生态免疫肠内营养保护肠屏障功能的研究

目的探讨生态免疫肠内营养对全身炎症反应综合征(SIRS)大鼠肠屏障功能的保护作用。方法通过尾静脉注射脂多糖(LPS)建立SIRS大鼠模型,60只雄性SD大鼠随机分为4组(标准营养组、免疫增强组、生态营养组、生态免疫组),分别给予不同构成的肠内营养剂7d,观察各组大鼠血浆D-乳酸、二胺氧化酶(DAO)以及尿乳果糖/甘露醇(L/M)比值的动态变化。结果治疗7d后,生态营养组大鼠血浆D-乳酸水平明显低于标准营养组和免疫增强组(P<0.05),但这3组均高于生态免疫组3倍或以上(P<0.01)。血浆DAO水平标准营养组显著高于其他3组(P<0.01)。注射LPS后第1天起,各组大鼠尿液L/M比值均有大幅升高,至第6天回落到注射前水平。第1天时生态免疫组尿L/M比值低于其他3组(P<0.05),第3天时标准营养组尿L/M比值显著高于另外3组(P<0.01),至第6天各组已无明显差异。结论联合应用免疫增强营养素和生态制剂的生态免疫肠内营养能更有效地保护肠屏障功能。     

腰椎间盘突出症患者腰腿痛的血循环障碍因素与推拿手法的促循环作用机制

推拿手法长期以来被广泛用于腰椎间盘突出症的治疗．但其疗效机制却不甚明了。腰椎间盘突出症最具特征性的临床症状是不同程度的腰腿痛，其发病机制主要是机械压迫、无菌性炎症刺激以及循环与营养障碍等因素导致受累神经根传导功能的障碍，其中血循环与营养障碍是腰腿痛发病的重要环节。手法治疗对患者腰腿痛的缓解与消除作用应与改善患者的血循环和营养障碍有直接或间接的关系。     

急性重症胰腺炎的治疗:证据、争议与反思

急性重症胰腺炎的治疗和研究近年来已经出现了一些新的变化。本文综述了循证医学分析的一些结论和研究的热点及争议，对急性重症胰腺炎的治疗思路提出反思。     

Development and reproducibility of a tool to assess school food-purchasing practices and lifestyle habits of Australian primary school-aged children

Objective: To describe the development and reproducibility of a self‐report instrument, for use with children in years 4–6, to identify sources of food eaten during the day, and type and frequency of food purchases at school. Design: Tool development stages included formulation of content and format, expert review, piloting and a test–retest study. Subjects/setting: The pilot study included school students (n = 20) in years 4 and 5 (seven girls, mean age 9.7 ± 0.7 years) attending an Australian public primary school. The test–retest study was performed in a large metropolitan public primary school (n = 245 children, 52% female, mean age 10.7 ± 0.91 years) including children from years 4 (n = 88), 5 (n = 84) and 6 (n = 73). Statistical analysis: A Kappa statistic was used to assess level of agreement between the two time periods separated by 1 week. The results were analysed using SAS version 8.2 with each question compared at time 1 and 2. Results: The mean kappa was 0.529 using pairings from 17 questions. Values ranged from 0.18 to 0.71 (CI 0.46–0.60). Conclusions and applications: The School Eating Habits and Lifestyle Survey has been developed and pilot‐tested in primary school‐aged children and shown to have moderate stability over time. The results show that each phase of development, particularly those spent in consultation and testing, led to progressive improvement of this instrument. This process improved the quality of information produced and gave insights to self‐report of dietary intake and behaviours among children.     

