保留灌肠清胰汤联合ERCP治疗急性胆源性胰腺炎的疗效及机制探讨

目的:探讨保留灌肠清胰汤联合内镜逆行胰胆管造影术(endoscopic retrograde pancreatic cholangiography,ERCP)治疗急性胆源性胰腺炎的临床疗效及作用机制。方法:选择2015年1月～2017年12月我院收治的97例胆源性胰腺炎患者为研究对象,根据治疗方法不同,将其分为对照组(ERCP组,46例)及观察组(保留灌肠清胰汤联合ERCP组,53例)。观察和比较两组的中医临床疗效,治疗前后7天的肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、C反应蛋白(c-reactive protein,CRP)、白细胞介素-6(Interleukins-6,IL-6)、白细胞介素-8(Interleukin-8,IL-8)、白细胞介素-10(Interleukin-10,IL-10)水平及治疗前、治疗后12 h、24 h、3 d的血清淀粉酶水平的变化,腹痛缓解时间、平均住院时间、平均住院费用。结果:治疗后,观察组的痊愈、显效比例明显高于对照组(P0.05)。两组治疗后的血清TNF-α、CRP、IL-6、IL-8、IL-10水平均显著低于治疗前,且观察组的血清TNF-α、CRP、IL-6、IL-8水平均明显低于对照组(P均0.05);两组的平均住院费用对比差异无统计学意义(P0.05);观察组的腹痛缓解时间、平均住院时间明显低于对照组(P0.05)。与治疗前相比,两组治疗后12 h、24 h、3 d时的血清淀粉酶水平均显著降低,且观察组治疗后12 h、24 h时的血清淀粉酶水平均明显低于对照组(P均0.05)。结论:保留灌肠清胰汤联合ERCP治疗可显著提高急性胆源性胰腺炎的治疗痊愈率及有效率,其作用机制可能与降低患者血清TNF-α、CRP、IL-6、IL-8及淀粉酶水平有关。     

Experimental acute pancreatitis is enhanced in mice with tissue nonspecific alkaline phoshatase haplodeficiency due to modulation of neutrophils and acinar cells

Tissue nonspecific alkaline phosphatase (TNAP) has a well established role in bone homeostasis and in hepatic/biliary conditions. In addition, TNAP is expressed in the inflamed intestine and is relevant to T and B lymphocyte function. TNAP KO mice are only viable for a few days, but TNAP^+/? haplodeficient mice are viable. Acute pancreatitis was induced by repeated caerulein injection in WT and TNAP^+/? mice. TNAP^+/? mice presented an increased expression of Cxcl2, Ccl2, Selplg (P-selectin ligand), Il6 and Il1b in the pancreas. Freshly isolated acinar cells showed a dramatic upregulation of Cxcl1, Cxcl2, Ccl2, Il6, Selpg or Bax in both pancreatitis groups. TNAP^+/? cells displayed a 2-fold higher expression of Cxcl2, and a smaller increase in Il6. These findings could be partly replicated by in vitro treatment of primary acinar cells with caerulein. Furthermore, the proinflammatory effect on acinar cells could be partially reproduced in wild type cells treated with the TNAP inhibitor levamisole. TNAP mRNA levels were also markedly upregulated by pancreatitis in acinar cells. Neutrophil infiltration (MRP8+ cells) and activation (IL-6 and TNF production in LPS treated primary neutrophils) were increased in TNAP^+/? vs WT mice. Neutrophil depletion greatly attenuated inflammation, indicating that this cell type is mainly responsible for the higher inflammatory status of TNAP^+/? mice. In conclusion, our results show that altered TNAP expression results in heightened pancreatic inflammation, which may be explained by an augmented response of neutrophils and by a higher sensitivity of acinar cells to caerulein injury.     

Alopecia Totalis in a Chimpanzee

A case of alopecia totalis in a chimpanzee is reported. The disease was probably due to an autoimmune phenomenon and was successfully treated with immunosuppressive therapy. However, possible side-effects outweighed benefits.     

中国遗传性胰腺炎患者胰蛋白酶原基因多位点杂合突变及其临床特征

用基因产物直接测序法对2个遗传性胰腺炎家系中胰腺炎患者(共有4例成员)的胰蛋白酶原基因(cationic trypsinogen,PRSS1)5个外显子进行测序,并分析其各自的临床特征.在4例胰腺炎患者中均出现了PRSS1基因杂合突变,但两家系PRSS1基因突变的位点不同,且临床表现差异较大,其中家系1出现6例糖尿病患者且发病年龄较家系2明显延迟,平均发病年龄为29岁,分析其PRSS1基因发现3号外显子336位碱基存在G→A杂合性突变,为中性突变,表达的氨基酸从赖氨酸(Lys)→赖氨酸(Lys),同时在同一外显子的361位碱基还存在另一个G→A杂合性突变,造成121位的丙氨酸(Ala)被苏氨酸(Thr)所取代,胰蛋白酶原的空间结构发生改变,其与抑制因子的结合位点消失,"保护失败"而产生有活性的胰蛋白酶,造成胰腺自身的消化.而家系2未发现糖尿病患者,其胰腺炎患者的血清肿瘤标志物不增高,先证者(Ⅲ8)在胰腺炎发病过程中表现为CD4 T/CD8 Tcell和乙肝表面抗体(anti-HBs)随病程进展逐渐降低,而Ⅲ7不表现出此现象,分析其PRSS1基因发现3号外显子361位碱基同样存在G→A(c.361G→A)突变,而且在415位还存在一个杂合性突变点T→A(c.415T→A),其中c.415T→A不存在于Ⅲ7.胰蛋白酶原基因存在多种形式的突变,而且与临床表型相关.     

