重症急性胰腺炎患者血清IL-6水平与内毒素移位及肠黏膜紧密连接蛋白表达关系的研究

目的：大量研究表明重症急性胰腺炎（SAP）患者血清中高浓度IL-6 和肠黏膜低表达的紧密连接蛋白可促进内毒素移位的发生。本文主要研究重症胰腺炎患者血清IL-6 水平对内毒素移位和肠黏膜紧密连接蛋白表达的影响。方法：50 例重症胰腺炎患者,其中12 例在患病早期因结肠受累合并腹胀,对12 例结肠受累患者应用结肠镜行结肠灌洗进行腹腔减压,同时取结肠黏膜进行活组织检查。所有病人在治疗的第3 天,第7天,第10 天,第14 天抽取外周静脉血。40 例健康志愿者作为对照组。应用ELISA方法检测血清IL-6 水平,鲎试验（LAL）方法检测血清内毒素含量,应用免疫荧光和Western blotting 方法检测肠黏膜紧密连接蛋白表达水平。结果：SAP 患者血清IL-6 和内毒素含量明显高于健康对照组,而结肠黏膜紧密连接蛋白表达低于对照组;在临床治疗过程中,早期SAP 患者血清IL-6 和内毒素水平高于晚期（P 值均＜0.05）。SAP 早期血清高浓度的IL-6 与结肠黏膜紧密连接蛋白的低表达具有相关性,差异有统计学意义（r=0.735,P＜0.05）。结论：血清IL-6 水平可作为早期评价重症急性胰腺炎严重程度的一项指标,IL-6 水平与重症急性胰腺炎临床病程有相关性,可能导致肠道内毒素移位。     

急性胰腺炎患者肠道屏障保护和炎性反应调控的研究

目的探讨肠黏膜防御屏障和炎性递质在急性胰腺炎（AP）发病机制中的作用。方法所有患者分为重型急性胰腺炎（SAP）患者19例,轻型急性胰腺炎（MAP）患者36例,入院当时取静脉血4ml,提取血清,平均分装于4个试管,检测TNF-α、IL-6、IL-2、内毒素。结果TNF-α、IL-6、IL-2、内毒素在SAP组、MAP组之间差异存在显著性（P〈0．05）。根据直线回归分析TNF-α与血浆内毒素含量呈正相关。结论IL-2、IL-6、TNF-α、内毒素参与了AP肠道屏障保护和炎性反应调控的机制,可预测急性胰腺炎的严重程度。     

骶神经电刺激对脊髓损伤大鼠肠黏膜机械屏障的保护作用

目的：观察骶神经电刺激对脊髓损伤大鼠肠黏膜机械屏障的保护作用。方法：56只Wistar大鼠分7组（n=8）：正常组、急性完全性脊髓损伤（SCI）组和骶神经电刺激组（按24、48、72h各8只）。进行内毒素测定;肠系膜淋巴结、肝脏、脾脏菌培养;肠道形态学观察;紧密连接蛋白zo-1的蛋白表达测定。结果：对照组肠黏膜不同程度损伤;肠道上皮细胞及细胞间连接破坏;内毒素血症和细菌移位明显。实验组肠黏膜得到改善,内毒素水平下降且细菌移位减少。ZO-1蛋白表达无统计学差异。对照组ZO-1的分布出现不同程度的散乱、排列不规则,实验组分布得到改善。结论：骶神经电刺激可促肠蠕动、排肠内容物、减少肠道菌群数量,保护肠黏膜上皮细胞及紧密连接的机械屏障,减少细菌移位和内毒素血症。     

连续性血液净化对重症胰腺炎患者炎症因子、内毒素及肠道黏膜屏障功能的影响

目的:研究连续性血液净化对重症胰腺炎患者炎症因子、内毒素及肠道黏膜屏障功能的影响。方法:选取2014年2月至2015年1月本院收治的86例重症胰腺炎患者,按照投硬币法分为观察组(43例)和对照组(43例)。对照组采取常规治疗,观察组在此基础上加以连续性血液净化治疗。比较两组患者治疗前后炎症因子、内毒素、肠道黏膜屏障功能变化情况,分析两组患者临床症状缓解时间。结果:治疗后,观察组血清白介素-6(IL-6)、白介素-8(IL-8)、白介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)、内毒素、D-乳酸、二胺氧化酶水平明显低于对照组(P0.05),压痛、腹痛、腹胀症状缓解时间显著短于对照组(P0.05)。结论:连续性血液净化能有效改善重症胰腺炎患者炎症因子水平、内毒素及肠道黏膜屏障功能,促进患者临床症状快速恢复。     

