促愈颗粒对胃溃疡实验大鼠胃黏膜表皮生长因子及其受体表达的影响

[目的]研究促愈颗粒对乙酸烧灼型胃溃疡(GU)大鼠胃黏膜表皮生长因子(EGF)及其受体(EGFR)表达的影响。[方法]将大鼠随机分为4组:正常对照组,模型组,促愈颗粒组和雷尼替丁组。乙酸制备慢性GU大鼠模型后,于给药14 d和28 d后分2次处死大鼠,观察胃黏膜组织形态,免疫组织化学技术检测大鼠胃黏膜EGF及EGFR水平。[结果]与模型组比较,促愈颗粒组和雷尼替丁组囊状扩张腺体数量均显著减少(P<0.01,<0.05),EGF及EGFR水平均显著增高(P<0.01,<0.05),且促愈颗粒组作用均优于雷尼替丁组(均P<0.05)。[结论]促愈颗粒可能通过增加胃黏膜EGF和EGFR的水平,进而提高GU再生黏膜结构和功能成熟度,从而促进溃疡愈合,提高溃疡愈合质量,并防止溃疡复发。     

复方中药安胃汤提高大鼠胃溃疡愈合质量的机制

目的:通过实验性乙酸大鼠胃溃疡模型,研究复方中药安胃汤提高慢性胃溃疡愈合质量机制．方法:40只Wistar大鼠随机平均分为正常对照组、模型组、安胃汤组和雷尼替丁．采用乙酸浸渍法建立胃溃疡模型,造模3 d后前两组分别用生理盐水灌胃,后两组分别用安胃汤和雷尼替丁灌胃．采用放射免疫方法和免疫组织化学方法观察复方中药安胃汤对大鼠胃溃疡模型愈合时血清表皮生长因子(EGF)和胃黏膜 EGF,表皮生长因子受体(EGFR)及转化生长因子-β1(TGF-β1)表达的影响．结果:模型组相比,安胃汤组和雷尼替丁组可提高血清EGF(1．12±0．24,0．99±0．15μg／L vs0．52±0．13μg／L,P<0．01),安胃汤组与雷尼替丁组相比差异也有显著意义(P<0．05)．与模型组相比,安胃汤组和雷尼替丁组可显著增强胃黏膜EGF、EGFR及TGF-β1表达(EGF: 29．7％±1．9％,26．5％±1．6％vs18．4％±2．0％, P<0．01:EGFR:29．6％±2．6％,25．9％±1．0％vs 20．4％±1．8％,P<0．01;TGF-β1:67．0％±2．0％, 49．5％±1．1％vs27．3％±1．0％,P<0．01),安胃汤组强于雷尼替丁组(均P<0．01)．结论:安胃汤可能通过提高血清EGF和增强胃黏膜EGF,EGFR及TGF-β1表达,增强胃黏膜保护作用而提高溃疡愈合质量．     

健胃愈疡颗粒对大鼠乙酸性胃溃疡及胃黏膜一氧化氮的影响

[目的]研究健胃愈疡颗粒对胃溃疡的治疗作用及作用机制.[方法]以Okabe改良法复制大鼠实验性胃溃疡模型,设正常组、假手术组、模型组、雷尼替丁组、健胃愈疡组,检测溃汤指数和胃黏膜中一氧化氮(NO)水平.[结果]健胃愈疡颗粒能显著降低溃疡指数(灌药7 d为1.67士0.49,与其他组比较,P＜0.05;灌药14 d为0.80士0.42,与其他组比较,P＜0.01),显著提高胃黏膜NO水平[灌药14 d后为(0.597±0.042)μmol/g蛋白,与其他组比较,P＜0.01].[结论]健胃愈疡颗粒可能通过诱导和促进胃黏膜NO的生成促进溃疡愈合.     

