幽门螺杆菌是人体胃内常见的致病菌,不仅导致胃器质性损害,还参与多种胃肠动力性疾病的发生发展.幽门螺杆菌影响胃肠动力的机制复杂,包括直接作用,如影响胃肠激素和神经肽的分泌、减少Cajal间质细胞、导致低度炎症等,也可通过脑—肠—微生物轴、神经免疫、神经内分泌等途径间接影响胃肠动力.因此,根除幽门螺杆菌可能对改善胃肠动力有益,多数胃器质性病变和功能性胃肠病都能从中获益.

目的:根据功能性便秘(functional constipation,FC)患者临床资料分析内脏自主神经功能与便秘症状特征、心理状态及生活质量的相关性.方法:评估102例FC患者和42例健康对照者的一般资料、精神心理状态和心率变异性(heart rate variability,HRV)检测结果,再根据HRV检测结果将FC患者分为自主神经张力偏向正常组、严重偏向交感神经张力组和严重偏向副交感神经张力组;比较各组间Zung's焦虑自评量表(self-rating anxiety scale,SAS)和抑郁自评量表(self-rating depression scale,SDS)、便秘评分系统(constipation scoring system,CSS)和便秘患者症状自评量表(patient assessment of constipation symptoms,PAC-SYM)、便秘患者生活质量自评问卷(patient assessment of constipation quality of life,PAC-QOL)分值差异,同时比较不同HRV分组间肛直肠测压参数、肠电图参数差异,分析便秘患者生活质量与自主神经功能、精神心理状态、便秘症状之间的相关性.结果:与健康对照组相比,FC患者焦虑抑郁水平显著升高,HRV检测结果显示自主神经功能异常率高.不同HRV分组的FC患者间肛直肠测压参数、肠电图参数差异无统计学意义;与交感-副交感神经张力偏向正常组相比,严重偏向交感神经张力组患者明显存在明显的焦虑抑郁情绪、PAC-SYM较高、生活质量降低(主要是躯体不适和担心焦虑两个维度).严重偏向副交感神经张力组患者CSS评分最高,可能与抑郁情绪为主导有关.多重线性回归显示,患者的焦虑抑郁情绪、自主神经功能显著影响便秘患者生活质量.结论:自主神经功能紊乱的便秘患者存在明显的焦虑抑郁情绪,与便秘严重程度相比,自主神经功能紊乱、焦虑抑郁情绪对便秘患者的生活质量具有更明显的负面影响.调节自主神经功能、心理干预或中枢神经药物等治疗可能具有重要临床意义.

目的:探讨吞咽困难对食管早期肿瘤及癌前病变患者食管动力、心理状态和临床相关症状的影响.方法:纳入2020年3月-2021年9月在南京医科大学第一附属医院消化内科住院确诊为食管早期肿瘤及癌前病变拟行内镜治疗的60例患者,根据有无合并吞咽困难将患者分为吞咽困难组和无吞咽困难组,分别比较两组患者在临床特征、高分辨率食管测压(HRM)参数以及焦虑自评量表(SAS)、抑郁自评量表(SDS)、胃食管反流病自评量表(GERDQ)评分的差异,分析HRM异常参数与原发病灶参数的相关性.结果:吞咽困难组患者的食管下括约肌(LES)中心点位置低于无吞咽困难组患者,LES静息压、LES残余压、无效吞咽百分比显著高于无吞咽困难组患者(P＜0.05),HRM异常参数与原发病灶参数之间未见明显相关性(P＞0.05),吞咽困难组患者的SAS、SDS评分高于无吞咽困难组(P＜0.05),而两组患者GERDQ评分比较差异无统计学意义(P＞0.05).结论:食管早期肿瘤及癌前病变患者出现的吞咽困难症状与合并的异常食管动力有关,同时在一定程度上影响了患者的心理状态,对患者的临床相关症状无明显影响.

[This corrects the article DOI: 10.3389/fcell.2020.00484.].

目的:探讨17β-雌二醇(17β-estraial,E2)对大鼠结肠平滑肌细胞(smooth muscle cell,SMC) RhoA/ROCK通路的影响.方法:体外分离培养Sprague-Dawley (SD)大鼠结肠SMCs.细胞免疫荧光双标法观察ROCK1、雌激素受体(ER)α与α肌动蛋白(α-SMA)共表达.不同浓度和不同时间E2刺激后,以反转录实时荧光定量qRT-PCR、Western blot检测RhoA、ROCK1表达.不同浓度ROCK抑制剂Y27632刺激后,Western blot检测E2对其下游蛋白表达情况.观察ER阻断剂ICI182780、牛血清白蛋白结合的E2(BSA-E2)、ERα激动剂PPT及ERβ激动剂DPN在E2影响RhoA、ROCK1表达的作用.构建ERα、ERβ的siR-NA,观察E2刺激对转染后SMC中RhoA、ROCK1表达的影响.结果:细胞免疫荧光示结肠SMC上ROCK1与α-SMA共表达.50 nmol/L E2刺激24h可显著抑制大鼠结肠SMC上RhoA、ROCK1表达(P＜0.05).Y27632可浓度依赖性抑制下游蛋白p-MYPT1、p-CPI17、p-MLC表达.E2组及PPT组RhoA、ROCK1表达显著低于其他各组(P＜ 0.05).ERα siRNA组可上调RhoA、ROCK1表达(P＜0.05).结论:大鼠结肠SMC上存在ROCK1,E2可抑制RhoMROCK通路表达,该作用由雌激素α受体介导.