Reproducibility and validity of a food frequency questionnaire in European and polynesian New Zealanders

The reproducibility and validity of a self‐administered 142‐item food‐frequency questionnaire (FFQ) was assessed in a population comprising 124 European and 52 Polynesian (17 Maori and 35 Pacific Island) New Zealanders aged 40–65 years. Reproducibility correlation coefficients, determined by administration of the same questionnaire on two occasions 3 years apart, were higher in European than Maori and Pacific Island. participants, ranging from 0.47 to 0.87 in Europeans (median 0.66) and from 0.41 to 0.79 in Maori and Pacific Island people (median 0.44). In general, there were no significant differences in mean nutrient intakes calculated from the two FFQs by Europeans or Maori and Pacific Island participants despite their cultural and language differences. When the FFQ was compared with a 3‐day food diary in a sub sample of 101 Europeans, 15 Maori and 22 Pacific Islanders, the validity was good for most nutrients, with overestimation of a few nutrients in each ethnic group. Correlation coefficients between the 3‐day food diary and FFQ ranged from 0.41 to 0.81 in Europeans (median 0.48) and from 0.36 to 0.56 in Maori and Pacific Island people (median 0.55). Ratios of energy intake to resting metabolic rate suggested that Maori and Pacific Island people were more likely to underestimate their habitual energy intake by the 3‐day diet diary method compared to Europeans, but that Europeans were more likely to underestimate total energy intake by the food frequency method and Pacific Island participants to overestimate it. Obese Europeans and Maori were more likely to under‐report dietary intakes by the 3‐day diary method. We conclude that our FFQ performed better in European than Maori and Pacific Island participants.     

肝脏外科患者术后输注脂肪乳剂对蛋白质代谢的影响

将32例肝脏外科疾病患者随机分为Ⅰ组（单能源TPN组10例）；Ⅱ组（双能源TPN组11例，其中脂肪乳剂用量为1g·kg－1·d－1）；Ⅲ组（双能，TPN组11例，其中脂肪乳剂用量为2g·kg－1·d－1）。术后按组别给予TPN支持共6天，术前1天、术后第1和第6天测定肝功，糖代谢及蛋白质合成代谢指标。结果：①Ⅱ、Ⅲ组术后第6天肝脏酶学指标明显下降（P＜0．05），而Ⅰ组仍高于术前水平（P＜O．05）；②Ⅱ、Ⅲ组术后糖代谢基本恢复正常，而Ⅰ组出现高血糖症及高胰岛素血症（P＜0．05）；③Ⅱ组肝脏蛋白质合成水平恢复术前水平或略有提高（P＜0．05），而Ⅰ和Ⅲ组术后蛋白质合成功能仍低（P＜0．05）。结果提示：含脂肪乳剂的TPN支持对肝脏外科患者术后的肝功恢复有益，能促进蛋白质合成及肝细胞再生，并且在进行TPN支持时按1g·kg－1·d－1给予脂肪乳剂较为安全合理。     

早期营养对IUGR大鼠糖耐量和胰岛素敏感性的远期影响

【目的】了解宫内发育迟缓(IUGR)和生后早期蛋白质营养不良对IUGR大鼠糖耐量和胰岛素敏感指数(ISI)及胰岛素抵抗指数(IRI)的远期影响。【方法】采用被动吸烟法制作IUGR大鼠动物模型,新生正常鼠仔102只和IUGR鼠仔105只随机分为4组:①正常对照组;②IUGR模型组;③正常大鼠低蛋白饮食组(CLP组);④IUGR大鼠低蛋白饮食组(SLP组)。观察各组大鼠在生后4周(幼年期)、12周(成年期)和48周龄(老年期)时糖耐量和胰岛素释放试验变化。【结果】①SLP组大鼠宫内发育迟缓和生后早期蛋白质营养不良其远期葡萄糖-胰岛素代谢功能受损明显,至48周时空腹血糖(5.2±1.4)mmol/L已升高,胰岛素(31. 2±3.4)mU/L水平明显升高,ISI(1.7±0.4)明显下降,IRI(8.7±1.8)明显升高,与正常对照组[(4.5±1.1)mmol/L,(12.9±1.0)mU/L和2.8±0.2,2.3±0.41比较均有显著性差异(P<0.05或P<0.01)。②CLP组大鼠生后早期单纯蛋白质营养不良的远期影响主要表现为糖负荷后胰岛素对血糖升高的应答分泌反应延迟和糖耐量减低。③IUGR模型组大鼠生后即给予正常营养供给,其葡萄糖-胰岛素代谢紊乱的程度减轻,但仍有糖耐量减低。【结论】在宫内和/或生后早期机体发育的关键时期,蛋白质营养不良将对葡萄糖-胰岛素代谢功能产生长期的不良影响,主要表现为糖耐量减     

