复合乳酸菌对不同营养治疗途径的重症急性胰腺炎大鼠肠屏障功能的影响

目的:观察复合乳酸菌对早期肠内营养(EEN)和肠外营养(PN)治疗的重症急性胰腺炎(SAP)大鼠肠屏障功能的影响.方法:♂ SD大鼠胰腺被膜下均匀注射38 g/L牛磺胆酸钠制作SAP模型,96只大鼠随机分为假手术早期肠内营养治疗组(Sham-EEN)、早期肠内营养治疗组(EEN)、早期肠内营养联合复合乳酸菌治疗组(EEN Lac);假手术肠外营养治疗组(Sham-PN)、肠外营养治疗组(PN)、肠外营养联合复合乳酸菌组(PN Lac),每组16只,分别于第4和7天随机取8只大鼠,预处理后取材,检测肝和肠系膜淋巴结(MLN)肠道菌群易位(BT)、血浆内毒素(ET)、肠转运指数,TUNEL法检测肠上皮细胞凋亡、BCA法测定小肠黏膜蛋白含量、ELISA法测定小肠黏液SIgA含量.结果:PN组大鼠的BT率高于EEN组和PN Lac组(14/16 vs 9/16,10/16,均P＜0.05);4 d EEN组高于EEN Lac组(12/16 vs 9/16,P=0.026).PN组血浆ET高于EEN组(276.83±30.81 EU/Lvs 138.52±22.56 EU/L,P＜0.05);不加用Lac组高于加用Lac组(均P＜0.05).PN Lac组肠转运系数高于PN组(0.70±0.08 vs 0.59±0.05,P＜0.01).PN组小肠上皮细胞AI高于EEN组和PN Lac组(22.67%±4.97% vs 15.31%±4.18%,18.40%±2.01%,P＜0.01).加用Lac组空肠黏膜蛋白含量高于不加用Lac组(均P＜0.05);EEN Lac组高于PN Lac组(56.91±3.73 mg/gvs 44.69±2.99 mg/g,P＜0.01).EEN Lac组小肠黏液SIgA含量高于EEN组和PN Lac组(82.17±6.02 μg/g vs 69.26±5.66 μg/g,59.87±5.54μg/g,P＜0.05及P＜0.01).结论:加用复合乳酸菌可改善EEN和PN治疗的SAP大鼠肠屏障功能,其中EEN Lac的作用最为显著,EEN在维护SAP大鼠肠屏障方面的作用优于PN.     

肠内营养与肠外营养对重症急性胰腺炎患者肠屏障功能影响的比较

目的 研究肠内与肠外营养对重症急性胰腺炎(SAP)患者肠屏障功能的影响.方法 苏州大学附属第一医院、上海交通大学附属第一医院、无锡市第二人民医院及泰州市人民医院4家单位符合SAP入选标准的63例患者随机分为肠内营养(EN)组及全肠外营养(TPN)组.其中,29例接受EN,经鼻空肠管给予高能肠内营养液;34例接受TPN,通过静脉补充营养液.观察两组患者的血清内毒素、二胺氧化酶(DAO)水平及尿乳果糖/甘露醇(L/M)比值的变化.结果 在第7、14、21天,EN组血清内毒素水平均明显低于TPN组[(39.30±15.82)EU/L比(73.05±21.16)EU/L、(22.64±14.31)EU/L比(49.34±24.54)EU/L、(14.81±10.93)EU/L比(30.08±14.10)EU/L,P值均＜0.05];在第7、14天,EN组的血浆DAO水平均明显低于TPN组[(9.97±3.84)U/L比(19.89±9.89)U/L、(5.42±1.84)U/L比(8.79±4.08)U/L,P值均＜0.05];在第7、14、21天,EN组的尿L/M比值明显低于TPN组(0.28±0.25比0.65±0.45、0.21±0.18比0.54±0.41、0.08±0.04比0.29±0.06,P值均＜0.05).结论 EN在改善肠屏障功能方面优于TPN.

