10分钟会诊 成人急性咳嗽

1名54岁的不吸烟健康女性因严重急性咳嗽就诊。2周前她开始出现咳嗽,伴有普通感冒的症状,但她担心咳嗽会持续存在,因此来就诊。     

2型糖尿病围产期结局较差

西班牙研究人员发表在Journal of Clinical Endocrinology ＆ Metabolism杂志上的一篇研究论文表明，尽管2型糖尿病妇女的血糖紊乱较轻，但围产期结局并未好于1型糖尿病妇女，提示2型糖尿病妊娠是一种严重的状况。     

先天抑郁大鼠内脏敏感性研究

目的 比较先天抑郁Fawn-Hooded(FH/Wjd)大鼠与Sprague-Dawley(SD)大鼠的内脏敏感性,探讨FH/Wjd大鼠作为精神障碍与肠易激综合征共病模型的可行性.方法 采用强迫游泳实验(FST)和糖水实验(SPT)验证FH/Wjd大鼠的抑郁特性.通过腹壁回撤反射(AWR)评估大鼠对不同压力结直肠扩张(CRD)的敏感性.免疫组织化学法检测大鼠结肠5-HT表达水平及结肠、大脑前额叶下边缘皮质(IL)、前边缘皮质(PrL)、前喙扣带回皮质(rACC)区域的c-fos表达水平.结果 FST中FH/Wjd大鼠水中静止时间显著长于SD大鼠(t＝8.931,P＝0.000).SPT中FH/Wjd大鼠糖水饮用量占总饮水量的比例显著低于SD大鼠(t＝4.155,P＝0.001).FH/Wjd大鼠在各CRD压力梯度(20、40、60、80 mm Hg,1 mm Hg=0.133 kPa)下的AWR评分均显著高于SD大鼠(t值分别＝-2.697、-3.464、-6.822、-3.976,P值分别＝0.022、0.006、0.000、0.003).FH/Wjd大鼠对照组结肠5-HT表达水平高于SD大鼠对照组(t=-11.371,P=0.000).FH/Wjd大鼠扩张组和SD大鼠扩张组结肠5-HT表达水平均较各自的对照组上升,且FH/Wjd大鼠表达水平高于SD大鼠(t＝-3.364,P＝0.007).FH/Wjd大鼠对照组和SD大鼠对照组结肠、前额叶各脑区c-fos表达水平差异无统计学意义(结肠:t＝-0.129、P＝0.900;IL:t＝-1.316、P＝0.218;PrL:t＝1.241、P＝0.243;rACC:t＝2.151、P＝0.057).FH/Wjd大鼠扩张组和SD大鼠扩张组结肠与前额叶脑区c-fos 表达水平均较各自的对照组显著上升,且FH/Wjd大鼠表达水平高于SD大鼠(结肠:t＝-5.864、P＝0.000;IL:t＝-2.530、P＝0.030;PrL:t＝-7.039,P＝0.000;rACC:t＝-6.489、P＝0.000).结论 先天抑郁FH/Wjd大鼠存在内脏高敏感性,其肠道高表达5-HT及结肠和大脑IL、PrL、rACC 区域对内脏伤害性刺激的高反应性.有可能作为精神障碍和肠易激综合征共病的动物模型.