阿司匹林对大鼠胃溃疡愈合的影响及其机制

目的 探讨阿司匹林对胃溃疡的影响和机制.方法 用乙酸诱导大鼠胃溃疡,8 d后随机分为模型组、盐水组、阿司匹林组.用组织学方法检测溃疡形态、再生黏膜厚度,扩张腺体数,用免疫组化方法检测环加氧酶(COX)-1、COX-2、胃泌素在胃黏膜中的表达,用酶联免疫吸附测定法检测胃黏膜中的前列腺素E2(PGE2)含量,并检测胃液pH.结果 阿司匹林组的溃疡面积和扩张腺体数高于模型和盐水组(P<0.05),再生黏膜厚度低于模型和盐水组(P<0.05);阿司匹林组COX-2、胃泌素积分光密度高于模型和盐水组(P<0.01);阿司匹林组的PGE2含量和胃液pH低于模型和盐水组(P<0.01).结论阿司匹林抑制COX活性使PGE2生成减少,引起胃泌素分泌增加,胃酸分泌增多,加重溃疡.     

酸奶对胃溃疡模型大鼠胃黏膜损伤的抑制作用

目的:观察酸奶对大鼠胃黏膜损伤的促进或抑制修复作用.方法:利血平0.5 mL/kg腹腔注射,制作大鼠胃溃疡模型,然后各组大鼠分别用酸奶,纯奶,生理盐水5 mL/kg每天1次灌胃,7 d后,处死并解剖大鼠.观察胃黏膜损伤情况、测定胃黏膜中前列腺素E2(PGE2)的表达量、超氧化物歧化酶(SOD)表达量来评估酸奶对胃溃疡的损伤或修复作用.结果:3组大鼠胃黏膜均有点状出血,Guth积分法得出酸奶组较纯奶组积分少,有统计学差异(1.33±0.577 vs 5.00±1.323,P<0.05),镜下病理切片观察发现,各组大鼠胃黏膜不同程度充血,生理盐水组上皮严重脱落且腺体萎缩,酸奶组损伤不明显,仅有少量中性粒细胞浸润和上皮脱落.酸奶组PGE2表达明显比生理盐水组表达量高,有统计学差异(248.6±43.73 vs79.52±31.74,P<0.05).酸奶组SOD表达量比纯奶组低,差异有统计学意义(148.1±2.18 vs156.6±1.66,P<0.01).结论:酸奶对大鼠胃溃疡的恢复有一定的促进作用,同时胃黏膜PGE2表达量升高,SOD表达量下降.     

双蒲散对大鼠慢性胃溃疡愈合质量及抗复发的影响

[目的]研究双蒲散对实验性大鼠慢性胃溃疡（GU）愈合质量及抗复发的影响，并探讨其可能机制。[方法]采用乙酸注射至大鼠浆膜下形成慢性GU模型，随机分为模型组、雷尼替丁组、双蒲散组，分别灌服0．85％氯化钠、雷尼替丁及双蒲散。[结果]双蒲散组溃疡指数（UI）、扩张腺体数和炎细胞数目明显低于模型组和雷尼替丁组，再生黏膜厚度、胃黏膜超氧化物歧化酶（SOD）及前列腺素E2（PGE2）水平显著高于模型组和雷尼替丁组，丙二醛（MDA）水平明显低于模型组和雷尼替丁组（均P〈0．01，〈0．05）。[结论]双蒲散可提高GU愈合质量，减少溃疡复发。其机制可能是通过增加胃黏膜组织PGE2和SOD水平，降低MDA水平，促进黏膜修复而实现的。     

