃泌素、胃动素及生长抑素在糖尿病性胃轻瘫的发病机理中起一定作用。     

慢性阻塞性肺病患者血清对氧磷酶水平与全身炎症反应的关系

目的 探讨慢性阻塞性肺病急性加重(AECOPD)患者血清对氧磷酶(PON_1)、氧化应激与全身炎症之间的关系.方法　采用乙酸苯酯法检测40例AECOPD患者和30例正常对照者血清PON_1活性;改良Hafeman法检测血清谷胱甘肽过氧化物酶(GSH-Px)活性;比色法测定总抗氧化能力(TAC);硫代巴比妥酸显色法测定丙二醛(MDA);放射免疫法测定血清IL-6和IL-8水平;免疫投射比浊法测定血清C反应蛋白(CRP)含量.结果 AECOPD患者血清PON_1活性(95.03±57.4)U/ml显著低于对照组(136.0±60.5)U/ml,GSH-Px活性(128.46±28.27)U/ml低于对照组(186.60±39.50)U/ml(P<0.05), 血清MDA (6.25±0.87)nmol/ml 显著高于对照组(3.65±0.54)nmol/ml(P<0.01), 血清TAC(9.86±3.19)nU/ml明显低于对照组(18.42±8.23)nU/ml(P<0.01); IL-6 (64.86±20.27)pg/ml、CRP(9.23±4.58)mg/L显著高于对照组(46.32±12.25)pg/ml、(3.34±1.29)mg/L(均P<0.01);IL-8 (2.63±0.75)ng/ml高于对照组(1.82±0.67)ng/ml(P<0.05); PON_1活性与IL-8呈显著负相关(r=-0.589,P<0.01),与FEV_1%呈正相关(r= 0.434,P<0.05),GSH-Px活性与IL-6呈负相关(r=-0.362,P<0.05),MDA与CRP呈显著正相关(r=0.512,P<0.01),与FEV_1%呈显著负相关(r=-0.800,P<0.01),TAC与IL-6呈显著负相关(r=-0.573,P<0.01),与FEV_1%呈正相关(r=0.357,P<0.05).结论 AECOPD患者血清PON_1活性明显降低,且与FEV_1%存在正相关,AECOPD患者存在氧化应激并与全身炎症之间密切相关.     

老年反流性食管炎患者固体胃排空状况及其心理因素

目的:老年反流性食管炎患者胃固体排空状况和相关因素分析,为临床诊治实践提供依据.方法:确诊为反流性食管炎的患者33例,采用13C辛酸呼气试验进行胃固体排空测定;1999年烟台会议制定的反流性食管炎分级标准进行内镜下分级;采用0-Ⅲ分法进行症状评分;Zung氏抑郁焦虑自评量表进行心理因素评估.结果:老年反流性食管炎患者胃半排空时间(halfgastricemptyingtime,T1/2)和延迟相时间(lagphasetime,Tlag)与对照组比较有显著性差异(147.5±19.3vs106.4±17.1,t=7.51,P<0.01;60.3±10.3vs34.2±9.2,t=9.42,P<0.01);病例组症状评分>6分组的T1/2和Tlag均高于<6分组(161.6±22.4vs137.6±16.7,t=4.01,P<0.01;71.8±11.8vs52.9±9.2,t=9.42,P<0.01);病例组中内镜分极Ⅰ级的患者其T1/2和Tlag与Ⅱ Ⅲ组比较无显著差异;病例组抑郁和焦虑评分与对照组比较,有显著性差异(56.8±12.3vs39.6±9.8,P<0.01;53.4±10.9vs37.7±11.5,P<0.01).结论:老年反流性食管炎患者存在胃固体排空延迟,且延迟程度与症状评分有关,与内镜下分级无关;老年反流性食管炎患者普遍存在抑郁和焦虑情绪.     