Abstract：

Objective To explore the feasibility of inherent depressive Fawn-Hooded (FH/Wjd)rats as a comorbidity model of mental disorder and irritable bowel syndrome (IBS) by comparing visceral sensitivity of FH/Wjd rats and Sprague-Dawley (SD) rats. Methods Depression trait of FH/Wjd rats was validated through forced swimming test (FST) and sucrose preference test (SPT).Visceral sensitivity to colorectal distention (CRD) under various pressures was assessed by abdominal withdrawal reflex (AWR). The expression of 5-HT in rats' colon,c-fos expression in colon and brain areas of infralimbic cortex (IL),prelimbic cortex (PrL) and rostral anterior cingulated cortex (rACC)was tested with immunohistochemistry. Results FST indicated that the immobility time of FH/Wjd rats was significantly longer than that in SD rats (t=-8. 931,P＜0. 01). SPT showed that the ratio of sucrose water in total liquid consumed was significantly lower in FH/Wjd rats than that of SD rats(t=4. 155,P=0. 01). At each CRD pressure gradient (20,40,60 and 80 mm Hg,1 mm Hg=0. 133kPa),AWR score was all significantly higher in FH/Wjd rats than that of SD rats (t=-2. 697,-3.464,-6.822 and -3. 976,P=0. 022,0.006,0.000 and 0.003). The expression level of 5-HT in FH/Wjd rats' control group was significantly higher than that of SD rats' control group (t=-11.371,P=0. 000). Compared with their own control group,5-HT expression increased both in FH/Wjd rats dilated groups and SD rats dilated groups,and the expression level in FH/Wjd rats was higher than that of SD rats (t= -3. 364,P= 0. 007). There was no significant difference of c-fos expression in colon and prefrontal brain areas between FH/Wjd rats' control group and SD rats'control group (colon:t=-0. 129,P= 0. 900;IL:t=-1. 316,P= 0. 218;PrL:t=1. 241,P = 0. 243;rACC:t=2. 151,P = 0. 057). Compared with their own control group,the expression of c-fos in colon and prefrontal brain areas significantly increased both in FH/Wjd rats dilated groups and SD rats dilated groups,and the expression level in FH/Wjd rats was higher than that of SD rats (colon: t=- 5.864,P= 0.000;IL:t=-2. 530,P = 0. 030;PrL:t=-7. 039,P= 0. 000;rACC:t=-6. 489,P=0. 000). Conclusions Inherent depressive FH/Wjd rats present visceral hypersensitivity. Meanwhile,the expression of 5-HT in colon is high,and with hyperreactivity to visceral noxious stimuli in colon and brain IL,PrL,and rACC areas. FH/Wjd rats might be a comorbidity animal model of mental disorder and IBS.     

先天抑郁对大鼠幼年结肠乙酸刺激致慢性内脏高敏感的影响

目的：比较先天抑郁大鼠Fawn-Hooded（FH/Wjd）与普通Sprague-Dawley（SD）大鼠对幼年结肠乙酸刺激导致的内脏高敏感和脑区激活的差异,了解先天抑郁对内脏敏感性形成的影响及可能的中枢机制。方法：构建大鼠幼年结肠乙酸刺激致慢性内脏高敏感模型（irritable bowel syndrome,IBS）。结肠扩张实验检测大鼠内脏敏感性;免疫组织化学技术检测大鼠结肠黏膜肥大细胞（mast cell,MC）数目和 结肠黏膜5-羟色胺（5-hydroxytryptamine,5-HT）的表达,以及结肠黏膜和特定脑区包括前边缘皮质（prelimbic cortex,PrL）和前喙扣带皮质（rostral anterior cingulated cortex,rACC）中吲哚胺2,3-双加氧酶（indoleamine 2,3 dioxygenase,IDO）的表达。结果：（1）大鼠幼年结肠乙酸刺激导致腹壁回测反射（abdominal withdrawal reflex , AWR）评分升高（FH/Wjd：2.44±0.04 vs.1.96±0.07,P<0.05;SD：1.75±0.13 vs.1.32±0.05,P<0.05）,且FH/Wjd IBS大鼠高于SD-IBS大鼠（2.44±0.04 vs.1.75±0.13,P<0.05）;（2）大鼠幼年结肠乙酸刺激导致结肠黏膜MC数目增加（FH/Wjd：43.24±1.72 vs. 24.92±1.38,P< 0.01;SD：23.80±1.28 vs. 14.24±0.92,P < 0.01）,FH/Wjd大鼠无论是对照组还是IBS 组,结肠黏膜 MC 数目均高于SD组（P均 < 0.01）;（3）幼年结肠乙酸刺激导致FH/Wjd及SD大鼠IBS组结肠黏膜 IDO 及5-HT阳性细胞数均升高（P均<0.01）,且FH/Wjd 大鼠对照及IBS组的IDO 及5-HT阳性细胞数高于SD 大鼠（对照：IDO,24.64 ± 2.22 vs. 15.52 ± 1.39;5 HT,21.32 ± 1.26 vs. 12.72 ± 1.12。 IBS：IDO,44.92 ± 2.31 vs. 20.85 ± 1.72;5-HT,31.84 ± 1.57 vs. 19.65 ± 1.09, P均<0.01）;（4）FH/Wjd-IBS大鼠PrL 脑区IDO表达高于SD-IBS 组（49.60 ± 4.31 vs. 35.60 ± 2.42,P <0.01）,rACC脑区IDO表达高于FH/Wjd对照（45.44 ± 1.16 vs. 34.08 ± 2.76,P<0.01）。结论：先天抑郁使大鼠结肠乙酸刺激后表现出更为显著的内脏高敏感,可能与结肠MC数目和5-HT、IDO表达升高有关,提示抑郁可能通过影响机体对炎症刺激的反应而加重胃肠道功能紊乱。