背景:肥胖与多种功能性胃肠病相关,肥胖者常存在胃肠动力障碍,且血清脂肪细胞因子内脏脂肪素(VF)水平明显升高.既往研究显示VF可抑制子宫、血管平滑肌收缩.目的:探讨VF对大鼠结肠平滑肌收缩的影响及其可能机制.方法:取正常Sprague-Dawley (SD)大鼠远端结肠制备成0.3 cm×0.8 cm的肌条,使用生物信号分析系统记录VF对肌条收缩活动的影响.体外培养SD乳大鼠结肠平滑肌细胞,予VF干预,以蛋白质印迹法检测肌球蛋白轻链(MLC)磷酸化水平和钙通道Cav1.2(α1亚基)表达;以激光共聚焦显微镜观察细胞外有或无Ca2+的情况下乙酰胆碱刺激引起的细胞内Ca2+浓度变化.结果:在肌条收缩实验中,VF(200 ng/mL)可显著减弱正常大鼠结肠平滑肌肌条的收缩张力(P＜0.05).在结肠平滑肌细胞实验中,VF(200 ng/mL)可下调Cav1.2通道表达,降低细胞内Ca2+浓度和MLC磷酸化水平(P＜0.05).结论:VF可能通过下调结肠平滑肌细胞膜Cav1.2通道表达降低细胞内Ca2+浓度,引起结肠平滑肌收缩障碍,从而参与结肠动力障碍的发生.

Objective To investigate the differences of anorectal manometry (ARM) parameters in different position (left lateral position and seated position) in patients with functional constipation (FC),and the value of rectoanal pressure gradient (RAPG) was assessed in seated position in the evaluation of anorectal motility disorder in patients with FC.Methods From March 2015 to July 2016,at Clinical Gastrointestinal Motility Center of Ningbo Yinzhou People's Hospital,66 consecutive patients with FC aged 18 to 75 who met Rome Ⅲ criteria were recruited.The questionnaires of patient assessment of constipation symptom (PAC-SYM)and patient assessment of constipation quality of life (PAC-QoL) were recorded.Patients randomly underwent ARM examination in left lateral or seated positions,and then followed by a balloon expulsion test (BET) in seated position.The differences of ARM parameters in different positions were compared.The correlation between ARM parameters and BET results,constipation symptoms and quality of life scores were analyzed.T-test,Spearman correlation analysis and Kappa coefficient were performed for statistical analysis.Results ARM parameters including rectal resting pressure,rectal defecation pressure and RAPG in seated position were both higher than those of left lateral position ((30.83 ±7.89) mmHg (1 mmHg =0.133 kPa) vs.(10.53 ± 3.94) mmHg,(78.86±22.25) mmHg vs.(54.92±21.26) mmHg,(17.53 ±27.40) mmHg vs.(-7.80 ±26.88) mmHg),and the differences were statistically significant (t =-21.10,-12.35 and-8.84,all P ＜ 0.01).However,there was no significant difference in anal-related pressure parameters (P ＞ 0.05).The RAPG in seated position was highly consistent with BET,with a maximum Kappa-value of 0.643,which was higher than the maxium Kappa-value of 0.349 in left lateral position.The optimal RAPG threshold of seated position was 10 mmHg,the sensitivity of RAPG in the prediction of BET was 85.71％ and the specificity was 79.17％.According to the optimal RAPG threshold in seated position,the patients were divided into high RAPG group and low RAPG group.The frequency of weekly spontaneous defecation of high RAPG group was higher than that of low RAPG group (2.88 ±2.16 vs.1.66 ±0.96),and the difference was statistically significant (t=2.65,P=0.01).The satisfaction score of PAC-QoL questionnaire of high RAPG group was lower than that of low RAPG group (2.05 ±0.55 vs.2.83 ±0.78),and the difference was statistically significant (t =-4.72,P ＜0.01).Conclusion It may be more reasonable to perform ARM in the seated position in FC patients,especially for the RAPG in seated position is better correlated with BET results,constipation symptoms and quality of life scores which may have more clinical value in the evaluation of anorectal motility disorder in FC patients.

