免疫型肠内营养对结肠癌根治术患者蛋白及炎性因子的影响

[目的]探讨免疫型肠内营养对结肠癌根治术患者蛋白及炎性因子的影响。[方法]选取2015年8月～2017年6月于我院接受根治术的结直肠癌患者96例,按照随机数字表法分为对照组和观察组,2组各48例,对照组患者给予常规肠内营养治疗,观察组患者接受免疫型肠内营养治疗,比较2组患者蛋白、炎性因子水平及不良反应发生率。[结果]2组患者术后第1天,白蛋白(ALB)、前白蛋白(PA)、免疫球蛋白G(IgG)水平较术前明显下降(P0.05),术后第7天,观察组患者ALB、PA、IgG水平较术后第1天明显升高(P0.05),对照组患者PA、IgG水平较较术后第1天明显升高(P0.05),且观察组患者术后第7天ALB、PA、IgG水平明显高于对照组(P0.05);2组患者术后第1天、第7天C反应蛋白(CRP)、白细胞介素6(IL-6)水平较术前均明显升高(P0.05),术后第7天,CRP、IL-6水平较术后第1天明显降低(P0.05),且观察组患者术后第7天CRP、IL-6水平明显低于对照组(P0.05);观察组患者不良反应发生率明显低于对照组(P0.05)。[结论]免疫型肠内营养可有效恢复结直肠癌根治术患者术后蛋白水平,减轻炎症反应,降低不良反应发生率,值得在临床上推广应用。     

肠内免疫微生态营养与肠内增强免疫营养在治疗重症肺炎的对比研究

目的对比分析肠内免疫微生态营养、免疫增强型肠内营养对重症肺炎疗效、大便菌群变化情况、营养状态及预后的影响。方法 2015年6月-2016年12月,呼吸内科收治重症肺炎患者96例,采用随机数字表达法,A、B组各入组48例,分别给予A组肠内免疫微生态营养、B组免疫增强型肠内营养。同期因胃肠动力紊乱或胃肠道不耐受肠内营养的对象40例,纳入对照组。对比干预前、干预后1周、2周疗效(C反应蛋白CRP、D-二聚体、纤维蛋白原FIB、肺部感染评分CPIS)、大便菌群检查(大便菌群失调发生率)、营养状况指标(前清蛋白PAB、转铁蛋白TRF),预后(术后并发症与死亡)。观察三组在治疗中的不良反应。结果第1周、第2周,组内对比三组CRP、D-二聚体、FIB、肺部感染评分CPIS水平低于干预前,组间对比A组第1、2周CRP、D-二聚体、FIB、肺部感染评分CPIS低于对照组、B组,B组低于对照组,差异有统计学意义(P0.05)。组间对比,A组、B组第1-2周PAB高于对照组,两组第1周TRF高于对照组,A组第2周PAB高于B组,差异有统计学意义(P0.05)。重症肺炎发病7-10天后,大便菌群涂片检查,A组菌群失调发生率低于对照组(B组),差异有统计学意义(P0.05)。干预两周后,A组、B组各类并发症发生率、严重并发症合计发生率差异无统计学意义(P0.05),A组、B组严重并发症合计发生率低于对照组(P0.05)。三组均未见不良反应,对照组1例死亡。结论早期肠内营养支持可增进疗效,降低并发症发生风险;肠内免疫微生态营养更有助于控制病情,改善营养状态,还可减少重症肺炎患者肠道菌群紊乱的发生。     

