免疫营养素在肠黏膜屏障功能障碍中的作用

近年来,随着对肠道屏障功能研究的深入,肠道屏障的概念已不再局限于传统的肠黏膜机械屏障;同时肠道细菌移位在临床全身感染中的作用已引起人们特别的关注,免疫营养支持的概念亦逐渐受到重视。笔者就免疫营养物质在维护肠黏膜屏障和减少肠道菌群易位机会方面的功能进行综述。消化道的吸收面积是皮肤表面积的100倍,具有防止微生物入侵的重要屏障。生理情况下肠道内有许多细菌,数量是地球上人类总数的1 000倍[1];在创伤或炎症的状态下肠道内细菌数量会更加显著地增加,并极易引起肠道细菌的移位[2],而免疫营养物质在保护胃肠道的作用方面有其独…     

艾滋病与肠道菌群的研究进展

肠道微生物群是我们身体的复杂和重要的部分,为正常的代谢功能和防止疾病提供重要支持。人类免疫缺陷病毒(HIV)是一种慢性炎性疾病,其中许多结构(肠细胞凋亡和上皮完整性的丧失),功能(粘蛋白/IgA的产生中的错误)和免疫(损伤亚黏膜淋巴细胞)缺陷导致高的死亡风险。HIV感染与胃肠道的损伤有关,导致上皮屏障的结构性损伤和肠内体内平衡的破坏。AIDS患者肠道菌群谱发生了明显改变,机会性细菌占主导地位。艾滋病及其产生的免疫缺陷与肠道腺病毒的扩张有关,肠道细菌多样性和丰富程度降低。文章综述了肠道菌群对肠道的影响,艾滋病与肠道菌群的相互关系,抗病毒治疗对肠道菌群的影响以及菌群失调的治疗等方面的研究进展。     

肠道微生物群系对炎症性肠病发生发展影响的研究进展Research progress in effect of intestinal microflora on occurrence and development of inflammatory bowel disease

肠道微生物群系主要包括细菌、真菌、病毒和蠕虫等,在肠道保护屏障和肠道免疫反应中发挥重要作用。炎症性肠病所引起的肠道功能障碍常常伴随着肠道微生物群系的失调,通常表现为多样性下降、致炎微生物增加及抗炎微生物的减少。目前炎症性肠病中肠道微生物群系的研究以细菌方面为主,但也有研究证明真菌、病毒和蠕虫等在炎症性肠病的发生发展中发挥了重要作用。目前已有肠道微生物群系来改善肠道炎症的治疗方法,如粪菌移植和饮食习惯治疗等,现有的药物治疗也被认为可以通过影响肠道微生物群系来发挥作用,肠道微生物群系已成为炎症性肠病的治疗重点。现对细菌、病毒、真菌和蠕虫等在炎症性肠病发生发展过程中的影响进行综述,并对通过改变肠道微生物群系进行炎症性肠病的治疗方法进行回顾总结,为炎症性肠病的治疗提供新的思路。     

危重症肠黏膜屏障功能障碍的机制研究

肠黏膜具有选择性渗透吸收营养物质和防御肠道内微生物及致炎因子入侵等屏障功能。在正常情况下肠道屏障功能使细菌和内毒素局限在肠道内,防止机体受内源性微生物及其毒素的侵害。在严重感染、创伤、手术、休克、重症胰腺炎等应激状态或长期进行肠外营养的情况下,肠黏膜发生缺血缺氧损伤,其结构和功能可能受到严重损害,导致肠黏膜屏障功能障碍,发生肠道细菌易位,引起全身炎性反应综合征甚至诱发多脏器功能衰竭而危及生命。因此,肠屏障功能已成为判断危重患者预后的重要指标之一,了解肠屏障功能损伤的机制对于防治多脏器功能衰竭有重要的临床意义。     

细菌源性囊泡在肠道屏障功能稳态中的诊疗潜力

肠道屏障功能稳态涉及肠道微生物群、肠道屏障和肠道免疫系统之间的动态平衡, 对维持宿主健康和防病机制至关重要。当肠道屏障功能紊乱时, 可能导致细菌和细菌产物渗透, 进而引发全身多脏器损伤以及全身炎症反应。肠道细菌分泌的细菌源性囊泡(BEVs)在这个复杂系统中起着关键作用。这些菌源性纳米颗粒参与肠道细菌和细胞的相互作用, 影响肠道的生理和病理过程, 包括调节免疫反应、维持肠道细菌的平衡和影响肠道屏障功能。本综述系统回顾了BEVs在肠道功能稳态中的作用和潜在机制, 探讨了BEVs在评估和治疗肠道屏障功能方面的临床应用潜力, 未来的研究需要更深入地探索和分析BEVs的功能机制及其在肠道健康和疾病中的作用, 以推动BEVs在肠道功能稳态评估和治疗领域的进一步应用。     

生命早期饮食与炎性肠病的关系

人体肠道内寄生着10万亿个细菌，它们能影响体质量和消化能力，抵御感染和自体免疫疾病的患病风险，人体的健康与肠道内的益生菌群结构息息相关。肠道微生物群已被证明受到多种因素的影响，包括宿主饮食、药物、宠物、社会经济地位、居住环境、心理压力和谱系的偶然获得。虽然饮食的暂时改变已被证明会导致肠道细菌组成的有限变化，但健康成年人的主要细菌组成仍然相对稳定，并受到长期饮食的影响。临床研究发现，早期生活环境，尤其是饮食，与炎性肠病的发病机制有关。     

