Immune function, gastrointestinal hormone levels, and their clinical significance in patients with gastric ulcers complicated with depression

BACKGROUND Gastric ulcer(GU)is a common digestive tract disease,and medical records of GU combined with depression are increasingly common.Currently,the risk factors and pathogenesis of GU complicated with depression remain unclear.Low immune function and gastrointestinal hormone levels may also be significant risk factors.Therefore,this study explored the immune function and gastrointestinal hormone levels in patients with GU combined with depression.AIM To explore the immune function,gastrointestinal hormone level,and clinical significance of patients with GU combined with depression.METHODS A retrospective analysis was conducted on 300 patients with GU combined with depression admitted to Guizhou Provincial People’s Hospital from January 2021 to June 2022 as the study subjects.According to the Hamilton Depression Scale(HAMD)score,patients were divided into mild-to-moderate(n=210)and heavy(n=90)groups.Basic data,immune function indices[immunoglobulin A(IgA),IgM,IgG,serum CD4+and CD8+percentage,and CD4+/CD8+ratio],and gastrointestinal hormone indices[serum gastrin(GAS),cholecystokinin(CCK),and motilin(MTL)levels]were collected.The basic data of the two groups were compared,and the immune function and gastrointestinal hormone indices were analyzed.Multivariate logistic regression was used to analyze the factors influencing the severity of GU complicated with depression.The receiver operating characteristic(ROC)curve and area under the ROC curve(AUC)were used to analyze the value of the immune function index,gastrointestinal hormone index,and combined index in predicting the severity of GU complicated with depression.RESULTS There were no marked differences in sex,age,body mass index,abdominal distension,abdominal pain,belching,nausea,vomiting,or sleep disorders between the heavy and mild-to-moderate groups(P>0.05).There was a marked difference in the family history of depression between the heavy and mild-to-moderate groups(P<0.05).There were significant differences in serum IgA and IgM levels and serum CD4+,CD8+,and CD4+/CD8+ratios between the heavy and mild-to-moderate groups(P<0.05).Multivariate analysis showed that IgA,IgM,GAS,and CCK serum levels influenced the severity of GU with depression(P<0.05).The AUC of the ROC curve for serum IgA level predicting GU with depression severity was 0.808[95%confidence interval(CI):0.760-0.857],the AUC of the serum IgM level was 0.757(95%CI:0.700-0.814),the AUC of the serum GAS level was 0.853(95%CI:0.810-0.897),the AUC of the serum CCK level was 0.762(95%CI:0.709-0.822),the AUC of immune function(IgA,IgM)and gastrointestinal hormone levels(GAS,CCK)for the prediction of GU with depression severity was 0.958(95%CI:0.933-0.976).CONCLUSION Important factors influencing GU complicated with depression are serum IgA,IgM,GAS,and CCK indicators.They can be used as indicators to predict the severity of GU complicated with depression.

Gastric emptying and plasma levels of gastrointestinal hormones in patients with peptic ulcer

IM To study the plasma level of gastrointestinal hormones and gastric emptying in patients with peptic ulcer. METHODS Thirty patients with gastric ulcer (GU), and 29 duodenal ulcer (DU) and 12 controls were studied. Plasma levels of SS, VIP and SP were measured by radioimmunoassay, and gastric emptying half time (GET1/2) was determined with TC99mresin solid meal method. RESULTS GET1/2(min) was significantly longer in GU than that in controls (659±148 vs 533±43, P<001) and plasma VIP levels (ng/L) were significantly higher than in controls (375±107 vs 184±59, P<005). There was a significant positive correlation between GET1/2 and plasma VIP levels (r=055,P<001). No significant changes were found in SS and SP in GU compared with controls (P>005). GET1/2 in DU was markedly shorter than the control group (417±102 vs 533±43, P<001), and plasma SS levels (ng/L) significantly lower than those in controls (64±25 vs 119±34,P<001), there was a significant positive correlation between GET1/2 and SS levels (r=056,P<001). Plasma SP levels (ng/L) in DU were significantly higher than the controls (544±127 vs 416±58,P<001),there was a significant negative correlation between GET1/2 and SP levels (r=-068,P<001). No significant difference was found in the plasma VIP levels between DU and controls (P>005).CONCLUSION VIP elevation may contribute to the GET1/2 delay and the occurrence of GU. The increased SP and lowered SS may play important roles in the GET1/2 acceleration and the pathogensis of DU.

