胎鼠肠管上皮细胞增殖分化与间质血管形成的关系

目的：探讨胎鼠肠管上皮细胞增殖分化与间质血管形成的关系。方法：通过免疫组织化学及电子计算机形态学分析方法,对血管内应生长因子（VEGF）和Ⅳ型胶原在胚胎期13～18d之胎鼠肠管的表达进行研究。结果：①在E13～15时,胎鼠肠管上度增殖胜盛,此后维持在20％左右;②间质血管一直占机体体积的20％左右,比较恒定;③VEGF呈波峰式表达,先在间充质中高表达而后则有上皮表达高峰;④E15～16时,Ⅳ型胶原显示血管基底膜形成完整。结论：胚胎期肠等血管形成不随上皮细胞的增殖而增多,与机体总体积有比较恒常的关系。     

中药保护肠屏障功能研究概况

对近年来中药保护肠黏膜屏障功能的研究进展进行分析和归纳，内容包括保护肠黏膜、调节免疫、改善微循环、减轻化学物质对肠黏膜的损伤、调节肠道菌群、降低内毒素水平等方面，并就中药在这方面的应用前景作了展望。     

Immune deficiencies in chronic intestinal pseudo-obstruction

Aim: Chronic intestinal pseudo-obstruction has been associated with urinary disorders, myopathy, and ophthalmoplegia in adults and cholelithiasis in children. We observed a high percentage of total-parenteral-nutrition-dependent patients with pseudo-obstruction and recurrent infections requiring gammaglobulin infusions. Methods: AH records for 23 children with chronic intestinal pseudo-obstruction (10 females and 13 males, mean age 9.8 y ± 4.9 y, range 4–24 y) referred for a nutritional evaluation from 1992 to 1995 were reviewed. Chronic intestinal pseudo-obstruction was diagnosed by clinical, radiographic findings and antroduodenal manometry. Intestinal full-thickness biopsies were performed in seven children. Results: Hypogammaglobulinemia was diagnosed in 18 patients (78%): 16 patients had various immunoglobulin deficiencies and 2 had selective antibody deficiency. Intravenous gammaglobulin was administered in 14 patients. Other medical conditions affecting the children are summarized as follows: autonomic dysfunction in 10 patients (43%), recurrent hypoglycemia in 9 (39%), asthma in 9 (39%), cholecystitis in 7 (30%), low serum carnitine level in 6 (26%), urinary dysfunction in 6 (26%), pancreatitis in 5 (22%), behavioral problems in 5 (22%), myopathy in 2 (9%), idiopathic thrombocytopenia in 2 (8%), velopharyngeal insufficiency in 1 (4%), oculocutaneous albinism in 1 (4%), Pierre-Robin syndrome in 1 (4%), and protein C deficiency in 1 (4%). Munchausen syndrome was suspected in two patients. Conclusions: Chronic intestinal pseudo-obstruction appears to be associated with immune deficiencies. It is unclear if the immune deficiencies, intestinal pseudo-obstruction, and the other medical conditions have a common underlying etiology. Repeated infections may be due to impaired immune function in children with chronic intestinal pseudo-obstruction. We recommend screening for immune deficiencies in children with chronic intestinal pseudo-obstruction.     

灯盏花素磷脂复合物改善大鼠小肠吸收的研究

目的研究灯盏花素磷脂复合物对灯盏花素实验性小肠吸收的改善作用。方法采用大鼠在体小肠循环法和离体外翻肠囊法研究灯盏花素普通粉剂和灯盏花素磷脂复合物的小肠吸收及肠壁通透性。结果大鼠在体小肠吸收实验中,灯盏花素磷脂复合物单位吸收量和单位吸收率分别提高7375%和4711%,肠壁通透性增加7313%;离体小肠吸收实验中,灯盏花素磷脂复合物单位吸收量和单位吸收率分别提高4121%和30%,肠壁通透性增加3935%;在0～100μg·mL^-1内,吸收符合Fick’s扩散定律,表现出一级动力学过程。结论灯盏花素磷脂复合物主要以被动扩散的方式吸收,并通过提高肠壁通透性来改善其吸收。     

