目的 分析枸杞多糖(LBP)对小鼠肝纤维化组织中基质金属蛋白酶-9(MMP-9)及其抑制剂-1(TIMP-1)含量的影响,探讨LBP对肝纤维化的作用机制.方法 胆总管结扎方法制造肝组织纤维化损伤小鼠,将12只小鼠按照随机数字法分组为肝纤维化组和LBP组,同时选取6只正常小鼠作为正常组.LBP组:肝组织纤维化小鼠每天经口服用LBP 25 μg/g;正常组及肝纤维化组:经口服用等体质量的生理盐水,3组同时连续服用3周.取出各组的肝组织,分别经苏木精-伊红染色、天狼猩红染料染色后,观察其结构改变情况以及肝组织中胶原纤维的含量;蛋白印迹技术评估肝组织中MMP-9和TIMP-1的含量.结果 肝纤维化组的肝组织结构紊乱,其内有程度不同的坏死组织,红色的胶原纤维面积和汇管区域小叶间胆管数量比正常组增多,肝组织内MMP-9的含量(0.044±0.011)比正常组增加,但是两组相比差异无统计学意义(P＞0.05),TIMP-1 的含量(0.712±0.038)比正常组增加(P＜0.05),MMP-9/TIMP-1 的值(0.051±0.011)比正常组减少(P＜0.05).LBP组肝组织的坏死程度减轻,红色的胶原纤维面积和汇管区域小叶间胆管数量比肝纤维化组减少,肝组织内MMP-9的含量(0.070±0.009)比肝纤维化组增多(P＜0.05),TIMP-1的含量(0.445±0.027)比肝纤维化组减少(P＜0.05),MMP-9/TIMP-1的值(0.163±0.025)比肝纤维化组增加(P＜0.05).结论 LBP能同时调节肝纤维化组织中MMP-9和TIMP-1的含量,使MMP-9/TIMP-1的值增加来有效阻止肝组织纤维化的进展,达到保护肝组织的目的.

目的 研究川芎嗪(TMP)对大鼠小肠缺血再灌注损伤及内质网应激通路的影响.方法 将120只Wistar大鼠按照随机数字表法平均分为假手术组、模型组和TMP低、中、高(15、30、60 mg/kg)剂量组.造模前30 min腹腔注射给药,假手术组、模型组腹腔注射生理盐水.通过夹闭肠系膜上动脉60 min制备小肠缺血再灌注大鼠模型,再灌注2 h后,检测肠组织含水量;通过HE染色法行肠组织病理学检查并进行损伤评分(Chiu's氏评分)、TUNEL法观察细胞凋亡情况并计算凋亡指数(AI);ELISA法检测肠组织CRP、TNF-α、IL-1β含量;Western blot法检测内质网应激相关蛋白(GRP78、CHOP)及Cleved Caspase-12、Cleved Caspase-3、NF-κB蛋白表达.结果 与模型组比较,TMP中、高剂量组大鼠肠组织含水量显著降低(P<0.05);肠系膜病变明显改善且凋亡细胞数量明显减少,Chiu's氏评分和AI显著降低(P<0.01);肠组织CRP、TNF-α、IL-1β含量和GRP78、CHOP、Cleved Caspase-12、Cleved Caspase-3、NF-κB蛋白表达水平均显著降低(P<0.05).结论 TMP能够通过抑制内质网应激相关炎症和细胞凋亡通路,对小肠缺血再灌注损伤起到保护作用.

