肝硬化大鼠小肠黏膜形态结构改变与内毒素血症

目的研究药物和胆汁淤积引起的肝硬化大鼠小肠黏膜形态结构改变和血浆内毒素水平。方法分别以硫代乙酰胺(TAA)(n=10)诱导和行胆管结扎术后(BDL)(n=7)的肝硬化大鼠为模型组,另以正常大鼠(n=12)作为正常对照组,分别观察光镜和透射电镜下小肠黏膜的形态,并采用鲎试剂基质显色法测定腹主动脉血浆内毒素含量。结果光镜下观察到模型组肝硬化大鼠小肠肠黏膜绒毛稀疏、萎缩,上皮细胞坏死,黏膜水肿伴有炎性细胞浸润;电镜下观察到模型组大鼠小肠壁超微结构有明显改变,肠黏膜绒毛破坏,减少,变短,倒伏,缺失,肠黏膜紧密间隙增宽,肠黏膜杯状细胞分泌减少,肠黏膜上皮细胞内线粒体和内质网肿胀。正常对照组大鼠的小肠黏膜绒毛形态及超微结构没有明显改变。模型组大鼠的血浆内毒素水平明显高于正常对照组(P<0.01)。结论模型组肝硬化大鼠都存在小肠黏膜结构的改变和内毒素水平的增高,提示肝硬化大鼠小肠黏膜的损伤与肠源性内毒素血症密切相关。     

双气囊小肠镜下小肠黏膜糜烂和溃疡

小肠曾被认为是一个少有病变的器官,近年来,随着双气囊小肠镜在临床上的广泛应用,发现了各种各样的小肠病变,其中最常见的病变是各种溃疡和糜烂。     

肝硬化患者十二指肠黏膜超微结构的改变及其意义

目的观察肝硬化患者十二指肠黏膜超微结构的改变,探讨其意义。方法按常规内镜下活检术获取研究对象的十二指肠黏膜并行透射电镜检查,观察其超微结构;分别检测血浆内毒素,血氨、PT、Alb和TBil水平,分析十二指肠黏膜超微结构改变与上述指标变化之间的关系。结果60例肝硬化患者中31例出现十二指肠黏膜超微结构改变,发生率为52%,表现为黏膜上皮细胞微绒毛减少、变短,胞核固缩;肠黏膜上皮细胞紧密连接间隙增宽以及线粒体肿胀等。其发生率以Child-Pugh A级组最低（25%）,B级组次之（45%）,C级组最高（85%）（P＜0．01）。伴有十二指肠黏膜超微结构改变的肝硬化患者,其血浆内毒素、血氨、TBil明显升高,PT延长,Alb水平明显降低（P＜0．01）。结论肝硬化患者存在十二指肠黏膜超微结构改变,其发生率随肝硬化病情的加重而增高;小肠黏膜超微结构改变在肝硬化患者内毒素血症、血氨升高等异常中可能具有重要意义。     

生长激素对脑出血大鼠血清白蛋白含量和小肠黏膜形态学的影响

目的 评价重组人生长激素(recombinant human growth hormom,rhGH)对脑出血大鼠血清白蛋白水平和小肠黏膜形态学的影响.方法 采用自体血注射法制作大鼠脑出血模型.56只SD大鼠分为假手术组(n=8),rhGH组(n=24;腹腔注射rhGH,1 U/kg,1次/d)和生理盐水对照组(n=24;腹腔注射等量生理盐水,1次/d),后两组均分别再分为术后1、7和14 d组(每组n=8).检测各组大鼠不同时问点血清白蛋白浓度,HE染色和图像分析观察小肠黏膜形态学改变.结果 脑出血各时间点,生理盐水对照组血清白蛋白水平均较假手术组显著降低(P均<0.01);rhGH组血清白蛋白水平随治疗进程逐渐增高,但仅在14 d时显著高于生理盐水对照组[(39.93±1.98)g,L对(37.93±1.57)g,L,P<0.01].脑出血后1 d和7 d时,rhGH组小肠绒毛高度和黏膜厚度与生理盐水对照组无显著差异,但14 d时显著增高(P<0.01).脑出血后1、7和14 d小肠绒毛面积进行性缩小,且rhGH组较生理盐水对照组随治疗进程进行性增高(P<0.01).脑出血后1 d和7 d.rhGH组肠腺深度较生理盐水对照组增高(P<0.01),但14 d时无显著差异;脑出血1 d,rhGH组组肠腺密度较生理盐水对照组显著增高(P<0.01),7 d时增高不显著,14 d时不仅不增反而稍有降低.结论 脑出血大鼠血清白蛋白水平较假手术组显著下降;脑出血可引起小肠黏膜损害.rhGH可提高脑出血大鼠血清白蛋白水平,不论在脑出血早期还是后期均可不同程度减轻小肠黏膜损伤,后期改善更为显著.rhGH对小肠黏膜损伤的改善程度与血清白蛋白水平的升高程度呈正相关.     