血浆肌钙蛋白I与脑钠肽浓度在心绞痛患者中的相关性研究

目的 研究冠心病患者血浆脑钠肽(BNP)浓度的差异,急性冠脉综合征(ACS)患者血浆BNP浓度与肌钙蛋白I(cTnI)的相关性,并探讨BNP对ACS危险分层的价值.方法 用酶联免疫吸附法(ELISA)检测了78例ACS患者、42例稳定型心绞痛(SAP)及30例非冠心病健康对照组的血浆cTnI、BNP水平,分析ACS组患者血浆BNP与cTnI的关系;随访120例冠心病患者60 d,观察终点为心肌梗死新发或再发、出现或心衰恶化和心源性猝死.结果 血浆BNP在ACS组(138.10±4.85)pg/ml明显高于SAP组(30.62±1.08)pg/ml及对照组(29.27±1.45)pg/ml(P均<0.05).SAP组和对照组BNP浓度差异无统计学意义(P＞0.05).ACS中cTnI阳性组血浆BNP浓度(152.21±1.86)pg/ml高于cTnI阴性组(78.10±1.85)pg/ml(P<0.01),血浆BNP浓度与cTnI浓度呈正相关(r=0.57,P<0.05).120例冠心病患者中BNP>80 pg/ml组较BNP≤80 pg/ml组有更高的心肌梗死新发或再发率以及心衰发生或恶化率.结论 ACS组血浆BNP浓度升高,并与cTnI呈正相关;BNP对ACS患者近期预后有重要的临床价值,可作为危险分层的指标.     

老年非溃疡性消化不良患者血清胃泌素、血浆胃动素及生长抑素的检测及其意义

本文采用放射免疫法对３１例老年非溃疡性消化不良（ＮＵＤ）患者和２０例对照者在空腹状态下进行了血清胃泌素、血浆胃动素及生长抑素的测定。结果显示：老年人ＮＵＤ组胃泌素浓度为８５．７２±２２．０３ｐｇ／ｍｌ，较对照组的９０．４２±１５．０６ｐｇ／ｍｌ，差异无显著性（Ｐ＞０．０５）；胃动素浓度为４２７．７４±９５．８５ｐｇ／ｍｌ，较对照组的５４５．７３±１１５．８０ｐｇ／ｍｌ，差异有显著性（Ｐ＜０．０５）；生长抑素浓度为６９．４７±１８．７５ｐｇ／ｍｌ，较对照组的５４．７６±１３．３２ｐｇ／ｍｌ，差异有显著性（Ｐ＜０．０５）。提示胃动素，生长抑素在老年人ＮＵＤ发病机理中起一定作用，而胃泌素则无明显作用。     

血浆胃动素与小肠传递时间关系的初步探讨

应用国产乳果糖-氢气呼吸试验法及放射免疫法同步探测了32例正常人及20例非溃疡消化不良(NUD)患者血浆胃动素(MTL)及小肠传递时间(SBTT)。结果发现MTL与SBTT有显著负相关关系(r=-0.8283,P<0.01)。即MTL含量越高,SBTT越短,提示内源性MTL可加速SBTT。NUD患者其平均MTL/SBTT比值为2.3:1,较正常人(4.7:1)降低50％。表明NUD与血浆MTL的分泌释放量减少有关。这对揭示NUD发病机制及开辟新的治疗途径具有一定意义。     

Effect of Cisapride on Gastric Emptying of Indigestible Solids and Plasma Motilin Concentration in Diabetic Autonomic Neuropathy

To investigate the role of motilin in diabetic gastroparesis, we evaluated gastric emptying and plasma concentrations of motilin in diabetic patients. Gastric emptying of radiopaque marker was significantly delayed in the diabetics with autonomic neuropathy (n = 14) compared with the healthy controls (n = 6) ( p < 0.01). Mean plasma motilin concentrations were significantly higher in the diabetics with autonomic neuropathy compared with the healthy controls ( p < 0.01). A positive correlation was observed between gastric emptying and plasma motilin concentrations in the healthy controls ( r = 0.955, p < 0.01), whereas these values were inversely correlated in the diabetics ( r = -0.620, p < 0.01). Oral administration of cisapride (15 mg/day 14 day) significantly accelerated gastric emptying without an effect on plasma motilin concentration ( p = 0.03). These observations suggest that gastric emptying in the diabetics with autonomic neuropathy is delayed despite elevated levels of motilin, and that cisapride accelerates gastric emptying, independent of the plasma motilin concentration.     

Effect of motilin on gastric emptying in patients with diabetic gastroparesis.

