枳实消痞汤对急性肝功能衰竭大鼠消化间期移行性运动复合波的影响

目的观察枳实消痞汤高、中、低剂量以及莫沙比利对急性肝功能衰竭大鼠胃肠消化间期移行性运动复合波（MMC）的影响及其变化特点。方法采用D-氨基半乳糖急性肝功能衰竭大鼠模型,用多道生理记录仪分别记录正常对照组（10只）和急性肝功能衰竭组（10只）,莫沙比利组（10只）以及枳实消痞汤高（10只）、中（10只）、低剂量组（10只）的胃肠消化间期MMC,并对各组大鼠胃肠消化间期MMC的各项指标进行比较分析。结果与莫沙比利组相比较,枳实消痞汤高剂量组和中剂量组胃窦、十二指肠、空肠MMCⅡ相差异没有统计学意义（P=0.658,P=0.879）;与低剂量组相比较,中剂量组胃窦、十二指肠、空肠MMCⅡ相显著缩短（P=0.001）;与莫沙比利组相比较,枳实消痞汤高剂量组和中剂量组胃窦、十二指肠、空肠MMCⅢ相持续时间差异没有统计学意义（P值分别为0.567和0.441）,枳实消痞汤高剂量组和中剂量组相比较,胃窦、十二指肠、空肠MMCⅢ相持续时间差异没有统计学意义（P=0.841）;与低剂量组相比较,高剂量组和中剂量组胃窦、十二指肠、空肠MMCⅢ相持续时间明显延长,差异均有统计学意义（P=0.006,P=0.004）;与莫沙比利组相比较,枳实消痞汤高、中、低剂量组对周期的改变差异没有统计学意义（P=0.372,0.347,0.716）。结论急性肝功能衰竭大鼠MMCⅡ相显著延长,呈移行性簇状收缩,MMCⅢ相明显缩短,这可能是导致急性肝功能衰竭大鼠胃肠动力障碍的主要原因。枳实消痞汤高、中、低剂量和莫沙比利组对急性肝功能衰竭大鼠的MMCⅡ相缩短和MMCⅢ相延长有明显的改善,其中枳实消痞汤高剂量、中剂量和莫沙比利组临床效果相近。提示枳实消痞汤对改善急性肝功能衰竭大鼠胃动力障碍起到了积极的作用。     

急性肝衰竭大鼠胃肠运动改变与肠神经元关系研究

目的观察急性肝衰竭大鼠胃肠消化间期移行性复合运动的变化与肠神经元的关系。方法采用D-氨基半乳糖诱导的急性肝衰竭大鼠模型,使用多道生理记录仪记录正常大鼠和急性肝衰竭大鼠的胃肠消化间期移行性复合运动,采用TUNEL法、5-HT和NSE免疫组化法检测空肠神经元的凋亡情况。结果急性肝衰竭大鼠空肠MMC周期较对照组显著延长（1897.71±815.77对1384.17±449.34S,P〈0.05）,尤以Ⅱ期延长为主（1870.90±1010.35S对643.04±450.67S,P〈0.05）,成簇状移行性收缩,Ⅲ期显著缩短（31.41±11.17S对53.11±14.74S,P〈0.05）;急性肝衰竭大鼠肠神经元凋亡明显增多,TUNEL染色阳性细胞核固缩或碎裂,呈棕黄色,细胞大小不一;5-HT和NSE免疫组化检测发现急性肝衰竭大鼠阳性物质表达较正常大鼠减少。结论急性肝衰竭大鼠胃肠MMCⅡ期延长,Ⅲ期明显缩短,导致胃肠动力异常,可能与肠神经元的凋亡有关。     