目的 探讨慢性睡眠剥夺(CSD)对大鼠空间学习记忆和海马体齿状回区(DG)去甲肾上腺素(NE)水平及其受体表达的影响,初步阐明CSD影响空间学习记忆能力的神经化学机制.方法 将大鼠设为CSD组及对照组(每组8只),应用睡眠剥夺仪进行睡眠剥夺(18 h/d,连续21 d).Morris水迷宫检测2组大鼠行为能力的改变情况.脑部微量透析法和高效液相色谱法检测DG区去甲肾上腺素(NE)水平,α1和β肾上腺素能受体(α1-AR和β-AR)表达应用免疫组织化学染色法检测.结果 CSD组大鼠第2、3d游到平台所用时间为(75.76±17.15)和(37.60±4.80)s,均高于对照组;第5天穿越原站台区域回数比较,CSD组[(3.25±1.25)次]与对照组[(8.00±1.82)次]比较,差异有统计学意义(P＜0.05);第2～4天CSD组大鼠DG区内NE水平分别为(285.82±75.56)％、(409.10±134.91)％、(503.27± 185.87)％,对照组分别为(601.41±36.96)％、(1 235.71±132.11)％、(1 085.41±188.21)％,差异均有统计学意义(均P＜0.05);α1-AR和β-AR表达评分在对照组分别为4.66±0.28和5.00±0.33,在CSD组大鼠分别为2.50±0.45和2.75±0.43,2组α1-AR和β-AR表达评分比较,差异均有统计学意义(均P＜0.05).结论 CSD可损害大鼠空间学习和记乙能力,可能与海马体DG区NE水平降低及其受体表达减少有关.

目的 探讨十全大补汤辅助肠内营养支持治疗对胃癌术后患者营养和免疫指标及肠内营养并发症的影响.方法 将75例胃癌术后患者随机分为治疗组35例和对照组40例.2组患者术后均给予规范化治疗,对照组于术后第2天肠功能恢复后给予肠内营养支持,治疗组在此基础上辅助使用中药十全大补汤,连续使用至术后第8天.检测2组患者术前及术后第8天营养指标[血清白蛋白(ALB)、血清前白蛋白(PAB)、转铁蛋白(TFN)、血红蛋白(Hb)]及免疫指标[淋巴细胞总数(TLC)和血清IgA、IgG、IgM],统计2组患者肠内营养并发症(腹痛、腹胀、腹泻、恶心)发生情况.结果 术后第8天,2组患者ALB、PAB、TFN、Hb、TLC、IgA、IgG、IgM水平均显著升高(P均<0.05),且治疗组均显著高于对照组(P均<0.05).治疗组肠内营养并发症发生率显著低于对照组(P<0.05).结论 十全大补汤辅助肠内营养支持治疗可以更加有效地改善胃癌术后患者机体营养状况,增强免疫功能,降低肠内营养并发症发生率,促进患者康复.

目的:探讨经空肠营养管早期给予免疫型肠内营养联合活菌制剂对高脂血症性急性胰腺炎患者临床预后的影响.方法:选择2012年1月至2015年12月收入院的高脂血症性急性胰腺炎患者68例,随机分为观察组(34例)和对照组(34例).所有患者均接受急性胰腺炎规范化治疗,待患者肠功能恢复后,均早期给予肠内营养支持治疗,对照组给予常规肠内营养,观察组在常规营养支持基础上添加免疫增强组件并联合使用活菌制剂.治疗后比较两组患者体征变化和血、尿淀粉酶恢复正常时间;比较两组患者治疗前和治疗后l周、2周的机体免疫指标和营养状态指标以及治疗2周后炎症反应指标的变化情况.结果:观察组腹痛、腹胀缓解时间及血、尿淀粉酶恢复正常时间均短于对照组(P＜0.05) ;两组患者治疗前的机体免疫指标和营养状态指标无明显差异(P＞0.05),但观察组在治疗l周和2周后的免疫指标和营养状态指标均优于对照组(P＜0.05) ;同时治疗2周后炎症反应指标下降,观察组指标均低于对照组(P＜0.05).结论:早期给予免疫型肠内营养联合活菌制剂治疗高脂血症性急性胰腺炎能更加有效地缓解临床症状,改善患者营养状况及免疫功能,降低患者急性反应期炎症反应,提高临床疗效.