Erythromycin markedly accelerates gastric emptying, possibly because it acts as a motilin agonist. In the present study, the effect of an equipotent dose of motilin was tested. In six patients with severe diabetic gastroparesis, gastric emptying of liquids and solids was examined scintigraphically after motilin or placebo in a double-blind crossover study. Motilin (10 pmol.kg-1.min-1) or saline was infused over a 90-minute period starting 5 minutes before breakfast. Motilin markedly accelerated emptying. For liquids, the half-emptying time was reduced from 51 +/- 6 to 22 +/- 11 minutes (P less than 0.01) and for solids from 111 +/- 4 to 51 +/- 12 minutes (P less than 0.01). The mean increase in plasma motilin levels was 1315 +/- 342 pg/mL, corresponding to an effective infusion rate of about 4 pmol.kg-1.min-1. In the control experiments, basal motilin levels (173 +/- 17 pg/mL) were within the normal range but increased steadily postprandially, reaching 321 +/- 25 pg/mL at the end of the study period, probably reflecting gastric distension. The postprandial increase in pancreatic polypeptide level was blunted compared with accepted normal values but was more pronounced during motilin infusion, i.e., 650 +/- 217 vs. 279 +/- 66 pg/mL (P less than 0.01), probably because of the improved emptying. Our data show that motilin accelerates gastric emptying in diabetic gastroparesis and support the hypothesis that erythromycin's effect is mediated through motilin receptors.     

Effects of Helicobacter pylori infection on gastric emptying rate in patients with non-ulcer dyspepsia

AIM: The pathogenesis of delayed gastric emptying in patients with non-ulcer dyspepsia (NUD) remains unclear. We aimed to examine whether gastric emptying rate in NUD patients was associated with Helicobacter pylori (H pylori) infection and whether it was affected by eradication of the infection. METHODS: Gastric emptying rate of a mixed solid-liquid meal was assessed by the paracetamol absorption method in NUD patients and asymptomatic controls (n=17). H pylori status was assessed by serology and biopsy urease test. H pylori-positive NUD patients (n=23) received 10-day triple eradication therapy. H pylori status was re-assessed by biopsy urease test four weeks later, and if eradication was confirmed, gastric emptying rate was re-evaluated. RESULTS: Thirty-three NUD patients and 17 controls were evaluated. NUD patients had significantly delayed gastric emptying compared with controls. The mean maximum plasma paracetamol concentration divided by body mass (Cmax/BM) was 0.173 and 0.224 mg/L.kg respectively (P=0.02), the mean area under plasma paracetamol concentration-time curve divided by body mass (AUC/BM) was 18.42 and 24.39 mg.min/L.kg respectively (P=0.01). Gastric emptying rate did not differ significantly between H pylori-positive and H pylori-negative NUD patients. The mean Cmax/BM was 0.172 and 0.177 mg/L.kg respectively (P=0.58), the mean AUC/BM was 18.43 and 18.38 mg.min/L.kg respectively (P=0.91). Among 14 NUD patients who were initially H pylori-positive, confirmed eradication of the infection did not significantly alter gastric emptying rate. The mean Cmax/BM was 0.171 and 0.160 mg/L.kg before and after Hp eradication, respectively (P=0.64), the mean AUC/BM was 17.41 and 18.02 mg.min/L.kg before and after eradication, respectively (P=0.93). CONCLUSION: Although gastric emptying is delayed in NUD patients compared with controls, gastric emptying rate is not associated with H pylori status nor it is affected by eradication of the infection.     