EFFECTS OF ENTERAL AND PARENTERAL NUTRITION ON GASTROENTERIC HORMONES AND GASTRIC MOTILITY AFTER SUBTOTAL GASTRECTOMY

Objective To investigate the effects of enteral nutrition （EN） and parenteral nutrition （PN） on gastric motility and gastroentefic hormones after subtotal gastrectomy. Methods Forty-one patients underwent gastrectomy were randomly divided into EN group （n=20） and PN group （n=21 ）. From the first postoperative day to the seventh day, patients received either EN （EN group） or PN （PN group） with isocalofic （84.9kJ·kg^-1·d^-1） and isonitrogenous （0.11g·kg^-1·d^-1） intake. Serum gastrin （GAS）, plasma mofilin （MTL）, and plasma cholecystokinin （CCK） were measured on preoperative day, the first and seventh postoperative day. Electrogastrography （EGG） was measured on preoperative day and the seventh postoperative day. Results Compared with preoperafion, blood GAS, MTL, and CCK levels of 41 patients decreased significantly on the first day after subtotal gastrectomy （ P 〈 0. 001 ）, but returned to the preoperative levels one week later. EGG after gastrectomy showed that gastric basal electrical rhythm was significantly restrained （ P 〈 0. 001 ）. On the seventh day after subtotal gastrectomy, plasma MTL and CCK levels in EN group were higher than those in PN group （ P 〈 0.05 ）. There was no difference in GAS level between two groups. EGG in EN group was better than that in PN group postoper- atively. Conclusions The levels of gastroentefitic hormones and the gastric motility decrease significantly after subtotal gastrectomy. In contrast with PN, EN can accelerate the recovery of MTL, CCK, and gastric motility after subtotal gastrectomy.

Effects of Xiangsha Liujunzi decoction drug serum on gastric antrum smooth muscle cells from rats with functional dyspepsia by regulating gastrointestinal hormones

Objective:To observe the effect and mechanism of Xiangsha Liujunzi decoction(XSLJZD)drug serum on gastric antrum smooth muscle cells(SMCs)in rats with functional dyspepsia(FD).Methods:Gastric antrum SMCs from rats with FD were isolated,cultured,and then divided into six groups as follows:control,model,domperidone,low-dose XSLJZD(LXSLJZD),medium-dose XSLJZD(MXSLJZD),and high-dose XSLJZD(HXSLJZD).Each group was administered the corresponding drug serum for intervention.Drug serum intervention conditions and proliferative activity of SMCs were tested by cholecystokinin octapeptide.Ghrelin,gastrin,somatostatin,and substance P(SP)levels were measured by ELISA.Somatostatin and SP mRNA expression was measured by real-time PCR.Results:A concentration of 10%drug serum for 24 h was decided to be the best intervention condition for later study.The mean optical density value in the model group was lower than that in the control group(P紏.001).Optical density values in the domperidone and HXSLJZD groups were higher than those in the model group(P?.025,P?.032,respectively).Gastrin,SP,and ghrelin levels in the model group were lower(P?.007,P?.037,P?.005,respectively),but somatostatin levels were higher,compared with those in the control group(P?.031).Gastrin,SP,and ghrelin levels in the domperidone,MXSLJZD,and HXSLJZD groups were higher than those in the model group(all P<.05).Somatostatin levels in the four drug-treated groups were lower than those in the model group(P?.002,P?.007,P?.001,P?.009,respectively).SP mRNA levels in the model group were lower than those in the control,domperidone,MXSLJZD,and HXSLJZD groups(P?.037 P?.016,P?.025,P?.002,respectively).Somatostatin mRNA levels in the model group were higher than those in the control and MXSLJZD groups(P紏.042,P紏.035).Conclusions:XSLJZD and domperidone drug serum effectively promote proliferative activity of gastric antrum SMCs in an FD model.The mechanism of this activity may be regulated by gastrointestinal hormones.

