银杏天宝对大鼠实验性结肠炎炎症损伤的保护作用

炎症性肠病(IBD)包括溃疡性结肠炎(UC)和克罗恩病(CD),病因和发病机制尚不清楚。肠黏膜局部免疫反应异常是UC发病的重要环节。炎症介质[包括活性氧簇(ROS)和细胞因子]在介导这一异常免疫反应中起重要作用。本研究观察银杏天宝(Ginkgo biloba extract,EGB)对2,4,6-三硝基苯磺酸(TNBS)诱导实验性结肠炎大鼠炎症介质的影响,探讨银杏天宝对大鼠实验性结肠炎的影响机制。一、材料和方法1．材料和试剂:TNBS购自Sigma公司。EGB为贵州     

脾胃湿热型溃疡性结肠炎模型大鼠超氧化物歧化酶活性和丙二醛水平的实验研究

[目的]探索脾胃湿热型溃疡性结肠炎(UC)的发病机制。[方法]采用高温高湿环境、高脂高糖饮食加免疫法构建脾胃湿热证UC大鼠模型,观察大鼠整体状态、病理变化,检测血清超氧化物歧化酶(SOD)活性和丙二醛(MDA)水平的表达。[结果]与正常对照组相比,脾胃湿热型UC各模型组大鼠的整体状态较差,肉眼可见结肠黏膜糜烂、溃疡形成;镜下呈急慢性炎症表现、溃疡形成,血清中SOD活性下降(P0.01),MDA水平升高(P0.05,0.01)。[结论]氧自由基参与了脾胃湿热型UC的发病过程,外周血SOD、MDA可作为炎症判断指标。     

杨倩教授治疗溃疡性结肠炎经验探析

溃疡性结肠炎(ulcerative colitis,UC)是一种慢性、非特异性炎症性肠炎,其主要表现为结肠和直肠的弥漫性黏膜炎症[1]。目前UC的发病机制尚不清楚,一般认为是遗传易感性、肠道菌群失调和免疫失衡共同作用的结果[2]。随着我国经济结构的调整、人民生活方式的改变,UC在我国的发病率逐年增高[3]。作为直结肠癌的危险因素之一,该病严重影响着UC患者的生活质量。5-氨基水杨酸、免疫抑制剂、皮质类固醇和生物制剂是控制UC患者炎症的主要治疗方案。     

通因通用法治疗溃疡性结肠炎的临床及实验研究

[目的]观察调肠通络饮(TTD)对溃疡性结肠炎(UC)患者的疗效及对实验性UC大鼠血小板功能的影响.[方法]103例UC患者随机分为两组,分别予TTD、柳氮磺胺砒啶(SASP)治疗后,观察临床综合疗效与结肠黏膜病变疗效;以2,4,6三硝基苯磺酸(TNBS)诱导实验性大鼠结肠炎,分别予TTD、SASP治疗后腹主动脉采血,测血小板黏附率、血小板聚集性,血浆与结肠组织中血栓烷B2(TXB2)、6-酮-前列腺素F1α(125 I-6-Keto-PGF1α),并取结肠组织,作病理观察.[结果]TTD组综合疗效明显优于SASP组;TTD能显著改善UC大鼠结肠病理状态,降低血浆及结肠组织中TXB2,升高血浆6-Keto-PGF1α.[结论]TTD为治疗UC的有效方药,能改善UC大鼠病损状况,有抑制血小板功能亢进的作用.     

溃疡性结肠炎的治疗策略

从诊断溃疡性结肠炎(UC)一开始,临床医师就面临着一系列挑战。对于UC的内科治疗而言,应认真排除各种“有因可查”的结肠炎,对疑诊病例可按本病治疗,其目的在于诱导疾病症状、黏膜炎症的缓解,维持疾病保持缓解状态,以提高患者的生存质量[1]。一旦确诊为UC,应立即对病变部位、范围以及严重程度进行评估,这决定着临床医师选取何种治疗方式,另外还需要对UC患者的肠外表现、健康情况、生活质量进行判断[2]。对活动性UC的治疗目标是尽快控制炎症,缓解症状,维持治疗的目的是预防复发。1对活动性UC的治疗1·1轻~中度远端结肠炎远端结肠炎是指病…     

