肠内营养联合生长激素对高龄患者胰十二指肠术后急性炎症反应的影响

[目的]观察肠内营养(EN)联合生长激素(GH)对胰十二指肠切除术(PD)后急性炎症反应的调理作用。[方法]32例高龄PD患者,随机分为EN联合GH(观察)组及EN(对照)组,检测两组术前和术后血清白细胞介素6(IL-6)、肿瘤坏死因于α(TNF-α)、C反应蛋白(CRP)水平变化,并观察术后全身炎症反应综合征(SIRS)及多器官功能不全综合征(MODS)的发生率。[结果]两组患者术后均有SIRS的发生,观察组术后第3和第7天的血清TNF-α和CRP水平明显低于对照组(P<0.05);观察组SIRS持续时间(2.87±1.41)d明显短于对照组(4.53±1.23)d(P<0.05);观察组MODS发病率(13.33%)明显低于对照组(23.53%)(P<0.01)。[结论]高龄患者PD术后EN联合GH能有效地减轻创伤后的急性炎症反应,降低MODS发病率,促进患者康复。     

不同营养方式对老年消化道恶性肿瘤病人术后免疫功能的影响

目的探讨不同营养方式对老年消化道恶性肿瘤病人术后免疫功能的影响。方法选择行消化道恶性肿瘤根治术老年病人,随机分为肠内营养组(EN)和肠外营养组(PN)。检测术前、术后不同时间段外周血补体及免疫球蛋白水平和各种淋巴细胞百分比的变化,并观察感染性并发症发生率及胃肠功能恢复时间。结果术后第1天两组补体、免疫球蛋白及淋巴细胞百分比均较术前均显著下降(P<0.05),而术后第8天两组免疫指标较术后第1天有所恢复,且改变量EN与PN组比较差异显著(P<0.05)。PN组术后感染性并发症的发生率高于EN组(P<0.05)。肠道功能恢复时间EN组早于PN组(P<0.05)。结论老年消化道恶性肿瘤病人根治术后肠内营养支持较肠外营养支持能更好的促进患者免疫功能的恢复,降低感染性并发症的发生率,并有利于胃肠功能的恢复。     

老年人全胃切除术后的早期肠内营养支持

目的探讨术后早期肠内营养对老年全胃切除术后患者营养状态、免疫功能、感染性并发症、住院时间及营养支持费用的影响。方法57例老年全胃切除术后患者分为常规营养组、早期肠外营养组(肠外营养组)和早期肠内营养组(肠内营养组)。于手术前后检测营养和免疫指标,观察术后感染性并发症,统计住院天数及营养支持费用。结果术后9d,肠外营养组的血清白蛋白、转铁蛋白、前白蛋白、CD3、CD4、CD4/CD8分别为(34.3±3.5)g/L、(1.7±0.2)g/L、(258.8±20.2)mg/L、(39.7±5.4)%、(34.3±4.0)%和(1.5±0.3),肠内营养组分别为(33.9±3.1)g/L、(1.7±0.2)g/L、(260.5±24.7)mg/L、(42.8±6.5)%、(37.2±4.5)%和(1.7±0.2),均显著高于常规营养组的(29.5±3.0)g/L、(1.3±0.2)g/L、(235.4±13.9)mg/L、(34.8±5.0)%、(30.4±4.4)%和(1.2±0.2),差异均有统计学意义(P<0.01);肠内营养组的CD3、CD4、CD4/CD8水平显著高于肠外营养组(P<0.05)。肠外营养组感染性并发症少于常规营养组,高于肠内营养组。肠外营养组和肠内营养组的住院天数分别为(14.4±2.1)d和(11.2±1.8)d,均显著少于常规营养组的(19.5±3.3)d,差异均有统计学意义(均为P<0.01),而肠内营养组又显著少于肠外营养组(P<0.05)。肠内营养组营养支持费用为(1540.9±164.7)元,显著少于肠外营养组的(3986.4±456.5)元(P<0.01)。结论对于老年全胃切除术后患者,早期肠外营养和早期肠内营养均可行,但早期肠内营养可作为第一选择。     

早期肠内营养对老年胃癌患者术后免疫功能的影响

目的研究早期肠内营养对老年胃癌患者术后免疫功能的影响。方法将64例老年胃癌患者随机均分为早期肠内营养组(EEN组)及肠外营养组(PN组)。两组患者于术后第1天开始营养支持。EEN组采用早期肠内营养,PN组采用肠外营养方式。营养支持共7 d。分别于术前1 d,术后1 d及术后第14天检测两组患者细胞免疫、体液免疫、肿瘤标志物水平。结果两组患者术前及术后第1天在细胞免疫、体液免疫及肿瘤标志物检测结果差异无统计学意义(P>0.05)。两组患者术后第1天细胞免疫及体液免疫较术前均有所下降,术后第14天EEN组细胞免疫及体液免疫水平均明显高于PN组(P<0.01),而EEN组肿瘤标志物水平明显低于PN组(P<0.01)。结论 EEN可改善老年胃癌患者术后营养状态,促进机体免疫功能恢复,提高机体抗肿瘤能力。     

梗阻性黄疸术后早期肠内营养对T淋巴细胞亚群的影响

目的 探讨手术后早期肠内营养(EEN)对梗阻性黄疸患者T淋巴细胞免疫功能的影响.方法 分别给予梗阻性黄疸术后患者普通静脉输液(对照组)、肠外营养(PN组)及肠内营养(EN组)8 d.术前、术后第1、9天以碱性磷酸酶-抗碱性磷酸酶法测定T淋巴细胞亚群(CD3、CD4、CD8)变化.结果 与对照组比较,PN、EN组体质量下降减少,负氮平衡明显降低,白蛋白、转铁蛋白、前白蛋白升高(P均<0.05).与术前比较,术后第1天三组CD3、CD4阳性细胞数及CD4/CD8比值降低,CD8阳性细胞数升高(P<0.05).术后第9天,EN组CD3、CD4阳性细胞数及CD4/CD8比值恢复至术前水平,且明显高于对照组和PN组(P<0.05),而CD8阳性细胞数低于对照组和PN组(P<0.05).结论 EEN可纠正梗阻性黄疸手术后患者的T淋巴细胞免疫抑制状态,促进其免疫功能恢复.     

