高压氧综合治疗糖尿病性胃轻瘫患者的疗效观察

目的观察高压氧（HBO）联合吗丁啉综合治疗对糖尿病性胃轻瘫患者胃动素及胃排空时间的影响。方法采用随机数字表法将2000年10月至2004年10月间连续人院的糖尿病性胃轻瘫患者112例随机分为高压氧组和对照组各46例，HBO组在给予吗丁啉（每次10mg，每天3次，连用4周）的基础上加用HBO治疗，HBO采用多人氧舱，在舱内停留120min，压力为0．25MPa（2．5ATA），戴面罩吸人纯氧60min（30min各2次，中间休息10min吸人舱内空气），10次为1个疗程，共3个疗程，每疗程间隔3～5d（排除HBO治疗禁忌证）。对照组为单纯吗丁啉，每次10mg，每天3次，连用4周。45d分别对两组患者治疗前后胃动素、空腹血糖、胃排空时间及症状的改善各项指标进行研究对比。结果HBO组和对照组总有效率分别为92．9％和76．8％，症状的改善、胃动素及胃排空时间治疗组均优于对照组，差异有显著性（P〈0．05）。结论糖尿病性胃轻瘫患者在服用吗丁啉的基础上应用HBO可降低胃动素、加速胃排空时间，对临床症状的改善具有积极作用。     

清热解毒凉血化瘀中药对慢加亚急性肝衰竭内毒素胃泌素及胃动素的干预作用

目的:分析慢加亚急性肝衰竭患者内毒素、胃泌素、胃动素的病情相关性并评价清热解毒凉血化瘀中药的干预作用。方法:临床收集69例慢加亚急性肝衰竭患者,其中早期26例,中期21例,晚期22例(并发上消化道出血12例),并设立22例Child-PughA级肝硬化患者对照观察,检测内毒素、胃泌素、胃动素水平并观察中药疗效。结果:①治疗后显效22例,有效32例,无效15例,总有效率78.26%,各期疗效差异有统计学意义(P<0.01)。②血清内毒素、血浆胃泌素、胃动素与肝损伤程度呈正相关,合并上消化道出血时各指标水平均值最高;各组之间两两比较,差异有统计学意义(P<0.01);治疗后慢加亚急性肝衰竭患者各期以及对照组ET、Gas、MTL值组间差异有统计学意义(P<0.01);慢加亚急性肝衰竭患者各期与对照组ET、Gas、MTL值比较,除早期无统计学意义外,其余各期均有统计学意义(P<0.01)。结论:慢加亚急性肝衰竭患者内毒素、胃泌素、胃动素水平升高与肝损伤程度相关,其水平变化有助于肝衰竭病情判断及预后估计,是上消化道出血的重要因素;在西医综合治疗基础上运用中医清热解毒凉血化瘀法可有效治疗慢加亚急性肝衰竭,疗效与病情分期相关,早期疗效明显。     

功能性消化不良患者胃排空障碍与胃肠激素的关系

目的 探讨功能性消化不良(FD)患者胃排空障碍与胃肠激素间的关系。方法 对54例四患者进行胃排空检查，根据结果将其分为胃排空延缓的FD组(FDD组)和胃排空正常的四组(FDN组)，另以17名正常人作为对照组。用放免法测定受试者血浆(空脂和餐后)、胃窦十二指肠粘膜组织的神经降压素(NT)和胃动宗(MTL)含量。结果 FDD组空脂和餐后血浆、胃窦和十二指肠粘膜组织的NT含量均明显高于对照组及FDN组。各组试餐前后血浆NT增幅差异无显著性。FDD组空脂和餐后血浆、胃窦和十二指肠粘膜组织的MIL含量均明显低于对照组及FDN组。各组十二指肠粘膜组织MTL含量均明显高于胃窦粘膜。结论 FD患者胃排空障碍与NT、MIL密切相关。NT、MIL在FD的发病机制中可能具有一定作用。     

The role of intracellular calcium stores in motilin induced contractions of the longitudinal muscle of the rabbit duodenum

