重组生长激素促短肠大鼠结肠代偿机制的探讨

目的　探讨重组生长激素促短肠大鼠结肠代偿的作用机制。方法　将短肠大鼠分成肠内营养（EN）和肠内营养+重组生长激素（EG）两组。结果　自术后第15天起,EG组体重的减轻明显低于EN组(P＜0.05),术后第21天起体重已大于术前;EG组氮平衡的改善明显好于EN组;血浆蛋白水平也高于EN组(P＜0.05);EG组结肠壁胰岛素样生长因子1(IGF-1)mRNA含量比EN组明显升高〔(1291±43）vs.（1026±42）,P＜0.05〕,IGF-1受体mRNA含量明显降低〔(899±5）vs.（1113±7）,P＜0.05〕;EG组的血IGF-1水平明显高于EN组〔(455±107）ng/mlvs．（329±68）ng/ml,P＜0.05〕,GH水平也显著升高〔(9.7±3.3）ng/mlvs.（5.8±2.4）ng/ml,P＜0.05〕。结论　重组生长激素可促使短肠大鼠IGF-1和结肠壁IGF-1mRNA的合成及残留肠道对营养物质吸收。     

短肠大鼠结肠对~(15)N-甘氨酸的吸收研究

目的　探讨短肠大鼠的结肠对氨基酸代偿吸收能力。方法　切除 80 %小肠的短肠大鼠 ,经肠喂养 2 1天后 ,测定结肠对15N 甘氨酸的吸收率和血15N 甘氨酸丰度及形态学改变。结果正常大鼠 3h水吸收为 (1± 0 5 )ml,对15N 甘氨酸无吸收 ,血中15N 甘氨酸丰度为零。短肠大鼠 3h水吸收为 (2 6± 0 82 )ml(P <0 0 5 ) ,15N 甘氨酸为 (4 39± 1 2 ) % (P <0 0 1) ,血中15N 甘氨酸丰度为(0 6 14± 0 5 17) % (P <0 0 1)。形态学检测显示 :喂养组与对照组相比结肠直径差异有显著意义(P <0 0 5 ) ,而结肠壁厚度、粘膜厚度、皱襞高度和皱襞表面积差异有极显著的意义 (P <0 0 1)。结论　短肠大鼠结肠对水和15N 甘氨酸有一定代偿性吸收 ,组织形态学也有一定程度的代偿     

肠内营养促短肠大鼠结肠代偿性增生

观察及评价肠内营养（ＥＮ）对治疗短肠大鼠的作用和短肠大鼠结肠形态学代偿性增生的作用。方法：制作切除８０％～８５％的超短肠大鼠模型,用Ｐｅｐｔｉ－２０００作ＥＮ治疗,观察其全身营养状况和结肠形态学的改变。结果：ＥＮ组存活率高达７６．９％,于术后第２１天净氮平衡与对照组无差异,体重仅比术前减轻１０ｇ±１．８ｇ。结肠壁明显增厚,皱襞增大增粗,结肠壁的厚度、粘膜厚度、腺上皮高度和表面积与对照组相比差异非常显著（Ｐ＜０．００１）。ＥＮ组与对照组相比：ＤＮＡ指数１．２１±０．１１比１．０１±０．１５（Ｐ＜０．０５）,Ｓ期细胞百分比５２．６％±５．５％比４２．９％±４．１％（Ｐ＜０．０５）。ＥＮ组的ＩＧＦ－１ｍＲＮＡ含量比对照组有极明显增高（１０２６±４２比７３８±４．４,Ｐ＜０．０１）。结论：大鼠结肠在短肠综合征时发生了明显的形态学代偿性增生。早期适当的肠内营养不但可使超短肠大鼠获得足够营养支持,并且能够促进结肠的形态学和功能上的代偿。     