Effects of gastric pacing on gastric emptying and plasma motilin

AIM:To investigate the effects of gastric pacing on gastric emptying and plasma motilin level in a canine model of gastric motility disorders and the correlation between gastric emptying and plasma motilin level.METHODS: Ten healthy Mongrel dogs were divided into:experimental group of six dogs and control group of four dogs. A model of gastric motility disorders was established in the experimental group undergone truncal vagotomy combined with injection of glucagon. Gastric half-emptying time (GEt1/2) was monitored with single photon emission computerized tornography (SPECT), and the half-solid test meal was labeled with an isotope-^99mTc sulfur colloid. Plasma motilin concentration was measured with radioimmunoassay (RIA) kit. Surface gastric pacing at 1.1-1.2 times the intrinsic slow-wave frequency and a superimposed series of high frequency pulses (10-30Hz) was performed for 45min daily for a month in conscious dogs.RESULTS:After surgery, GEt1/2 in dogs undergone truncal vagotorny was increased significantly from 56.35&#177;2.99min to 79.42&#177;1.91min (P&lt;0.001), but surface gastric pacing markedly accelerated gastric emptying and significantly decreased GEt1/2 to 64.94&#177;1.75min (P&lt;0.001) in animals undergone vagotomy. There was a significant increase of plasma level of motilin at the phase of IMCⅢ (interdigestive myoelectrical complex, IMCⅢ) in the dogs undergone bilateral truncal vagotomy (baseline vsvagotomy, 184.29&#177;9.81pg/ml vs 242.09&#177;17.22pg/ml;P&lt;0.01).But plasma motilin concentration (212.55&#177;11.20pg/ml; P&lt;0.02) was decreased significantly after a long-term treatment with gastric pacing.Before gastric padng, GEt1/2 and plasma motilin concentration of the dogs undergone vagotomy showed a positive correlation (r=0.867, P&lt;0.01), but after a long-term gastric pacing, GEt1/2 and motilin level showed a negative correlation (r=-0.733, P&lt;0.04).CONCLUSION: Surface gastric pacing with optimal pacing parameters can improve gastric emptying parameters and significantly accelerate gastric emptying and can resume or alter motor function in a canine model of motility disorders. Gastric emptying is correlated well with plasma motilin level before and after padng, which suggests that motilin can modulate the mechanism of gastric pacing byaltering gastric motility.motilin can modulate the mechanism of gastric pacing by altering gastric motility.     

Effect of Helicobacter pylori on gastric emptying in non-ulcer dyspepsia--evaluation of Helicobacter pylori by 13C-urea breath test]

AIM: Non-ulcer dyspepsia (NUD) is a common disorder in clinical field. The pathogenesis of NUD are still unclear especially the participation of Helicobacter pylori (H. pylori) in NUD is controversy. Aim of the present study was to clarify the effect of H. pylori at view of urea breath test on liquids and solids gastric emptying in patients with NUD. SUBJECTS AND METHODS: H. pylori positive (n = 24) and negative NUD subjects (n = 11), and H. pylori positive non-NUD subjects (n = 10) as control group were studied. Liquids and solids gastric emptying was evaluated according to the acetaminophen method and sulfamethzole modified method delta 13C-AUC was calculated as estimation of H. pylori by 13C-urea breath test. H. pylori positive NUD was classified into high delta 13C-AUC group (n = 11), median group (n = 8) and low group (n = 5). High delta 13C-AUC group (n = 6) and low delta 13C-AUC group (n = 4) group were treated by eradication therapy. In H. pylori positive NUD subjects, high and low delta 13C-AUC group were estimated the changes of liquids and solids gastric emptying, symptoms before and after eradication. RESULTS: H. pylori positive NUD group has higher liquids gastric emptying that H. pylori negative NUD group (7.6 +/- 2.8 vs. 4.9 +/- 1.4, p = 0.0022). No difference was observed between H. pylori positive and H. pylori negative group of solids gastric emptying. There was no significant difference in liquids gastric emptying among high-, median- and low-delta 13C-AUC group of H. pylori positive NUD subjects. Solids gastric emptying was significantly delayed in high delta 13C-AUC group compared with low delta 13C-AUC group (10.3 +/- 3.7 vs. 5.3 +/- 3.1, p = 0.014). delta 13C-AUC was not correlated to liquids gastric emptying, but to solids gastric emptying (r = -0.573. p = 0.006). In Non-NUD group as control group, delta 13C-AUC has not correlation to liquids and solids gastric emptying H. pylori positive NUD has higher delta 13C-AUC than Non-NUD group. Eradicated low delta 13C-AUC group did not show significant changes in liquids gastric emptying, but did improvement of solids gastric emptying and symptoms scores. Eradicated low delta 13C-AUC group did not show any significant changes. CONCLUSION: In non-ulcer dyspepsia patients H. pylori does not influence liquids gastric emptying, but does solids gastric emptying according to delta 13C-AUC of H. pylori, especially high delta 13C-AUC patients.     