强化精氨酸的肠内营养制剂对肝癌患者免疫功能的影响

肝癌患者常合并不同程度的免疫功能低下 ,手术创伤又可使其免疫状况进一步恶化 ,术后应用免疫增强剂将提高患者的抗肿瘤能力。我们对部分行肝癌切除术的患者术后给予强化精氨酸的肠内营养制剂 ,并对其免疫指标进行了观察。现报告如下。1　资料与方法2 0 0 0年 3月至 2 0 0 2年 1 0月 ,在我院行肝癌切除术的肝癌患者共 41例 ,男 2 6例、女 1 5例 ,年龄 (5 1 .7±1 0 .4)岁 ,随机分为强化精氨酸 (Arg)的肠内营养组 (Arg+EN组 ) 2 0例、肠内营养组 (EN组 ) 1 1例、对照组 1 0例。对照组术后初期禁饮食 ,完全静脉补液 ,待排气后逐步进食 ;EN…     

肠内营养对胰十二指肠切除患者术后营养、免疫和预后的影响

目的探讨肠内营养(EN)支持对老年胰十二指肠切除(PD)患者术后营养、免疫和预后影响。方法 90例研究对象随机分为术后EN组和肠外营养(PN)组,给予营养支持7¹0 d。术前、术后1 d、7 d分别检测营养指标、免疫指标和机体变化。结果与术前比较,术后1 d两组患者体质量下降,人体前白蛋白和转铁蛋白含量降低;CD3、CD4阳性细胞数及CD4/CD8比值降低,CD8阳性细胞数升高(P<0.05)。术后7 d,EN组CD3、CD4阳性细胞数及CD4/CD8比值恢复至术前水平,且明显高于PN组(P<0.05),而CD8阳性细胞数低于PN组(P<0.05),两组患者术后并发症发生率、住院时间和住院费用有显著差异(P<0.05)。结论 EN干预可纠正老年PD患者术后营养、免疫状况和促进机体康复。     

食管癌术后早期肠内营养对患者免疫功能的影响

目的观察食管癌术后早期肠内营养对患者免疫功能的影响。方法将62例食管癌手术治疗患者随机分为两组,EN组早期给予肠内营养支持治疗,PN组给予肠外营养支持治疗;分别于术前及术后第1、8天,检测体液免疫指标(IgA、IgG、IgM)及细胞免疫指标(T淋巴细胞及其亚群、NK细胞、B淋巴细胞)。结果两组患者术后第1天IgA、IgG、IgM均较术前明显下降,第8天均明显回升,EN组较PN组增幅大(P均<0.05)。两组术后第1天CD3、CD4、CD4/CD8、NK细胞、B淋巴细胞均较术前明显下降,第8天均明显回升,EN组较PN组增幅大(P均<0.05)。结论食管癌术后早期肠内营养较肠外营养可显著改善患者的细胞及体液免疫功能。     

肝癌患者血清铁含量及手术前后T淋巴细胞亚群变化

目的探讨肝癌患者血清铁(Fe)含量及手术前后T淋巴细胞亚群变化,揭示Fe含量与肝癌的关系及手术对患者免疫功能的影响。方法选取100例原发性肝癌患者(肝癌组)及50名门诊体检正常者(对照组),测定血清Fe、铁蛋白(Ferr)、转铁蛋白(TRF)含量,术前第2天及术后第3天、术后第7天、术后第14天T淋巴细胞亚群CD3+、CD4+、CD8+、CD4+/CD8+水平。结果肝癌组患者血清Fe、Ferr含量明显高于对照组,TRF含量低于对照组,两组相比,差异有统计学意义(P0.05);肝癌组术前CD3+、CD4+、CD4+/CD8+水平低于对照组,CD8+水平高于对照组,两组相比,差异有统计学意义(P0.05);肝癌组术后3 d、7 d CD3+、CD4+、CD8+、CD4+/CD8+水平明显低于术前,差异有统计学意义(P0.05);术后14 d与术前相比,水平接近,差异无统计学意义(P0.05)。结论肝癌患者Fe、Ferr含量较正常人群明显增高,TRF、细胞免疫较正常人群明显下降,在术后细胞免疫被抑制状态更为严重,后随着时间延长有所恢复,因而对肝癌患者应进行血清Fe、Ferr、TRF含量监测及术后免疫干预治疗。     

术后早期肠内免疫营养对老年胰腺癌、胃癌患者免疫的影响

目的 观察术后早期肠内免疫营养对老年胰腺癌、胃癌患者机体免疫功能的影响。方法采用前瞻性、开放性研究,选择20例胰腺癌、40例胃癌患者分别应用免疫营养制剂(士强,荷兰Nutricia公司产品)(n=30)和对照剂能全力(无锡Nutricia公司产品)(n=30)治疗。均于术后第二天开始等热卡肠内营养支持7d(30keal·kg~(-1)·d~(-1))。检测术前、术后第1天、5天、8天的营养及免疫指标。结果 1.两组病例术后免疫球蛋白(IgG、IgM、IgA)下降(P<0.01),肠内营养支持7d,两组病例T细胞亚群无显著改变(P>0.05);试验组IgA较术前提高(P相似文献   

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.