实验性急性肝内胆汁淤积幼年大鼠胃肠消化间期移行性肌电复合波的变化

目的:探讨异硫氰酸萘酯(ANIT)所致刚断乳大鼠急性肝内胆汁淤积胃肠消化间期移行性肌电复合波(MMC)的变化.?方法:?56只刚断乳SD大鼠被随机分为正常对照组(n?=?16)、中毒组(n?=?40).?两组分别随机取8只在胃窦、十二指肠、空肠分别慢性埋置三对银丝电极;?其余大鼠同时行假手术.?术后7-10?d,?埋置电极组大鼠均在清醒、空腹、自由活动状态下记录胃肠道MMC.?中毒组按200?mg/kg一次性灌服ANIT诱发大鼠急性肝内胆汁淤积病变,?观察灌服ANIT后中毒组在48,?96,?144,?192?h胆汁流量、血中TB和ALT值及胃肠MMC的变化.?结果:中毒组灌服ANIT后,?48?h时胆汁流量中断,?血清TB和ALT明显升高;?48?h后其胆汁流量逐渐增加,?血清TB和ALT逐渐下降,?于192?h基本恢复.?在ANIT灌胃前,?埋置电极的所有大鼠在清醒、禁食状态下均记录到典型的MMC节律性电活动,?正常对照组与中毒组之间差异无显著性意义;?中毒组灌服ANIT后,?MMC节律完全消失,?代之以Ⅱ期样节律紊乱波;?144?h后,?中毒组MMC节律运动开始恢复;?192?h时中毒组MMC均为节律运动,?但中毒组MMC持续时间(911.67±140.47?s)较正常对照组(682.87±77.39?s)明显延长,?其中主要是Ⅱ期持续时间延长(414.12±69.21?vs?150.28±35.45?s),?而Ⅲ期持续时间略缩短(121.21±27.38?s?vs?170.27±38.98?s)?,?差异有显著意义(P<0.05).结论:?急性肝内胆汁淤积时胃肠MMC表现MMC节律短暂消失或MMC周期延长;?其部分原因可能与消化间期胆汁流量减少有关.     

多潘立酮在增强胃十二指肠协调运动中的作用

目的观察多潘立酮对增强消化间期移行性复合运动(MMC)及促进胃窦十二指肠协调运动的有效性。方法在体实验:将30只Wister大鼠均分为对照(生理盐水)组、多潘立酮组和莫沙必利组。在各组大鼠胃窦、幽门和十二指肠埋植应力传感器,记录MMC及测定胃窦十二指肠协调运动。离体实验:应用血管灌流(Krebs-Ringer液、多潘立酮、阿托品+多潘立酮、河豚毒素+多潘立酮或莫沙必利)大鼠离体胃十二指肠制备。在胃窦和十二指肠缝一应力传感器,记录胃和十二指肠运动及测定胃窦十二指肠协调性。结果在体实验:①清醒大鼠消化间期出现典型MMCⅠ、Ⅱ、Ⅲ、Ⅳ相。②多潘立酮可明显增强MMC的收缩运动,使胃窦和十二指肠平均振幅分别比对照组增加85.1%±11.4%和83.0%±6.3%。③多潘立酮可明显增加MMC胃窦十二指肠协调运动,由胃窦引发的十二指肠收缩波比对照组增加91.2%±9.4%。离体实验:①血管灌流多潘立酮可显著刺激离体胃十二指肠运动和胃窦十二指肠协调运动,分别较Krebs-Ringer液组增加66.2%±12.1%和76.5%±5.8%。②阿托品与河豚毒素可阻断多潘立酮兴奋胃十二指肠运动及胃窦十二指肠协调性的作用。结论多潘立酮可明显增加胃窦十二指肠动力及协调运动。多潘立酮促进胃肠动力和协调运动的作用机制,除已知阻断外周多巴胺受体外,还可能通过肠神经系统内胆碱能神经介导。     