愈疡散对胃溃疡大鼠血一氧化氮和内皮素的影响

[目的]探讨愈疡散对胃溃疡大鼠血一氧化氮(NO)和内皮素-1(ET-1)的影响.[方法]采用大鼠冰醋酸胃溃疡模型,设空白对照组(A组)、假手术组(B组)、西药对照组(C组)、愈疡散大、小剂量组(D、E组)、胃溃疡模型组(F组).A、B、F组均灌服0.85%氯化钠溶液;D、E组分别灌服愈疡散5.0g/kg体重、2.5g/kg体重;C组灌服雷尼替丁0.03g/kg体重.于治疗前后分别检测血NO及ET-1.实验结束后,用苏木精-伊红染色对大鼠再生胃黏膜厚度、上皮细胞/腺腔数比值进行观察.[结果]造模7 d,C、D、E、F组血清NO显著降低,血浆ET-1明显升高,与A、B组比较差异有统计学意义(P＜0.05).治疗28 d,D组血清NO显著升高,而血浆ET-1明显降低,与F、E组比较均P＜0.05.再生胃黏膜厚度:D、E、C组明显高于F组(P＜0.05),D、E组与A、B组比较均P＜0.05.上皮细胞/腺腔数比值:A、B组与C、F组,D组与C、F组之间均P＜0.05.[结论]愈疡散促进溃疡愈合,增加胃黏膜的防御能力,提高再生黏膜功能成熟度,可能与其诱导、促进NO合成,反馈性地抑制ET-1释放,维持NO和ET-1的动态平衡有关.     

乳香提取物对大鼠乙酸胃溃疡愈合质量的影响

目的:研究乳香提取物对大鼠乙酸胃溃疡愈合质量的影响.方法:用冰醋酸制备大鼠慢性胃溃疡模型,随机分为6组,分别灌服0.85%氯化钠溶液、乳香提取物、雷尼替丁等.用苏木精-伊红染色、粘液组织化学染色和苦味酸-酸性品红染色对大鼠愈合性胃溃疡再生粘膜厚度、再生粘膜粘液含量、囊状扩张腺体数量、炎症细胞浸润数量等进行定量观察.结果:乳香提取物组再生粘膜厚度增加、囊状扩张腺体数量减少和粘液高碘酸无色品红(PAS)含量增加;肉芽组织胶原含量增加,炎症细胞浸润数量减少.结论:乳香提取物能提高溃疡再生粘膜结构和功能成熟度,提高溃疡愈合质量.     

模拟失重对大鼠实验性胃溃疡愈合的影响

目的:探讨模拟失重对乙酸诱导的大鼠实验性胃溃疡愈合的影响及可能机制.方法:32只SD大鼠随机分为4组,即尾部悬吊7d组、尾部悬吊14d组和相应的同步对照组.采用乙酸烧灼法制备大鼠慢性胃溃疡模型,造模后第3天悬吊组大鼠采用尾悬吊法建立模拟失重动物模型.游标卡尺检测胃溃疡面积,电镜下观察再生黏膜结构,放免法检测胃液EGF含量,观察大鼠胃溃疡愈合分期.结果:与对照7d组相比,悬吊7d组大鼠溃疡面积明显增大(6.0mm2±1.7mm2vs2.2mm2±0.7mm2,t=5.661,P<0.01),溃疡分期明显降低(χ2=12.771,P<0.01);与对照14d组相比,悬吊14d组溃疡面积明显增大(3.0mm2±1.2mm2vs1.1mm2±0.4mm2,t=4.233,P<0.01),胃液EGF含量明显增高(0.155ng/mL±0.052ng/mLvs0.103ng/mL±0.019ng/mL,t=2.635,P<0.05);与悬吊7d组比较,悬吊14d组溃疡面积明显减小(3.0mm2±1.2mm2vs6.0mm2±1.7mm2,t=3.805,P<0.01),胃液EGF含量明显降低(0.155ng/mL±0.0...     

