头孢曲松钠对豚鼠胆囊收缩功能影响的实验研究

目的研究头孢曲松钠对豚鼠胆囊收缩功能的影响,以更好地指导临床用药。方法将60只豚鼠随机分为四组,A组(空腹对照组)、B组(饱餐对照组)、C组(空腹实验组)和D组(饱餐实验组)。对实验组C组、D组肌肉注射头孢曲松钠,建立头孢曲松钠相关性胆囊模型。造模成功后,对四组豚鼠的胆囊体积、胆汁量、胆汁及血清中胆汁酸、丙氨酸氨基转移酶(ALT)及胆囊收缩素(CCK)含量及胆囊组织中胆囊收缩素A受体(CCK-AR)基因的表达等进行测定。结果 C组和饱餐实验组的胆囊体积均显著高于A组和B组,表明头孢曲松钠可显著增高豚鼠的胆囊体积(P0.05);实验组豚鼠的胆汁量均显著高于对照组(P0.05),表明实验组豚鼠胆囊内出现胆汁淤积。胆汁中实验组豚鼠的胆汁酸水平均显著低于对照组;而血清中实验组豚鼠的胆汁酸水平均显著高于对照组(P0.05),表明实验组胆汁中胆汁酸的浓度出现下降,而血清中胆汁酸的含量则呈上升趋势。实验组豚鼠的ALT含量显著高于对照组豚鼠,表明头孢曲松钠可致豚鼠ALT水平升高。血清及胆囊组织中实验组的CCK水平均显著低于对照组;实验组胆囊组织中CCK-AR mRNA的相对表达量均显著低于对照组(P0.05)。结论头孢曲松钠可降低血清及胆囊组织中CCK的含量,并抑制CCK受体基因的表达,从而减弱胆囊的收缩功能,导致胆囊内出现胆汁淤积,促进结石的形成。为减少此类不良反应的发生,临床上应尽量避免长期、大剂量的使用头孢曲松钠。     

胆胃舒颗粒对豚鼠胆囊平滑肌CCK-A受体的影响

目的:探讨利胆健脾法在分子层面预防胆囊结石复发的机制。方法:将90只豚鼠随机分为空白组、模型组和治疗组,每组30只,分别给豚鼠喂食标准饲料、致石饲料、致石饲料加胆胃舒颗粒,2个月后处死取材,用改良UPP法及放射配基结合法检测豚鼠胆囊壁CCK-A受体,同时观察胆囊收缩率及结石形成率。结果:与模型组比较,治疗组豚鼠胆囊收缩率、CCK-A受体效果更好(P0.05)。结论:胆胃舒颗粒具有预防结石复发的作用,其作用机制可能与调节胆囊壁CCK-A受体有关。     

肥胖孕妇血清BMP-7及胰岛素抵抗水平的研究

目的 探讨肥胖孕妇血清BMP-7(人骨成形蛋白7)和胰岛素抵抗水平的变化及意义.方法 选取妊娠期肥胖孕妇22例,正常妊娠孕妇122例,测定空腹血清BMP-7、空腹血糖、空腹胰岛素(FINS),计算胰岛素抵抗指数(HOMA-IR).结果 妊娠期肥胖组血清BMP-7含量平均值1 619.61±633.23 ng/L,正常妊娠组血清BMP-7含量平均值1 472.05±1196.18 ng/L;妊娠期肥胖组血清BMP-7水平明显高于正常妊娠组(P＜0.05);妊娠期肥胖组胰岛素抵抗指数平均值2.30±1.21,正常妊娠组胰岛素抵抗指数平均值1.80±1.41,两组之间的差异有统计学意义(P＜0.05);分析结果显示,空腹血清BMP-7水平与FINS呈正相关(P＜0.05).结论 妊娠期肥胖组孕妇血清BMP-7水平的升高,可能参与了妊娠期糖尿病病理性胰岛素抵抗的发生.     