Rikkunshito increases peripheral incretin-hormone levels in humans and rats

BACKGROUND It was reported that rikkunshito(TJ-43)improved the cisplatin-induced decreases in the active form of ghrelin in plasma;however,other effects on gastrointestinal hormones have not been investigated.AIM To investigate the effects of TJ-43 on peripheral levels of incretin hormones,including gastric inhibitory polypeptide(GIP)and glucagon-like polypeptide-1(GLP-1),in humans and rats.METHODS Patients were divided into two groups,namely patients who received TJ-43 immediately following surgery[TJ-43(+)group]and those who received TJ-43 on postoperative day 21[TJ-43(-)group],and the plasma levels of active GIP and active GLP-1 were assessed.In animal experiments,rats were treated with TJ-43[rat(r)TJ-43(+)group]or without[rTJ-43(−)group]by gavage for 4 wk,and the plasma active GIP and active GLP-1 levels were measured.The expression of incretin hormones in the gastrointestinal tract and insulin in the pancreas were investigated by immunohistochemistry.Furthermore,the cyclic adenosine monophosphate activities were assessed in pancreatic tissues from rats treated with or without TJ-43 in vivo,and the blood glucose levels and plasma insulin levels were measured in rats treated with or without TJ-43 in oral glucose tolerance tests.RESULTS In humans,the active incretin hormone levels increased,and values were significantly greater in the TJ-43(+)group compared those in the TJ-43(-)group.In rats,the plasma active incretin levels significantly increased in the rTJ-43(+)group compared with those in the rTJ-43(-)group.GIP and GLP-1 expressions were enhanced by TJ-43 treatment.Moreover,plasma insulin levels increased and blood glucose levels were blunted in the rTJ-43(+)group.CONCLUSION The results show that TJ-43 may be beneficial for patients who undergo pancreatic surgery.

Gastrointestinal hormone abnormalities and G and D cells in functional dyspepsia patients with gastric dysmotility

AIM: To investigate the relationship between gastric dysmotility,gastrointestinal hormone abnormalities, and neuroendocrine cells in gastrointestinal mucosa in patients with functional dyspepsia (FD).METHODS: Gastric emptying was assessed with solid radiopaque markers in 54 FD patients, and the patients were divided into two groups according to the results, one with delayed gastric emptying and the other with normal gastric emptying. Seventeen healthy volunteers acted as normal controls. Fasting and postprandial plasma levels and gastroduodenal mucosal levels of gastrointestinal hormones gastrin, somatostatin (SS) and neurotensin (NT)were measured by radioimmunoassay in all the subjects.G cells (gastrin-producing cells) and D cells (SS-producing cells) in gastric antral mucosa were immunostained with rabbit anti-gastrin polyclonal antibody and rabbit anti-SS polyclonal antibody, respectively, and analyzed quantitatively by computerized image analysis.RESULTS: The postprandial plasma gastrin levels, the fasting and postprandial plasma levels and the gastric and duodenal mucosal levels of NT were significantly higher in the FD patients with delayed gastric emptying than in those with normal gastric emptying and normal controls. The number and gray value of G and D cells and the G cell/D cell number ratio did not differ significantly between normal controls and the FD patients with or without delayed gastric emptying.CONCLUSION: Our findings suggest that the abnormalities of gastrin and NT may play a role in the pathophysiology of gastric dysmotility in FD patients, and the abnormality of postprandial plasma gastrin levels in FD patients with delayed gastric emptying is not related to the changes both in the number and gray value of G cells and in the G cell/D cell number ratio in gastric antral mucosa.