理肠汤灌胃结合溃疡灵灌肠治疗大鼠溃疡性结肠炎实验研究

[目的]观察理肠汤灌胃结合溃疡灵灌肠治疗大鼠实验性溃疡性结肠炎(UC)的疗效。[方法]将动物随机分为正常对照(正常)组、模型组、中药治疗小剂量(小剂量)组、中药治疗大剂量(大剂量)组、柳氮磺吡啶(SASP)组。其中除正常组外,其余4组均采用2,4,6-三硝基苯磺酸(TNBS)溶液制作大鼠模型,成功后大、小剂量组分别予大、小剂量理肠汤灌胃及溃疡灵灌肠;SASP组予SASP溶液灌胃,各组灌药时间均为14 d。[结果]大剂量组肠黏膜组织学损伤评分显著低于模型组(P0.01);小剂量组、SASP组肠黏膜组织学损伤评分亦低于模型组(P0.05),但小剂量组和SASP组疗效相近(P0.05)。[结论]理肠汤灌胃结合溃疡灵灌肠治疗大鼠实验性UC有明显疗效。     

纯化的羊表皮生长因子治疗大鼠乙酸实验性结肠炎

溃疡性结肠炎(ulcerative colitis,UC)病因不明,目前发病率呈上升趋势,且缺乏特效治疗.大量研究表明,免疫调节缺陷可导致UC,大量炎性因子介入,表皮生长因子(epidermal growth factor,EGF)的修复作用与病理过程密切相关[1,2].现已有EGF用于UC及对其保护胃肠黏膜作用的研究[3].本研究在成功建立稳定的大鼠乙酸实验性结肠炎模型基础上,应用山羊颌下腺EGF灌肠治疗乙酸实验性结肠炎,观察EGF对大鼠肠黏膜病变的治疗作用,并探讨可能的机制,为临床治疗、新药开发提供基础研究依据.     

实验性结肠炎大鼠结肠上皮claudin-1、-2、-4表达改变

背景:溃疡性结肠炎(UC)是一种慢性非特异性肠道炎症病变,大量研究表明,UC肠黏膜损伤与紧密连接蛋白改变有关。目的:探讨实验性结肠炎大鼠结肠中claudin-1、-2、-4的表达。方法:将40只雌性Wistar大鼠随机分为正常对照组和模型组,给予大鼠7.5 mg/m L恶唑酮灌肠制备实验性结肠炎模型,以等量0.9%NaCl溶液灌肠作为正常对照。造模7 d后,行大体评分和结肠组织学评分,以ELISA法检测血清和结肠中细胞因子TNF-α、IL-4、IL-5、IL-10含量,免疫组化和蛋白质印迹法检测紧密连接蛋白claudin-1、-2、-4蛋白表达,实时PCR法检测claudin-1、-2、-4 mRNA表达。结果:与正常对照组相比,模型组结肠大体评分和组织学评分均显著升高(P0.05);血清和结肠组织IL-4和IL-5含量均显著增高(P0.05),而两组TNF-α和IL-10含量无明显差异(P0.05);claudin-1、-4mRNA和蛋白表达显著降低(P0.05),claudin-2 mRNA和蛋白表达显著增高(P0.05)。结论:实验性结肠炎大鼠中紧密连接蛋白claudin-1、-2、-4的分布和表达发生改变,导致肠黏膜屏障功能受损,有望作为UC治疗的潜在靶点。     

血清维生素D与溃疡性结肠炎相关性系统评价

[目的]对血清维生素D水平与溃疡性结肠炎(ulcerative colitis,UC)的相关性进行探讨。[方法]计算机检索Pubmed、EMbase、Cochrane Library、万方、中国知网、维普等数据库中关于UC患者血清25羟维生素D[25(OH)D]的病例对照研究,应用RevMan5.3、Stata 12.0软件进行Meta分析。[结果]共有11篇文献纳入研究,涉及1 269例研究对象。Meta分析结果显示,UC患者25(OH)D浓度明显低于健康对照组,其标准均数差(standard mean difference,SMD)为-0.49(95%CI:-0.74^-0.24);25(OH)D缺乏检出率的比值比(OR)为1.87(95%CI:1.43~2.45)。[结论]UC患者血清25(OH)D水平低于健康人群。     