血清果糖胺测定对妊娠期糖代谢异常的诊断价值

目的探讨血清果糖胺对妊娠期糖代谢异常的临床价值,为妊娠期糖代谢异常筛查提供新方案。方法选择2009年6月至2010年3月到瑞康医院产检并进行妊娠期糖尿病(GDM)筛查(简称糖筛)的孕妇185例,用Roche P800全自动生化分析仪检测糖筛及葡萄糖耐量结果。根据测定结果设置糖筛查异常组60例,糖耐量异常组(包括GDM)45例,正常妊娠组80例,同时设健康对照组50例,对各组的空腹、1 h及糖耐量异常组各时间点进行血清果糖胺分析。结果糖筛查异常组空腹果糖胺水平为(220.8±16.89)μmol/L,糖耐量异常组空腹果糖胺水平为(227.1±19.64)μmol/L,与正常妊娠组[(141.39±20.83)μmol/L]比较,差异有统计学意义(P<0.01),各组间空腹果糖胺水平与1 h血清果糖胺水平差异无统计学意义(P>0.05),糖耐量异常组各时间点血清果糖胺水平无统计学意义(P>0.05)。结论血清果糖胺检测可作为妊娠期糖代谢筛查及监测指标。     

芒果苷对妊娠期糖尿病大鼠抗氧化能力的影响

目的探索芒果苷(MAN)对妊娠期糖尿病大鼠抗氧化能力的影响。方法腹腔注射链脲佐菌素(STZ)法制备大鼠糖尿病模型,实验分3组:对照组(正常妊娠期大鼠),模型组(妊娠期糖尿病大鼠)和实验组(妊娠期糖尿病大鼠芒果苷治疗)。分别于造模后第7和14天检测各组大鼠空腹血糖;14 d后化学定量法检测各组大鼠血清天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、碱性磷酸酶(ALP)以及总抗氧化能力(T-AOC)活性;ELISA法检测肝脏组织中丙二醛(MDA)含量、过氧化氢酶(CAT)、超氧化物歧化酶(SOD)以及谷胱甘肽过氧化氢酶(GSH-px)活性;化学定量法及western blotting法分别检测肝脏组织中一氧化氮(NO)和内皮型一氧化氮合酶(eNOS);14 d后取肝脏组织进行HE染色和eNOS免疫组织化学染色。结果第7天,实验组与模型组空腹血糖和胰岛素水平无显著差异(P0.05),而第14天,空腹血糖实验组显著低于模型组,胰岛素实验组显著高于模型组(P0.05);14 d后,实验组AST、ALT和ALP活性显著低于模型组,T-AOC实验组显著高于模型组,肝脏组织中实验组NO显著低于模型组(P0.05);MDA含量实验组显著低于模型组,而CAT、SOD和GSH-px显著高于模型组(P0.05);肝脏组织中NO和eNOS表达量实验组显著低于模型组,免疫组织化学染色显示eNOS平均光密度实验组显著低于模型组(P0.05)。结论芒果苷可显著提高妊娠期糖尿病大鼠的抗氧化能力。     

胆囊功能CCK及其受体与结石成因关系之研究

本文用B超对24例胆囊结石患者进行胆囊功能各方面的研究,并对照血浆中胆囊收缩素(CCK)浓度与胆囊壁CCK受体(CCK-R)数目,以进一步探讨胆囊功能改变在胆囊结石发病中的意义。结果发现14例胆囊收缩率“正常组”患者:空腹胆囊体积增大,正常的餐后CCK血浓度,而10例胆囊收缩率“降低组”患者;胆囊残留体积增大,餐后CCK血浓度明显高于正常组。胆囊壁CCK-R结合位点数胆囊收缩率“正常组”明显多于胆囊收缩率“降低组”,胆囊收缩性的差异与CCK-R数有关。揭示了二组胆囊结石患者产生结石的某些过程和机制的不同点及最终形成结石的胆囊功能基础。     