服用阿司匹林患者发生严重小肠黏膜损伤与乳果糖氢呼气试验的关系初探

目的 初步探索服用阿司匹林患者发生严重小肠黏膜损伤与乳果糖氢呼气试验(lactulose hydrogen breath test,LHBT)阳性的关系.方法 收集2019年5月至2019年12月在首都医科大学附属北京安贞医院就诊的服用肠溶阿司匹林治疗1个月以上的患者106例,均行磁控胶囊内镜和LHBT,收集患者临床资...     

冷冻保存后成人胰岛细胞与小肠黏膜下层的共培养

目的:探讨猪小肠黏膜下层(SIS)对冷冻保存后的胰岛细胞的支持和保护作用．方法:分离纯化后的成人胰岛细胞经冷冻保存1 mo后分为 SIS组和对照组,在RPMI-1640培养液培养1 wk后分别测定两组的胰岛细胞回收率,观察胰岛细胞形态并进行胰岛素刺激释放试验．结果:SIS组胰岛细胞回收率为90．5±1．8％,较游离组62．7± 3．6％显著提高(P<0．05),胰岛形态较对照组完整．在高糖刺激下,SIS组胰岛素分泌量较游离组增高(25．8±1．7 mU／L vs 14．6±1．3 mU／L,P<0．05)．在含有茶碱的高糖溶液中,微囊组的刺激指数为游离组的3倍．结论:SIS作为一种天然的细胞外基质材料,可显著提高胰岛细胞冷冻保存后的回收率,并改善胰岛细胞的功能．     

猪小肠黏膜下层海绵的三维重建、表面修饰和细胞黏附性

目的探讨利用EDC对猪小肠黏膜下层进行化学改性后的小肠黏膜下层(SIS)形态学结构进行表面修饰和复合细胞,来鉴定其生物学支架特性。方法利用胃蛋白酶-EDC系统进行SIS改性,联合骨髓间充质干细胞(BMSCs),观察体外的细胞生长、扩增和分化,从形态学,苏木素-伊红(HE)染色、扫描电镜等方法进行检测。结果和未经过三维重建的SIS对比,SIS海绵在空间结构上更加合理,孔径大小为100²00μm,吸水率高,统计学意义显著,生物降解不明显,不同含量的SIS海绵,以1wt%、2wt%组细胞的生物学特性形态的变化比较明显,没有细胞的排斥现象。结果三维重建的SIS结构合理,弹性良好,结构稳定率低,细胞生长良好,可以作为一种生物学材料,为进一步临床应用打下基础和提供依据。     

华法林过量致小肠黏膜下出血1例

华法林过量引起自发性小肠壁内血肿是抗凝过程中较为少见的并发症之一,其导致亚急性肠梗阻.患者可表现为腹痛、凝血功能明显异常,可同时伴随恶心、呕吐、贫血,在临床工作中易被误认为肠系膜血栓形成或外科急腹症而给以溶栓或外科手术治疗.     

冷束缚应激状态对大鼠小肠黏膜细胞凋亡的影响及其机制的研究

目的观察冷束缚应激(coldrestrainstress,CRS)状态下大鼠小肠黏膜细胞的凋亡情况;探讨CRS状态下对大鼠小肠黏膜细胞凋亡的影响机制。方法选取出生80~100d的SD大鼠为实验动物,随机分为正常对照组(N组)和冷束缚应激组(S组),S组按应激后检测时间又分为S2h、S4h、S8h、S12h、S24h组,应激动物模型制作参照Brodie的方法制作。分别观察各组大鼠的小肠黏膜细胞凋亡情况,以原位末端标记法(TUNEL)法检测2组小肠黏膜细胞凋亡情况;免疫组化法检测bcl-2以及PCNA的表达情况。结果S组中各时段组大鼠小肠黏膜细胞凋亡率明显高于N组(除24h组隐窝外)。2h、4h、8h组未见bcl-2的表达,N组和S12h、S24h组可见少量表达。而2组的PCNA的表达情况无明显差异。结论应激状态下小肠黏膜细胞凋亡明显增加,从而导致肠屏功能的损伤,而在短期内对小肠黏膜细胞增殖无明显影响。     

NSAIDs相关性小肠黏膜损伤机制及防治研究进展

非甾体类抗炎药(non-steroidal anti-in?ammatory drugs,NSAIDs)广泛应用于临床,胃黏膜损伤是其主要的不良反应.随着诊疗技术的进步,近年发现NSAIDs对小肠黏膜的损伤远比以往估计的严重.阐明NSAIDs对小肠黏膜的损伤机制对临床防治具有重要的意义,本文结合国内外文献综述此方面的研究进展.     