化瘀通络汤对大鼠实验性溃疡性结肠炎血小板活化的影响

[目的]观察化瘀通络汤对大鼠实验性溃疡性结肠炎（UC）的疗效和对其血小板活化的影响，探讨化瘀通络汤治疗UC的机制及UC的发病机制。[方法]将动物按体重随机分为化瘀通络组、柳氮磺胺吡啶（SASP）组、模型对照组和正常对照组。其中除正常对照组外其余3组均采用2，4-二硝基氯苯和醋酸复合法制作UC大鼠模型。各组连续治疗4周后，取外周血测血清P-选择素和可溶性CD40配体（sCD40L）的水平。[结果]模型对照组血清P-选择素和sCD40L水平及肠黏膜损伤评分较正常对照组、化瘀通络组和SASP组显著升高（P〈0．05），而化瘀通络组与SASP组间差异无统计学意义（P〉0．05）。[结论]血小板活化在UC发病过程中起重要作用。化瘀通络汤治疗UC有效，其机制可能在于对血小板活化的阻抑而间接对免疫炎症进行调解，也可能直接通过对免疫炎症反应的调解而实现。     

Pathology of the rectal wall in solitary rectal ulcer syndrome and complete rectal prolapse.

BACKGROUND--The aetiology and pathology of rectal prolapse and solitary rectal ulcer are poorly understood. AIMS--To examine the full thickness rectal wall in these two conditions. METHODS--The pathological abnormalities in the surgically resected rectal wall were studied from nine patients with solitary rectal ulcer syndrome, 11 complete rectal prolapse, and nine cancer controls. Routine haematoxylin and eosin and Van Gieson staining for collagen were performed. RESULTS--The rectal wall from solitary rectal ulcer syndrome specimens was thickened compared with complete rectal prolapse and controls. The major difference was in the muscularis propria (2.2 v 1.1 v 1.2 mm, medians, p < 0.005) and particularly the inner circular muscular layer, and to a lesser extent the submucosal and outer longitudinal muscular layers. Some solitary rectal ulcer syndrome specimens showed unique features such as decussation of the two muscular layers (four of nine), nodular induration of inner circular layer (four of nine) and grouping of outer longitudinal layer into bundles (three of nine); these were not seen in complete rectal prolapse or control specimens. CONCLUSIONS--These features, which resemble the features of high pressure sphincter tissue, may be of aetiological importance, and suggest a different pathogenesis for these two disorders. Excess collagen was seen in both disorders, was more severe in solitary rectal ulcer syndrome specimens, and probably reflects a response to repeated trauma.     

Internal rectal intussusception seldom develops into total rectal prolapse

PURPOSE: This study was designed to analyze how often internal rectal intussusception develops into total rectal prolapse. METHODS: Repeated investigations with defecography were performed in 312 patients because of persisting symptoms. In 79 patients who had a rectal intussusception at the first defecography, results of the second defecography and the patients' records were studied. RESULTS: A total of 38 patients had not undergone any surgical treatment of rectal intussusception or rectal prolapse between the first and second defecographies. One of these patients had a rectal prolapse at the second defecography, and another developed a clinical prolapse after the second defecography. CONCLUSIONS: The present study demonstrates that the risk of developing a rectal prolapse in patients with rectal intussusception is small. This risk should, therefore, not be used as an indication for surgery.     

Complete rectal prolapse

Optional treatment for complete rectal prolapse remains controversial. PURPOSE: We reviewed our experience over a 19-year period to assess trends in choice of operation, recurrence rates, and functional results. METHODS: We identified 372 patients who underwent surgery for complete rectal prolapse between 1976 and 1994. Charts were reviewed and follow-up (median, 64; range, 12–231 months) was obtained by mailed questionnaire (149 patients; 40 percent) and telephone interview (35 patients; 9 percent). Functional results were obtained from 184 responders (49 percent). RESULTS: Median age of patients was 64 (11–100) years, and females outnumbered males by nine to one. One-hundred and eighty-eight patients (51 percent) were lost to follow-up; 183 patients (49 percent) underwent perineal rectosigmoidectomy, and 161 patients (43 percent) underwent abdominal rectopexy with bowel resection. The percentage of patients who underwent perineal rectosigmoidectomy increased from 22 percent in the first five years of the study to 79 percent in the most recent five years. Patients undergoing perineal rectosigmoidectomy were more likely to have associated medical problems as compared with patients undergoing abdominal rectopexy (61vs. 30 percent,P=0.00001). There was no significant difference in morbidity, with 14 percent for perineal rectosigmoidectomyvs. 20 percent for abdominal rectopexy. Abdominal procedures were associated with a longer length of stay as compared with perineal rectosigmoidectomy (8vs. 5 days,P=0.001). Perineal procedures, however, had a higher recurrence rate (16vs. 5 percent,P=0.002). Functional improvement was not significantly different, and most patients were satisfied with treatment and outcome. CONCLUSIONS: We conclude that abdominal rectopexy with bowel resection is associated with low recurrence rates. Perineal rectosigmoidectomy provides lower morbidity and shorter length of stay, but recurrence rates are much higher. Despite this, perineal rectosigmoidectomy has appeal as a lesser procedure for elderly patients or those patients in the high surgical risk category. For younger patients, the benefits of perineal rectosigmoidectomy being a lesser procedure must be weighed against a higher recurrence rate.Read at the meeting of The American Society of Colon and Rectal Surgeons, Seattle, Washington, June 9 to 14, 1996, and at the Tripartite Meeting, London, United Kingdom, July 8 to 10, 1996.     