Objective To observe the influence of early enteral nutrition on gastrointestinal function and nutritious status of gastric carcinoma after operation.Methods 92 patients with gastric carcinoma were selected and randomly divided into the control group and the observation group,with 45 cases in each group.The control group was treated with parenteral nutrition group 24 h after operation.The observation group was treated with enteral nutrition group.Recovery time of evacuation,defecation,and bowel sound in the 2 groups were recorded.Occurrence rate of abdominal distension was compared in both groups.Levels of prealbumin (PA),albumin (ALB),and growth hormone (GH) were detected in both groups by Elisa.Results After operation,time of evacuation,defecation,and bowel sound for the first time in the observation group were shorter than the control group (P ＜ 0.01).Occurrence rate of abdominal distension in the observation group was obviously lower than the control group 24 and 48 hours after operation(P ＜ 0.01).The excellent and good rate of the observation group was 53.33％,which was higher than the control group,28.89％ with statistical differences (P ＜ 0.05).10 days after operation,serum levels of GH,PA,and ALB in the observation group were evidently higher than the control group with statistical differences (P ＜ 0.01).Condusion Early enteral nutrition can promote the recovery of gastrointestinal function and improve nutritious status of gastric carcinoma after operation.

高脂血症性急性胰腺炎(HAP)是急性胰腺炎的常见病因之一.临床治疗以综合治疗为主,在患者恢复排气、疼痛缓解及充分的液体复苏后,应尽快采取肠内营养(EN) [1].免疫营养组件强化的EN治疗可改善患者营养状况及免疫功能,减少并发症.我们对HAP患者给予添加精氨酸、谷氨酰胺、ω-3多不饱和脂肪酸等免疫增强组件的免疫型肠内营养支持治疗,评价免疫型肠内营养支持对HAP患者临床预后的改善.

Objective To investigate the effect of surgical resection combined with chemotherapy on the survival of pa -tients with advanced colorectal cancer liver metastasis .Methods 102 patients with advanced colon cancer liver metastasis were selected.35 patients with surgical resection combined with chemotherapy were the observation group ,and 67 patients treated with chemotherapy were the control group .Follow up was 3 years,till TTP the adverse reactions occurred .1-,2-and 3-year cumulative survival rates of the 2 groups were compared .Results In the observation group ,160 patients were treated by chemotherapy ,and the average was 4.57 courses,TTP was 14 months.The control group was treated with 359 courses of chemotherapy ,the average was 5.35 courses,TTP was 8 months,and the difference between the two groups (P<0.05).The incidence of anemia in the ob-servation group was significantly higher than that of the control group (P<0.05),and the last adverse reactions was not statisti-cally significant(P>0.05).In the observation group,the median survival time was 26.5 months,and the median survival time was 22.7 months in the control group,the difference was statistically significant(P<0.05).1-,2-and 3-year survival rates of the observation group were 88.6%,42.9%and 57.1%,respectively,and 34.3%,71.6%,44.8% of the control group.There was significant difference in 1-year survival rate(P<0.05),the difference in 2-and 3-year survival rate was not statistically significant (P>0.05).Conclusion Surgery combined with chemotherapy for advanced colon cancer patients does not increase the side effects of chemotherapy ,it can improve efficacy and survival .Patients of advanced colorectal cancer with liver metastases in sur-gery testified should be treated actively .

目的 探讨手术切除联合肝动脉化疗栓塞对晚期结肠癌肝转移患者生存状况的影响.方法 回顾性研究接受手术切除联合肝动脉化疗栓塞治疗的晚期结肠癌肝转移85例患者的临床及随访资料、生存状况,并对影响远期生存率的因素进行统计学分析.结果 85例患者在经过手术切除联合肝动脉化疗栓塞治疗后,1、3、5年生存率分别达到85.9％ (73/85),27.1％(23/85)和7.1％(6/85).单因素分析表明年龄、化疗时间、肝外转移、肿瘤大小数目和结肠癌肿瘤原发位置为晚期结肠癌肝转移患者生存状况的影响因素.多因素分析结果表明肝内肿瘤大小及数目(P =0.003)、化疗时间的选择(P =0.024)、患者的年龄(P=0.031)以及合并肝外转移(P =0.029)为患者生存状况的独立影响因素.结论 采用手术切除联合肝动脉化疗栓塞治疗晚期结肠癌肝转移,其预后主要受肝脏肿瘤的数目和大小、化疗时间的选择以及患者的年龄和是否有肝外转移的影响.