胆汁胆固醇对胆囊平滑肌线粒体及TGF-β1表达的影响

目的探讨胆汁胆固醇对胆囊平滑肌线粒体及TGF-β1表达的影响及作用机制.方法64只实验豚鼠随机分为4组,每组16只对照组(标准颗粒饲料饲养2周),高胆固醇组(标准颗粒饲料加入2%高胆固醇饲养2周)、自然恢复组(高胆固醇组2周后,标准颗粒饲料饲养2周)和治疗组(高胆固醇组2周后,标准颗粒饲料+中药灌胃2周).各组豚鼠实验到期后,腹腔麻醉后剖腹测量胆囊体积,记录胆汁量,测量胆汁中胆固醇浓度.取胆囊全层约1 mm3的组织,按常规制作电镜标本,采用图像分析仪观察胆囊平滑肌细胞线粒体平均体积(V)及数密度(Nv).利用蛋白免疫印迹分析的方法测定其余胆囊组织活化TGF-β1的含量.结果经高胆固醇饲养2周后,高胆固醇组豚鼠胆囊平滑肌细胞线粒体的平均体积(V),数密度(Nv)与对照组相比分别显著性升高(0.08056±0.0069 vs 0.0653±0.02868,P＜0.001)和下降(0.2677±0.0138 vs 0.3180±0.02868,P＜0.001).高胆固醇组豚鼠胆囊平滑肌组织活化TGF-β1与对照组相比显著升高(P＜0.001).治疗2周后与自然恢复组比较,治疗组线粒体平均体积(V)下降(0.0715±0.0113 vs 0.0778±0.0092,P＜0.001),而数密度上升(0.3086±0.0230 vs 0.2681±0.0128,P＜0.001),胆囊平滑肌组织活化的TGF-β1明显下降(P=0.000).结论清热利胆理气活血方药可改善线粒体功能,下调活化TGF-β1的表达促进胆囊收缩功能的恢复,其作用机制可能与降低胆汁中胆固醇有关.     

血清E2-FAE、β-HCG联合胎盘血管指数预测妊娠期高血压患者不良妊娠结局的价值

目的 探究血清雌激素脂肪酯(E2-FAE)、人绒毛膜促性腺激素(β-HCG)联合胎盘血管指数(VIMV)预测妊娠期高血压患者不良妊娠结局的价值。方法 纳入2020年7月至2022年6月该院收治的106例妊娠期高血压患者作为研究对象,收集患者临床资料,根据妊娠结局将患者分为不良妊娠结局组(n=34)和正常妊娠结局组(n=72)。对比两组血清E2-FAE、β-HCG以及胎盘血管指数水平。结果 不良妊娠结局组血清E2-FAE、胎盘血管仪-血流指数(VFI)均低于正常妊娠结局组,β-HCG高于正常妊娠结局组,差异有统计学意义(P<0.05)。血清E2-FAE、β-HCG、胎盘VFI是影响妊娠期高血压患者不良妊娠结局的独立危险因素(P<0.05)。血清E2-FAE、β-HCG、胎盘VFI及三者联合预测妊娠期高血压患者不良妊娠结局的受试者工作特征(ROC)曲线下面积为0.776(95%CI:0.683～0.869)、0.758(95%CI:0.654～0.861)、0.727(95%CI:0.623～0.831)、0.855(95%CI:0.779～0.931)。结论 血清E2-FAE...     

不同孕期妇女血清碱性磷酸酶的变化及意义

目的 探讨妊娠期血清碱性磷酸酶(ALP)的变化及意义.方法 用ELIMAT-240生化分析仪对459例妊娠妇女(实验组)及108例育龄非孕健康妇女(对照组)血清ALP值进行监测.结果 早期妊娠时血清ALP值为(43.17±13.25)U/L,较对照组(64.21±19.84)U/L要低(P＜0.001);中期妊娠时血清ALP值为(62.24±19.57)U/L,与对照组相比差异无统计学意义(P＞0.05);晚期妊娠时血清ALP值为(124.20±63.28)U/L,与对照组相比显著增高(P＜0.001);妊娠高血压综合征患者血清ALP值为(253.61±42.74)U/L,较对照组及晚期妊娠组高(P＜0.001);过期妊娠患者血清ALP值为(40.28±8.43)U/L,比晚期妊娠组及对照组低(P＜0.001).结论 健康妊娠在早孕时血清ALP值轻度降低,中期妊娠时无显著变化,晚期妊娠及妊娠高血压综合征时血清ALP值显著升高,但过期妊娠时则有所下降.     