免疫营养对重症脑卒中病人免疫状态及炎症反应的影响

目的评价免疫增强型肠内营养对急性重症脑卒中病人免疫状态、炎症反应的影响。方法将62例急性重症脑卒中病人随机分为免疫增强型肠内营养组(IEN组)和标准肠内营养组(SEN组)。入院后第1天、第7天及第13天分别检测两组病人的T细胞亚群(CD_4、CD_8、CD_4/CD_8)、血清免疫球蛋白(IgA、IgG、IgM)及C-反应蛋白(CRP),并通过第1天、第7天及第13天的格拉斯哥昏迷评分(GCS)评估病人的意识状态。统计两组病人感染发生例数,计算临床感染发生率。结果两组病人CD_4、CD_4/CD_8、IgA、IgG、IgM及GCS动态评分在入院第1天最低,CD_8及CRP在入院第1天时最高。动态观察显示:入院第13天时CD_4、CD_4/CD_8、IgA、IgG、IgM及GCS动态评分均较入院第1天时显著升高(P0.05),而入院第13天时CD_8和CRP较入院第1天显著降低(P0.05)。组间比较,第13天时IEN组CD_3、CD_4、CD_4/CD_8、IgA、IgG、IgM、CRP水平均高于SEN组(P0.05),IEN组CD_8水平低于SEN组(P0.05),而两组病人各时间点GCS评分差异无统计学意义(P0.05)。IEN组病人临床感染率小于SEN组(χ~2=5.406,P0.05)。结论重症脑卒中病人常出现意识障碍、吞咽功能障碍、神经源性呼吸衰竭等并发症,能够增加感染的风险,而免疫增强型肠内营养可上调机体受损的免疫功能,控制炎症反应,增强肠黏膜屏障功能,降低感染发生率。     

早期康复锻炼联合免疫肠内营养支持对老年重症脑卒中患者神经功能的影响

目的探讨早期康复锻炼联合免疫肠内营养支持对老年重症脑卒中患者神经功能恢复的影响。方法选取2017年3月至2019年5月我院收治的老年重症脑卒中患者98例,随机分为对照组和观察组,每组49例。两组患者均给予脑卒中常规综合治疗以及早期康复锻炼。在此基础上,观察组患者给予肠内营养乳剂(TPF-T)进行免疫肠内营养支持治疗,对照组患者则给予肠内营养混悬液进行常规肠内营养支持治疗。比较两组患者治疗前、治疗第10天、治疗第21天的血清白蛋白(ALB)、血红蛋白(Hb)、甘油三酯(TG)、肿瘤坏死因子-α(TNF-α)、白细胞介素-2(IL-2)、白细胞介素-6(IL-6)水平;比较两组患者治疗前后的改良Barthel(BI)量表和美国国立卫生研究院卒中量表(NIHSS)评分;比较两组患者治疗期间的不良反应发生情况。结果两组患者的血清ALB、Hb和TG水平均随着干预时间的变化而变化,观察组患者的血清ALB、Hb和TG水平先下降后上升,对照组患者的血清ALB、Hb和TG水平呈逐渐下降趋势;早期康复锻炼、肠内营养支持干预与干预时间之间存在交互效应(P0.05)。两组患者的血清TNF-α、IL-2、IL-6水平均着随干预时间的延长而逐渐下降;早期康复锻炼、肠内营养支持干预与干预时间之间存在交互效应(P0.05)。出院8周后,两组患者的BI评分均显著增高,NIHSS评分均显著降低;观察组患者的BI评分显著高于对照组,NIHSS评分显著低于对照组,差异有统计学意义(P0.05)。治疗过程中两组患者的不良反应发生率比较差异无统计学意义(P0.05)。结论早期康复锻炼联合免疫肠内营养支持能有效改善老年重症脑卒中患者的营养状况,减轻炎症反应,促进神经功能恢复,值得推广应用。     