4重症急性胰腺炎患者早期肠内营养治疗的作用及价值探讨

目的：探讨经鼻空肠管早期行肠内营养（EN）在重症急性胰腺炎（S AP）治疗中的作用。方法：40例SAP患者随机分为治疗组和对照组,每组各20例,对照组给予常规治疗,治疗组在常规治疗的基础上加用肠内营养。观察两组治疗前后血清白蛋白和淀粉酶水平、血浆内毒素及肿瘤坏死因子TNF-α水平的变化情况。考察治愈率症、感染率、病死率、平均住院时间及费用。结果：治疗组患者行肠内营养后,血浆内毒素、TNF-α下降速度明显快于对照组P〈0.05,感染率、平均住院时间与费用明显降低。结论：EN能改善ASP患者的营养状况,改善肠道黏膜屏障及降低炎性细胞因子分泌来加强治疗效果,是SAP重要治疗手段。     

重症急性胰腺炎患者早期肠内营养治疗的作用及价值探讨

目的:探讨经鼻空肠管早期行肠内营养(EN)在重症急性胰腺炎(S AP)治疗中的作用。方法:40例SAP患者随机分为治疗组和对照组,每组各20例,对照组给予常规治疗,治疗组在常规治疗的基础上加用肠内营养。观察两组治疗前后血清白蛋白和淀粉酶水平、血浆内毒素及肿瘤坏死因子TNF-α水平的变化情况。考察治愈率症、感染率、病死率、平均住院时间及费用。结果:治疗组患者行肠内营养后,血浆内毒素、TNF-α下降速度明显快于对照组P<0.05,感染率、平均住院时间与费用明显降低。结论:EN能改善ASP患者的营养状况,改善肠道黏膜屏障及降低炎性细胞因子分泌来加强治疗效果,是SAP重要治疗手段。     

重症急性胰腺炎患者肠道菌群和代谢产物的变化特征及其与病情的相关性

目的 研究重症急性胰腺炎（SAP）患者肠道菌群和代谢产物的变化特征及其与病情的相关性。方法 选择2017年8月至2021年8月期间丽水市中心医院消化科收治的SAP患者作为SAP组,轻症急性胰腺炎（MAP）患者作为MAP组,同期体检的健康志愿者作为对照组。收集全部入选对象粪便标本检测肠道菌群失调情况。收集入选对象血清标本检测二胺氧化酶（DAO）、D-乳酸（D-LA）、肿瘤坏死因子-α (TNF-α)、高迁移率族蛋白B1(HMGB-1)、白介素（IL）-6、IL-8的水平。采用急性生理与慢性健康评分（APACHE-Ⅱ评分）、急性胰腺炎严重程度床边指数评分（BISAP评分）、全身炎症反应综合征评分（SIRS评分）评价SAP的病情,采用28 d生存情况评价SAP患者的短期预后。结果 SAP组的肠道菌群失调发生率及血清DAO、D-LA水平均高于对照组和MAP组（均P<0.05）。SAP组中肠道菌群失调患者的血清DAO、D-LA、TNF-α、HMGB-1、IL-6、IL-8水平及APACHE-Ⅱ评分、BISAP评分、SIRS评分、28 d累积病死率均高于肠道菌群正常患者（均P<0.05...     