胶囊内镜对小肠腔内隆起性病变诊断价值

目的探讨胶囊内镜对小肠腔内隆起性病变的诊断价值。方法计算小肠腔内隆起性病变的例数,描述隆起性病变的特点和分析影响因素,初步判断隆起性病变的性质。结果共发现45处隆起,其中22处证实为隆起性病变,约占隆起总数的48.9%,阴性排除率51.1%;胶囊内镜对体积小的隆起性病变观察清晰,体积、位置和小肠液等因素影响观察效果。结论胶囊内镜对隆起性病变具有较高的指导诊断价值。     

Spontaneous free perforation of the small intestine

In western cultures, spontaneous free perforation of the small intestine in adults is rare. The vast majority of published reports are of isolated cases. A review of 19 patients treated at the Lahey Clinic over the past 23 years is presented. All patients presented with an acute onset of peritoneal signs, and free perforation subsequently was documented at operation or at autopsy. Causes of the perforations were malignancy, six; inflammatory small bowel disease, four; combinations of radiotherapy, chemotherapy, or steroids, four; mechanical, three; and iatrogenic, two. Of the 19 patients, 15 had a history of previous abdominal surgery or recent steroid use, chemotherapy, or radiation therapy. Although the underlying disease may be of prime importance in causing perforation, these treatment modalities may be important factors in enhancing predisposition to perforation. Of the 16 patients operated on, ten had intestinal resection with primary anastomosis, and six had primary closure of the perforation. Four major complications included two deaths, and five minor complications occurred. In general, earlier operative intervention decreased mortality. A population of patients who may be at risk for small bowel perforations is identified. A review of the pertinent literature is presented. Read at the meeting of the American Society of Colon and Rectal Surgeons, San Francisco, California, May 2 to 6, 1982.     

双气囊内镜检查对小肠溃疡病变的诊断研究

目的 研究双气囊内镜(DBE)检查对小肠溃疡病变的诊断价值.方法 统计2003年9月到2007年12月广州南方医院DBE检查发现的小肠单纯溃疡而内镜活检显示为"小肠溃疡"或"慢性炎症"者的资料.结果 符合以上条件者62例,其中男48例,女14例,年龄10～71岁,平均43.9岁.临床主诉为消化道出血38例(61.3%)、腹痛16例(25.8%)、腹胀5例(8.1%)、消瘦2例(3.2%)、腹泻1例(1.6%).DBE诊断为克罗恩病53例(85.5%)、药物性溃疡4例(6.5%)、慢性非特异性炎症2例(3.2%)、淋巴瘤2例(3.2%)、结核1例(1.6%).62例内镜活检常规病理全部为"慢性炎症".其中32例行手术治疗(51.6%),在DBE诊断为克罗恩病的30例中,手术后诊断为克罗恩病22例(3例合并癌变)、淋巴瘤4例、白塞病3例、小肠结核1例,DBE确诊率73.3%;DBE诊断的1例小肠结核和1例淋巴瘤,手术后诊断均为克罗恩病.62例小肠溃疡病变DBE总的确诊率为68.8%(22/32),误诊率达31.2%(10/32).结论 对小肠溃疡病变的定性诊断,DBE结合常规活检也不是特异的,常规病理结合免疫组化技术有可能提高诊断的准确率,当内科治疗效果不好时,适时外科手术对其诊断和治疗都是有益的.     

高血压脑出血与消化道出血的关系

目的 探讨高血压脑出血患者脑出血部位、出血量与消化道出血率及病死率的关系.方法 对540例脑出血患者,按脑出血部位、血肿量、有无脑室出血、中线结构移位,分别比较消化道出血率和病死率.结果 合并消化道出血132例（24.4%）,死亡112例（20.7%）.消化道出血发生率分别为脑叶出血组25.4%,小脑出血组17.6%,脑干出血组30.4%,蛛网膜下腔出血组36.7%,脑基底节区出血并脑室出血组37.0%和局限脑基底节区出血组11.5%;病死率脑叶出血组25.4%,小脑出血组11.8%,脑干出血组21.7%.蛛网膜下腔出血组30.0%,脑基底节区出血并脑室出血组35.2%、局限脑基底节区出血组6.9%.合并消化道出血组病死率48.5%,无消化道出血组病死率11.8%.结论 脑出血并消化道出血提示死亡率的增加.应毫不延误地积极治疗.     