多种胃肠激素在消化间期移行性复合运动中作用的研究

目的　通过研究胃肠激素与消化间期移行性复合运动(MMC)的关系,探讨 MMC发生及其调节机制。方法　应用胃十二指肠测压技术对30例健康志愿者的消化间期胃十二指肠运动的特征进行研究,并在检测过程中分别于MMCⅠ、Ⅱ和Ⅲ相采集静脉血行胃动素(MTL)、生长抑素(SS)、P物质(SP)及一氧化氮(NO)的血浆浓度检测。结果　MMC周期为112.7 min±37.2 min,MMCⅠ相最长,Ⅱ相次之、Ⅲ相最短,MMCⅢ相多起源于胃窦,也可起源于十二指肠。MMC多向远端移行,偶见逆向传导。MMCⅢ相血浆MTL为921.7 pg/ml±109.8 pg/ml,SP为10.9 pg/ml±7.2 pg/ml,明显多于Ⅰ相(分别为334.7 pg/ml±58.1 pg/ml,11.3 pg/ml±8.8 pg/ml)和Ⅱ相(分别为 370.0 pg/ml±69.2 pg/ml,11.0 pg/ml±10.0 pg/ml),差异有统计学意义(P<0.05)。血浆 SS、NO水平各时相相比差异无统计学意义(P>0.05)。结论　MTL、SP可能与 MMCⅢ相的诱发有关。血浆 SS、NO水平可能对胃肠MMC无直接作用。     

肝胃不和型功能性消化不良大鼠胃动素和P物质的表达及中药情志舒的干预作用

目的：观察肝胃不和型功能消化不良（FD）大鼠胃和十二指肠运动功能、血浆胃动素（MOT）含量和胃肠壁P物质（SP）的表达，探讨肝胃不和型FD的发病机制及中药情志舒治疗肝胃不和型FD的可能机制。方法：将64只大鼠随机分为对照组，模型组，多潘立酮组及情志舒组；应力传感器记录大鼠胃和十二指肠移行性复合运动（MMC）；放免法测定大鼠血浆MOT含量；PAP免疫组化法观察SP在胃窦壁和十二指肠壁的表达情况。结果：与模型组比较，情志舒组MMC周期缩短，Ⅲ相延长，频率加快，幅度高，MMCⅢ相发生率增加，胃和十二指肠协调收缩率显著增加，MMCⅢ相时血浆MOT含量显著增加；胃肠壁SP免疫阳性产物表达也明显增强（P＜0．01，＜0．05）。结论：胃肠MMCⅢ相异常，胃肠协调运动障碍可能是肝胃不和型FD的发病机制之一，肝胃不和型FD大鼠血浆MOT含量的降低和胃肠壁SP表达的降低可能是肝胃不和型FD发病的神经生学基础，情志舒可能增加MMCⅢ相血浆MOT的释放和胃肠壁SP的表达，从而改善胃肠运动功能来治疗肝胃不和型FD。     

功能性消化不良患者24小时十二指肠运动变化

目的研究功能性消化不良(FD)患者的十二指肠运动及FD不同临床类型的特点.方法用动态胃窦十二指肠压力监测仪对31例FD患者和20例健康对照行24h胃窦十二指肠压力检测.结果FD患者消化间期移行性运动复合波(MMC)周期数(2.18±0.97)较正常对照组显著减少(3.05±0.80,P＜0.01),MMCⅡ相时程明显延长(FD患者69.80min±31.85min,正常对照组44.70min±13.59min,P＜0.01).FD各临床类型中,运动障碍样型患者的MMC周期数减少最为明显(1.98±0.98).FD患者餐后十二指肠动力指数较正常对照组明显降低(P＜0.05),也以运动障碍样型降低最为明显.检测过程中,FD组12例(38.71%)和正常对照组2例(10%)出现高幅孤立性活动(P＜0.05),FD组中10例发生于运动障碍样型患者(P＜0.05).结论FD患者存在消化期及消化间期十二指肠运动异常,以运动障碍样型表现最为明显.     

十二指肠胃反流胃肠动力机制研究

十二指肠胃反流（DGR）是一种常见的生理和病理现象，与许多疾病的发生有关。目前其发生机制尚不明确。目的：探讨DGR发生与胃窦十二指肠消化间期移行性复合运动（MMC）的关系。方法：对20名健康志愿者行24h同步胃内pH监测和胆汁监测，以及夜间长时胃窦十二指肠压力测定。结果：24h同步胃内pH监测和胆汁监测后，20名健康志愿者分为2组：DGR阴性组（D1组）（7名）和DGR阳性组（D2组）（13名）。D1组MMC周期数较D2组显著增加（P〈0．05）；D2组胃窦十二指肠协调收缩较D1组显著减少，十二指肠推进性蠕动减少（P均〈0．05）。D1组十二指肠MMCm相逆蠕动发生率显著低于D2组（P〈0.05）。D2组发生MMCm相逆蠕动前后10min，胃内pH值分别为1.72±0.61和3.70±0.72，差异有统计学意义（P〈0．01）。夜间MMCⅡ相晚期碱反流和胆汁反流的发生率显著高于I相、Ⅱ相早期和Ⅲ相（P均〈0．05）。结论：DGR的发生与胃窦十二指肠MMC周期数、Ⅱ相晚期和Ⅲ相逆蠕动有关。     