谷氨酰胺对短肠综合征大鼠模型结肠黏膜作用的初步研究

目的 探讨谷氨酰胺联合肠内营养对动物模型结肠黏膜的影响。方法 将大鼠随机分为5组，即模型肠内营养组、谷氨酰胺大剂量＋肠内营养组，谷氨酰胺中剂量＋肠内营养组，谷氨酰胺小剂量＋肠内营养组。分为7天，14天2个时间点进行观察。结果 Gln各组肠壁肌层增厚明显，皱襞明显增高，肠腺数量增多，其中大、中剂量组的皱襞不仅高且密集，皱襞高度、肠腺密度均明显大于模型组（P〈0．01）。结论 谷氨酰胺＋肠内营养比单用营养的模型组更可以促进大鼠结肠的代偿，大、中剂量组优于小剂量组。     

精氨酸促进短肠综合征肠道代偿及其机制的初步研究

/L、(13.5±3.0) mg﹒cm-1·100 g-1、(26.0±2.6) μg·cm-1·100 g-1、(59.8±6.2) μg·cm-1·100 g-1、(35.4±2.3) μg·cm-1·100 g-1、(22±3)及(25±3),均P＜0.05];小肠超微结构亦观察到SB-Arg组大鼠小肠绒毛高度、隐窝深度及黏膜厚度均大于SB组大鼠(P＜0.05).结论 肠内营养中添加适量精氨酸能促进短肠综合征大鼠肠道结构及功能的代偿,其机制可能为促进肠黏膜细胞增殖、抑制其凋亡.     

胰岛素样生长因子Ⅰ在生长激素促小肠代偿中的作用

目的　探讨胰岛素样生长因子Ⅰ（insulin-like growth factorⅠ,IGFⅠ）在生长激素（growthhormone,GH）促小肠代偿中的作用。　方法　将20只SD大鼠随机分成GH组及STD组,建立PN短肠大鼠动物模型。用光镜检查小肠粘膜形态学变化,用放射性免疫分析法测定血GH及IGFⅠ浓度,用Northernblot法测定残存小肠IGFⅠmRNA表达。结果　GH组大鼠小肠粘膜厚度、绒毛高度及隐窝深度均显著高于STD组,分别为(471±16)μmvs.(374±13)μm,(299±17)μmvs.(212±19)μm及(161±20)μmvs.(96±9)μm,P＜0.01。血GH及IGFⅠ浓度在GH组显著高于STD组,分别为(5.2±0.8)ng/mlvs.(3.3±1.7)ng/ml及(425±19)ng/mlvs.(326±30)ng/ml,P＜0.05,残存小肠形态学改变与血GH及IGFⅠ浓度变化间呈显著正相关。GH组小肠局部IGFⅠmRNA的表达显著高于STD组(0.62±0.04vs.0.41±0.02),P＜0.05。结论IGFⅠ在GH的促小肠代偿机制中起着重要的介导作用,全身性IGFⅠ增加及小肠局部IGFⅠ产生的增加均与小肠的代偿密切相关。     

化疗后肠屏障功能损害及谷氨酰胺和生长激素对肠粘膜屏障的作用

目的　研究谷氨酰胺双肽（Gln）和生长激素（rHGH）对肠粘膜屏障的协同保护作用。方法　将大鼠分为4组正常饮食组（Chow组）予正常饮食;传统肠外营养组（STD组）予传统肠外营养;Gln组传统肠外营养＋Gln;Gln＋rHGH组传统肠外营养＋Gln＋rHGH。4组均予腹腔化疗。检测体重,血氨基酸谱、肠粘膜形态学、细菌移位率和肠粘膜通透性。结果　Gln＋rHGH组的空肠绒毛高度显著优于其他3组［（626.5±23.5)比(403.2±19.5)μm、(548.3±17.8)和(561.6±16.3)μm,P＜0.05］。Gln＋rHGH组和Chow组细菌移位率均为20％,Gln组为30％,均显著低于STD组（80％,P＜0.05）。第8天时STD组肠通透性(0.0441±0.0065)显著高于其他3组（Chow组0.0261±0.0032、Gln组0.0279±0.0044、Gln+rHGH组0.0275±0.0032）。结论　Gln具有保护肠粘膜屏障的作用,而Gln和rHGH联合支持肠粘膜屏障的作用更显著。     