荆花胃康胶丸对大鼠胃黏膜的保护机制

目的:研究中药制剂荆花胃康胶丸对大鼠乙醇性急性胃黏膜损伤的预防和治疗作用并探讨其作用机制.方法:将84只SD大鼠随机分为7组,每组12只.Ⅰ组为空白对照组,Ⅱ组为预防组,Ⅲa组为治疗对照组,Ⅲb为达喜对照组,Ⅲc,Ⅲd,Ⅲe分别为荆花胃康胶丸10,20,30 mg/(kg·d)治疗组.于治疗1,3,7 d分别处死大鼠,检测黏膜损伤指数,刮取胃黏膜测定组织中前列腺素E2(PGE2)和表皮生长因子(EGF)的含量,并作组织学观察.结果:荆花胃康胶丸的不同剂量组可不同程度的减轻无水乙醇对大鼠胃黏膜的损伤(P＜0.05,P＜0.01),增加组织中PGE2和EGF的含量(P＜0.05,P＜0.01),效应与剂量及治疗时间成正比.达喜及荆花胃康胶丸治疗组在治疗同一时间段的黏膜炎症程度明显轻于Ⅲa组,黏膜细胞水肿、变性减轻,炎性细胞减少.同时预先给予一定剂量的荆花胃康胶丸与同样浓度的治疗组相比,能明显增加黏膜中PGE2(3 d:190.73±12.20 pg/g vs 158.46±11.44 pg/g;P＜0.05)和EGF(3 d:5.60±0.46 ng/g vs 4.56±0.70 ng/g,P＜0.05)的含量,减轻无水乙醇对大鼠胃黏膜的损伤程度(3 d:10.50±2.08 vs 18.25±1.50,P＜0.05).结论:荆花胃康胶丸对乙醇所致大鼠急性胃父黏膜损伤有预防及修复治疗作用,其作用机制可能与增加胃黏膜中PGE2和EGF有关.     

Complications associated with ulcer recurrence following gastric surgery for ulcer disease

The present study is an attempt to assess the risks of the complications associated with recurrent ulcers in patients who have undergone gastric surgery and to determine whether these risks differ from those observed in patients receiving long term maintenance treatment with H2-receptor antagonists for ulcer disease. One hundred and thirty studies reported in the literature during the past three decades have been analysed to determine both the approximate rate of ulcer recurrence and the proportion of patients with recurrent ulcers who have presented with either haemorrhage or perforation following the various types of gastric surgery for ulcer disease. From these data, estimates of the risks of haemorrhage and of perforation during the years following gastric surgery have been calculated. Vagotomy and antrectomy is associated with a low risk of ulcer recurrence (< 1%) and the risk of complications in later years is accordingly very small (< 0.5°/o). Partial gastrectomy, although associated with low recurrence rates, has a higher risk of complications (1.3% for haemorrhage, 0.3% for perforation) because the proportion of recurrent ulcers that present with haemorrhage or perforation is high (33% and 8%, respectively). Truncal vagotomy plus drainage (TV+D) and highly selective vagotomy (HSV) are associated with recurrence rates of 9% and 12%, respectively, but ulcer recurrences following these operations are less frequently accompanied by complications then recurrences after gastric resection and, as a result, the risks of haemorrhage (1.7% for TV+D; 1.3% for HSV) are similar to the risks after gastric resection. During long term (five years or more) maintenance treatment with H2-receptor antagonists, the risks of haemorrhage and perforation are < 2% and < 0.5%, respectively. It appears, therefore, that the likelihood of developing haemorhage or perforation following gastric surgery is of the same order as that during maintenance treatment with H2-receptor antagonists, at least during the first decade of follow-up.     

根除幽门螺杆菌对胃溃疡愈合质量及复发的影响研究

目的探讨幽门螺杆菌（Helicobacter pylori，Up）对胃溃疡愈合质量及复发的影响。方法120例坳阳性活动期胃溃疡患者，口服泮托拉唑、阿莫西林、甲硝唑一周后，继续口服泮托美拉唑5周。治疗结束后复查胃镜取病理组织学检查并检测Hp根除情况，对比却根除组与却根除失败组内镜下溃疡愈合形态差异和愈合质量（包括内镜下再生黏膜成熟度和再生黏膜组织学成熟度）。所有患者随诊1年以上了解溃疡复发情况。结果治疗后92例胃溃疡患者月p检测阴性，坳根除率为80．43％；却根除组与跏根除失败组在内镜下愈合率方面的差异无显著性意义（P〉0．05），但两组在再生黏膜成熟度和再生黏膜组织学成熟度方面的差异有显著性意义（P〈0．01）。坳根除组1年溃疡复发率为4．35％，却根除失败组为21．43％，两组差异有显著性意义（P〈0．05）。结论根除Hp可提高胃溃疡的愈合质量，减少溃疡病复发。     