Summary The contraction of longitudinal muscle strips of the rabbit duodenum in response to motilin and acetylcholine was investigated in normal and high K⁺-solutions in the presence and absence of external calcium, in order to demonstrate the existence of pharmaco-mechanical coupling for motilin and to examine whether the peptide mobilizes calcium from an intracellular store. In depolarized smooth muscle (140 mM K⁺), motilin (3.2×10⁹ –1×10^–7 M) and acetylcholine (1×10^–5 M) were still capable of causing a considerable, transient, concentration-dependent contraction in the presence of Ca²⁺. The extra-contraction to motilin was not blocked by tetrodotoxin (1 g/ml) nor by atropine (10^–7 M), but acetylcholine (10^–5 M) was blocked by atropine. Verapamil (10^–7 M) could selectively block the K⁺ contraction without affecting the extra agonist contraction. Nitroprusside was ineffective up to 10^–4 M in high K⁺-solutions, but in normal Hepes-buffer it caused a concentration-dependent rightward shift of the concentration-response curve of motilin and acetylcholine contractions. In a calcium-depleted medium, high K⁺-depolarized muscle strips were still responsive to motilin and acetylcholine, but higher concentrations (10^–6 M) were needed than in the presence of calcium and the contractions reached only 57 +- 11% and 74 +- 9% respectively of the maximal contraction in 1.2 mM Ca²⁺ containing solutions. The response to motilin (10^–6 M) was not only smaller than that to acetylcholine (10^–5 M), it also faded more rapidly with time. The response to one agonist could not be repeated except by using a higher concentration of the same or the other agonist, and the magnitude of this second response depended upon the dose used in the first one. We conclude that pharmaco-mechanical coupling exists for motilin and that this peptide is able to elicit contractions by mobilization of calcium from an intracellular store. This store overlaps with the one used by acetylcholine. Our experiments also reinforce the hypothesis that in the rabbit motilin exerts a direct action upon smooth muscle cells.     

人胎儿胃肠道P物质和胃动素的动态测定

用放射免疫方法测定了不同胎龄胎儿胃肠道Ｐ物质和胃动素的含量。结果发现Ｐ物质在第１０周胎儿胃肠道即可测及。以２６～３０周为最高。胃动素同样于第１０周胎儿胃肠道测及，而且也以２６～３０周含量最高。这说明含有Ｐ物质和胃动素的内分泌细胞和神经元及神经纤维以２６～３０周发育最快。     

脑梗死患者血浆神经肽Y、降钙素基因相关肽、神经降压素、胃动素动态变化及其临床意义

观察脑梗死(CI)患者神经肽Y(NPY)、神经降压素(NT)、胃动素(MTL)、降钙素基因 相关肽(CGRP)浓度变化及其临床意义。方法选择C162例,用放免法检测血浆NPY、NT、MTL与CGRP浓度。结果NPY、NT与MTL浓度显著高于对照组(P<0.0001);于发病后24h内显著升高,7d内达高峰,8～15d开始下降,15d后仍在较高水平。NPY浓度重型与大灶组显著高于轻型(P<0.05)与小灶组(P<0.01);发病积分≥6分组显著高于<6分组(P<0.05);高血压组显著高于正常血压组(P<0.05)。NT与MTL浓度重型组显著高于中(P<0.05)、轻型组(P<0.01);高血糖组显著高于正常血糖组(P<O.01)。CGRP浓度显著低于对照组(P<0.0001),发病24h内即显著降低,2～7d进一步降低,8～15d开始升高,15d后逐渐升至正常水平。重型与大灶组显著高于轻型(P<0.0001)、中型(P<0.01)与小灶组(P<0.01);伴发病积分≥6分组显著低于<6分组(P<0.05)。结论CI患者NPY、NT、MTL、CGRP浓度变化以7d内最显著,15d后逐渐恢复正常水平;四种浓度监测可作为判断CI患者病情严重程度、病灶大小及伴发病的实验室指标。     

云南拉祜族六个基因座的遗传多态性研究

目的：了解云南拉祜族６ 个短串联重复序列基因座遗传多态性分布。方法：应用复合扩增技术对ＣＳＦ１ＰＯ、ＴＰＯＸ、ＴＨ０１ 、Ｆ１３Ａ０１、ＦＥＳＦＰＳ和ｖＷＡ等６ 个ＳＴＲ基因座进行分析,采用高分辨率的聚丙烯酰胺凝胶电泳分离、银染法显影技术,对云南拉祜族上述６ 个ＳＴＲ基因座进行遗传多态性调查。结果：ＣＳＦ１ＰＯ基因座,观察到８ 个等位基因,２０ 个基因型;ＴＰＯＸ 基因座,观察到５ 个等位基因,１４ 个基因型;ＴＨ０１ 基因座,观察到６ 个等位基因,１７ 个基因型;Ｆ１３Ａ０１ 基因座,观察到６ 个等位基因,１３ 个基因型;ＦＥＳＦＰＳ基因座,观察到７ 个等位基因,１５ 个基因型;ｖＷＡ基因座,观察到７ 个等位基因,１７ 个基因型。结论：上述６ 个短串联重复序列基因座基因频率分布与Ｈａｒｄｙ Ｗｅｉｎｂｅｒｇ 平衡吻合良好。     

Ca2+ dependence of motilide-induced contractions in rabbit duodenal muscle strips in vitro

