回肠造瘘术在新生儿重症坏死性小肠结肠炎肠穿孔治疗中的应用体会

目的 总结回肠造瘘术在新生儿重症坏死性小肠结肠炎(NEC)并发肠穿孔治疗中的临床应用经验。方法 回顾性分析郑州大学第三附属医院2016年5月—2017年5月收治54例行回肠造瘘术的重症NEC患儿临床资料,统计治愈率、死亡率,记录住院时间和并发症发生情况。结果 本组54例患儿住院时间为(23.52±5.32)d。其中49例治愈(90.74%),5例死亡(9.26%)。死亡5例皆是腹腔感染严重患儿,其中2例患儿家属放弃治疗、3例在肠管暂时性造瘘后病情加重,均于术后1个月内死亡。49例患儿术后随访6个月,患儿体质量为5.7~13.1(7.01±1.36)kg,生长发育均正常。结论 回肠造瘘术治疗重症NEC效果良好,能够有效提高NEC患儿治愈率;但要重视术后并发症的处理,进而提高患儿生存率,帮助新生儿尽早恢复健康。     

炎症预激活间充质干细胞条件培养基调控坏死性小肠结肠炎小肠炎性反应的作用研究

背景　骨髓间充质干细胞具有强大的免疫调节和抗炎能力。既往研究发现不同状态间充质干细胞条件培养基能下调多种小肠损伤炎性反应,对肠道起到保护作用,但对于坏死性小肠结肠炎（NEC）炎性反应的作用和机制尚未明确。目的　建立新生大鼠NEC模型,探讨炎症预激活间充质干细胞条件培养基调控NEC炎性反应的作用。方法　2018年7月—2019年4月,建立新生大鼠NEC模型,随机选取造模后的80只SPF级新生Sprague-Dawley（SD）大鼠,根据处理方式分为对照组、单纯NEC损伤组、NEC损伤+正常间充质干细胞条件培养基（MSC-CMNOR）组、NEC损伤+经肿瘤坏死因子α（TNF-α）、白介素（IL）-1β和一氧化氮（NO）联合培养诱导的炎症预激活间充质干细胞条件培养基（MSC-CMTNF-α+IL-1β+NO）组,每组20只。采用腹腔注射给药的方式,对照组、单纯NEC损伤组、NEC损伤+MSC-CMNOR组、NEC损伤+MSC-CMTNF-α+IL-1β+NO组分别给予等量的0.9%氯化钠溶液、DMEM-F12培养基、MSC-CMNOR及MSC-CMTNF-α+IL-1β+NO。在注射药物后第4天开腹观察小肠大体标本,收集回肠末端和血液标本,行苏木素-伊红（HE）染色观察小肠病理学变化并进行病理学评分,采用酶联免疫吸附试验（ELISA）对小肠组织及血清标本行炎性因子检测。结果　小肠大体标本变化：对照组新生大鼠小肠色泽红润,无充血,弹性好,有蠕动,未见肠壁积气或坏死。单纯NEC损伤组及NEC损伤+MSC-CMNOR组新生大鼠肠道色泽呈暗红色,充血明显,可见肠壁积气、坏死,弹性差,肠管扩张。NEC损伤+MSC-CMTNF-α+IL-1β+NO组新生大鼠肠道轻度充血,未见肠壁积气或坏死,弹性尚可。小肠组织病理学评分及NEC发生率：对照组、单纯NEC损伤组、NEC损伤+MSC-CMNOR组、NEC损伤+MSC-CMTNF-α+IL-1β+NO组病理学评分总分为16、51、43、16分;4组病理学评分比较,差异有统计学意义（H=41.70,P<0.01）。其中单纯NEC损伤组、NEC损伤+MSC-CMNOR组病理学评分高于对照组（P<0.01）,NEC损伤+MSC-CMTNF-α+IL-1β+NO组病理学评分较单纯NEC损伤组降低（P<0.01）。对照组无NEC发生,单纯NEC损伤组、NEC损伤+MSC-CMTNF-α+IL-1β+NO组、NEC损伤+MSC-CMNOR组分别有17、4、16只诊断为NEC（NEC发生率为85.0%、20.0%、80.0%）;4组NEC发生率比较,差异有统计学意义（χ2=44.00,P<0.01）。4组血清和小肠组织中促炎因子和抑炎因子水平：4组血清中TNF-α、IL-1β、IL-6、IL-8、IL-10、IL-12水平比较,差异有统计学意义（P<0.01）;4组小肠组织中TNF-α、IL-1β、IL-6、IL-10水平比较,差异有统计学意义（P<0.01）。其中,与单纯NEC损伤组、NEC损伤+MSC-CMNOR组相比,NEC损伤+MSC-CMTNF-α+IL-1β+NO组血清中TNF-α、IL-1β、IL-6、IL-8、IL-12水平降低,IL-10水平升高,MSC-CMTNF-α+IL-1β+NO组小肠组织中TNF-α、IL-1β、IL-6水平降低,IL-10水平升高（P<0.01）。结论　炎症预激活间充质干细胞条件培养基对NEC新生大鼠的肠道具有保护作用,能够调控促炎因子和抑炎因子的平衡,减轻肠道的损伤。     