Low rectal cancer

INTRODUCTION: The aim of this study was to evaluate the impact of combined radiotherapy and chemotherapy (leucovorin and 5-fluorouracil) on the treatment of potentially resectable low rectal cancer using the following end points: 1) toxicity of this combined modality regimen; 2) clinical and pathologic response rate and local control; 3) downstaging of the tumor and its influence on the number of sphincter-saving operations; 4) disease-free interval, patterns of relapse, and overall survival. METHODS: From 1991 to 1996, 118 patients with potentially resectable cases of histologically proven adenocarcinoma and no distant metastases were enrolled into this protocol. All patients were evaluated by clinical and proctologic examination, abdominal computed tomography, transrectal ultrasound, and chest radiography. Therapy consisted of 5,040 cGy (6 weeks) and concurrent leucovorin (20/mg/m²/day) with bolus doses of 5-fluorouracil administered intravenously at 425 mg/m²/day for three consecutive days on the first and last three days of radiation therapy. After two months, all patients underwent repeat evaluation and biopsy of any suspected residual lesions or scar tissue. RESULTS: Median follow-up was 36 months. Toxicity of chemotherapy regimen was minimum. Thirty-six patients (30.5 percent) were classified as being complete responders. In six of these patients, complete response was confirmed by the absence of tumor in the surgical specimens (3 abdominoperineal resections and 3 proctosigmoidectomies with coloanal anastomosis). In the remaining 30 patients, confirmation of a complete response was made by the absence of symptoms, negative findings on physical examination, and biopsy, transrectal ultrasound, and pelvic computed tomographic test results during follow-up. Eighty-two patients (69.4 percent) were considered incomplete responders. Residual lesions had already been identified during the first examination in 74 patients. In the other eight patients, residual tumor was only identified after 3 to 14 months. All patients underwent surgical treatment, except one patient who refused surgery. Eighty-seven patients underwent 90 surgical procedures: local excision, 9; coloanal anastomosis, 36; abdominoperineal resection, 4; Hartmann's procedure, 1. Isolated local recurrences occurred in five patients (4.3 percent) and combined local and distant failure in eight patients (6.7 percent). Ninety patients are alive and disease-free at a median follow-up of 36 months. CONCLUSIONS: Combined up-front chemoradiotherapy was associated with tolerable and acceptable side effects. A significant number of patients had complete disappearance of their tumors (30.5 percent) within a median follow-up of 36 months. This regimen spared 26.2 percent of patients from surgical treatment and allowed sphincter-saving management in 38.1 percent of patients who may have required abdominoperineal resection. Preliminary results of this trial suggests a reduction in the number of local recurrences and reinforces the concept that infiltrative low rectal cancer may be initially treated by chemoradiotherapy.Read at the meeting of The American Society of Colon and Rectal Surgeons, Philadelphia, Pennsylvania, June 22 to 26, 1997.     

Intermittent rectal motor activity: a rectal motor complex?

Prolonged nocturnal recordings from multiple sites in the anorectum and duodenum were performed in 12 healthy volunteers to investigate the presence and determine the characteristics of nocturnal rectal motor activity and assess any synchronicity with phase III of the small intestinal migrating motor complex. Runs of phasic contractions of two contractile frequencies (3 or 6/minute), sustained for more than three minutes, and preceded and followed by motor quiescence were observed in 10 of the 12 subjects. This phenomenon is similar to that described by other investigators and termed the 'rectal motor complex'. The runs of contractions showed considerable inter- and intrasubject variation, with a duration of 3-30 minutes (median 9.0), amplitude of 10-55 mm Hg (median 20.0), and periods of 10-420 minutes (median 55.5) between contractile activity. There was no propagation through the rectum, the phasic motor activity rarely occurred simultaneously at more than one rectal recording site. No consistent relation with phase III of the small intestinal migrating motor complex was observed in any subject. In view of these findings, we question whether this intermittent motor activity merits the term 'rectal motor complex'.