益生菌对急性胰腺炎大鼠肠道微生态及紧密连接的影响

目的 探讨经肠道补充益生菌对急性胰腺炎（AP）大鼠肠上皮细胞紧密连接、屏障功能及微生态的影响.方法 经胰管注射3%牛磺胆酸钠造成大鼠AP后,分别给予肠外营养（PN组）和PN＋益生菌（益生菌组）,持续5天;第6天处死大鼠,取腔静脉血、肺及肝组织和肠系膜淋巴结匀浆作细菌培养测细菌易位率;取末段回肠和结肠,采用免疫组织化学法测定其跨膜结合蛋白表达,电镜观察肠上皮细胞紧密连接超微结构;取盲肠内粪便作厌氧培养及细菌种群DNA指纹图谱分析.结果 益生菌组大鼠肠道内乳杆菌和双歧杆菌数量高于PN组（P＜0.05）,而潜在致病菌产气荚膜梭菌低于PN组（P＜0.05）,DNA指纹图谱也显示益生菌组优势菌群的基因条带和正常大鼠具有较高一致性,与PN组相比则有明显差异;益生菌组小肠和大肠跨膜结合蛋白的表达明显优于PN组（P=0.001,P=0.036）,肠上皮细胞紧密连接、微绒毛较完整;益生菌组大鼠的血、肺、肝、肠系膜淋巴组织的细菌易位率低于PN组（P=0.0413）.结论 益生菌能纠正AP大鼠PN时肠道菌群紊乱,增加肠上皮跨膜结合蛋白表达,维持肠上皮紧密连接,减少细菌易位。     

谷氨酰胺和重组人生长激素对门静脉高压症患者术后肠黏膜屏障功能的影响

目的研究单独或联合应用谷氨酰胺（Gln）和重组人生长激素（rhGH）对门静脉高压症患者术后肠黏膜屏障功能的影响。方法将29例肝硬化门静脉高压症接受手术治疗的患者随机分为4组：Gln组（n=6）、rhGH组（n=8）、Gln＋rhGH组（n=7）和对照组（n=8）。术后3天开始进行等氮、等热量的全胃肠外营养（TPN）支持，持续7天。对患者手术前、后的尿乳果糖／甘露醇（L／M）、十二指肠降段黏膜绒毛高度及陷窝深度进行测定。结果Gln＋rhGH组L／M升高的幅度显著小于对照组（P〈0．05），Gln和rhGH组与对照组比较差异无显著性。Gln＋rhGH组肠黏膜绒毛高度和陷窝深度均大于对照组（P〈0．05），Gln和rhGH组与对照组比较差异无显著性（P〉0．05）。Gln＋rhGH组术后绒毛高度及陷窝深度均显著大于术前（P〈0．05）；对照组术后绒毛高度小于术前（P〈0．05），陷窝深度差异无显著性（P〉0．05）；Gln和rhGH组手术前、后绒毛高度及陷窝深度差异无显著性（P〉0．05）。结论联合应用Gln和rhGH能降低门静脉高压症患者术后肠壁通透性并维护肠黏膜形态学完整性，单独应用Gln或rhGH无此作用。     

肠道感染相关性出血性休克与脑病综合征临床分析

目的探讨肠道感染相关的出血性休克与脑病综合征临床特点。方法分析12例与文献报道的出血性休克与脑病综合征相一致的患儿,均为突发昏迷和抽搐、高热、休克、水样腹泻、代谢性酸中毒、DIC、肝肾功能损害,前躯期为严重的水样便。结果大便检测3例轮状病毒阳性:高死亡率和严重的运动和语言障碍是其特点;极显著的肝酶学改变,血胆红素多正常。入院1～2d后肝转氨酶达高峰,多于1周内恢复正常;随着休克的纠正,肾功能于1～2d内转正常,病情缓解,但神经功能却发生进行性损害:发病后持续昏迷或频繁抽搐,肺出血,难以纠正的休克,持续无尿,出血不止,多于短期内死亡;本组死亡7例,4例留有严重的神经后遗症,1例神经功能正常。结论应提高对出血性休克与脑病综合征的临床认识。治疗关键是纠正休克,肠源性的全身炎症反应可能参与发病机制。     

Living donor small bowel transplantation: Literature review 2003–2006

The experience with living donors for intestinal transplantation is limited. However, Intestinal Registry data suggest that the outcomes of the procedure are comparable with those obtained with intestinal transplant from deceased donors. In selected cases, this strategy may have a role in the treatment of patients with irreversible intestinal failure suffering life-threatening complications from total parenteral nutrition. The present review covers most of the published data on this topic between 2003 and 2006, with special reference to living donor intestinal transplantation of pediatric recipients.     