短肠综合征患者血清瓜氨酸水平与小肠吸收面积和功能的相关性

目的研究短肠综合征患者血清瓜氨酸水平的变化及其与肠道面积及吸收功能的相关性。方法采用高效液相色谱法测定22例短肠患者（短肠组）和33例健康人（对照组）血清瓜氨酸水平。短肠患者残存小肠长度及直径采用X线造影检测，并测定短肠患者尿D-木糖排泄率和肠道蛋白吸收度。分析短肠患者血清瓜氨酸与残存小肠长度、面积、蛋白及D-木糖吸收的相关性。6例行肠康复治疗的患者测定康复治疗前后瓜氨酸、D-木糖及蛋白吸收水平的变化。结果短肠组血清瓜氨酸水平显著低于健康对照组[（5．94±2．65）比（16．87±5．97）μmol／L，P〈0．01]。短肠组患者血清瓜氨酸水平与残存小肠长度（r=0.82）及表面积（r=0.86）呈正相关，与尿D-木糖排泄（r=0.56）及肠道蛋白吸收（r=0.48）也呈正相关。6例行肠康复治疗的患者治疗后血清瓜氨酸水平、蛋白及D-木糖吸收均显著增加，但3者增加百分比之间并无相关。结论血清瓜氨酸水平与短肠患者的小肠吸收面积和吸收功能呈正相关，能反映短肠患者小肠功能和衰竭程度，是康复疗效的良好指标。     

高良姜素在大鼠肠道的吸收机制

摘要目的 探讨高良姜素在大鼠肠道的吸收机制。方法采用大鼠在体单向肠灌流吸收实验模型,以质量法校正灌流液体积,采用反相高效液相色谱法测定灌流液中高良姜素浓度,考察不同肠段、药物浓度和P糖蛋白（P gp）抑制药对高良姜素吸收的影响。结果高良姜素在整个肠段都有吸收,在十二指肠、空肠、回肠和结肠的吸收速率常数Ka分别为（5.12±1.14）×10－2,（2.23±1.02）× 10－2,（4.61±0.75）× 10－2和（2.68±0.70）×10－2·min－1,同时它在回肠的吸收不受自身浓度和P gp抑制药盐酸维拉帕米的影响。结论高良姜素在肠道吸收良好,吸收过程以被动扩散为主,不受P gp外排蛋白的影响。     

全小肠切除术后结肠形态学代偿和酶学改变

目的　研究全小肠切除术后 ,大鼠残留结肠的代偿性增生和粘膜上皮细胞酶学改变。方法　建立全小肠切除大鼠模型 ,经肠内营养支持 3个月 ,处死 10只模型大鼠为实验组 ,10只正常大鼠为对照组。切取结肠 ,测量长度、直径、腺窝深度、皱襞高度及粘膜厚度。刮取结肠粘膜组织 ,测量双糖酶活性。结果　实验组结肠长度、直径、湿重、腺窝深度、皱襞高度及粘膜厚度均优于对照组 ,差异有非常显著性 (P <0 .0 1)。实验组结肠蔗糖酶特异性酶活性和总体酶活性明显高于对照组 ,差异有非常显著性 (P <0 .0 1)。实验组麦芽糖酶特异性酶活性高于对照组 ,差异有非常显著性 (P <0 .0 1)。实验组麦芽糖酶总体酶活性、乳糖酶特异性酶活性和总体酶活性和对照组差异无显著性 (P >0 .0 5 )。结论　全小肠切除术后 ,经过肠内营养支持 ,大鼠结肠粘膜发生了明显的适应性代偿增生并伴有蔗糖酶、麦芽糖酶的代偿性表达     

Effect of Dietary Fiber and Growth Hormone on Colonic Adaptation in Short Bowel Syndrome Treated by Enteral Nutrition