Gastric motor effects of ghrelin and growth hormone releasing peptide 6 in diabetic mice with gastroparesis

AIM:To investigate the potential therapeutic significance of ghrelin and growth hormone releasing peptide 6 (GHRP-6) in diabetic mice with gastric motility disorders. METHODS: A diabetic mouse model was established by intraperitoneal (ip) injection of alloxan. Diabetic mice were injected ip with ghrelin or GHRP-6 (20-200 μg/kg), and the effects on gastric emptying were measured after intragastric application of phenol red. The effect of atropine, NG-nitro-L-arginine methyl ester hydrochloride (L-NAME) or D-Lys3-GHRP-6 (a growth hormone secretagogue receptor (GHS-R) antagonist) on the gastroprokinetic effect of ghrelin or GHRP-6 (100 μg/kg) was also investigated. The effects of ghrelin or GHRP-6 (0.01-10 μmol/L) on spontaneous or carbachol-induced contractile amplitude were also investigated in vitro, in gastric fundic circular strips taken from diabetic mice. The presence of growth hormone secretagogue receptor 1a transcripts in the fundic strips of diabetic mice was detected by reverse transcriptase polymerase chain reaction (RT-PCR). RESULTS: We established a diabetic mouse model with delayed gastric emptying. Ghrelin and GHRP-6 accelerated gastric emptying in diabetic mice with gastroparesis. In the presence of atropine or L-NAME, which delayed gastric emptying, ghrelin and GHRP-6 (100 μg/kg) failed to accelerate gastric emptying. D-Lys3-GHRP-6 also delayed gastric emptying induced by the GHS-R agonist. Ghrelin and GHRP-6 increased the carbachol-induced contractile amplitude in gastric fundicstrips taken from diabetic mice. RT-PCR confirmed the presence of GHS-R mRNA in the strip preparations. CONCLUSION: Ghrelin and GHRP-6 increase gastric emptying in diabetic mice with gastroparesis, perhaps by activating peripheral cholinergic pathways in the enteric nervous system.

Gastric mammalian target of rapamycin signaling,hormone production and energy metabolism

The obesity epidemic imposes a significant health burden on human beings.Current understanding of the mechanisms underlying the development of obesity is incomplete and contemporary treatment is often ineffective.Gastrointestinal hormones are important regulators of food intake and energy metabolism.Previous studies indicate that the mammalian target of rapamycin signaling pathway in the gastric mucosa is crucially involved in fuel sensing in the gastrointestinal tract and plays a critical role in the coordination of nutrient availability and ingestive behavior via the production of gastric hormones.As an important component of the brain-gut axis regulating food intake and energy homeostasis,energy sensing in the gastrointestinal tract may provide a novel insight into our understanding of the precise coordination between the organism and cel-lular energy state.

Role of sex hormones in gastrointestinal motility in pregnant and non-pregnant rats

AIM: To correlate gastric contractility, gastrointestinal transit, and hormone levels in non-pregnant(estrous cycle) and pregnant rats using noninvasive techniques. METHODS: Female rats(n = 23) were randomly divided into(1) non-pregnant,(contractility, n =6; transit, n = 6); and(2) pregnant(contractility, n = 5; transit, n = 6). In each estrous cycle phase or at 0, 7, 14, and 20 d after the confirmation of pregnancy, gastrointestinal transit was recorded by AC biosusceptometry(ACB), and gastric contractility was recorded by ACB and electromyography. After each recording, blood samples were obtained for progesterone and estradiol determination. RESULTS: In the estrous cycle, despite fluctuations of sex hormone levels, no significant changes in gastrointestinal motility were observed. Days 7 and 14 of pregnancy were characterized by significant changes in the frequency of contractions(3.90 ± 0.42 cpm and 3.60 ± 0.36 cpm vs 4.33 ± 0.25 cpm) and gastric emptying(168 ± 17 min and 165 ± 15 min vs 113 ± 15 min) compared with day 0. On these same days, progesterone levels significantly increased compared with control(54.23 ± 15.14 ng/m L and 129.96 ± 30.52 ng/mL vs 13.25 ± 6.31 ng/mL). On day 14, we observed the highest level of progesterone and the lowest level of estradiol compared with day 0(44.3 ± 15.18 pg/mL vs 24.96 ± 5.96 pg/mL). CONCLUSION: Gastrointestinal motility was unaffected by the estrous cycle. In our data, high progesterone and low estradiol levels can be associated with decreased contraction frequency and slow gastric emptying.