早期肠内营养治疗对急性重症胰腺炎患者炎性因子水平的影响及临床意义

目的探讨早期肠内营养治疗对急性重症胰腺炎患者炎性因子水平、细胞免疫功能的影响。方法 130例重症胰腺炎患者根据不同营养治疗方式分为观察组74例,给予肠内营养治疗,对照组56例给予早期肠外营养治疗,治疗7 d后比较两组炎性因子水平、细胞免疫功能及临床症状改善情况。结果观察组住院时间、住院费用均明显低于对照组(P0.05);治疗后第3、7天,观察组肿瘤坏死因子(TNF)-α、白细胞介素(IL)-1β、IL-6、IL-8、IL-10、内毒素水平均明显低于对照组,CD3~+、CD4~+、CD4~+/CD8~+均明显高于对照组,CD8~+明显低于对照组(P0.05);观察组急性生理与慢性健康(APACHE-Ⅱ)评分、肠功能恢复时间、全身炎症反应综合征(SIRS)改善时间、多器官功能障碍综合征(MODS)发生率和胰腺及胰周感染率均明显低于对照组(P0.05)。结论早期肠内营养治疗有效减少了重症胰腺炎患者体内炎症细胞因子的分泌,提高了免疫功能,降低全身炎性反应及继发感染,改善了患者全身状况。     

肠内营养支持干预在急性胰腺炎患者中的临床效果及对营养状态的影响研究

目的研究肠内营养支持干预在急性胰腺炎患者中的临床效果及对营养状态的影响。 方法选取2019年11月至2021年12月内蒙古科技大学包头医学院第二附属医院消化科治疗的83例急性胰腺炎(AP)患者作为研究对象,按随机数表法分为二组,对照组41例、观察组42例。对照组进行常规肠外营养支持干预,观察组给予肠内营养支持干预。比较两组患者的急性生理功能和慢性健康状况评分系统Ⅱ(APACHE Ⅱ)评分,比较两组患者血细胞因子水平和营养指标水平。 结果干预2周后,观察组APACHE Ⅱ评分显著高于对照组(P<0.05);肿瘤坏死因子α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-1β(IL-1β)水平均明显低于对照组(P<0.05);干预2周后,观察组患者血清前白蛋白(PA)、白蛋白(ALB)、转铁蛋白(TF)水平均显著高于对照组(P<0.05)。 结论肠内营养支持干预能提高急性胰腺炎患者健康水平,降低血细胞炎症因子水平,改善患者营养状况,值得推广。     

连续性高容量血液滤过在肾移植术后严重肺部感染治疗中的应用

观察连续高容量血液滤过(CHVHF)对肾移植术后6月内严重肺部感染患者预后的影响.方法:选择2001年11月～2007年1月在南京军区南京总医院全军肾脏病研究所行肾移植术后早期出现肺部感染的患者34例,根据出现全身炎症反应综合征(SIRS)时是否给予CHVHF治疗将患者分为CHVHF组和对照组,其中CHVHF组16例,对照组18例.观察两组患者生命体征、氧合指数(PaO2/FiO2)、急性生理学及慢性健康状况评分系统Ⅱ( APACHEⅡ)评分、炎症因子[C反应蛋白(CRP)、白细胞介素6(IL-6)、IL-10]以及免疫功能指标(外周血白细胞、CD4+、CD8+细胞计数)的变化情况.比较两组患者机械通气的人数、时间、继发感染率及存活率.结果:与对照组比较,CHVHF治疗后患者体温在48h后明显下降,平均动脉压在24h后上升,72h后PaO2/FiO2上升,48h后APACHEⅡ评分明显下降(P＜0.05).CHVHF治疗72h后CRP下降,治疗24h后IL-6明显下降(P＜0.05).在急呼吸窘迫综合征(ARDS)时CHVHF组CD4+、CD8+细胞计数下降程度与对照组相比明显减少(P＜0.05),而治疗后第5、10天外周血白细胞、CD4+、CD8+细胞计数上升的程度与对照组比显著增加(P＜0.05).CHVHF组机械通气患者中有2例患者发生继发感染,1例(6.3%)死亡;对照组机械通气患者中有6例因继发其他感染死亡,1例无继发感染者亦死亡;两组患者半年生存曲线差异显著(P＜0.05).结论:肾移植肺部感染患者经CHVHF治疗后体温、平均动脉压、PaO2/FiO2、APACHE II评分等生命体征得到有效改善,治疗后炎症因子CRP、IL-6明显下降,与对照组相比CHVHF治疗组免疫功能指标外周血白细胞、CD4+、CD8+细胞计数恢复较快,机械通气时间明显缩短,继发感染的发生率减少,存活率较对照组明显提高.     