丙氨酰谷氨酰胺联合奥曲肽对重症急性胰腺炎患者的临床疗效

目的:探讨丙氨酰谷氨酰胺(Ala-Gln)联合奥曲肽治疗重症急性胰腺炎(SAP)的临床疗效及对患者血清白细胞介素-6(IL-6)、C反应蛋白(CRP)水平及相关生化指标的影响。方法:选取我院2013年1月~2016年12月收治的100例SAP患者,根据随机数字表法均分为两组。对照组仅予以奥曲肽治疗,观察组给予Ala-Gln联合奥曲肽治疗。记录比较两组的临床疗效、治疗前后血清IL-6、CRP、淀粉酶(AMY)、乳酸脱氢酶(LDH)、前清蛋白(PA)和白蛋白(ALB)水平的变化情况。结果:治疗10 d后,观察组总有效率为88.0%,明显高于对照组的64.0%(P0.05)。两组治疗10 d后血清IL-6、CRP、AMY、LDH水平均显著低于治疗前(P0.01),且与对照组对比,观察组血清IL-6、CRP、AMY、LDH水平的改善程度均更为显著(P0.01)。与治疗前相比,两组治疗10 d后血清PA、ALB水平均明显上升(P0.05),且观察组治疗10 d后血清PA和ALB水平的改善程度均显著优于对照组(P0.01)。结论:丙氨酰谷氨酰胺联合奥曲肽治疗更能有效消除或缓解重症急性胰腺炎患者的症状与体征,控制机体炎症反应,提高营养代谢水平,改善预后。     

早期肠内营养加微生态制剂对重症急性胰腺炎患者疗效的影响

目的：探讨早期肠内营养加微生态制剂对重症胰腺炎患者临床疗效、炎症指标及酶学指标的影响。方法：选取165例诊断为重症急性胰腺炎的患者,按就诊先后顺序分为对照组和观察组,对照组给予早期肠内营养,观察组给予早期肠内营养加微生态制剂,选取治疗后1、2w为观察时间点,比较两组患者的临床疗效、胃肠功能恢复情况,比较治疗前后血清白细胞介素6（IL-6）、肿瘤坏死因子（TNF-α）、C反应蛋白（CRP）水平变化情况,比较治疗前后血清淀粉酶、血清脂肪酶、血清乳酸脱氢酶（LDH）及感染发生率。结果：观察组患者的临床疗效优于对照组,胃肠功能显著优于对照组,差异具有统计学意义（P＜0.05）,观察组患者的血清IL-6、TNF-α、CRP较对照组明显降低,差异具有统计学意义（P＜0.05）,观察组患者的血清淀粉酶、血清脂肪酶、LDH水平较对照组明显降低,差异具有统计学意义（P＜0.05）,观察组患者感染发生率明显低于对照组,差异具有统计学意义（P＜0.05）。结论:重症急性胰腺炎患者治疗早期,在肠内营养支持基础上加用微生态制剂能够明显降低患者炎症指标及相关酶学指标水平,且感染发生率明显降低,具有重要的临床意义。     

柴芩承气汤对重症急性胰腺炎并发肝损伤大鼠的治疗作用及其机制

目的：研究柴芩承气汤（CQCQD）对重症急性胰腺炎（SAP）并发肝损伤大鼠的治疗作用及其机制。方法：72只SD大鼠随机分为3组（n=24）：假手术（sham）组,重症急性胰腺炎模型（SAP）组和柴芩承气汤治疗（CQCQD）组。去氧胆酸钠胰胆管逆行注射建立SAP大鼠模型,CQCQD组给予柴芩承气汤治疗,于造模后1 h、5 h、10 h观察各组不同时间点的胰腺、肝脏组织病理学变化,检测血清中淀粉酶（AMS）、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）活性、白介素-6（IL-6）水平及胰腺、肝脏组织单核细胞趋化蛋白-1（MCP-1）和IL-6 mRNA的表达情况。结果：与sham组比较,SAP组血清AMS、ALT、AST活性及IL-6水平明显升高,胰腺、肝脏组织MCP-1及IL-6 mRNA表达升高（P<0.05）;与SAP组比较,CQCQD组血清AMS、ALT、AST活性及IL-6水平明显降低;胰腺和肝脏组织病理损伤减轻,胰腺、肝脏组织MCP-1及IL-6 mRNA表达明显减弱（P<0.05）。结论：MCP-1参与了SAP并发肝损伤的进展;柴芩承气汤能显著抑制胰腺、肝脏组织MCP-1的表达,减轻SAP时胰腺、肝脏组织病理损伤,对SAP并发肝损伤起到治疗作用。     

利奈唑胺对肾功能不全G~+感染患者血小板减少的相关性研究

目的:分析利奈唑胺对肾功能不全G+患者血小板减少的关系。方法:回顾性分析92例应用利奈唑胺治疗的革兰阳性球菌感染患者的临床资料,根据是否伴有肾功能不全分为肾功能不全组(33例),正常组(59例),检测用药前、用药后血小板计数,观察停药后血小板计数恢复正常时间及不良反应发生情况。结果:肾功能不全组治疗后血小板计数显著低于治疗前及正常组(P0.01),正常组治疗前、后血小板计数比较无统计学意义(P0.05);肾功能不全组血小板减少发生率高于正常组(P0.05);停药后正常组血小板恢复正常时间短于肾功能不全组(P0.01);肾功能不全组血红蛋白下降率高于正常组(P0.05),其余不良反应发生率比较差异无统计学意义(P0.05)。结论:感染患者肾功能可影响利奈唑胺所致血小板减少发生率,肾功能不全患者在应用利奈唑胺时应定期监测血小板计数。     