Abstract：

Objective To evaluate the effect of enteral nutrition (EN) versus total parenteral nutrition(TPN) on gut barrier function in patients with severe acute pancreatitis (SAP). Methods Sixtythree patients with SAP enrolled from 4 hospitals were randomly assigned into EN group(29 cases) and TPN group(34 cases). EN group patients were fed via a spiral nasojejunal feeding tube placed routinely by endoscopy or fluoroscopy, and TPN group patients were nourished intravenously with TPN during the same period. The changes of serum endotoxin, diamine oxidase, and urinary excretion of lactulose and mannitol ratio (L/M) were observed. Results Plasma concentration of endotoxin were markedly decreased in EN group as compared with that in TPN group at the 7th,14th ,21th day of entry trial [(39. 30 ± 15. 82) EU/L vs (73.05 ±21.16) EU/L,(22.64 ±14.31) EU/L vs (49.34 ±24.54) EU/L,(14.81 ± 10.93)EU/L vs ( 30. 08 ± 14. 10 ) EU/L, P ＜ 0. 05]. Plasma concentration of diamine oxidase were markedly decreased in EN group as compared with that in TPN group at the 7th, 14th day of entry trial [(9. 97 ± 3. 84)U/Lvs (19.89±9.89)U/L,(5.42±1. 84) U/Lvs (8.79 ±4.08) U/L, both P ＜ 0. 05]. The urinary L/M decreased significantly in EN group than those in TPN group at the 7th, 14th,21th day of entry trial (0.28 ±0.25 vs 0. 65 ±0.45,0.21 ±0. 18 vs 0.54 ±0.41,0.08 ±0.04 vs 0.29 ±0.06, all P＜0.05).Conclusion EN has better effect on improving intestinal barrier function than TPN in treatment of patients with SAP.     

肠内及肠外营养在根治性远端胃大部切除术后胃瘫治疗中的作用

目的:比较肠内营养(enteral nutrition,EN)与肠外营养(parenteral nutrition,PN)在根治性远端胃大部切除术后胃瘫治疗中的作用,探究术后胃瘫治疗中的适当营养方式.方法:52例根治性胃大部切除术后胃瘫患者,按术后营养治疗方式分为EN组(n=36)和PN组(n=16),分别给予EN或PN治疗.比较两组平均胃排空功能恢复时间和血红蛋白、总蛋白、白蛋白的差异.结果:EN组平均胃排空功能恢复时间低于PN组,组间比较差异无显著性(25.3d vs28.2d,P>0.05).治愈后EN组血红蛋白、总蛋白、白蛋白水平与PN组比较差异无显著性(均P>0.05).E N组患者营养支持费用明显低于PN组(398.74元/d±47.68元/d vs512.77元/d±54.31元/d,P<0.05).与治疗前比较,EN组治疗后的血红蛋白、总蛋白、白蛋白均明显升高,差异均有统计学意义(123.25g/L±15.68g/Lvs117.25g/L±13.28g/L;70.34g/L±12.85g/Lvs65.13g/L±10.76g/L;40.65g/L±8.15g/Lvs36.20g/L±9.16g/L,均P<0.05);PN组治疗后血红蛋白(125.14g/L±13.39g/Lvs120.32g/L±14.67g/L)和总蛋白变化较大(67.52g/L±13.09g/Lvs64.23g/L±12.47g/L,P<0.05),而白蛋白仅略升高(P>0.05).治疗前后EN组血红蛋白、总蛋白及白蛋白的变化幅度均明显高于PN组各项指标,且差异均有统计学意义(P<0.05).结论:EN对术后胃瘫的全身支持及减少并发症的发生有着积极的治疗作用,是术后胃瘫的营养治疗中的安全有效措施.     

益生菌对肝硬化患者肠黏膜通透性的影响

目的:探讨肝硬化门脉高压患者肠黏膜屏障功能及双歧杆菌等三联活菌胶囊(培菲康)对肝硬化患者肠黏膜通透性的影响.方法:选择我院肝硬化门脉高压、肝功能Child-pugh分级为B级的患者34例,随机分为对照组和双歧杆菌等三联活菌胶囊(培菲康)治疗组,两组均给予常规对症治疗,治疗组加用培菲康,每次420 mg,每日3次,口服2 wk.所有患者均于治疗前后测定血清二胺氧化酶(DAO)及内毒素(ETX)含量.另选12例健康体检者作为正常对照组.结果:肝硬化患者治疗组及对照组血清DAO及ETX含量均高于正常对照组,差异有统计学意义(0.2502±0.0969 kU/L,0.2263±0.1145kU/L vs 0.1145±0.0680 kU/L,P<0.01;0.3801±0.1929 EU/mL,0.3283±0.1251 EU/mL vs0.2338±0.0843 EU/mL,均P<0.05);血清DAO及ETX两指标呈线性相关(r=0.800,P<0.01);培菲康组治疗后血清DAO及ETX水平较治疗前下降,差异均有统计学意义(0.1635±0.0592kU/L vs 0.2502±0.0969 kU/L,0.2445±0.1219EU/mL vs 0.3801±0.1929 EU/mL,P<0.05);对照组治疗后血清DAO及ETX水平较治疗前下降,但差异无统计学意义.结论:血清DAO及ETX水平可作为肝硬化Child-pugh分级B级患者肠黏膜屏障功能的监测指标;补充肠道益生菌可帮助改善肠黏膜屏障功能.     