Effect of stomach motility on measuring stomach permeability with saccharose in vivo]

Determination of the urinary excretion of sucrose after an oral dose has been used as a noninvasive test to measure gastric permeability in several clinical studies. Regarding different contact times of sucrose solution within the gastric mucosa, the present study investigates a possible influence of the gastric emptying rate on the sucrose permeability test. Urinary sucrose excretion and the gastric emptying rate of liquids using 13C-acetate breath test were determined in twelve healthy volunteers. Furthermore, in seven volunteers gastric emptying was accelerated by intravenous erythromycin and prolongated by oral anticholinergic propantheline in nine healthy controls. Breath samples were measured using infrared spectroscopy. The half-emptying time and Lag-phase were correlated with the urinary sucrose excretion. Erythromycin caused a significant (p = 0.02) reduction of the half-emptying time (median 35.0 min) compared with untreated controls (median 59.9 min), whereas propantheline significantly increased the half-emptying time (median 69.4 min, p = 0.01). After pharmacological increase of the half-emptying time the urinary sucrose excretion only slightly differs from the sucrose excretion of controls (median [range] 0.057 [0.034-0.106]% versus 0.031 [0.017-0.162]%), but there was an increase of urinary sucrose excretion in probands following reduction of the half-emptying time with erythromycin (0.077 [0.023-0.221]%. The present study shows that gastric motility has a possible influence on the sucrose permeability test. The sucrose permeability has to be interpreted critically concerning its clinical use especially in patients with altered gastric motility.     

Ghrelin stimulates gastric emptying and hunger in normal-weight humans

CONTEXT: Ghrelin is produced primarily by enteroendocrine cells in the gastric mucosa and increases gastric emptying in patients with gastroparesis. MAIN OBJECTIVE: The objective of the study was to evaluate the effect of ghrelin on gastric emptying, appetite, and postprandial hormone secretion in normal volunteers. DESIGN: This was a randomized, double-blind, crossover study. SUBJECTS: Subjects included normal human volunteers and patients with GH deficiency. INTERVENTION: Intervention included saline or ghrelin (10 pmol/kg.min) infusion for 180 min after intake of a radioactively labeled omelette (310 kcal) or GH substitution in GH-deficient patients. MAIN OUTCOME MEASURES: Measures consisted of gastric empty-ing parameters and postprandial plasma levels of ghrelin, cholecystokinin, glucagon-like peptide-1, peptide YY, and motilin. RESULTS: The emptying rate was significantly faster for ghrelin (1.26 +/- 0.1% per minute), compared with saline (0.83% per minute) (P < 0.001). The lag phase (16.2 +/- 2.2 and 26.5 +/- 3.8 min) and half-emptying time (49.4 +/- 3.9 and 75.6 +/- 4.9 min) of solid gastric emptying were shorter during ghrelin infusion, compared with infusion of saline (P < 0.001). The postprandial peak in plasma concentration for cholecystokinin and glucagon-like peptide-1 occurred earlier and was higher during ghrelin infusion. There was no significant effect of ghrelin on plasma motilin or peptide YY. There was no difference in gastric emptying before and after GH substitution. CONCLUSION: Our results demonstrate that ghrelin increases the gastric emptying rate in normal humans. The effect does not seem to be mediated via GH or motilin but may be mediated by the vagal nerve or directly on ghrelin receptors in the stomach. Ghrelin receptor agonists may have a role as prokinetic agents.     

慢性病毒性肝病患者胃动力学变化的临床研究

探讨（1）慢性病毒性肝病（Chronic viral liver disease,CVLD)是否存在胃动力障碍？（2）CVLD如存在胃动力障碍，是否与胃肠激素[胃动素（MTL），胆囊收缩素（CCK）和生长抑素（SS）]有关？用放射免疫法同批测定入选者血清MTL、CCK及SS浓度。入选患者均进行胃电图和X光下钡条测胃排空检查。空腹胃电图和胃排空检查结果显示CVLD组号健康对照组相比，胃排空延迟有显著性差异。CVLD的胃排空延迟组血清MTL、CCK及SS浓度明显高于非延迟组，（P＜0．001）。说明胃肠激素紊乱是引起CVLD患者胃动力紊乱的重要原因之一。