肠肝轴在肝硬化并门脉高压症的发病机制中的作用研究进展

在正常情况下,肠道的屏障功能和肝脏的解毒功能可以防止肠道内细菌易位及肠道细菌产物如脂多糖（LPS）进入全身血液循环,然而,若肠道的屏障和肝脏的解毒等防御机制被破坏．细菌则可易位到肠道外的空间并促使免疫系统异常活化,从而引发肝脏慢性炎症损害。本文就近年来关于细菌易位和肠道细菌产物如LPS在肝硬化中的作用以及有关影响因素加以综述。     

肠道菌群变化对实验小鼠肠黏膜免疫的影响

目的探讨肠道菌群变化对肠黏膜相关淋巴组织的影响。方法通过变性梯度凝胶电泳(Denaturing gradient gel electrophoresis, DGGE)法研究了三种不同级别实验小鼠即清洁级小鼠、SPF小鼠和普通小鼠肠道菌群的组成,并用免疫组织化学 (immunohistochemistry, IHC)方法研究了此三种不同级别的实验小鼠肠黏膜相关淋巴组织 sIgA 阳性细胞分布情况。结果普通小鼠肠道细菌种类最多,其sIgA阳性细胞分布最多,肠道不同部位之间sIgA 分布情况差异有显著性(P<0.05),小肠和大肠之间的阳性细胞分布差异极显著(P<0.01);其次是清洁级小鼠,其肠道不同部位之间菌种组成差异无显著性,小肠和大肠之间的阳性细胞分布差异有显著性(P<0.05);SPF小鼠肠道细菌种类最少,故其 sIgA 阳性细胞分布最少,且其肠道不同部位之间菌种组成差异无显著性,小肠和大肠之间的阳性细胞分布差异无显著性(P>0.05)。结论随着动物微生物控制级别的增高,肠道微生物多样性递减; sIgA 阳性细胞与肠道细菌种类正相关。     

细菌功过的辩证之思 粪菌移植的美好前景

曾几何时, 人类以为细菌是我们的敌人, 必欲除之而后快。但现有研究表明, 微生物既可以促进人体健康, 也能导致疾病, 这种利害兼具的二元论不仅是微生物本身就与生俱来的, 也是人类对它们的认知, 因此也是相关研究的核心主轴。这就如同分处天秤两端的善与恶, 有时单个细菌本身就兼具这两种特质。为了有助于人们正确认识细菌, 德国科学记者汉诺·夏里修斯和里夏德·弗里贝撰写了《细菌:我们的生命共同体》一书, 真实地记述了人类对细菌认识的转变过程。这本有关细菌的百科全书分为微观人类、自我对抗的人类、消毒的疾病、微生物疗法及向商业化发展5个部分, 共计23章, 其主要内容涉及:人类超级生物体、肠道同居宿舍、动物农庄、微生物学简史、寻找失落的细菌、微生物之爱、抗生素导致的生态浩劫、不同出生方式的比较、免疫系统的学校、微生物对肥胖症和糖尿病的影响、细菌如何影响我们的心理、微生物与肿瘤的关系、生病的肠道、为个人微生物群而量身打造的医疗、拯救世界的80种有效微生物和肠道有限公司。作者通过翔实的史料和大量的科学研究成果, 向我们展示出微生物世界的惊奇之旅, 以厘清人体内生态体系的运作机制。作者指出, 细菌不仅影...     

肠道菌群在疾病中的研究进展

人体胃肠道内存在着大量的微生物, 它们被称为人类的第二大基因组——肠道菌群。肠道微生物系统的复杂性和重要性, 决定其第二大脑的地位。人体肠道内存在的细菌, 不仅参与维持肠道的正常生理功能, 更直接影响机体免疫功能。近年来, 研究发现肠道菌群与消化道、心血管、神经系统以及代谢等疾病息息相关, 现就肠道菌群在疾病中的研究进展做一综述, 旨在为临床治疗有提示作用。     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.     

TCM Treatment of Ankylosing Spondylitis by Tonifying the Kidney and Strengthening the Governor Vessel

Ankylosing spondylitis is a chronic and progressive disorder with inflammation mainly involving the central axis joints. It mainly affects the cervical spine and the lumbosacral area, with the pathogenesis closely related to the kidney and the Governor Vessel (GV). TCM holds that the syndrome is deficiency in origin and excess in superficiality, which is due to insufficiency of the kidney, deficiency of GV, and blocking of the channels with the invasion of exogenous evil, leading to poor circulation of qi and blood and malnutrition of the bones, muscles and joints. The TCM method of tonifying the kidney and strengthening GV to regulate circulation of qi and blood and check the arthralgia pain should be adopted, with the Kidney-Tonifying and GV Strengthening Decoction (益肾强督汤) prescribed.     

IMPROVING P-gp EXPRESSION IN HUMAN MONONUCLEAR CELLS IN VITRO TRANSFECTED BY MULTIDRUG RESISTANCE-1 mRNA

CHEMOTHERAPY playsa greatrolein the treat- ment of malignanttumors,especiallyingynecolo- gicalones.But inanticancerchemotherapy,leuko-cytopeniaisfrequentlytheprimarydose-limitingsideeffect factor.Moreover,cancersarefrequentlychemoresistantbe-causeof overexpressionof P-glycoprotein(P-gp), which isencodedby multidrugresistancegene (MDR1 ) and detectableinup to50% ofhuman cancersand renderscellsresistancetoanticancerdrugs.The safetyand potentialtherapeuticbenefitof mdr1 gene transferredto h…