功能性消化不良患者幽门与胃窦十二指肠运动的时空关系

本文通过连续5小时上消化道测压观察了11例健康人(HS)和14例功能性消化不良(FD)病人消化间期和消化期胃窦、幽门、十二指肠运动功能变化。结果显示,HS组胃窦部、幽门、十二指肠移行性复合运动(MMC)Ⅲ期出现率为7/11、8/11和10/11,FD组分别为3/14(P<0.05)、4/14(P<0.05)和6/14(P相似文献   

肠易激综合征患者小肠移行性复合运动的研究

目的 了解肠易激综合征(IBS)患者移行性复合运动(MMC)与健康人相比是否有差异及IBS患者离散性丛集波(DCC)与腹痛是否有关.同时改进目前胃肠运动的监测方法 .方法 采用16导水灌注测压导管对16例便秘型IBS(IBS-C)患者、18例腹泻型IBS(IBS-D)患者、18例健康对照者进行MMC的监测.结果 IBS-C[(127.5±25.5)min]及IBS-D患者[(74.5±18.7)min]MMC周期持续时间与健康对照组[(87.5±24.2)min]相比存在显著不同(P值均<0.001).与健康对照者相比,IBS-C患者MMC Ⅲ相波幅及传播速度显著降低[(39.8±11.7)mm Hg比(61.1±14.1)mm Hg,P<0.001,1 mm Hg=0.133 kPa;(1.8±0.9)cm/min比(2.6±0.8)cm/min,P<0.01];而IBS-D患者MMC Ⅲ相波幅[(69.7±20.5)mm Hg]升高,MMC Ⅲ相传播速度[(4.1±2.5)cm/min]显著加快.IBS-C、IBS-D患者及健康对照组MMC Ⅱ相DCC发生率分别为87.5%,88.8%,83.3%,各组之间差别无统计学意义(P>0.05).IBS-C及IBS-D患者MMC Ⅲ相波中断、传导障碍等异常现象发生率分别为68.8%、66.7%,且只在空肠部位观察到,而健康人中未见到该异常.结论 (1)IBS-C、IBS-D患者的MMC与健康人相比有明显差异,提示MMC运动异常是IBS重要发病机制之一,而且IBS患者空肠部位MMCⅢ相波的变化可能是IBS重要的胃肠道运动异常.(2)DCC与IBS患者腹痛无明显相关性.     

Effects of motilin and ursodeoxycholic acid on gastrointestinal myoelectric activity of different origins in fasted rats

AIM: To investigate gastrointestinal migrating myoelectric complex (MMC) and the effects of porcine motilin and ursodeoxycholic acid (UDCA) on MMC of gastrointestinal tract of different origins in fasted rats. METHODS: Three bipolar silver electrodes were chronically implanted on the antrum, duodenum and jejunum. Seven days later 24 experimental rats were divided into 2 groups. One group was injected with porcine motilin via sublingual vein at a dose of 20 microg/kg, the other group was perfused into stomach with UDCA. The gastrointestinal myoelectric activity was recorded 1 h before and 2 h after the test substance infusions into the rats. RESULTS: In all fasted rats a typical pattern of MMC was observed. Among the totally 68 activity fronts recorded in fasted rats under control, 67% started in duodenum, and 33% in antrum. MMC cycle duration and duration of phase III of antral origin were longer than those of duodenal origin. Administration of 20 microg/kg porcine motilin induced a premature antral phase III of antral origin. But perfusion into stomach with UDCA resulted in shorter MMC cycle duration, longer duration of phase III of duodenal origin, which were followed with shorter cycle duration and duration of antral phase III. CONCLUSION: In fasted rats, MMC could originate from antrum and duodenum respectively. The characteristics of MMC of different origins may contribute to the large variations within subjects. The mechanisms of different origins of phase III may be different. Porcine motilin and UDCA could affect MMC of different origins of the gastrointestinal tract in fasted state, respectively.     

