肝硬化的胃肠道并发症

肝硬化是慢性肝病的终末阶段,可影响到全身多器官功能。而肝硬化所致消化道损害临床上更为常见。肝硬化会导致胃肠动力下降、影响营养物质的消化吸收及破坏肠黏膜屏障功能,还会并发一系列胃肠道并发症,影响患者预后。临床上,更应重视肝硬化相关胃肠道并发症,做到早期监测、早期诊断和早期治疗,控制肝硬化病情进展、减少晚期并发症、提升患者生活质量。     

Effect of lactobacillus on the gut microfiora and barrier function of the rats with abdominal infection

AIM: To investigate the effect of probiotics supplemented by gut on the tight junctions of epithelial cells, barrier function and the microflora of rats with abdominal infection. METHODS: After the model of cecal ligation and perforation established, SD rats were divided into two groups: parenteral nutrition (PN) group and PN+probiotics (probiotics) group, PN solution was supplemented by neck vein and probiotics was delivered via the jejunostomy tube for five days. Vena cava blood and the homogenated tissue of liver, lung and mesenteric lymph nodes were cultured to determine the bacterial translocation rate (BTR). The ultrastructure of epithelial tight junctions and microvilli of the gut were observed by electron microscopy; occluding expression was measured by indirect-immune fluorescence method; anaerobic bacterial growth by anaerobic culture and DNA fingerprint of bacterial colonies of the feces by PCR. RESULTS: The quantity of lactobacteria and bifydobacteria in probiotics group was higher than that of PN group. The profiles of DNA fingerprint expression in probiotics group were similar to that in the normal group, a new 16S rDNA sequence appeared in the profile in PN group. The occludin expression, the integrality of the gut epithelial tight junctionand microvilli in probiotics group were improved as compared with PN group. The BTR and endotoxin in blood were reduced more significantly in probiotics group as compared with PN group.CONCLUSION: The probiotics could improve the gut microflora disturbance, increase occludin expression, maintain the gut epithelial tight junction and decrease the bacterial translocations rate.     

胃粘膜肠化与胃癌的CEA免疫组化和DNA定量研究

我们应用ABC免疫组化和显微分光光度法,观察了胃癌及不同类型肠化组织中CEA的表达和DNA含量的变化.发现肠型胃癌CEA染色阳性率显著高于胃型胃癌(P<0.001);Ⅲ型肠化中CEA的阳性率显著高于Ⅰ、Ⅱ型肠化(P<0.001)。细胞核DNA含量和超3C及超4C细胞的比率均随细胞去分化程度而递增。Ⅲ型肠化DNA均值显著高于Ⅰ、Ⅱ型肠化和正常胃粘膜(P<0.05～0.01)。结果表明,Ⅲ型肠化与胃癌的发生有密切关系。     

重组人小肠三叶因子对肠黏膜上皮细胞保护作用的研究

目的 应用基因重组获得人小肠三叶因子（hITF）．并研究外源性hITF保护肠黏膜的作用及其可能机制。方法 构建毕赤酵母重组表达质粒pPICg／hITF，经发酵上清过柱纯化，应用质谱技术鉴定所得目的蛋白；用大鼠小肠隐窝上皮细胞株（IEC-6）观察不同浓度重组hITF对肠上皮细胞形态、增殖和迁移功能的影响。结果获得基因重组hITF，质谱分析证实为所需目的蛋白。体外实验结果表明，在10^-9、10^-7、10^-5mol／L浓度，重组hITF能促进肠上皮细胞迁移，但对肠上皮细胞的光镜下形态和增殖功能无明显影响。结论 重组hITF能促进肠上皮细胞迁移，可能是其对肠黏膜保护的主要作用。     

大鼠肠黏膜肥大细胞生长抑素和血管活性肠肽受体mRNA的表达

背景：已知胃肠多肽生长抑素(SST)和血管活性肠肽(VIP)可调节肠黏膜肥大细胞(IMMC)的生物学活性。多数胃肠多肽对IMMC活性的调节作用可能与其受体途径有关。目的：探讨大鼠IMMC上是否有SST受体(SSTR)和VIP受体(VIPR)mRNA表达，确定SST和VIP调节IMMC活性的分子机制。方法：采用胶原酶消化法分离大鼠小肠IMMC，Percoll不连续密度梯度离心法纯化，逆转录聚合酶链反应(RT-PCR)观察IMMC上SSTR-1、SSTR-3和VIPR-1、VIPR-2mRNA的表达。结果：大鼠IMMC上有SSTR-1和VIPR-2 mRNA表达，其电泳条带分别位于1183bp和494bp，但无SSTR-3和VIPR-1mRNA表达。结论：大鼠IMMC可表达SSTR-1和VIPR-2基因，SST和VIP对IMMC活性的调节作用可能是通过其相应受体SSTR-1和VIPR-2途径实现的。     

Role of small bowel investigation in iron deficiency anaemia after negative endoscopic/histologic evaluation of the upper and lower gastrointestinal tract

BACKGROUND: The usefulness of small bowel investigation in iron deficiency anaemia (IDA) patients is controversial. AIM: To evaluate the presence of small bowel lesions likely to cause IDA in patients with unexplained IDA after negative gastroscopy with biopsies and colonoscopy (CS). METHODS: A total of 117 outpatients, referred for unexplained IDA, underwent gastroscopy with biopsies and colonscopy. In 17 (14.5%) patients, endoscopic/histological investigations were negative. Of these patients, 13 underwent small bowel follow-through (SBFT) and if necessary to confirm the diagnosis, further gastrointestinal (GI) investigations. RESULTS: Small bowel lesions likely to cause IDA were found in five (38%) patients. Four of these lesions were detected by SBFT, two of them were malignant. These findings, confirmed at surgery and ileoscopy (IS), led to the final diagnoses ofjejunal and ileal adenocarcinoma, idiopathic ileal ulcers and ileal Crohn's disease. In one case, after negative SBFT, jejunal angiodysplasia was detected by video capsule endoscopy (VCE). Faecal occult blood test (FOBT) was positive in four (31%) patients, all of whom presented lesions likely to cause IDA, detected in three cases by SBFT and in one case by VCE. CONCLUSIONS: This study shows the importance of investigating the small bowel in IDA patients after negative upper and lower GI endoscopy, particularly if FOBT is positive.     