Serum markers of bone formation in parenteral nutrition patients

Summary Bone gamma-carboxyglutamic acid containing protein (BGP) has been utilized effectively as a serum marker of bone turnover in healthy normals and in individuals with a variety of metabolic bone disorders including postmenopausal osteoporosis and Paget's disease. The utility of this serum marker in other bone disorders, including that associated with the maintenance of patients on long-term parenteral nutrition, still requires definition. Because of our interest in this clinical syndrome and the availability of serum and of bone formation rates (BFR) measured directly from double tetracycline labeling in 11 long-term parenteral nutrition patients, we measured BGP levels in these patients and attempted to correlate this measure with BFR. Serum vitamin D metabolites, immunoreactive parathyroid hormone (PTH), and alkaline phosphatase (alk phos) were also measured. Serum BGP was only weakly and not significantly correlated (r=0.24, p=NS) with bone formation rate for the group as a whole. However, in a subgroup of 10 patients without hyperparathyroidism, there was strong and significant correlation (r=0.81,P<0.01) between BGP and BFR. There was also a strong correlation between bone formation rate and serum 1,25 dihydroxyvitamin D [1,25(OH)2D] levels (r=0.89,P<0.01, n=11). The mechanism of this association could not be established. A correlation of borderline significance was observed between bone formation rate and serum alk phos (r=0.60,P=0.05, n=11). The current data suggest that additional studies may help to more fully define the utility of serum measurements in quantifying bone dynamics in parenteral nutrition patients, and that measures of vitamin D metabolites, BGP, and alk phos may prove useful.     

Pre- and postoperative nutritional care in liver transplantation in children

Orthotopic liver transplantation (OLT) is now a definitive treatment option for most cases of endstage liver disease (ESLD) in children. Efforts now focus on active supportive treatment to maintain, if not improve, the patient's clinical status before OLT and to ensure normal patterns of growth and development after OLT. Malnutrition adversely affects the outcome of OLT and is probably the single area in pre-operative management where the largest potential improvement can be made. Our studies indicate significant abnormalities of protein energy metabolism and body composition in children referred for OLT. We have shown that the use of enteral formulae, enriched with branched-chain amino acids, have significant advantages. Other adjunctive therapy, such as growth hormone, is the subject of current investigation. Following transplantation, catch-up weight and growth does occur with the advent of normal liver functioning, but patients at continuing risk for undernutrition, such as those with rejection and/or chronic infection, need to be targeted for specific nutritional therapy.     

普通外科危重患者围手术期的营养支持

目的：研究普通外科危重患者围手术期营养支持的临床疗效。方法：对1995年以来147例普通外科危重患者围手术期营养支持应用情况进行了分析，腹部手术138例（93.9%)，颈部手术9例（6.1%)，采用以全胃肠外营养（TPN）为主的阶段性营养支持方法补充营养。深静脉置管方法：经颈内静脉置管132例（89.8%)、腋静脉11例（7.5%)、股静脉4例（2.7%)，使用单腔导管127例（86.4%)，双腔20例（13.6%)，41例（27.9%)，放置肠内营养（EN）管。106例（72.1%)为TPN→PN 口服饮食→口服饮食，41例（27.9%)为TPN→PN EN→EN→EN 口服饮食→口服饮食。结果：本组营养支持期间无置管和代谢并发症。142例（96.6%)康复，5例（3.4%)死于原发病。结论：普通外科危重患者围手术期营养支持是重要辅助治疗方法，可保证手术安全，促进术后康复。