专用肠内营养制剂对急性坏死性胰腺炎大鼠蛋白质代谢的影响

目的 观察专用肠内营养制剂(EN-S)对ANP大鼠蛋白质代谢的调节作用.方法 应用3.8%牛磺胆酸钠逆行胆胰管注射制备32只ANP模型大鼠,分为对照组、EN-S 组、EN组和PN 组4组,各8只.营养各组于造模后12 h分别给予EN-S、EN和PN制剂.检测各组制模后12 h、24 h、48 h的血淀粉酶,观察胰腺组织的病理改变,以及第7天大鼠体重、血浆氨基酸谱和血清白蛋白含量.结果 制模后第7天,EN-S组大鼠体重、血清白蛋白、血浆天门冬氨酸(Asp)、蛋氨酸(Met)和赖氨酸(Lys)显著高于普通EN组(P＜0.05).EN-S组与PN组的体重、血清白蛋白、氨基酸谱整体构成无显著性差异.结论 EN-S制剂能够改善ANP大鼠的蛋白质代谢,有助于整体情况的改善.     

通腑颗粒治疗MODS胃肠功能障碍140例

目的:观察通腑颗粒治疗MODS时胃肠功能障碍的临床疗效.方法:采用前瞻性、多种心、临床随机对照研究方法,收集10家北京三级医院ICU病房符合入选标准的140例患者,随机分为A组和B组,分别以加斯清和通腑颗粒治疗.于入选后0h、给药后48h、第7天或死亡前,观察患者肠鸣音及腹部B超肠管积气、积液的情况;抽血并测定血浆内毒素含量、血浆二胺氧化酶(DAO)活性及血浆D-乳酸水平;进行两组胃肠功能评分的比较.结果:治疗第7天加斯清组与通腑颗粒组患者肠鸣音(2.29±1.685次/minvs3.62±1.762次/min,P<0.01),腹部B超积气或积液阳性率(34.4%vs13.5%,P<0.05),血浆内毒素(180±30EU/Lvs111±21EU/L,P<0.05),血浆DAO(4.45±1.67μkat/Lvs3.17±0.83μkat/L,P<0.01),血浆D-乳酸(14.594±2.022mg/Lvs10.49±4.185mg/L,P<0.05),胃肠功能评分(0.407±0.12vs1.32±0.14,P<0.01),各项监测指标差异显著.结论:通腑颗粒能够明显促进MODS时胃肠功能障碍患者肠蠕动,改善肠黏膜屏障功能.     

益生菌及肠内外营养对重症急性胰腺炎大鼠肠道黏附分子及免疫屏障的影响

目的:观察益生菌及肠外、肠内营养对重症急性胰腺炎(SAP)大鼠肠道黏附分子MAdCAM-1及免疫屏障的影响.方法:经胆胰管逆行注射50g/L牛磺胆酸钠制作SAP模型24h后,分别给予肠外营养(PN组),肠外 肠内营养(PN EN组),肠外 肠内营养 益生菌(益生菌组),持续6d,7d时处死,检测腹腔脏器组织菌群易位率,免疫组化法测定末端回肠和Peyer结MAdCAM-1,CD4,CD8,IgA.结果:益生菌组、PN EN组CD4、CD8T细胞数量及IgA,MAdCAM-1表达高于PN组(P<0.05);益生菌组Peyer结MAdCAM-1,CD8表达高于PN EN组(P<0.05).PN组菌群易位率(70.2%)、7d死亡率(75.6%)高于益生菌组(27.5%,50.0%)、PN EN组(30.5%,52.4%)(P<0.01或P<0.05),但后两组间差异无显著性意义.结论:EN能增加MAdCAM-1表达,提高SAP时肠免疫屏障,减少菌群易位,提高生存率.加用益生菌后总体改善不明显.     

