美常安对重症急性胰腺炎肠道屏障的影响

[目的]探讨美常安对重症急性胰腺炎(SAP)肠道屏障的影响.[方法]48例SAP患者于入院后随机分为2组,即治疗组(常规治疗加美常安辅助治疗)25例和对照组(常规治疗组)23例,疗程14d,比较2组患者治疗后临床症状的发生率及检测治疗前、后内毒素(ET)、肿瘤坏死因子(TNF-α) 、C-反应蛋白(CRP)的改变.[结果]2组患者治疗前ET、TNF-α、CRP比较差异无统计学意义;治疗后,治疗组上述指标较对照组明显下降(P＜0.01),临床症状的发生率显著减少(P＜0.05).[结论]加用美常安治疗能显著改善SAP患者的临床症状,减少内毒素血症的发生,从而对SAP肠道屏障起保护作用.     

生长抑素联合连续性血液净化对急性重症胰腺炎患者炎症及并发症的影响

[目的]探讨连续性血液净化(CBP)联合生长抑素强化治疗对急性重症胰腺炎(SAP)患者炎症及并发症的影响。[方法]选取2016年4月～2018年4月我院SAP患者120例,依据随机数字表分为强化组和常规组,每组60例,常规组给予CBP联合常规生长抑素治疗,强化组给予CBP联合生长抑素强化治疗,比较2组炎症[肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、IL-7]、病情指标[血和尿淀粉酶(AMS)、急性生理和慢性健康状况评分系统得分(APACHEⅡ)]、临床症状(腹痛、腹胀、恶心呕吐、腹膜刺激征)缓解时间、并发症。[结果]强化组和常规组治疗后TNF-α、IL-6、IL-7、血和尿AMS、APACHEⅡ评分明显低于治疗前,强化组治疗后TNF-α、IL-6、IL-7、血和尿AMS、APACHEⅡ评分明显低于常规组,差异有统计学意义(P0.05);强化组腹痛、腹胀、恶心呕吐、腹膜刺激征缓解时间明显低于常规组,差异有统计学意义(P0.05);强化组并发症率明显低于常规组,差异有统计学意义(P0.05)。[结论]CBP联合生长抑素强化治疗可有效改善SAP患者的炎症、病情及临床症状,有利于减少患者并发症,值得临床推广。     

益生菌联合谷氨酰胺对急性重症胰腺炎患者肠黏膜屏障功能的影响

[目的]分析益生菌联合谷氨酰胺(Gln)对急性重症胰腺炎(SAP)患者肠黏膜屏障功能的影响。[方法]选取SAP患者78例,随机分为观察组与对照组,各39例。2组均予以加用Gln的肠内营养治疗,观察组在此基础上加用四联益生菌制剂,观察治疗第1、7、14、21天2组急性生理与慢性健康Ⅱ(APACHE-Ⅱ)评分、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、内毒素、D-乳酸及二胺氧化酶(DAO)水平的变化。[结果]2组治疗第7天APACHE-Ⅱ评分与治疗第1天比较无明显变化(P0.05),但治疗第14、21天明显降低(P0.01),其中观察组降低程度更为显著(P0.05)。治疗第7、14、21天,2组CRP、TNF-α水平及内毒素、D-乳酸、DAO水平均较治疗第1天明显降低(P0.05或P0.01),但观察组治疗第14、21天上述各水平均显著低于对照组,差异有统计学意义(P0.05)。[结论]益生菌联合Gln的肠内营养能有效缓解SAP患者的机体炎症反应,减轻内毒素血症,减少肠道细菌移位,从而利于肠黏膜屏障功能的恢复。     

