锌缺乏对生长期大鼠小肠黏膜形态和消化酶活性的影响

目的 了解锌缺乏对大鼠小肠黏膜形态和消化酶活性的影响.方法 3周龄刚断乳SD雄性大鼠30只,随机分成3组,每组10只:正常组自由食用含锌30μg/g正常饲料;缺锌组自由食用含锌0.4μg/g的缺锌饲料(参照AIN-76配方);配饲组食用正常饲料,但进食量限制为缺锌组大鼠前1天的进食量,各组自由饮用去离子水.每日清晨称大鼠体重并记录前1天的进食量,观察有无厌食、腹泻、皮炎、生长迟缓等缺锌的症状.2周后处死,检测血清锌的浓度;留取空肠黏膜作病理切片和HE染色,测定空肠黏膜绒毛高度和隐窝深度的比例;检测空肠黏膜刷状缘乳糖酶、γ谷氨酰转肽酶(GGT)和氨基寡肽酶(APN)的活性.结果 实验开始时正常组、缺锌组、配饲组大鼠的平均体重分别为(67.4±5.3)g、(64.7±4.8)g和(66.5±4.1)g,平均日进食量分别为(11.2±1.0)g、(11.6±1.6)g和(11.2±1.4)g,差异均无统计学意义.实验第7天缺锌组平均进食量与正常组和配饲组差异不明显,而平均体重则明显低于正常组和配饲组(P＜0.01);而2周实验结束时缺锌组平均体重为(112.0±11.5)g,明显低于正常组和配饲组的(164.0±15.9)g、(137.5±16.2)g;缺锌组平均进食量(13.4±5.1)g明显低于正常组的(18.2±2.4)g,差异有统计学意义(P均＜0.01).缺锌组血清锌的含量(733±231)μg/L明显低于正常组的(1553±159)μg/L和配饲组的(1457±216)μg/L(P＜0.01).三组大鼠空肠黏膜绒毛高度与隐窝深度比例分别为(2.98±0.5)、(2.77±0.5)和(2.81±0.7);乳糖酶活性分别为(26.1±15.0)U/mg、(27.4±12.8)U/mg和(40.8±18.5)U/mg,差异均无统计学意义.缺锌组空肠黏膜GGT为(12.7±6.5)U/g明显低于正常组的(19.1±10.4)U/g和配饲组的(18.5±7.7)U/g,但差异无统计学意义;缺锌组空肠黏膜APN(25.5±7.5)U/g明显低于正常组的(48.7±16.8)U/g和配饲组的(43.9±14.5)U/g,差异有统计学意义(P＜0.01).结论 锌缺乏可致食欲下降、体重减轻,可引起空肠黏膜刷状缘肽酶活性下降,但对绒毛高度与隐窝深度的比例和乳糖酶活性影响不大,表明锌缺乏最先影响的可能是蛋白质的消化与吸收功能.