妊娠糖尿病患者血清CRP、IL-6水平的变化及其临床意义

目的探讨炎症因素在妊娠期糖尿病发生、发展中的意义。方法选取116名孕12-16周的孕妇作为研究对象,按照ADA诊断标准将研究对象分为妊娠糖尿病组(GDM)、妊娠糖耐量异常组(IGT)及妊娠葡萄糖耐量正常组(NGT)。分别检测各组患者空腹血糖,空腹胰岛素,血清CRP,血清IL-6的水平,计算胰岛素抵抗指数(HOMA-IR),并进行统计学分析。结果与NGTI、GT组比较,GDM组血清CRPI、L-6、HOMA-IR值明显升高,差异有统计学意义(P0.05)。妊娠晚期与妊娠早期比较CRPI、L-6、HOMA-IR值明显升高,差异有统计学意义(P0.05)。结论血清CRP、IL-6等炎症因子与妊娠糖尿病患者胰岛素抵抗密切相关,参与了妊娠期糖尿病的发生、发展。     

Changes of gallbladder and gastric dynamics in patients with acute hepatitis A

Transient alterations of gallbladder morphology and dynamics have been reported in patients with during acute hepatitis A. The presence of dyspepsia also suggests involvement of gastric motility. During a 60-day follow-up, we investigated gallbladder and gastric motility in relation to dyspepsia in acute viral hepatitis A patients. Twenty patients were assessed at referral (day 0) and at days 7, 21, 42 and 60 and compared with 20 healthy volunteers. Gallbladder morphology and motility and gastric motility were assessed in the fasting and postprandial period by functional ultrasonography using a liquid test meal. Dyspeptic symptoms were scored. At day 0, fasting gallbladder volume was 5.9 +/- 1.3 mL, 32.6 +/- 4.6 mL, and 21.5 +/- 1.9 mL (mean +/- SE) in patients with gallbladder sludge (n = 7), without sludge (n = 13) and controls, respectively (P < 0.05 in sludge vs. no sludge and controls; P < 0.05 in no sludge vs. controls, ANOVA). Small fasting gallbladder volume in patients with sludge increased and sludge disappeared within 7 days. At day 0, patients with sludge also had increased thickness of fasting gallbladder wall and increased serum transaminase levels compared with patients without sludge and controls. Gallbladder contraction was similar in patients and controls. However, patients had delayed gastric emptying, which positively correlated with dyspepsia score. Gallbladder morphological changes observed in the acute phase of hepatitis A are transient and are associated with hepatocellular damage. Gastric emptying is delayed during the first week of disease and is associated with dyspeptic symptoms.     

The effect of vitamin C in high doses on plasma and biliary lipid composition in patients with cholesterol gallstones: prolongation of the nucleation time

Vitamin C deficiency in guinea pigs leads to cholesterol supersaturation of bile and formation of cholesterol gallstones. It has been suggested that there may also exist an association between vitamin C and cholesterol gallstones in man, but such a relationship has not been studied in gallstone patients. In order to study the possible effects of vitamin C on gallstone disease in humans, plasma lipid levels, hepatic cholesterol metabolism, biliary lipid composition, cholesterol saturation and nucleation time of gallbladder bile were analysed in 16 consecutive gallstone patients, who were planned for laparoscopic cholecystectomy and were treated with vitamin C (500 mg, four times a day) for 2 weeks before surgery. The plasma concentration of vitamin C increased by 42% in the treatment group. The concentrations of plasma lipids did not differ before and after vitamin C treatment; nor did the plasma levels of lathosterol and 7α-hydroxy-4-cholesten-3-one, reflecting cholesterol and bile acid synthesis respectively. The relative concentrations of cholesterol, bile acids and cholesterol concentration of bile did not differ significantly between the two groups, but the relative concentration of phospholipids was slightly higher in the treated group. The bile acid composition was changed; the percentage of cholic acid being lower and those of deoxycholic acid, ursodeoxycholic acid and lithocholic acid higher in the vitamin C-treated patients compared with the untreated group. The nucleation time was significantly longer in the treatment group (7 days) compared with the untreated group (2 days). Our findings indicate that vitamin C supplementation may also influence the conditions for cholesterol gallstone formation in humans.     