Bleeding peptic ulcer occurring in hospitalized patients

We reviewed 84 consecutive cases of peptic ulcer hemorrhage, which occurred, in an area of 270,000 people, from 1986 to 1988, in patients already hospitalized for other diseases (in-bleeders). These subjects were compared with a prospective series of 386 patients who initially bled as out-patients and were then admitted (out-bleeders). Of 84 hemorrhages in hospitalized patients, 41 followed major surgery, while 43 were associated with other severe conditions. Bleeding site was duodenal in two thirds. Mean age was 67 ± 15 years versus 59 ± 15 among out-bleeders. Fifty percent of in-bleeders had recently received nonsteroidal antiinflammatory drugs (NSAIDs), and one third were on anticoagulants and 10% on corticosteroids; in 39 (46%) bleeding was shown to be persistent or recurrent, 5 (5.9%) underwent endoscopic and 18 (21%) surgical therapy; 29 died (34%). The corresponding figures among out-bleeders were: further bleeding 80 (20.7%), endoscopic therapy 12 (3.1%), surgery 25 (6.5%), deaths 17 (4.4%). As regards in-bleeders, only active bleeding and endoscopic stigmata emerged as statistically significant risk factors for further bleeding. The latter was shown to be significantly related to mortality. The most relevant finding was, however, that NSAIDs and anticoagulants, in association with stress and aging, are very frequently involved in peptic ulcer bleeding of hospitalized patients. The fatal outcome of one third, despite all available treatments, highlights the importance of prevention against drug- and stress-related mucosal damage in in-patients suffering from severe diseases.     

Association between ulcer site and outcome in complicated peptic ulcer disease: a Danish nationwide cohort study

Objective: Mortality rates in complicated peptic ulcer disease are high. This study aimed to examine the prognostic importance of ulcer site in patients with peptic ulcer bleeding (PUB) and perforated peptic ulcer (PPU).

Materials and methods: Design: a nationwide cohort study with prospective and consecutive data collection. Population: all patients treated for PUB and PPU at Danish hospitals between 2003 and 2014. Data: demographic and clinical data reported to the Danish Clinical Registry of Emergency Surgery. Outcome measures: 90- and 30-d mortality and re-intervention. Statistics: the crude and adjusted association between ulcer site (gastric and duodenal) and the outcome measures of interest were assessed by binary logistic regression analysis.

Results: Some 20,059 patients with PUB and 4273 patients with PPU were included; 90-d mortality was 15.3% for PUB and 29.8% for PPU; 30-d mortality was 10.2% and 24.7%, respectively. Duodenal bleeding ulcer, as compared to gastric ulcer (GU), was associated with a significantly increased risk of all-cause mortality within 90 and 30 d, and with re-intervention: adjusted odds ratio (OR) 1.47 (95% confidence interval 1.30–1.67); p?p?p?p?=?0.698, OR 0.93 (0.78 to 1.10); p?=?0.409, and OR 0.97 (0.80–1.19); p?=?0.799, respectively.

Conclusions: DU site is a significant predictor of death and re-intervention in patients with PUB, as compared to GU site. This does not seem to be the case for patients with PPU.     

消化性溃疡发病与气象因素的关系

此文综述了近年来世界范围内有关气象因素对消化性溃疡的发病及其并发症发生的有关研究结果,显示消化性溃疡及其出血、穿孔等并发症的发病均有明显的季节性波动,与某些具体的气象因子如气温、气压等有较密切的关系。气象因素影响溃疡发病的机理尚不清楚,内分泌激素紊乱可能在其中起作用。     

延边地区消化性溃疡4 348例胃镜分析

目的探讨少数民族地区消化性溃疡的发病学特点.方法分析1990年至1998年间延边地区的28547例内镜检查患者.结果在所有被检查患者中检出消化性溃疡4348例(15.23%),其中十二指肠溃疡2097例(48.22%),胃溃疡1921例(44.18%),复合性溃疡330例(7.59%).消化性溃疡中,男2974例(19.05%),女1374例(10.62%).男女检出率差异显著(P＜0.01);朝鲜族占2727例,汉族占1621例,检出率分别为13.96%和17.98%,但检出率差异显著(P＜0.01).结论延边地区消化性溃疡中汉族检出率高于朝鲜族,男性高于女性.     