Effect of Pretreatment with Carbimazole in Patients with Thyrotoxicosis Subsequently Treated with Radioactive Iodine

Preliminary treatment with carbimazole in a series of 181 patients with thyrotoxicosis selected for treatment with radioactive iodine did not make any significant difference to the subsequent response to ¹³¹I therapy.     

Appearance of enterotoxigenic Escherichia coli in piglets with diarrhea in connection with feed changes

Twelve weaned piglet (3-week-old) were divided into three groups according to time of feed change and observed for diarrhea during the time they were 3 to 8 weeks of age. A total of 553 strains of Escherichia coli were isolated from rectal fecal samples and examined for heat-labile (LT) and heat-stable (ST) enterotoxins, pilus antigens (K88, K99, and 987P), hemolysin (Hly), raffinose utilization (Raf) and drug resistance. Enterotoxins and/or hemolytic E. coli strains appeared in the rectal feces of 5- to 6-week-old piglets with diarrhea in connection with feed change and changing temperatures. Most of the isolates showed multiple drug resistance to sulfonamides (Sa), streptomycin (Sp), ampicillin, and/or mercury. Enterotoxigenic E. coli isolates represented four phenotypes: K88+.LT+.Hly+.Raf+.(SaSmCpTcKmSp) (12 strains), K99+.ST+.Raf+.(TcKm) (7 strains), ST+.Raf+.(TcKm) (7 strains), and ST.+(SaSmKm) (25 strains). The drug resistance determinants were transferable concurrently and some of them mobilized the determinants for K88, LT, Hly, and Raf to an E. coli C strain.     

Immunologic correction with immunoglobulin of toxemia with exicosis in infants with acute intestinal infections]

The clinical course of acute intestinal infections complicated by toxicosis and exicosis was studied in 150 infants undergoing multimodality therapy, including natural human immunoglobulin for intravenous injections. The use of the new complex in the treatment of intestinal toxicoses was accompanied by increasing host immunological reactivity within short periods and decreasing of the treatment duration by 5.0 +/- 1.3 days; there were no persisting and chronic forms of the diseases and fatal outcomes. It was concluded that the use of the immunoglobulin for intravenous injections in the multimodality therapy of intestinal toxicoses in infants made it possible to prevent death in complicated intestinal infections and at the same time to accelerate their recovery.     

Decrease in scale invariance of activity fluctuations with aging and in patients with suprasellar tumors

Motor activity in healthy young humans displays intrinsic fluctuations that are scale-invariant over a wide range of time scales (from minutes to hours). Human postmortem and animal lesion studies showed that the intact function of the suprachiasmatic nucleus (SCN) is required to maintain such scale-invariant patterns. We therefore hypothesized that scale invariance is degraded in patients treated for suprasellar tumors that compress the SCN. To test the hypothesis, we investigated 68 patients with nonfunctioning pituitary macroadenoma and 22 patients with craniopharyngioma, as well as 72 age-matched healthy controls (age range 21.0–70.6 years). Spontaneous wrist locomotor activity was measured for 7 days with actigraphy, and detrended fluctuation analysis was applied to assess correlations over a range of time scales from minutes to 24 h. For all the subjects, complex scale-invariant correlations were only present for time scales smaller than 1.5 h, and became more random at time scales 1.5–10 h. Patients with suprasellar tumors showed a larger decrease in correlations at 1.5–10 h as compared to healthy controls. Within healthy subject, gender and age >33 year were associated with attenuated scale invariance. Conversely, activity patterns at time scales between 10 and 24 h were significantly more regular than all other time scales, and this was mostly associated with age.

In conclusion, scale invariance is degraded in healthy subjects at the ages of >33 year as characterized by attenuation of correlations at time scales 1.5–10 h. In addition, scale invariance was more degraded in patients with suprasellar tumors as compared to healthy subjects.