Effect of sildenafil citrate on postprandial gallbladder motility

OBJECTIVE: Sildenafil stimulates the nitric oxide-cyclic guanosine monophosphate (NO-cGMP) pathway through inhibition of type 5 phosphodiesterase. NO-cGMP pathway causes smooth muscle relaxation. The aim of this study is to evaluate the effects of sildenafil on gallbladder motility. METHODS: Twenty healthy male volunteers (21-35 years old) participated in this randomized, double blind, crossover, and placebo-controlled study. Oral sildenafil (50 mg) or placebo was randomly dispensed to each volunteer on two consecutive days. After the sildenafil or placebo, a special meal with a high fat content was administered. Gallbladder volume was measured using sonography preprandially and at 5, 15, 30, 60, 120 and 180 minutes postprandially. RESULTS: Sildenafil showed an inhibitory effect on gallbladder contraction in healthy volunteers that began at 30 minutes. Gallbladder volumes showed significant differences at 30 minutes following the test meal (approximately 50-60 min after the sildenafil intake), between placebo (15.4 +/- 5.1 mL) and the sildenafil groups (19.3 +/- 6.1 mL) (P < 0.05). In addition, gallbladder volume was significantly higher during the refilling phase in the sildenafil group (P < 0.05 at 180 min). Maximal contraction was achieved at 60 minutes in each group. CONCLUSIONS: Sildenafil constituted a significant inhibitory effect on gallbladder discharge in healthy individuals when compared with placebo group. Because of this inhibitory effect, sildenafil consumption for long periods may potentiate risks of gallbladder disorders and gallstone formation resulting from disturbed gallbladder motility.     

超声探讨中晚期妊娠并发胆石症的临床意义

目的：分析探讨中晚期妊娠并发胆石症的临床意义。方法：随机选择1998年至2000年间,在我院建孕卡,产前检查,且在我院生产,原无胆系疾病的孕妇共592例,其中孕16-20周210例,孕21－30周196例,孕31－40周186例,行空腹胆囊定期超声检查。结果;210例孕16－20周孕妇中,1例胆囊胆固醇结晶,无1例胆结石。196例孕21－30周孕妇中,胆囊胆固醇结晶2例,胆囊结石2例,186例孕31－40周孕妇中,胆囊结石2例,胆囊胆泥1例,胆囊大小随孕龄增加而增大,经统计学处理孕6－20周与孕31－40周孕妇的胆囊大小比较有显著性差异。结论：中晚期妊娠是诱发胆石症的重要病因之一。     

Sonographic evaluation of gallbladder volume and ejection fraction in obese women without gallstones

PURPOSE: Obese people have an increased incidence of gallstones. Although the exact pathogenic mechanisms of gallstone development are unknown, impaired gallbladder emptying has been suggested as a possible underlying mechanism. Our aim was to investigate this possibility by evaluating gallbladder motility and related factors in obese and nonobese women without gallstones. METHODS: This study included 79 obese women and 25 nonobese healthy women. Using real-time sonography, we evaluated fasting and postprandial (15th-, 30th-, 45th-, 60th-, 75th-, 90th-, 120th-, and 150th-minute) gallbladder volumes and ejection fractions. The smallest postprandial volume was considered the residual volume. RESULTS: Mean (+/- standard deviation) fasting and residual gallbladder volumes were 43.2 +/- 18.3 cm(3) and 21.4 +/- 11.2 cm(3), respectively, in the obese women and 28.1 +/- 12.3 cm(3) and 7.9 +/- 3.4 cm(3), respectively, in the nonobese women. Maximal ejection fraction was 49 +/- 19% in obese women and 63 +/- 29% in nonobese women (p = 0.001). The fasting and residual volumes and the postprandial volumes at all time points were higher in obese women than in nonobese women (p < 0.001). In addition, 15th-, 30th-, 45th-, 60th-, 75th-, and 90th-minute postprandial ejection fractions were lower in obese women than in nonobese women (p < 0.001). Positive correlations were found between fasting gallbladder volume and body mass index and body fat weight and between residual volume and body mass index, waist circumference, body fat percentage, and body fat weight (p < 0.05 for all comparisons). CONCLUSIONS: Our results show that fasting and postprandial gallbladder volumes are higher and that postprandial gallbladder motility is lower in obese than in nonobese women. There are positive correlations between fasting gallbladder volume and body weight, body mass index, and body fat weight.     