Summary Recent studies suggested that certain erythromycin A (EM-A) derivatives are motilin receptor agonists. As proposed by Itoh they may be called motilides. We have investigated the Ca²⁺-dependence of contractions induced by two potent motilides, ME-34 [de(N-methyl) 8,9-anhydroeryhtromycin A 6,9-hemiacetal] and EM-523 [de(N-methyl)-N-ethyl-8,9-anhydro-erythromycin A 6,9-hemiacetal], in duodenal tissues and compared the results with those previously obtained with motilin.Isometric and isotonic contractile responses of isolated longitudinal muscle sheets from the rabbit duodenum were tested under normal, Ca²⁺-free and depolarizing conditions. Prior to stimulation with motilides, the maximal response to acetylcholine was recorded and all responses were always expressed as a percentage of this response. Both motilides induced contractions in normally polarized tissue, with an EC₅₀ of 26 ± 5 nM for ME-34 (n = 7), and 27 ± 5 nM for EM-5231 (n = 16) and maximal responses of respectively 88 ± 4% and 80 ± 3%. Like motilin, both compounds induced an extra-contraction in depolarized tissues. The EM-523 response in 140 mM K⁺under isotonic conditions was 84 ± 3% (n = 5) at 10^–5 M, with an EC₅₀ that was shifted to 65 ± 18 nM. Similar figures were obtained for ME-34. When Ca²⁺ was added to Ca²⁺-depleted strips, half-maximal Ca²⁺ values (in mM) were 1.10 ± 0.11 (n = 9) for EM-523 and 1.13 ± 0.12 (n = 3) for ME-34, as compared with 1.12 ± 0.13 (n = 7) for motilin and 2.8 ± 1.1 (n = 9) for K⁺. Both ME-34 and EM-523 also induced a transient contraction in Ca⁺-free solutions under isometric conditions. The response to EM-523 (5 × 10^–6 M) was 49 ± 15% (n = 4) after 3 min. A maximal EM-523 -stimulation reduced a subsequent ACh response by 78 ± 7%, whereas EM-523 and ME-34 could not induce a contraction after ACh.We conclude that motilides depend upon external Ca²⁺ to a similar extent to motilin. Like motilin, they are also able to mobilize intracellular Ca Z + stores. Our results support the hypothesis that motilides act on motilin receptors. Send offprint requests to T. L. Peeters at the above address     

比较不同药物硬膜外镇痛对家兔胃肠运动的影响

目的比较曲马多、罗哌卡因、吗啡三组药物用于硬膜外术后镇痛效果及对家兔胃肠运动功能的影响,探讨胃动素(MOT)、血管活性肠肽(VIP)血浆浓度与家兔胃肠运动功能的关系。方法健康家兔、性别不限、体重无差异(P>0.05),喂少纤维饲料3天,清水1天。随机分为四组,其中生理盐水7只(N组),曲马多组(T组)、罗哌卡因组(R组)、吗啡组(M组)各为8只,经胃管注入美蓝2ml,静脉注射3%戊巴比妥钠1ml/kg,静脉采血2ml。硬膜外穿刺置管接硬膜外镇痛泵(2ml/h)。术后1小时、4小时分别采血2ml。处死家兔,分离小肠。检测镇痛评分、美蓝运动速率及不同时点的胃动素(MOT)、血管活性肠肽(VIP)。结果N组疼痛评分均数与其他三组均有显著差异(P<0.05),其余三组镇痛效果比较无显著意义(P>0.05);四组美蓝运动速率均数比较差异有显著意义(P<0.05),其中R组美蓝运动速率最快,与M组和N组比较均有显著差异(P<0.05),T组较M组比较有显著差异;各组组内MOT均数比较无显著意义(P>0.05);各组各时点VIP测定值比较差异无显著意义(P>0.05)。结论曲马多、罗哌卡因及吗啡镇痛效果较好,曲马多,罗哌卡因对胃肠运动功能影响较小;家兔血清MOT、VIP浓度与硬膜外术后镇痛胃肠运动功能无相关性。     

Intestinal pseudo-obstruction：An uncommon condition with heterogeneous etiology and unpredictable outcome

Intestinal pseudo-obstruction （IPO） either acute or chronic is a condition including features of intestinal ileus in absence of mechanical obstruction. Our paper presents such a rare case of idiopathic IPO in a 53-year-old male patient with recurrent episodes of pseudo-obstruction, which were successfully resolved by anticholinesterase agents, motilin agonists or colonic decompression. However, the patient finally underwent total colectomy. Huge colonic dilatation was identified intraoperatorily, while histology showed a neuropathic variant of chronic intestinal pseudo-obstruction. Etiologic mechanisms and current therapeutic methods are reviewed in this paper, which concludes that IPO is a condition in which conservative treatment usually fails. Total colectomy with ileoanal pouch may be the only solution in these situations.