Localisation of drug permeability along the rat small intestine, using markers of the paracellular, transcellular and some transporter routes

The small intestine is the major site of drug absorption. Some reports in the literature have evoked the concept of “absorption windows” in the small intestine: are there specific regions where drug absorption is significantly higher than others? To investigate this question, we used an everted gut sac method to study the permeability of drugs and markers every 3–4 cm down the entire small intestine in rat. These markers were chosen to be representative of the mechanisms by which drugs cross the small intestinal mucosa: paracellular and transcellular passive diffusion, via influx transporters, and a drug (digoxin) that is effluxed from cells by P-glycoprotein (P-gp). The passive diffusion and influx transporter markers gave similar profiles with a plateau of permeability along the jejunum, and with the exception of L-Dopa, lower permeability in the ileum. Digoxin showed a linear decrease in the profile from the proximal jejunum to the ileum. Permeability in the duodenum was two to three times lower than the jejunum for all compounds. There were no narrow specific regions of high permeability and so the concept of discrete “absorption windows” along the small intestine as suggested from some pharmacokinetic studies may be related to other effects such as pH and/or solubility.     

基于16S rDNA测序的肠道菌群探讨解郁祛痰化浊方对高脂饮食大鼠肠-肝轴的影响

目的 研究解郁祛痰化浊方（JQHP）对高脂饮食大鼠肠道菌群的影响，探讨中药调控肠道微生物群进而恢复肠-肝轴的平衡。方法 将70只雄性SPF级别Wistar大鼠随机分为正常组（10只）与模型组（60只），正常组饲喂正常饲料，模型组饲喂高脂饲料。12周后将模型组随机分为6组，每组10只，即模型组，血脂康组，立普妥组，JQHP低、中、高剂量组。JQHP低、中、高剂量组分别灌胃JQHP颗粒剂0.4，0.8，1.6 g·kg^-1，立普妥组予立普妥2 mg·kg^-1，血脂康组予血脂康0.1 g·kg^-1，正常组和模型组大鼠灌胃同等量蒸馏水，连续灌胃8周后收集粪便，进行16S rRNA基因测序，行腹主动脉取血检测血脂，取肝脏组织及回肠组织苏木素-伊红（HE）染色后进行病理形态学观察。结果 与正常组比较，模型组大鼠血脂四项总胆固醇（TC），甘油三酯（TG），低密度脂蛋白胆固醇（LDL-C）均见明显升高，高密度脂蛋白胆固醇（HDL-C）降低（P<0.01）；与模型组比较，血脂康组、立普妥组TC，TG显著性下降（P<0.01），血脂康组HDL-C升高（P<0.05）。JQHP中剂量组较模型组对肝脏脂肪样变有一定的缓解作用，可以减轻炎性细胞的浸润情况。JQHP可使回肠结构淋巴组织增生情况好转，且中剂量组疗效最显著。Shannon曲线结果表明，与正常组比较，JQHP中剂量组显著提高（P<0.01）；与模型组比较，JQHP中、高剂量组明显升高（P<0.05，P<0.01）；与JQHP中剂量组比较，其他用药组降低（P<0.05，P<0.01）。主成分多样性分析（PCA）示中药中剂量组多样性和丰度高于其他用药组。线性判别分析（LDA）中，与正常组比较，模型组拟杆菌纲，瘤胃球菌科，拟杆菌S24-7，瘤胃球菌UCG-005下调（P<0.01），脱硫弧菌目、丹毒丝菌目、毛螺菌科上调（P<0.05，P<0.01）。与模型组比较，JQHP中剂量组的拟杆菌纲，瘤胃球菌科，拟杆菌S24-7，瘤胃球菌UCG-005上调（P<0.05，P<0.01），丹毒丝菌目下调（P<0.01）。与JQHP中剂量组比较，其他用药组拟杆菌纲，瘤胃球菌科，拟杆菌S24-7，瘤胃球菌UCG-005中降低（P<0.05，P<0.01），在丹毒丝菌目、毛螺菌科中升高（P<0.05，P<0.01）。结论 JQHP调整肠道物种丰度和多样性，改善肝脏组织和回肠黏膜状态，调节血脂水平，恢复正常肠道生态环境，可能与调节与炎症相关的肠道菌群而恢复肠-肝轴平衡有关，以中剂量组效果最佳。