国产生长抑素联合丙氨酰谷氨酰胺对急性胰腺炎患者肠道功能的影响

[目的]观察国产生长抑素联合丙氨酰谷氨酰胺对急性胰腺炎患者肠道功能的影响。[方法]选取2014年9月~2016年9月我院急性胰腺炎患者98例,随机分为对照组和观察组,各49例。对照组在常规治疗基础上给予国产生长抑素,观察组在对照组基础上加用丙氨酰谷氨酰胺。治疗2周后,记录两组患者腹痛持续时间、血淀粉酶恢复正常时间、住院时间、肠功能评分等临床指标;比较两组患者治疗前后体重指数(BMI),白蛋白(ALB),前白蛋白(PA),血红蛋白(HB)等营养指标;比较两组患者治疗前后血浆二胺氧化酶(DAO)、C反应蛋白(CPR)、肿瘤坏死因子-α(TNF-α)、白介素-1(IL-1)、白介素-6(IL-6)等肠黏膜功能及免疫指标。[结果]治疗2周后,观察组腹痛持续时间、血淀粉酶恢复正常时间低于对照组(P0.05);观察组肠功能优于对照组(P0.05);观察组白蛋白较对照组升高(P0.05);观察组DAO,CRP,TNF-α,IL-1,IL-6均低于治疗前,治疗均有效(P0.05);两组治疗后比较,观察组DAO,CRP,TNF-α,IL-1,IL-6均低于对照组(P0.05)。[结论]国产生长抑素联合丙氨酰谷氨酰胺可缓解急性胰腺炎患者临床症状,减轻炎症反应,保护肠道功能。     

生长抑素联合加贝酯对老年重症急性胰腺炎患者细胞因子及肠黏膜功能的影响

[目的]探讨生长抑素联合加贝酯治疗老年重症急性胰腺炎患者的治疗效果及细胞因子和肠黏膜功能的影响。[方法]选择我院治疗的68例老年重症急性胰腺炎患者采用随机数字表法分为观察组和对照组,对照组给予生长抑素治疗,观察组联合加贝酯治疗,观察治疗效果。[结果]观察组治疗总有效率为94.12%,对照组治疗总有效率为76.47%,组间比较差异有统计学意义(P0.05)。观察组治疗后肿瘤坏死因子α(TNF-α)(16.83±1.56)μg/L,白细胞介素-6(IL-6)(31.86±3.01)μg/L;对照组治疗后TNF-α(24.92±2.67)μg/L,IL-6(50.28±4.27)μg/L,统计学分析显示组间比较差异有统计学意义(P0.05)。观察组治疗后血浆内毒素(7.13±1.87)EU/ml,血浆二胺氧化酶(DAO)(10.34±2.51)U/L;对照组治疗后血浆内毒素(11.84±3.14)EU/ml,血浆DAO(19.14±4.36)U/L,统计学分析显示组间比较差异有统计学意义(P0.05)。[结论]采用生长抑素联合加贝酯治疗老年重症急性胰腺炎临床疗效可靠,有效抑制体内炎性因子反应,降低患者早期肠道通透性,减少内毒素异位,保护肠黏膜功能,值得在临床上推广应用。     

丙氨酰-谷氨酰胺对重症急性胰腺炎患者IL-6、TNF-α、D-二聚体的影响及临床意义

目的探讨静脉应用丙氨酰-谷氨酰胺(Aln-Gln)对重症急性胰腺炎(severe acute pancreatitis,SAP)患者血浆IL-6、TNF-α、D-二聚体水平的影响及临床意义。方法 56例SAP患者随机分为Aln-Gln治疗组(n=28)和对照组(n=28),入院后均给予常规治疗,治疗组在此基础上加用Aln-Gln。补充Aln-Gln前1天和补充后第7天高效液相色谱法检测血浆Gln水平,酶联免疫吸付测定(ELISA)法检测患者血浆中IL-6、TNF-α、D-二聚体水平。结果治疗组补充Aln-Gln后第7天血浆IL-6、TNF-α、D-二聚体水平及CRP明显均低于对照组及治疗前1天(P0.05),ALB水平升高(P0.05),APACHEⅡ总分明显低于治疗前1天(P=0.03),两组ICU治疗时间、肠道功能恢复时间、总住院天数比较,差异均有统计学意义(P0.05)。结论 SAP患者在常规治疗的基础上加用Aln-Gln可以降低血浆IL-6、TNF-α、D-二聚体水平,减轻炎症反应和微循环障碍,进一步改善患者的临床结果。     

大黄清毒汤灌肠改善肝硬化患者肠黏膜屏障功能的研究

[目的]:观察大黄清毒汤灌肠治疗肝硬化合并肠黏膜屏障功能障碍患者临床疗效,探讨大黄清毒汤灌肠对肝硬化患者肠黏膜屏障功能的影响。[方法]将符合研究要求的患者60例按随机数字表分为治疗组30例和对照组30例。观察治疗前后尿乳果糖和甘露醇的比率、血浆内毒素含量、血浆二胺氧化酶(DAO)水平。[结果]治疗后与治疗前相比较,2组LAC/MAN比值和血浆内毒素水平下降,差异有统计学意义(P0.05);治疗组较对照组下降更明显(P0.01)。治疗组血浆二胺氧化酶(DAO)水平无明显下降。[结论]大黄清毒汤灌肠可改善肝硬化患者的肠黏膜屏障功能,并在一定程度上改善肝功能。     