Focus: Rare Disease: Behçet’s Disease and Pregnancy: A Retrospective Case-control Study

Background: Behçet’s disease (BD) is a rare chronic multisystemic vasculitis of unknown etiology. It is usually diagnosed between the 2^nd and 4^th decades of life, so its association with pregnancy is not unusual. This study aims to characterize the evolution of pregnancy in a group of pregnant women with BD and the impact of this pathology in embryo-fetal morbidity. Methods: A retrospective case-control study included 49 pregnancies in women suffering from BD, followed in our institution. Pregnancy outcomes were compared with a control group of healthy pregnant women. Two controls per case were randomly selected. Statistical analysis used SPSS 25.0, and a p-value of 0.05 was considered statistically significant. Results: Forty-nine pregnancies were included in 27 patients with BD. BD exacerbation occurred in 32.6% of the pregnancies. There were no significant statistical differences between the two groups regarding the rate of preterm delivery, gestational diabetes, and preeclampsia (p>0.05). In the BD group, we found a higher rate of miscarriage (24.5%) and fetal growth restriction (FGR, 13.3%, p<0.05). In the study group, 13 (32.5%) of the pregnant patients did not need treatment. The cesarean rate was significantly higher in the BD group (43.2% vs 20.4% in the control group, p<0.05), and there were no significant differences in median gestational age at the time of delivery (p>0.05). The birth weight of newborns did not differ significantly between the groups. There was no association of BD with maternal morbidity and neonatal complications. Conclusion: In this study, the majority of pregnant with BD did not present clinical exacerbation of their pathology. However, BD may have an adverse influence on pregnancy outcomes. FGR and miscarriage rates were significantly higher in the study group.     

Identification of highly potent and selective PI3Kδ inhibitors

Selective PI3Kδ inhibitors have recently been hypothesized to be appropriate immunosuppressive agents for the treatment of immunological disorders such as rheumatoid arthritis. However, few reports have highlighted molecules that are highly selective for PI3Kδ over the other PI3K isoforms. In this letter, isoform and kinome selective PI3Kδ inhibitors are presented. The Structural Activity Relationship leading to such molecules is outlined.     

Discovery of 7-(3-(piperazin-1-yl)phenyl)pyrrolo[2,1-f][1,2,4]triazin-4-amine derivatives as highly potent and selective PI3Kδ inhibitors

As demonstrated in preclinical animal models, the disruption of PI3Kδ expression or its activity leads to a decrease in inflammatory and immune responses. Therefore, inhibition of PI3Kδ may provide an alternative treatment for autoimmune diseases, such as RA, SLE, and respiratory ailments. Herein, we disclose the identification of 7-(3-(piperazin-1-yl)phenyl)pyrrolo[2,1-f][1,2,4]triazin-4-amine derivatives as highly potent, selective and orally bioavailable PI3Kδ inhibitors. The lead compound demonstrated efficacy in an in vivo mouse KLH model.     

Discovery of AAT-008, a novel,potent, and selective prostaglandin EP4 receptor antagonist

Starting from acylsufonamide HTS hit 2, a novel series of para-N-acylaminomethylbenzoic acids was identified and developed as selective prostaglandin EP4 receptor antagonists. Structural modifications on lead compound 4a were explored with the aim of improving potency, physicochemical properties, and animal PK predictive of QD (once a day) dosing regimen in human. These efforts led to the discovery of the clinical candidate AAT-008 (4j), which exhibited significantly improved pharmacological profiles over grapiprant (1).     

急性出血坏死性胰腺炎肝损伤中TLR2, 4mRNA和蛋白的表达

目的:观察急性出血坏死性胰腺炎肝损伤中TLR-2、TLR4的表达水平,分析TLR2和TLR4在AHNP肝损伤中的表达意义。方法:48只成年Wistar大鼠作为实验动物,随机分为对照组和造模组各24只,造模组利用牛磺胆酸钠建立AHNP模型,在造模后3 h、12 h以及24 h时,每组分别各取8只大鼠,应用RT-PCR法检测TLR2、TLR4mRNA表达水平,应用Western blot检测肝脏组织中TLR2、TLR4蛋白表达水平。结果:造模后,造模组TLR2mRNA、TLR4mRNA、TLR2蛋白、TLR4蛋白显著升高,且在造模后12 h出现峰值,与同时段对照组相比差异显著(P0.01)。结论:急性出血坏死性胰腺炎肝损伤组织中TLR2、TLR4mRNA和蛋白表达水平异常升高,TLR2、TLR4可能参与了急性出血坏死性胰腺炎肝损伤发生发展过程。