专用肠内营养制剂对急性坏死性胰腺炎大鼠蛋白质代谢的影响

目的观察专用肠内营养制剂(EN-S)对ANP大鼠蛋白质代谢的调节作用。方法应用3.8%牛磺胆酸钠逆行胆胰管注射制备32只ANP模型大鼠,分为对照组、EN-S组、EN组和PN组4组,各8只。营养各组于造模后12h分别给予EN-S、EN和PN制剂。检测各组制模后12h、24h、48h的血淀粉酶,观察胰腺组织的病理改变,以及第7天大鼠体重、血浆氨基酸谱和血清白蛋白含量。结果制模后第7天,EN-S组大鼠体重、血清白蛋白、血浆天门冬氨酸(Asp)、蛋氨酸(Met)和赖氨酸(Lys)显著高于普通EN组(P<0.05)。EN-S组与PN组的体重、血清白蛋白、氨基酸谱整体构成无显著性差异。结论EN-S制剂能够改善ANP大鼠的蛋白质代谢,有助于整体情况的改善。     

益生元对急性胰腺炎大鼠肠屏障功能的影响

目的 研究肠道补充益生元对急性胰腺炎肠上皮细胞紧密连接和屏障功能的影响.方法 Wistar大鼠腹腔注射左精氨酸建立AP模型,按随机数字法分组法分成对照组、AP组、益生元组.益生元组于造模前7 d开始给予益生元4 g·kg-1·d-1.建模后12 h处死大鼠,心脏取血检测血浆二胺氧化酶(DAO)活性,观察空肠病理变化、采用免疫组化方法检测紧密结合蛋白Occludin的含量.结果 AP组的血浆DAO活性为(7.29±0.68)U/L,显著高于对照组的(2.01±0.34)U/L(P＜0.01)和益生元组的(3.44±0.59)U/L(P＜0.05).AP组肠上皮occludin蛋白表达的灰度值为95.1±9.2,明显高于对照组的44.7±8.2和益生元组的59.7±7.8(P＜0.01).益生元组occludin表达也显著高于对照组(P＜0.05).结论 AP大鼠补充益生菌可增加肠上皮occludin蛋白表达,维持肠上皮紧密连接,维持正常的肠道通透性,从而达到保护肠黏膜屏障的效果.     

高迁移率族蛋白B1在重症急性胰腺炎肠屏障损害中的作用

目的:探讨高迁移率族蛋白B1在重症急性胰腺炎(SAP)肠屏障损害中的作用及其机制.方法:采用逆行胆胰管注射50 g/L牛磺胆酸钠制备SAP大鼠模型.将56只Wistar大鼠随机分为正常对照组(Control组),SAP 3h,6h,12h,24h,48h 5个亚组,二硫代氨基甲酸吡咯烷处理组(PDTC组),每组8只.PDTC组于建模后24h取材.测定血浆内毒素(LPs)、二胺氧化酶(DAO)水平,用逆转录-聚合酶链反应(RT-PCR)方法检测肠组织高迁移率族蛋白B1(HMGB1)mRNA表达,用Western blot法检测肠组织HMGB1水平.结果:与对照组比较,SAP 6h组大鼠肠组织HMGB 1 mRNA表达显著增高(0.41±0.06 vs 0.26±0.03,P<0.01),12h呈现进一步升高趋势,24h达峰值(0.62±0.06),并持续至48h.PDTC干预可显著降低肠组织HMGB1 mRNA表达(0.35±0.06 vs 0.62±0.06,P<0.01).PDTC组较SAP 24h组肠组织HMGB1 mRNA表达,血浆LPS和DAO显著下降(HMGB1 mRNA表达:0.35±0.06 vs 0.62±0.06,P<0.01;LPS:0.433±0.120 KEU/L vs 0.852±0.232 KEU/L,P<0.01;DAO:0.65±0.12 kU/L vs 1.36±0.22 kU/L,P<0.01).结论:SAP时,肠组织内HMGB1表达上调;PDTC可以明显抑制SAP时肠组织内HMGB1表达.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.