舒血宁注射液对急性胰腺炎患者氧化应激状态的影响

[目的]观察舒血宁注射液对急性胰腺炎(AP)患者氧化应激水平的影响。[方法]79例AP患者随机分成治疗组(41例)和对照组(38例),对照组给予AP常规治疗,治疗组在此基础上予舒血宁注射液20ml稀释后静脉注射,1次/d,共10d,观察治疗前后疗效及氧化应激水平的变化。[结果]治疗前,治疗组及对照组血清IL-6、TNF-α、SOD、MDA水平及CTSI、APACHEⅡ评分比较,差异无统计学意义。治疗后,治疗组血清IL-6、TNF-α、MDA水平及CTSI、APACHEⅡ评分与对照组比较明显降低(P<0.01,P<0.05),而血清SOD则显著升高(P<0.01)。相关性分析表明:血清SOD水平与血清IL-6、TNF-α水平及CTSI、APACHEⅡ评分均呈明显负相关(r分别为-0.720、-0.538、-0.422、-0.661,P<0.01);血清MDA水平与血清IL-6、TNF-α水平及CTSI、APACHEⅡ评分均呈明显正相关(r分别为0.505、0.796、0.473、0.809,P<0.01)。[结论]舒血宁注射液联合常规疗法临床疗效明显优于单用常规疗法,其机制可能与其抗氧化,清除氧自由基的作用有关。     

金双歧对肝硬化自发性腹膜炎肠黏膜屏障功能的影响以及临床疗效研究

[目的]观察金双歧对肝硬化自发性细菌性腹膜炎(SBP)患者肠黏膜屏障功能的保护作用,以及临床疗效分析。[方法]收集2013年1月~2015年9月我院感染科收治的肝硬化伴发SBP患者92例,患者使用数字法随机分为常规治疗对照组和金双歧辅助治疗观察组,每组46例。比较2组治疗前后血清二胺氧化酶(DAO)、D-乳酸(D-Lac)、内毒素(ET)、白介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)表达的改变,以及临床疗效。[结果]2组治疗前DAO、D-Lac、ET、IL-6和TNF-α表达差异无统计学意义(P0.05),治疗后2组DAO、D-Lac、ET、IL-6和TNF-α均显著减低(P0.01),但观察组对DAO、D-Lac、ET、IL-6和TNF-α的减低作用显著优于对照组(P0.05)。观察组的临床治疗有效率为89.13%(41/46),显著高于对照组的71.74%(33/46)(P0.05)。[结论]金双歧辅助治疗肝硬化SBP,可以保护肠黏膜,抑制炎症反应,临床疗效显著,值得临床推广使用。     

外源性维生素D对炎症性肠病患者肠道黏膜屏障和炎症因子水平的影响

背景:炎症性肠病(IBD)是一种慢性肠道炎症性疾病,其病因目前尚不明确。研究表明,IBD患者存在维生素D水平降低,口服维生素D_3可明显降低IBD的发病风险。但具体机制尚不清楚。目的:探讨外源性维生素D对IBD患者肠道黏膜屏障和炎症因子水平的影响。方法:选取2016年1月—2018年12月南京市溧水区人民医院收治的IBD患者198例,以195名健康人作为正常对照。将IBD患者随机分为观察组和对照组,对照组给予常规治疗,观察组在其基础上给予外源性维生素D治疗。检测血清25(OH)D_3、二胺氧化酶(DAO)、D-乳酸、内毒素水平以及炎症因子IL-1β、IL-6、CRP和TNF-α水平。结果:健康组血清25(OH)D_3水平显著高于IBD组(P 0. 05),而UC与CD患者之间差异无统计学意义(P 0. 05)。治疗前,观察组和对照组DAO、D-乳酸和内毒素水平以及炎症因子IL-1β、IL-6、CRP和TNF-α水平相比差异均无统计学意义(P 0. 05);治疗后,观察组DAO、D-乳酸、内毒素、IL-1β、IL-6、CRP和TNF-α水平均显著低于对照组(P 0. 05)。结论:IBD患者存在明显的维生素D缺乏,补充外源性维生素D可降低炎症因子水平,改善肠道黏膜屏障功能。     

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.     

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.     

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.     

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.