Effects of ghrelin on interdigestive contractions of the rat gastrointestinal tract

Ghrelin causes interdigestive contractions of the stom- ach in rats. However, it remains unknown whether ghrelin causes interdigestive contractions in the small intestine. Four strain gauge transducers were implanted on the antrum, duodenum, proximal and distal jejunum. After an overnight fast, gastrointestinal （GI） contrac- tions were recorded in freely moving conscious rats. Spontaneous phase m-like contractions were observed at every 13-16 min in rat GI tract. The fasted motor patterns were replaced by the fed motor pattern imme- diately after food intake. Two minutes after finishing the spontaneous phase Ill-like contractions in the antrum, acyl ghrelin （0.8, 2.4 and 8.0 μg/kg per min） was con- tinuously infused for 30 min. Three-five minutes after the starting ghrelin infusion, augmented phase Ⅲ-like contractions were observed at the antrum, duodenum, and jejunum. Ghrelin infusion （0.8, 2.4 and 8.0μg/kg per min） significantly increased motility index of phase Ⅲ-like contractions at the antrum and jejunum in a dose dependent manner, compared to that of saline in- jection. Thus, it is likely that exogenously administered ghrelin causes phase Ⅲ-like contraction at the antrum, which migrates to the duodenum and jejunum. The possible role of 5-HT, in addition to ghrelin, in mediating intestinal migrating motor complex （MMC）, is discussed.     

Relationship between entero-hepatic bile acid circulation and interdigestive migrating myoelectrical activity in rats

AIM: To investigate the effects of entero-hepatic bile acid circulation on the inter-digestive migrating myoelectrical complex (MMC) in rats. METHODS: Thirty-two rats were divided into four groups. Three pairs of bipolar silver electrodes were chronically implanted in the antrum, duodenum and jejunum. Three groups of them were ligated around the upper part of common bile duct (CBD). The experiments were performed in conscious and fasting state. The gastrointestinal myoelectrical activity was recorded. Ursodeoxycholic acid (UDCA) and saline were then perfused into stomachs of two groups with CBD obstruction and the effects of them on the MMC were observed. RESULTS: A typical pattern of MMC was observed in normal fasting rats. MMC of antral and duodenal origin disappeared temporarily in earlier stage of CBD obstruction. While MMC of jejunum origin appeared. increased MMC cycle duration was seen after 4 d in rats with CBD obstruction. The MMC after CBD obstruction was characterized by an increased duration of phase Ⅱ-like activity and decreased duration of phase Ⅰ & Ⅲ activity. Perfusion into stomachs with UDCA resulted in a shorter MMC cycle duration and a longer duration of phase Ⅲ of duodenal origin compared to the normal group. CONCLUSION: Entero-hepatic bile acid circulation initiates inter-digestive MMC of duodenal origin.     

Interdigestive Gallbladder Emptying, Antroduodenal Motility, and Motilin Release Patterns Are Altered in Cholesterol Gallstone Patients

The role of interdigestive gallbladder emptying in gallstone formation is unknown. In fasting healthy subjects, gallbladder emptying is associated with antral phase III of the migrating motor complex (MMC) and high plasma motilin. Therefore, gallbladder volumes and motilin levels were measured during 13 MMC cycles in 10 cholesterol gallstone patients and compared with 20 MMC cycles in 10 healthy subjects. MMC cycle length was longer in gallstone patients than in healthy subjects (158.2 ± 17.0 vs 105.5 ± 10.4 min, respectively; P < 0.05), due to longer phase I (39.8 ± 5.7 vs 17.2 ± 3.7 min, respectively; P < 0.05). In contrast to healthy subjects, gallstone patients had no significant fluctuations of gallbladder volume during the MMC cycle, and motilin concentrations were not different in MMC cycles with phase III originating in antrum or duodenum. During MMC cycles with phase III originating in the duodenum, motilin levels were twice as high in gallstone patients as in healthy subjects (P < 0.002). In conclusion, cholesterol gallstone patients have an abnormal MMC and motilin release pattern. Their interdigestive gallbladder emptying is reduced and dissociated from the MMC. These disturbances may contribute to gallstone formation.     