Recovery of allografted small intestine function

AIM: To investigate recovery of the allografted small intestine function after clinical small bowel transplantation (SBT).METHODS: The structure of the graft was evaluated by endoscopic biopsy and histopathologic examination. Graft functions were assessed by D-xylose absorption, barium studies, nitrogen balance calculation, and blood and stool cultures. Nutritional status of the recipients was judged by measurement of body weight and serum protein concentrations.RESULTS: The recipient discontinued total parenteral nutrition (TPN) and resumed oral nutrition 100 d after SBT. On oral diet, the patient maintained a normal nutritional status, gained weight by 3 kg, and had a normal serum albumin concentration (40.2 g/L ± 0.2 g/L). Satisfactory D-xylose absorption was achieved 8 wk after the operation. Nitrogen balance of the gut was maintained well and increased gradually. Serial mucosal biopsy showed normal structures 2 wk after grafting, without evidence of rejection and graft versus host diseases (GVHD). Barium studies conducted on the 10^th day and 38^th day by barium studies revealed that the grafted small bowel motility showed normal patterns of peristalsis and transit. No bacterial translocations were noted.CONCLUSION: Function of the grafted small intestine recovered satisfactorily 100 d after transplantation, indicating good clinical outcome of SBT.     

Heterogeneity across the murine small and large intestine

The small and large intestine of the gastrointestinal tract (GIT) have evolved to have discrete functions with distinct anatomies and immune cell composition. The importance of these differences is underlined when considering that different pathogens have uniquely adapted to live in each region of the gut. Furthermore, different regions of the GIT are also associated with differences in susceptibility to diseases such as cancer and chronic inflammation. The large and small intestine, given their anatomical and functional differences, should be seen as two separate immunological sites. However, this distinction is often ignored with findings from one area of the GIT being inappropriately extrapolated to the other. Focussing largely on the murine small and large intestine, this review addresses the literature relating to the immunology and biology of the two sites, drawing comparisons between them and clarifying similarities and differences. We also highlight the gaps in our understanding and where further research is needed.     

Henoch-Schonlein purpura with intestinal perforation and cerebral hemorrhage: A case report

Henoch-Schonlein purpura (HSP) with intestinal perforation and cerebral hemorrhage is a very rare clinical condition. There has been no report of HSP complicated with both intestinal perforation and cerebral hemorrhage until October 2012. Here we describe a case of HSP with intestinal perforation and cerebral hemorrhage in a 5-year-old girl. Plain abdominal radiograph in the erect position showed heavy gas in the right subphrenic space with an elevated diaphragm. Partial resection of the small intestine was performed, and pathological analysis suggested chronic suppurative inflammation in all layers of the ileal wall and mesentery. Seventeen days after surgery, cerebral hemorrhage developed and the patient died.     

非类固醇类抗炎药的小肠黏膜损害

非类固醇类抗炎药(NSAIDs)对胃十二指肠黏膜的损害十分突出,得到临床广泛重视。近年来随着诊断手段的不断发展,发现NSAIDs的小肠黏膜损害的发生率也不低。NSAIDs导致小肠黏膜损伤是一个复杂的多步骤的过程,可导致黏膜通透性增加、炎症、溃疡、出血、狭窄及穿孔等。目前尚无有效的防治方法。本文就NSAIDs导致的小肠黏膜损害作一综述。     

224例小肠疾病的临床分析

目的 增加对小肠疾病的认识,提高对其的诊断率并探讨检查方法。方法 观察２２４例小肠疾病患者的临床表现,分析其主要症状、病因及所采用的诊断方法。结果 小肠疾病以腹痛（５８％）,腹部包块（１８％）,发热（１７％）及便血（１２％）为主要表现：病因以恶性肿瘤为多见（３２％）,其次为憩室（２９％）,平滑肌瘤（７％）,出血,坏死性小肠炎（６％）、克隆病（４％）。小肠气钡双重造影及剖腹探查仍为目前主要的确诊手段     

Adenomyoma of the small intestine

Adenomyoma of the gastrointestinal tract is a rare benign tumor-like lesion.The small intestine is the second most frequent location,usually in the periampullary area,but the lesion also occurs in the jejunum and ileum.While adenomyoma of the Vaterian system is primarily diagnosed in adults,more than half of reported cases of jejunal and ileal adenomyoma have been diagnosed in pediatric patients.Adenomyoma of the periampullary area usually presents with biliary obstruction or abdominal pain,whereas jejunal and ileal adenomyoma usually presents with intussusception or is incidentally discovered during surgery or autopsy.Since endoscopic and radiological examination yields uncharacteristic findings,histopathological evaluation is important in adenomyoma diagnosis.Pathologically,adenomyoma consists of glandular structures of various sizes and interlacing smooth muscle bundles that surround the glandular elements.The pathogenesis of adenomyoma is generally considered to be either a form of hamartoma or a pancreatic heterotopia.Although limited resection is considered the most effective treatment,pancreaticoduodenectomy is often performed when the lesion occurs in the periampullary area due to preoperative misdiagnosis as a carcinoma.It is,therefore,important that clinicians and pathologists maintain current knowledge of the disease to avoid inaccurate diagnosis,which could lead to unnecessary surgery.