Abstract：

Objective In this study,a growing rat model of zinc deficiency was established to investigate the effect of zinc deficiency on intestinal mucosal morphology and digestive enzyme activity as well as to provide a scientific basis for zinc supplementation therapy in patients with diarrhea.Method Threeweek-old weaned Sprague-Dawley male rats(n =30)were randomly divided into 3 groups with 10 in each:rats in the control group(ZA)were fed with a normal diet containing 30 μg/g zinc; rats in the zinc deficient group(ZD)were fed with a zinc-deficient diet containing 0.4 μg/g zinc(refer to AIN-76 formula); and rats in the paired fed group(PF)were fed with a normal diet,but the food intake was limited to intake of rats in ZD group in the previous day.All rats were provided with deionized water for drinking.Their body weight was measured and the food intake during the previous day was recorded early in the morning of the following day.Symptoms of zinc deficiency,such as anorexia,diarrhea,dermatitis,and growth retardation,were observed. Two weeks later,the rats were sacrificed and serum zinc concentration was measured.Jejunal mucosa was taken for biopsy and was stained with hematoxylin and eosin(HE).The height ratio of the jejunal mucosal villi and crypts was measured.In addition,the activity of lactase in the jejunal mucosal brush border,γ-glutamyl peptidase(GGT),and aminopeptidase N(APN)were measured.Result The average weight of the rats in the ZA,ZD,and PF groups at the beginning of the experiment was(67.4±5.3)g,(64.7±4.8)g,and(66.5±4.1)g,respectively,and the average daily food intake was (11.2±1.0)g,(11.6±1.6)g,and(11.2±1.4)g,respectively.The intergroup differences were not significant.On the 7th day of experiment,no significant differences in average food intake were observed between the ZD group and the ZA and PF groups,but the average body weight in the ZD group was significantly lower than that in the ZA and PF groups(P＜0.01).At the end of the experiment(2 weeks),the average weight in the ZD group(112.0±11.5)g was significantly lower than that in the ZA(164.0±15.9)g and PF groups(137.5±16.2)g.The average food intake in the ZD group(13.4±5.1)g was significantly lower than that in the ZA group(18.2±2.4)g(P＜0.01).Serum zinc level in the ZD group(733±231)μg/L was significantly lower than that in the ZA(1553±159)μg/L and PF groups (1457±216)μg/L(P＜0.01).The height ratio of jejunal mucosa villus and crypt in the ZA,ZD,and PF groups was 2.98±0.5,2.77±0.5,and 2.81±0.7,respectively,and lactase activity was(26.1±15.0)U/mg,(27.4±12.8)U/mg,and(40.8±18.5)U/mg,respectively,without significant intergroup differences.The GGT activity in the jejunal mucosa in the ZD group(12.7±6.5)U/g was significantly lower than that in the ZA(19.1±10.4)U/g and PF groups(18.5±7.7)U/g,but the difference was not significant.The activity of APN in the jejunal mucosa in the ZD group(25.5±7.5)U/g was significantly lower than that in the ZA(48.7±16.8)U/g and PF groups(43.9±14.5)U/g(P＜0.01).Conclusion Zinc deficiency can cause loss of appetite,weight loss,and decreased activity of peptidase in the jejunal mucosal brush border.Zinc deficiency has little effect on the height ratio of the villus and crypt and lactase activity,thereby indicating that zinc deficiency may first affect protein digestion and bsorption.     

双侧肾源性乳糜尿2例诊治报告并文献复习

目的 探讨双侧肾源性乳糜尿的诊断与治疗.方法 回顾性分析2011 年我院收治的2 例双侧定位乳糜尿患者病例资料,结合相关文献总结讨论乳糜尿的发病机制、临床表现、诊断方法和治疗方案.结果 2 例患者术前膀胱镜检查和双侧逆行插管收集双侧尿液均证实乳糜尿来源于一侧,行患侧腹腔镜肾蒂淋巴管结扎术,术后不久均再发乳糜尿.再次膀胱镜检查及逆行插管收集双侧尿液均证实乳糜尿来源于对侧,再分别行对侧腹腔镜肾蒂淋巴管结扎术治愈,随访1 年多均无复发.结论 乳糜尿定位诊断常用方法为膀胱镜检查,联合逆行肾盂造影可提高双侧乳糜尿定位敏感性,明确双侧肾蒂淋巴管扩张显影情况,估计一侧手术后另外一侧发作的可能性.手术方式选择腹腔镜肾蒂淋巴管结扎术,时间短、创伤小、术中出血少、术后恢复快、疗效可靠.     

儿童药物临床试验机构资格认定的前期准备

国家药物临床试验机构(以下简称机构)资格认定是个系统工程,需要做大量的前期准备工作.我们总结我院机构资格认定过程中积累的一些细节性经验,希望能给新申报机构特别是儿童机构一些帮助. 一、建立组织机构 首先要建立医院的药物临床试验组织管理办公室和药物临床试验医学伦理委员会.办公室除设立主任、秘书外,建议增设档案管理员、药品保管员或药品监督员.伦理委员会委员除常规要求的人员配备外,需有代表儿童利益的委员如教育工作者或社区工作者[10].     