胃肠癌术后伪膜性肠炎回顾分析

目的研究我院胃肠癌术后发生伪膜性肠炎的临床特点。 方法分析我科2010年1月至2012年12月收治的236例胃癌、结肠癌以及直肠癌术后发生伪膜性肠炎患者的临床资料。 结果236例患者所患疾病：胃癌61例,结肠癌98例,直肠癌77例。患者年龄范围35～78岁,平均年龄64.5岁。其中201例患者于术后6天内发生伪膜性肠炎。236例患者均常规予以鼻饲甲硝唑,肠道益生菌治疗,其中61例患者加用口服万古霉素治疗。233例患者治愈康复,3例死亡。 结论高龄、抗菌药物应用种类多、时间长以及术后胃酸分泌减少是术后伪膜性肠炎的高危因素。合理应用抗生素、注意早期肠内营养的应用,减少伪膜性肠炎的发生。另外,早期诊断、早期治疗以及隔离治疗对伪膜性肠炎患者是十分必要的。     

粪便钙卫蛋白水平检测在极低出生体质量儿坏死性小肠结肠炎中的意义

目的探讨中性粒细胞源性粪便标志物粪便钙卫蛋白(FC)检测在极低出生体质量(VLBW)儿坏死性小肠结肠炎(NEC)诊断中的价值。 方法选取2011年7月至2013年6月江苏省常州市儿童医院新生儿科和江苏省常州市妇幼保健院新生儿科收治的胎龄≥28孕周的35例有NEC表现的VLBW儿为研究对象,并纳入NEC组,按照是否确诊为NEC,将其进一步分为确诊NEC亚组(n＝15)和疑似NEC亚组(n＝20)。选择江苏省常州市儿童医院新生儿科和江苏省常州市妇幼保健院同期收治的30例喂养不耐受VLBW儿纳入喂养不耐受组(n＝30),以及江苏省常州市妇幼保健院同期收治的无胃肠道症状且喂养情况良好的30例VLBW儿纳入对照组(n＝30)。4组患儿性别构成比、平均胎龄、平均出生体质量等一般临床病历资料比较,差异无统计学意义(P>0.05)。本研究遵循的程序符合江苏省常州市儿童医院和江苏省常州市妇幼保健院人体试验委员会制定的伦理学标准,得到该委员会批准,分组征得受试对象监护人的知情同意,并与受试对象监护人签署临床研究知情同意书。对4组VLBW儿FC水平及大便隐血(OB)进行检测,并对4组VLBW儿FC水平及OB阳性检出率进行对比分析。 结果确诊NEC亚组早期和极期FC水平较对照组FC水平明显升高,差异有统计学意义(t＝6.62,8.44;P<0.05),确诊NEC亚组极期FC水平较早期和恢复期明显升高,且3者比较,差异有统计学意义(F＝9.563,P<0.05),喂养不耐受组FC水平与对照组比较,差异无统计学意义(t＝0.64,P>0.05)。确诊NEC亚组患儿极期OB阳性检出率和对照组比较,差异有统计学意义(χ²＝15.469,P<0.05),确诊NEC亚组早期和恢复期分别与对照组比较,差异均无统计学意义(χ²＝0.703, 0.000;P>0.05)。疑似NEC亚组疑似期和恢复期及喂养不耐受组OB阳性检出率分别与对照组比较,差异均无统计学意义(χ²＝2.000,0.000,0.185;P>0.05)。 结论FC水平检测比OB检测在NEC早期诊断方面具有更高灵敏度,可以作为VLBW儿NEC的诊断、严重程度判断及疗效预测的有效指标,同时还可以作为NEC与喂养不耐受患儿相鉴别的客观依据。     