目的 研究经鼻空肠营养管给予中药复方大柴胡汤联合生大黄外敷治疗高脂血症性急性胰腺炎(hyperlipidemic acute pancreatitis,HLAP)的临床疗效.方法 选择2012年1月-2014年12月收治的80例HLAP患者作为研究对象,随机分为对照组和治疗组各40例.对照组给予急性胰腺炎(acute pancreatitis,AP)规范化治疗,治疗组在对照组的基础上经鼻空肠营养管注入复方大柴胡汤煎剂75 ml/次,2次/d,同时给予生大黄30 g外敷治疗,2次/d,两组均治疗7d.比较两组临床疗效及患者腹痛、腹胀缓解时间、首次排便时间及血、尿淀粉酶恢复时间、血TG浓度.计量资料组间比较采用t检验,组内比较采用配对t检验,计数资料采用x2检验,P＜0.05为差异有统计学意义.结果 治疗组总有效率为95.0％,高于对照组的72.5％,两组比较差异有统计学意义(P＜0.05).治疗组腹痛、腹胀缓解时间、首次排便时间及血、尿淀粉酶恢复时间分别为[(2.9±0.5)、(3.3±0.7)、(3.8±0.6)、(6.6±0.6)、(8.8±1.2)d],均短于对照组的[(4.8±0.9)、(5.0±1.3)、(4.9±0.8)、(7.3±1.1)、(10.2±1.5)d],差异均有统计学意义(均P＜0.05).治疗后,对照组与治疗组血TG浓度分别为(2.20±0.39)、(3.10±1.66)mmol/L,均低于治疗前的(9.91±3.90)、(10.06±4.28)mmol/L,差异均有统计学意义(均P＜0.05),两组治疗后比较差异有统计学意义(P＜0.05).结论 经鼻空肠营养管给予复方大柴胡汤联合生大黄外敷治疗能有效控制HLAP患者的全身炎症反应,促进胃肠道功能恢复,缩短病程,疗效满意.

Objective To evaluate the curative effect of the integrated traditional Chinese and western medicine for the treatment of acute biliary pancreatitis (ABP). Methods Seventy-eight patients with ABP were admitted in our hospital from January 2008 to December 2012 were randomly divided into integrated traditional Chinese and western medicine treatment group (group A) and western medicine treatment group (group B). The patients in group B (n=32) received emergent endoscopic procedures and routine treatment, while those in group A (46 cases) were treated by the Chinese medicineDa Chai Hu Tangby stomach tube based on emergent endoscopic procedures and routine treatment. Results Compared with group B, the total effective rate of group A (89.1%) was significantly higher (P0.05). The two groups showed no statistically significant difference in blood amylase before treatment (P0.05). 3 d, 7 d and 14 d after treatment, the decrease in blood amylase of group A was more significant than that of group B (P0.05). Conclusion The method of duodenoscope combined with Chinese medicineDa Chai Hu Tangis effective, with good curative effect, fast recovery, which is worthy to be widely used.

目的 探讨中西医结合治疗对急性胆源性胰腺炎患者临床预后的影响.方法 将60例急性胆源性胰腺炎患者,随机分为治疗组(中西医结合治疗组)与对照组(西医治疗组)各30例.二组患者经十二指肠镜治疗后,均予急性胰腺炎规范化治疗,包括监测生命体征、禁食水、胃肠减压、补充液体、维持水电解质和酸碱平衡、抗感染、镇痛、抑酸治疗、抑制胰酶活性等.治疗组经胃管注入中药复方大柴胡汤.比较二组患者治疗效果,观察二组患者腹痛腹胀缓解时间、首次排便时间、血尿淀粉酶恢复正常时间及第三天、第七天时A-PACHE-Ⅱ评分等.结果 治疗组疗效优于对照组,差异有统计学意义(P＜0.05).治疗组腹痛腹胀缓解时间、首次排便时间、血尿淀粉酶恢复正常时间均短于对照组,差异均有统计学意义(P＜0.05).二组治疗3d、7d时APACHE-Ⅱ评分均下降,以治疗组下降更明显,差异有统计学意义(P＜0.05).结论 十二指肠镜联合经胃管注入复方大柴胡汤治疗急性胆源性胰腺炎能够提高临床疗效,促进胃肠道功能恢复,缩短病程,值得推广应用.