丹参注射液对2型糖尿病下肢血管病变患者炎症学指标的影响

目的检测2型糖尿病下肢血管病变的炎症学指标变化,并观察丹参注射液对炎症因子的干预治疗效果。方法将90例2型糖尿病下肢血管病变患者分为两组,治疗组在常规治疗基础上加用丹参注射液,对照组给予常规治疗。观察两组治疗前后血清炎症因子c反应蛋白（CRP）、白细胞介素6（IL-6）水平的变化,并与2型糖尿病无下肢血管病变患者进行对比。结果糖尿病无下肢血管病变患者血清CRP、IL-6水平明显高于糖尿病无下肢血管病变患者,治疗组治疗后血清CRP、IL-6水平明显低于对照组（P〈0．05或〈0．01）。结论2型糖尿病下肢血管病变患者炎症学指标明显升高．丹参注射满对炎瘫因子的干预治疗效果佩著。     

COPD急性发作期患者血清IL-2、IL-8、CRP水平变化及与肺功能的相关性分析

目的:探讨慢性阻塞性肺疾病(COPD)急性发作期患者血清中的白细胞介素2(IL-2)和白细胞介素8(IL-8)、C反应蛋白(CRP)水平变化及与肺功能的相关性。方法:检测COPD组治疗前、后(n=34)和对照组(n=32)血清IL-2和IL-8、CRP水平,以及与第1秒用力呼吸量占预计值的百分比的相关分析。结果:①COPD组治疗前血清IL-2和IL-8、CRP水平均高于对照组,有明显统计学差异(P<0.05)。COPD组IL-2和IL-8、CRP水平与FEV1/pre%呈负相关(r=-0.814,P<0.05);②COPD组IL-2和IL-8、CRP水平治疗前、后有显著统计学差异(P<0.05);③COPD组治疗后血清IL-2和IL-8、CRP水平均高于对照组,有明显统计学差异(P<0.05)。结论:COPD气道炎症与IL-2和IL-8、CRP水平释放增多有关,检测血清IL-2、IL-8、CRP水平可作为判断COPD预后的指标。     

IL-12、IL-18对单纯疱疹病毒2型DNA疫苗的免疫增强效果

目的分析白细胞介素-12(IL-12)、白细胞介素-18(IL-18)对单纯疱疹病毒2型(HSV-2)DNA疫苗的免疫增强效果。方法选取60只雌性BALB/c小鼠,按照随机数字表法分为观察组、对照组,各30只,分别运用IL-12、IL-18基因联合HSV-2 DNA疫苗或单独应用HSV-2 DNA疫苗免疫,末次免疫3周后,使用致死剂量攻毒试验炎症疫苗的保护作用,并检测两组小鼠脾脏T细胞增殖能力、抗HSV-2 Ig G抗体水平、调节活化正常T细胞表达与分泌的趋化因子(RANTES)、CD4+和CD8+T淋巴细胞百分比、分泌干扰素-γ(IFN-γ)和白细胞介素-4(IL-4)的T细胞百分比等指标,分析IL-12、IL-18对HSV-2 DNA疫苗的免疫增强效果。结果观察组Con A、灭活单纯疱疹病毒的SI、抗HSV-2 Ig G抗体水平、RANTES含量、抗CD4+和CD8+T淋巴细胞百分比、分泌IFN-γ的T淋巴细胞百分比均高于对照组,其分泌IL-4的T淋巴细胞百分比低于后者,差异有统计学意义(P0.05)。HSV-2病毒攻毒实验2周后,观察组存活9只,保护率为90.00%,对照组存活4只,保护率为40.00%,两组保护率比较,差异有统计学意义(P0.05)。结论 IL-12、IL-18基因能够明显增强HSV-2 DNA诱导小鼠产生特异性抗HSV-2的体液免疫、细胞免疫功能,是理想的免疫佐剂,值得进一步研究。     

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.