目的 分析食管高分辨率测压(HRM)参数与经口内镜下肌切开术(POEM)术后贲门失弛缓症(AC)症状改善程度的相关性.方法 收集POEM术前与术后AC患者的Eckardt评分问卷及HRM检查结果.采用Spearman相关系数分析HRM参数与POEM术后AC症状改善程度的相关性.结果 24例AC患者的Eckardt总分及各症状评分均较术前明显下降,且下降程度与AC分型无关.12例AC患者术后IRP及Ⅱ型AC患者远端食管体部收缩波幅均较术前明显下降.POEM术前IRP与术后Eckardt总分、体质量下降评分的改善程度呈正相关.结论 IRP与POEM术后AC症状改善程度具有相关性.

目的 建立硫氰酸钾分光光度法快速测定多维铁口服液中铁含量的分析方法.方法 样品经酸化氧化处理,考察了硫氰酸钾分光光度法的最大吸收波长、显色剂的最佳用量、最佳显色时间、精密度和加标回收率,并与国标法进行了比较.结果 方法的最大吸收波长为480 nm,最佳显色剂用量为1.00 mL 50％的硫氰酸钾溶液,最佳显色时间是10 min,方法线性回归方程为Y=0.12037X+0.00357,相关系数为0.99988,检出限为0.020 μg/mL,回收率为99.5％～100.94％,相对标准偏差为0.15％～0.48％.结论 与国标法比较,该方法具有良好的精密度、准确度和重复性,且成本较低、易于控制、操作简单、快速、稳定等优点.

Aims: To investigate the effect of advanced glycation end products (AGEs) on contractile activity of rat distal colon and its possible mechanisms. Methods: Contractile responses of colonic smooth muscle strips from male SD rats were recorded using a polyphysiograph. Colonic smooth muscle cells were isolated and identified by immunofluorescence. Changes in [Ca2+] i in response to AGEs were measured by confocal laser scanning microscopy. Immunoprecipitation and Western blotting were used to examine the phosphorylation of type 3 InsP3 receptors (InsP3R3) in colonic smooth muscle cells. The PKC inhibitor chelerythrine and the PKC activator phorbol 12-myristate 13-acetate (PMA) was used to examine the role of PKC in the responses to AGEs. Results: Carbachol-induced contractions of colonic smooth muscle strips were relaxed following the administration of 150 mu g/mL and 200 mu g/mL AGEs compared to control, and this was significantly counteracted by prior administration of chelerythrine and decreased more significantly by prior administration of PMA before exposure to AGEs. AGEs at the concentration of 150 mu g/mL or 200 mu g/mL significantly inhibited [Ca2+] i compared with the control group. AGEs at 150 mu g/mL was considered as the most effective concentration in vitro, but this effect was less marked in the presence of chelerythrine. PMA (1 mu M) significantly enhanced AGEs-mediated effect on the decrease of [Ca2+] i. AGEs increased PKC activity compared to controls, and increased phosphorylation of InsP3R3. The latter effect was prevented by chelerythrine. Conclusions: AGEs inhibit contraction of colonic smooth muscle strips and reduce [Ca2+] i in colonic smooth muscle cells. The mechanism involves the release of InsP3R3-operated Ca2+ stores, regulated by the PKC signaling pathway.

Lowering of defense capability of esophageal mucosa plays an important role in the pathogenesis of gastroesophageal reflux disease (GERD). The defense function of esophageal mucosa is mainly completed by epithelial barrier, including epithelial cell membrane and tight junction (TJ). Studies have found that abnormal expression and distribution of esophageal epithelium TJ proteins may cause dilated intercellular spaces (DIS) in GERD patients. DIS may be served as an objective indicator of abnormal morphological structure of GERD esophagus. Therefore, investigating the correlation between TJ proteins, DIS and GERD has important clinical significance. It may provide a new direction for diagnosis and treatment of GERD, even for evaluation of therapeutic effect.

<正>便秘(constipation)即为排便次数减少、粪便量减少、粪便干结、排便费力;慢性便秘(chronic constipation,CC)的病程至少是6个月。随着社会老龄化、饮食结构改变、精神心理压力、社会因素等影响,CC的患病率逐年增加。CC可继发痔疮、肛裂等肛肠疾病,增加结肠癌、心血管疾病、阿尔茨海默病等发生风险,增加患者的经济和心理负担。目前的治疗主流是以药物为主的经验治疗,长期药物通便导致的不良反应、疗效减退、医疗资源耗费等,使便秘的非药物治疗得以重视。本文就CC的非药物治疗进行初步探讨。

血小板源性生长因子(platelet-derived growth factor,PDGF)是一种可刺激结缔组织增生的常见肽类调节因子,是成纤维细胞、平滑肌细胞(smooth muscle cell,SMC)、内皮细胞、神经元细胞及其他间充质来源的细胞强促分裂剂.近年来发现PDGF信号系统与消化道的许多疾病密切相关,但目前PDGF系统在哺乳动物胃肠道中的功能研究非常有限.现总结目前有关PDGF信号系统在消化道生理及疾病状态下的研究,为进一步研究其在哺乳动物消化系统发育、生理及病理状态下的功能提供背景。