Effects of Taxol plus radiation on the apoptotic and mitotic indices of mouse intestinal crypt cells

Purpose: In this study we investigated the effect of Taxol, radiation, or Taxol plus radiation on highly proliferative normal tissue – the intestinal crypt cells of Swiss albino mice. Materials and methods: Swiss-albino mice, 3–4 months old, were used in this study. Taxol was administered by bolus intravenously through the tail vein. Radiation was given using a linear accelerator. There were four treatment categories, which comprised a total of 34 groups. Each group consisted of five animals. The first category was a control category which comprised one group (n=5). The second treatment category was Taxol alone which comprised three groups (n=15). The third treatment category was radiation alone which comprised three groups (n=15). The fourth treatment category was Taxol plus radiation which comprised 27 groups (n=135). Mice were killed 24 h after Taxol or radiation or combined administration using ether anesthesia. Using a light microscope, apoptotic and mitotic indices were counted on jejunal crypt cells of mice that were stained with hematoxylin-eosin. Differences between groups were statistically evaluated with Student's t-test. Results: Taxol caused a dose-dependent increase in apoptosis (P=0.045) and decreased the mitotic index (P=0.006) at high doses. Similarly, radiation caused a dose-dependent increase in apoptosis (P=0.046) and decreased the mitotic index (P=0.299) at higher radiation doses. Compared to radiation alone, Taxol caused a significant induction of apoptosis (P=0.010). In combination, no significant radiosensitizing effect of Taxol was observed (enhancement ratio <1), when compared to radiation alone. However, an increase in apoptosis was observed after 24 h of Taxol exposure when compared to 12 or 48 h of Taxol exposure (P=0.0001 and P=0.0001). Conclusion: These findings suggest that Taxol did not cause a radiosensitizing effect in intestinal crypt cells. However, a 24-hour pretreatment of Taxol exposure followed by radiation caused significant induction of apoptosis and reduction of the mitotic index when compared to other Taxol timing sequences. Thus, the lack of a radiosensitizing effect of Taxol in these proliferative cells may be due to enhanced mitotic death rather than apoptotic death. Received: 17 April 2000 / Accepted: 3 January 2001     

清毒汤治疗肝病肠源性内毒素症临床观察

目的:观察中药复方清毒汤治疗肝病肠源性内毒素症的疗效.方法:将60例重型肝炎、失代偿性肝硬化合并腹水、腹腔感染,内毒素检测阳性的患者,分为治疗组和对照组各30例.在综合治疗基础上治疗组加用清毒汤,对照组加用乳果糖,观察两组患者治疗前后鲎试验,症状等变化及对肝、肾功能的影响,并进行统计学分析.结果:清毒汤治疗慢性重型肝病肠源性内毒素症,可减少内毒素血症时间,快速缓解肠源性内毒素相关的发热、腹胀等症状,对抗内毒素所致肝损害,提高重型肝病好转率,显著优于对照组,在降低血氨方面也有较好作用.结论:中医药治疗肝病肠源性内毒素症安全、有效,值得进一步研究推广.     

Sutureless Intestinal Anastomosis With the Biofragmentable Anastomosis Ring: Experience of 632 Anastomoses in a Single Institute

PURPOSE Uncertainty with the safety of the biofragmentable anastomosis ring makes surgeons hesitate in its widespread use in intestinal surgery. This study was designed to evaluate the validity of the biofragmentable anastomosis ring as a routine anastomotic device in enterocolic surgery. METHODS The study analyzed the nine-year experience of 632 biofragmentable anastomosis ring anastomoses performed in 617 patients: 525 (83 percent) as elective procedures and 107 (17 percent) as emergency. Three classic types of anastomosis, end-to-end (n = 354), end-to-side (n = 263), and side-to-side (n = 15), were performed with a standard technique. RESULTS Anastomotic sites included ileocolic/ileorectal in 283 patients (45 percent), colorectal in 148 (23 percent), enteroenteric in 101 (16 percent), and colocolic in 100 patients (16 percent). Anastomotic leakage with clinical relevance was observed in five patients (0.8 percent): three elective cases, and two emergency (2 colorectal anastomoses and 1 ileorectal required diversions). Among 13 instances (2.1 percent) with postoperative intestinal obstruction, only 1 required relaparotomy for closed-loop obstruction. Seven patients (1.1 percent; 4 elective cases, and 3 emergency) died postoperatively; no deaths were directly related to the biofragmentable anastomosis ring technique. CONCLUSIONS Our data suggest that the anastomosis using the biofragmentable anastomosis ring is a uniform and highly reliable technique even in high-risk emergency surgery. Along with its clinical validities, clinical application of the biofragmentable anastomosis ring in different types of anastomoses in enterocolic surgery is expected to be expanded with a high level of technical safety. Supported by the Dong-A University Research Fund in 2004. Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Dallas, Texas, May 8 to 13, 2004.     

肠屏障功能障碍的研究现状与展望

肠屏障功能障碍正日益受到关注,多种疾病均可引起肠屏障功能障碍,促使细菌移位,加重原发病,形成恶性循环。此文就肠屏障功能障碍的发病机制、检测方法和治疗措施进展作一综述。