Omeprazole versus placebo in duodenal ulcer healing

The study objective was to study the ulcer healing effects and safety of the proton pump inhibitor, omeprazole, given in a dose of 20 mg once daily before breakfast. The study design was a randomized, double-blind, multicenter comparison of omeprazole and placebo using endoscopy to assess ulcer healing after two or four weeks of therapy. One hundred fifty-three patients with endoscopically documented active duodenal ulcer were studied. One hundred two patients received omeprazole and 51 received placebo. Patients in both groups were similar with regard to age, sex, duration of disease, initial ulcer size, smoking history, and alcohol use. A per protocol analysis of healing rates showed a significant advantage for omeprazole (P<0.01) at both week 2 (41% vs 13%) and week 4 (75% vs 27%). Concomitant factors (including smoking and ulcer size) did not alter the significance of the differences in healing rates between omeprazole and placebo. Complete relief of day and night pain was more often achieved (P<0.01) in the omeprazole group. All-patients treated analyses for healing and pain relief gave results similar to the respective per protocol analyses. Omeprazole was well tolerated; fewer patients had clinical and laboratory adverse experiences in the omeprazole group than in the placebo group. Fasting serum gastrin levels increased with omeprazole therapy (mean 34.9 to 73.5 pg/ml) but exceeded the normal range (>150 pg/ml) in only 12.3% of patients. Two weeks after therapy was stopped, serum gastrin levels showed a decrease toward baseline but had not yet completely returned to pretreatment levels (mean 49.7 pg/ml). Observations from Europe and Australia of >90% healing of duodenal ulcers after four weeks of omeprazole therapy were not confirmed in this study. No single factor explains this difference. Considerable variation in the degree of suppression of acid secretion has been demonstrated with the 20-mg daily dose of omeprazole; it is possible that, in US populations, a greater degree of antisecretory effect may be required to achieve the healing rates observed in Europe and Australia. In conclusion, omeprazole was more effective than placebo in the treatment of active duodenal ulcer, as determined by ulcer healing and relief of pain, and was well tolerated in the short-term treatment of patients with duodenal ulcer.     

Discriminant factors of gastric ulcer healing by colloidal bismuth

One hundred and twelve patients with 49 corpus and 35 prepyloric gastric ulcers and 28 duodenal ulcers associated with gastric ulcers were entered into a stratified, controlled double-blind randomized study comparing the healing efficacy of colloidal bismuth suspension with placebo. Healing of corpus and prepyloric ulcers, but not duodenal-ulcer associated gastric ulcers, was significantly better with the bismuth compound than with placebo. The clinical, personal, ulcer and acid secretory data of these patients were prospectively collected and evaluated by stepwise discriminant analysis in two phases. In the first phase, the collected data of 91 consecutive patients were entered into computer analysis. The derived discriminant function classified patients into healed and unhealed categories with a sensitivity of 82%, specificity of 77%, positive diagnostic value of 73%, negative diagnostic value of 85% and diagnostic efficiency of 79%. In phase two, the discriminant function from phase 1 was applied prospectively to 21 patients to predict the outcome of treatment. Five out of five healed and 11/16 unhealed gastric ulcers were correctly predicted, giving a diagnostic efficiency of 76%. The present study shows that healing or non-healing of gastric ulcer can be predicted with reasonable accuracy by discriminant analysis. In addition, discriminant analysis identified, aside from the efficacious drug, ulcer size, young age, co-existing duodenal ulcer, and concomitant medical condition as adverse factors for gastric ulcer healing.