BACKGROUND: Colon adaptation can partially compensate for the reduced capacity of nutrient absorption in patients with short bowel syndrome (SBS). OBJECTIVE: The aim of this study was to assess the effect of combined treatment with enteral nutrition (EN), dietary fiber, and recombinant human growth hormone (rhGH) on promoting colonic adaptation. METHODS: A group of 40 male Sprague-Dawley rats undergoing up to 80% to 85% small intestine resection were randomly assigned to four groups of 10 rats each: enteral nutrition (EN, the control); enteral nutrition/dietary fiber (EF); enteral nutrition/rhGH (EG); and enteral nutrition/dietary fiber/rhGH (EFG). All groups received isonitrogenous, isocaloric enteral feeding for 21 days. Body weight, daily nitrogen balance, colonic morphology, DNA, insulin-like growth factor-1/IGF-1 receptor (IGF-1)/IGF-1R) expression were determined. CONCLUSION: Morphologic adaptation of the colon (including increased mucosal thickness and plica height, enlarged surface area, increased hyditloid cells) was observed on postoperative day 21. GH is superior to fiber in several aspects: increasing colon diameters (0.46 +/- 0.03 vs. 0.38 +/- 0.02 cm, P < 0.05), villous height (356 +/- 23 vs. 307 +/- 21 microm, P < 0.05) and total surface area (15,222 +/- 1344 vs. 13,178 +/- 1727 microm(2), P < 0.05). Increased DNA content-1.66 +/- 0.13 (EG) and 1.71 +/- 0.13 (EGF) vs. 1.28 +/- 0.11(EF), P < 0.05-in the colon was also found in the EG and EGF groups. GH administration led to a significant increase in plasma IGF-1 (439.6 +/- 88.3 ng/ml in the EG group, 455.4 +/- 107.4 ng/ml in the EGF group) and growth hormone (9.29 +/- 6.49 ng/ml in the EG group, 9.68 +/- 3.26 ng/ml in the EGF group) as compared to the EN group (IGF-1, 328.7 +/- 68.1 ng/ml; GH, 5.81 +/- 2.41 ng/ml) and the EF group (IGF-1, 356.4 +/- 52.1 ng/ml; GH, 6.51 +/- 4.66 ng/ml). Analysis of IGF-1 and IGF-1 receptor mRNA also demonstrated a significantly higher IGF-1 mRNA in the EG and EFG groups than in the EN and EF groups. Colon functional adaptation was also associated with accelerated absorptive function of water in the EF, EG, and EGF groups. Improved nutritional status (body weight, nitrogen retention, plasma protein) were seen in the EG and EGF groups. Dietary fiber, in combination with growth factor, synergistically promoted colon adaptation in the SBS animal model and facilitated maintenance of daily nutritional needs in rodents.     

Bombesin in short bowel syndrome.

Short bowel syndrome comprises the sequel of nutrient, fluid, and weight loss that occurs subsequent to greatly reduced functional surface area of the small intestine. The aim of this study is to investigate the trophic and functional effects of bombesin on remaining gut in rats with experimentally induced short bowel syndrome. Thirty-two rats were allocated randomly and experimental short bowel syndrome was induced by 80% bowel resection in all rats. A regular enteral diet and isocaloric elemental enteral nutrition for 12 days were given in the control group and the elemental nutrition group, respectively. In the bombesin group 10 microg/kg subcutaneous bombesin (t.i.d.) for 10 days with regular enteral diet for 12 days was given. In the elemental nutrition and bombesin group the diet consisted of 10 microg/kg subcutaneous bombesin (t.i.d.) for 10 days with isocaloric elemental enteral nutrition for 12 days was given. All rats underwent physical, histological, and biochemical evaluation. Reduction in weight loss, bowel diameter, fecal fat content, and glycemia, increase in cellularity, and d-xylose absorption were observed in all treatment groups. These changes were more evident in the bombesin treatment groups. Increases in serum protein and albumin levels were seen with bombesin treatment with or without elemental diet, whereas reductions in villous height and crypt depth were observed only with bombesin treatment without elemental diet. Serum calcium, iron, and vitamin B(12) levels were not affected with any treatment. It is concluded that bombesin may be a useful trophic agent contributing to increased absorptive capacity and improved biochemical values even in the absence of elemental nutrition.     