阴式超声测量双侧搏动指数结合血清雌孕激素水平检测在异位妊娠患者诊断中的作用

  目的  研究阴式超声测量双侧搏动指数(PI)结合血清雌孕激素水平检测在异位妊娠患者诊断中的效能。  方法  选取2019年2月~2021年2月在本院诊断并治疗的107例异位妊娠患者为观察组,另选取同期在本院同期产检的宫内早孕组患者107例作为对照组,比较两组患者的阻力指数(RI)、功能侧PI、非功能侧PI、峰值流速、舒张末期流速、卵泡雌激素、黄体生成素、孕酮激素以及雌二醇(E2)水平。分析功能侧PI、非功能侧的PI、E2及孕酮激素联合检测对异位妊娠的诊断效能。  结果  观察组患者的RI低于对照组(t=51.534,P < 0.001),功能侧PI(t=5.884,P < 0.001)、非功能侧PI(t=8.565,P < 0.001)、峰值流速(t=45.597,P < 0.001)、舒张末期流速(t=12.302,P < 0.001)水平高于对照组; 观察组患者的卵泡雌激素(t=3.676,P < 0.001)、黄体生成素(t=6.334,P < 0.001)、E2(t=28.259,P < 0.001)、孕酮激素(t=48.787,P < 0.001)水平低于对照组。功能侧PI、非功能侧的PI、孕酮激素联合E2检测在诊断异位妊娠中的特异度明显较单独检测高。通过ROC曲线分析,功能侧PI、非功能侧PI、E2及孕酮激素联合检测对异位妊娠的诊断的曲线下面积高于单独检测,功能侧PI、非功能侧的PI、E2及孕酮激素临界值依次为2.58、2.76、422.56 pmol/L、15.13 ng/mL。  结论  阴式超声测量双侧PI结合血清雌孕激素水平对于异位妊娠患者诊断具有显著的意义。      

Cholesterol gallstones: Focusing on the role of interstitial Cajal-like cells

Cholesterol gallstone (CG) is a common, frequent biliary system disease in China, with a complex and multifactorial etiology. Declined gallbladder motility reportedly contributes to CG pathogenesis. Furthermore, interstitial Cajal-like cells (ICLCs) are reportedly present in human and guinea pig gallbladder tissue. ICLCs potentially contribute to the regulation of gallbladder motility, and aberrant conditions involving the loss of ICLCs and/or a reduction in its pacing potential and reactivity to cholecystokinin may promote CG pathogenesis. This review discusses the association between ICLCs and CG pathogenesis and provides a basis for further studies on the functions of ICLCs and the etiologies of CG.     

Ultrasonographic assessment of gallbladder bile exchanges in healthy subjects and in gallstone patients.

Impaired gallbladder motility may contribute to gallstone pathogenesis by providing time for nucleation and aggregation of cholesterol crystals. Simultaneous scintigraphic-ultrasonographic techniques have been proposed to assess alternating phases of gallbladder emptying and filling. To evaluate patterns of gallbladder motility and of postprandial bile flow by means of a single ultrasonographic technique, 12 healthy volunteers and 20 gallstone patients underwent minute-by-minute gallbladder ultrasonography for 3 h postprandially. Mathematical analysis of volume measurements was used to estimate hepatic and cholecystic bile flux through the gallbladder. Compared to controls, gallstone patients showed greater amounts of unexchanged cholecystic-to-hepatic bile (11% vs. 1%, p <.001) and most of them showed impaired gallbladder washout efficacy. Utrasonographic values of bile exchanges were similar to those derived from scintigraphic-sonographic studies in comparable groups of subjects. This study provides new ultrasonographic variables, which better express gallbladder bile retention in gallstone patients and strongly discriminate gallstone patients from controls.