2005年中国腹泻病高峰会会议纪要

由博福-益普生(天津)制药有限公司发起的2005年中国腹泻病高峰会于6月11日在天津召开。全国36个城市的104位儿科医师出席大会。会议由中华医学会儿科分会消化学组顾问董永绥教授主持，有7位专家作了专题报告。分别为董永绥教授的“我国小儿腹泻病50年研究回顾和今后展望”，李义民教授的“天津市0～18岁儿童腹泻流行病学调查”，孙梅教授的“小儿胃肠功能障碍与粘膜保护机制”，董梅教授的“腹泻与微生态制剂”，朱肩镕教授的“轮状病毒胃肠炎的热点研究”，龚四堂教授的“新配方ORS及腹泻后补锌的原则”，以及黄留玉教授的“腹泻的病原监测分析研究”。与会代表热烈参加讨论，大家对小儿腹泻病有了更深入的认识。现就本次会议的主要内容总结如下。     

胃癌根治术后疼痛分析及护理对策

目的 总结胃癌根治术后疼痛原因和护理对策.方法对35例胃癌根治术后患者资料进行回顾性总结分析.结果 患者本身因素、手术因素、管道因素、护理人员因素是导致胃癌根治术后疼痛的主要因素.结论加强患者、管道、护理人员管理,能减少术后疼痛,降低术后并发症和病死率发生.     

小儿非心源性胸痛与胃食管反流的关系

目的了解小儿非心源性胸痛(NCCP)与胃食管反流(GER)的关系,探讨食管pH值监测在小儿NCCP诊断中的意义。方法对36例(病例组)诊断为NCCP并排除呼吸系统和胸部肌肉骨骼病变患儿进行24 h食管pH值监测,其中20例行胃镜检查。根据食管炎诊断标准,诊断为食管炎(食管炎组)11例,非食管炎(非食管炎组)9例。结果病例组24 h食管pH值<4、反流≥5 min、最长反流时间、酸性反流指数、Boix-Ochoa评分分别为(60±7)次、(2．44±0．74)次、(12．4±2．8)min、6．72±1．39、(24．6±3．9)分,对照组分别为(33±4)次、(0．35±0．11)次、(4．3±0．9) min、1．25±0．19、(7．7±0．9)分,两组比较差异有统计学意义(t分别=3．44、2．79、2．73、3．89、4．24, P均<0．01);以Boix-Ochoa评分>11．99为病理性GER诊断标准,病例组GER阳性为58．3％(21／36)。20例经胃镜检查的患者中诊断为食管炎为55．0％(11／20),其中GER阳性为81．8％(9／11);诊断为非食管炎为45．0％(9／20),其中GER阳性者为33．3％(3／9)。食管炎组反流≥5 min、酸性反流指数分别为(5．8±2．0)次、12．5±3．5,非食管炎组分别为(0．9±0．5)次、3．4±1．4,两组比较差异有统计学意义(Z分别=-2．400、-2．545,P均<0．05);食管炎组24 h食管pH值<4、最长反流时间、Boix-Ochoa评分分别为(73±11)次、(26±7)min、(41±10)分,非食管炎组分别为(34±11)次、(4±3)min、(14±5)分,两组比较差异有统计学意义(Z值分别为-2．926、-2．675、-2．584,P均<0．01)。结论GER是小儿NCCP的重要原因,食管pH值监测有助于小儿NCCP的病因诊断,并能指导治疗。     

母婴床旁护理模式对产妇及家属满意度影响的临床研究

目的 探讨母婴床旁护理模式对产妇及家属满意度的影响.方法 选取产妇200例,按照随机数字表法,分为对照组与观察组,各100例.对照组接受传统封闭护理模式,观察组接受母婴床旁护理模,比较两组产妇及家属遵医行为与满意度情况.结果 相较于对照组,观察组具备更高的遵医行为评分,差异具有统计学意义(P<0.05);相较于对照组,观察组具备更高的满意度,差异具有统计学意义(P<0.05).结论 母婴床旁护理干预的开展可使产妇及家属的遵医行为和满意度得到提升,从而促使医患关系保持和谐.