Organ Transplantation: From Myth to Reality

Short bowel syndrome comprises the sequel of nutrient, fluid, and weight loss that occurs subsequent to greatly reduced functional surface area of the small intestine. The aim of this study is to investigate the trophic and functional effects of bombesin on remaining gut in rats with experimentally induced short bowel syndrome. Thirty-two rats were allocated randomly and experimental short bowel syndrome was induced by 80% bowel resection in all rats. A regular enteral diet and isocaloric elemental enteral nutrition for 12 days were given in the control group and the elemental nutrition group, respectively. In the bombesin group 10 μg/kg subcutaneous bombesin (tid) for 10 days with regular enteral diet for 12 days was given. In the elemental nutrition and bombesin group the diet consisted of 10 μg/kg subcutaneous bombesin (tid) for 10 days with isocaloric elemental enteral nutrition for 12 days was given. All rats underwent physical, histological, and biochemical evaluation. Reduction in weight loss, bowel diameter, fecal fat content, and glycemia, increase in cellularity, and d-xylose absorption were observed in all treatment groups. These changes were more evident in the bombesin treatment groups. Increases in serum protein and albumin levels were seen with bombesin treatment with or without elemental diet, whereas reductions in villous height and crypt depth were observed only with bombesin treatment without elemental diet. Serum calcium, iron, and vitamin B₁₂levels were not affected with any treatment. It is concluded that bombesin may be a useful trophic agent contributing to increased absorptive capacity and improved biochemical values even in the absence of elemental nutrition.     

管饲全肠内营养在大肠癌术前应用的临床研究

目的研究大肠癌病人术前管饲全肠内营养的效果及其肠道清洁的作用。方法对2004年1~12月收治的40例大肠癌病人随机分为两组(各20例),试验组术前予管饲全肠内营养7d;对照组行传统肠道准备。比较两组在血清蛋白、术中肠清洁度、术后感染性并发症发生及肠道功能恢复时间等方面的差异。结果试验组术前1d和术后7d血清白蛋白、前白蛋白、转铁蛋白均高于对照组,肛门排气时间则短于对照组(P<0·01),两组差异有显著性。但两组术中肠道清洁度、住院天数和术后感染性并发症发生率差异无显著性意义。结论大肠癌病人术前应用管饲全肠内营养能获得有效的营养支持和肠道清洁,该方法可替代大肠癌术前传统的肠道准备。     

大肠癌术后早期肠内营养支持对术后恢复的影响

目的 探讨大肠癌术后早期肠内营养支持对术后恢复的影响.方法 将86例患者随机分成胃肠外组(PN)41例,胃肠内组(EN)45例,分别于大肠癌术后早期给予肠外营养制剂及肠内营养制剂,观察术前第3天及术后第5天、第8天细胞和体液免疫指标、白蛋白、体重等变化.结果 PN、EN术后第5天组间比较:白蛋白、前白蛋白、IgA、IgM、淋巴细胞指标P＜0.05;PN、EN术后第8天组间比较:白蛋白、前白蛋白、淋巴细胞指标P＜0.05;IgA、IgM指标P＜0.01.结论 大肠癌术后早期给千肠内营养支持,可提高患者术后营养状况及免疫力,提升血清前白蛋白和白蛋白水平,减少并发症,明显加速患者康复.     