Localized pseudomembranous colitis in the cecum and ascending colon mimicking acute appendicitis

A 61-year-old male was admitted to our hospital due to right lower abdominal pain and watery diarrhea for 3 d.Beginning 3 wk before he arrived in our hospital,he took 3 rd-generation cephalosporin(cefixime) for 2 wk due to chronic left ear otitis media.Colonoscopic examination revealed yellowish patches of ulcerations and swelling covered with thick serosanguineous exudate in the cecum and ascending colon.After 7 d of oral metronidazole treatment,his symptoms completely disappeared.We report a case of localized pseudomembranous colitis in the cecum and ascending colon mimicking acute appendicitis associated with cefixime.     

The zebrafish as a model to study intestinal inflammation

Starting out as a model for developmental biology, during the last decade, zebrafish have also gained the attention of the immunologists and oncologists. Due to its small size, high fecundity and full annotation of its genome, the zebrafish is an attractive model system. The fact that fish are transparent early in life combined with the growing list of immune cell reporter fish, enables in vivo tracking of immune responses in a complete organism. Since zebrafish develop ex utero from a fertilized egg, immune development can be monitored from the start of life. Given that several gut functions and immune genes are conserved between zebrafish and mammals, the zebrafish is an interesting model organism to investigate fundamental processes underlying intestinal inflammation and injury. This review will first provide some background on zebrafish intestinal development, bacterial colonization and immunity, showing the similarities and differences compared to mammals. This will be followed by an overview of the existing models for intestinal disease, and concluded by future perspectives in light of the newest technologies and insights.     

Yersinia enterocolitica bacteremia and enterocolitis in a previously healthy 20-month-old girl

Yersinia enterocolitica is a gram-negative bacillus that can cause illness ranging from a self-limiting enterocolitis to life-threatening bacteremia. Y. enterocolitica biotype 1B, serotype O:8 (1B/O:8), is the most pathogenic of the Yersinia species because of the presence of the high-pathogenicity island and the Yersinia virulence plasmid (pYV). Here, we report a pediatric case of Y. enterocolitica 1B/O:8 bacteremia and enterocolitis. A 20-month-old girl was admitted to hospital with fever, pharyngitis, and abdominal pain on day 2. Blood culture on admission was positive for Y. enterocolitica 1B/O:8. Stool culture on day 5 after cefotaxime treatment was also positive for Y. enterocolitica 1B/O:8, but only after cold enrichment at 4°C for 3 weeks. PCR assays identified the pYV only in stool specimens, indicating that strains from routine blood culture at 37°C lacked the pYV. The present case showed the usefulness of stool culture with cold enrichment and agglutination test for the diagnosis of Y. enterocolitica infection. We would therefore like to emphasize the importance of collection and preservation of stool specimens for the identification of pYV. To our knowledge, this is the first reported pediatric case of Y. enterocolitica 1B/O:8 bacteremia.     

小牛血去蛋白注射液在盆腔放疗患者中对肠道反应的影响

目的研究小牛血去蛋白注射液对于放射性肠炎患者肠道反应的影响。方法对本科近3年来行盆腔放疗的62例盆腔肿瘤患者进行回顾性分析,按照有无使用小牛血去蛋白注射液保留灌肠分为两组,小牛血去蛋白注射液组33例,对照组29例。比较两组患者的毒性反应。结果小牛血去蛋白注射液灌肠组与对照组肠道反应有明显差异（P〈0．05）。结论小牛血去蛋白注射液灌肠可以明显降低放疗期间及放疗后肠道不良反应级别,并且降低了肠道不良反应的发生率。     

Necrotizing enterocolitis

Improvement in survival rates of low birth-weight infants particularly in the neonatal intensive care units of India appears to be accompanied by frequent recognition of Necrotizing enterocolitis (NEC) among early survivors. As the philosophy and practice of advanced care for tiny infants becomes more acceptable and affordable in the country, a steady increase in survival of such infants is predictable. However there is growing concern in India that NEC could become a significant contributor to morbidity and mortality in the future. NEC is currently regarded as the most common acquired gastrointestinal emergency in the newborn period, and the outcome of this disease is universally poor. Improved understanding of the pathophysiology and pathogenesis of this condition is required for formulating optimal principles of prevention and management.