5-HT4受体对人消化间期小肠运动调控及其机制研究

目的通过观察5-羟色胺(5-HT4)受体激动剂对人消化间期移行性复合运动(MMC)及血浆胃肠激素的影响,探讨5-HT4受体激动剂对MMC的调控作用及其可能的介导因素。方法选取健康志愿者18人并观察给予选择性5-HT4受体激动剂后MMC的变化。并且在给药前后检测MMC不同时期血浆胃动素(MOT)、生长抑素(SS)、NO的浓度。结果健康人给药后MMC周期显著缩短[(87.5+24.2)min vs(60.5±18.4)min,P0.001],MMCⅢ期波幅、动力指数、传播速度均比给药前显著升高(P0.05)。MMC不同时期血浆MOT含量无显著变化(P0.05),SS水平显著升高(P0.01),而NO含量显著降低(P0.05)。结论 5-HT4受体激活对人MMC有兴奋性作用,该兴奋作用可能通过SS、NO等胃肠激素起作用。     

Jejunoileal transplantation

This study was designed to determine if extrinsic innervation and intrinsic neural continuity with the duodenum (neuroenteric physiologic pathways disrupted during intestinal transplantation) modulate the characteristics of interdigestive motor activity in the canine small bowel. Five dogs served as neurally intact controls (group 1) and 10 dogs (group 2) underwent a model of jejunal autotransplantation involvingin situ neural isolation of the jejunoileum. Fasting duodenal and jejunal motor activity was recorded on-line to a microcomputer using closely spaced duodenal and jejunal manometry catheters. Characteristics of global motor patterns, the migrating motor complex (MMC), and local motor patterns, including individual contractions and grouped clustered contractions, were determined. Neural isolation of the jejunoileum disrupted coordination of duodenal and jejunal phase III activity, increased the variability of cycling of the MMC, decreased the period of the jejunal MMC, and increased motility indices in the neurally isolated jejunum. In contrast, single pressure waves and clustered contractions in the neurally isolated jejunum were not altered significantly in incidence or direction, distance, or velocity of spread.In situ neural isolation of the jejunoileum leads to temporal dissociation of the MMC between the transplanted segment (jejunum) and the duodenum but does not appear to alter markedly the characteristics of local contractile activity as measured by individual or grouped contractions. The occurrence of interdigestive jejunal motor patterns and the local organization of individual and grouped small intestinal contractions are not controlled by extrinsic innervation or intrinsic neural continuity with the duodenum.     

Effect of octreotide on fasting gall bladder emptying, antroduodenal motility, and motilin release in acromegaly.

Subcutaneous octreotide (Sandostatin) injections lead to gall stone formation in 13-50% of acromegaly patients during one year of therapy. This study explored the effects of octreotide on interdigestive gall bladder emptying, antroduodenal motility, and motilin release. Ambulatory antroduodenal manometry was performed in six acromegaly patients before and after two months of octreotide therapy (100 micrograms thrice daily, subcutaneously). Ultrasonographic gall bladder volume measurements and plasma motilin concentrations were obtained during two migrating motor complex (MMC) cycles. Before octreotide treatment, nine of 26 phase III activities started in the antrum and 17 of 26 in the duodenum whereas during treatment 47 of 48 of phase III activity started in the duodenum (p < 0.05). Before treatment, interdigestive gall bladder emptying (mean (SEM) 39.9 (4.0)% of maximal fasting volume) and plasma motilin peaks preceded antral phase III but not duodenal phase III. During octreotide therapy no significant motilin fluctuation or gall bladder emptying was seen. Fasting gall bladder volume increased from 40.9 (9.1) ml before to 68.0 (14.8) ml (p < 0.05) during octreotide treatment. In conclusion, two months' treatment with octreotide increases the number of duodenal phase III like activity and virtually abolishes antral phase III, plasma motilin peaks, and interdigestive gall bladder emptying. These effects might contribute to the high risk of gall stone formation during longterm octreotide treatment.