强化谷氨酰胺的肠内营养支持辅助治疗高脂血症性急性胰腺炎的临床研究

目的探讨强化谷氨酰胺的肠内营养支持对高脂血症性急性胰腺炎辅助治疗的作用。方法选取2012年1月至2015年12月邯郸市中心医院收治的86例高脂血症性急性胰腺炎患者为研究对象,随机分为观察组(43例)和对照组(43例)。两组患者均给予急性胰腺炎规范化治疗,待肠功能恢复后均早期给予肠内营养支持治疗,观察组给予强化谷氨酰胺的肠内营养支持。将两组患者治疗前与治疗10d后的免疫状态指标及炎性状态指标进行比较,并对比两组患者平均住院时间及住院费用。结果两组患者治疗前的免疫状态指标及炎性状态指标无明显差异(PO.05),给予不同的肠内营养液治疗10d后,观察组的免疫状态指标回升及炎性状态指标下降程度均优于对照组(PO.05),同时观察组患者平均住院时间及住院费用均低于对照组(PO.05)。结论强化谷氨酰胺的肠内营养支持治疗高脂血症性急性胰腺炎能更加有效的提高患者免疫功能、减轻炎症反应、降低医疗费用、缩短住院时间,从而改善预后、提高临床疗效。     

微生态肠内营养对重症急性胰腺炎大鼠肠黏膜损伤的防护作用

目的：探讨早期应用微生态肠内营养(EMN)对重症急性胰腺炎(SAP)大鼠炎症反应和肠黏膜损害的影响。
方法： 60只大鼠随机分为对照组(C组),SAP+传统肠内营养组(EN组),SAP+EMN组,每组20只。建模后8 h各组开始给予营养支持,12,24,48,72 h处死大鼠留取标本,检测血清巨噬细胞移动抑制因子(MIF),观察小肠组织病理学改变;逆转录-聚合酶链反应(RT-PCR)方法检测小肠组织中Toll样受体4(TLR4) mRNA含量。
结果：(1)12 h时点,EN组和EMN组MIF水平较C组已明显升高(P＜0.01);72 h时点,3组MIF呈不同程度的下降趋势,其中EMN组明显低于EN组［(95.33±1.96) vs.(117.59±1.86),P＜0.05］。(2)病理学观察显示,C组小肠黏膜结构正常,EN组和EMN组均有改变,但EMN组病变程度较EN轻。(3) EN组和EMN组TLR4 mRNA含量在造模后12 h时点显著高于C组(P＜0.01),72 h点,EMN组TLR4 mRNA的含量较EN组显著降低［(0.56±0.33) vs.(0.71±0.51),P＜0.01］。
结论：EMN能有效调节SAP大鼠炎症细胞因子水平,减轻肠道屏障损害,增强免疫功能。     

结肠癌根治术后老年患者不同营养支持护理效果研究

目的探究结肠癌根治术后老年患者不同营养支持途径护理效果的差异。方法:回顾性分析2018 年12 月—2020年12 月于我院肛肠外科收治的100 例行结肠癌根治术老年患者的临床资料,根据术后采用的不同营养支持途径进行分组,每组50 例,术后给予肠内营养支持护理患者为EN 组,术后给予肠外营养支持护理患者为TPN 组,比较两组患者营养指标、免疫功能指标、胃肠功能恢复情况及并发症情况。结果:术后7 d,两组患者血清前血蛋白(PAB)、转铁蛋白(TRF)及血清白蛋白(ALB)水平均较术后1 d 显著升高(P ＜ 0.05),EN 组明显高于TPN 组(P ＜ 0.05);EN 组肠鸣音恢复时间、肛门排气时间及住院时间显著少于TPN 组(P ＜ 0.05);EN 组并发症发生率为14.00%,TPN 组为18.00%,差异无统计学意义(P ＞ 0.05);术后7 d,两组患者血清免疫球蛋白IgG、IgA、IgM 水平均显著高于术后1 d(P ＜ 0.05),EN 组明显高于TPN 组(P ＜ 0.05);术后7 d,两组患者T 淋巴细胞亚群CD3+、CD4+ 及CD4+/CD8+ 值均较术后1 d 显著升高(P ＜ 0.05)。结论:肠内营养支持护理具有改善老年患者营养状况,促进胃肠功能恢复,增强免疫功能的作用,可作为结肠癌术后老年患者早期营养补充的护理方案。