Growth hormone receptor expression in human primary gastric adenocarcinoma

The aim of this study was to determine the expression of growth hormone receptor（GHR） in patients with pri-mary gastric adenocarcinoma.We investigated 48 specimens of primary gastric adenocarcinoma and their cor-responding normal gastric mucosa.Immunohistochemistry and reverse transcription-polymerase chain reaction（RT-PCR） were used to detect the expression of GHR.Immunohistochemical analyses revealed that GHR was expressed in human primary gastric adenocarcinoma（36/48,75.0%） and appeared to be upregulated,compared to the normal mucosa（28/48,58.3%,P 〈 0.001）.A significant correlation was found between GHR expression and tumor stage（P 〈 0.001） and tumor differentiation（P 〈 0.001）.The average positive rate of ki-67 in GHR-positive tumors was 16.06%,while the positive rate in GHR-negative tumors was 6.17%（P 〈 0.01）.The average apoptosis index（AI） of GHR-positive tumors was 3.36%,which was significantly lower than that（7.33%） of GHR-negative tumors.In addition,27 of 48 cases of tumors had GHR mRNA expression,while only 17 of all 48 cases of normal mucosa did so.Our results indicate that the frequency of GHR was significantly higher in primary gastric adeno-carcinoma than that in normal gastric mucosa.GHR expression was significantly correlated with tumor differen-tiation and tumor grade.This finding supported a possible role of growth hormone in primary gastric adenocarci-noma pathophysiology.

替吉奥联合奥沙利铂对老年胃癌患者胃动力相关激素及基质金属蛋白酶-2、基质金属蛋白酶-9的影响

目的探讨替吉奥联合奥沙利铂对老年胃癌患者胃动力相关激素及基质金属蛋白酶-2(MMP-2)、基质金属蛋白酶-9(MMP-9)的影响。方法选取128例老年胃癌患者为研究对象,随机分成对照组(n=64)与观察组(n=64)。对照组给予替吉奥治疗,观察组给予替吉奥联合奥沙利铂治疗。观察2组的胃动力相关激素[胃动素(MTL)、血管活性肠肽(VIP)]、MMP-2与MMP-9、肿瘤标志物[癌胚抗原(CEA)、糖类抗原125(CA125)、糖类抗原19-9(CA19-9)]、临床疗效以及不良反应发生情况。分析胃动力相关激素与MMP-2、MMP-9及肿瘤标记物水平的相关性。结果治疗后,2组MTL低于治疗前,VIP高于治疗前,且观察组MTL低于对照组,VIP高于对照组,差异有统计学意义(P<0.05)。治疗后,2组MMP-2、MMP-9及CEA、CA125、CA19-9低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。观察组总有效率为70.31%,高于对照组的53.13%,差异有统计学意义(P<0.05)。2组不良反应发生率比较,差异无统计学意义(P>0.05)。MTL与MMP-2、MMP-9、CEA、CA125、CA19-9呈负相关(P<0.05);VIP与MMP-2、MMP-9、CEA、CA125、CA19-9呈正相关(P<0.05)。结论替吉奥联合奥沙利铂治疗老年胃癌患者的效果较好,且安全性较高。MTL、VIP与MMP-2、MMP-9及CEA、CA125、CA19-9在老年胃癌患者的疾病发展中起相互关联作用。

附子理中汤联合足三里穴位注射配合循经热熨法对腹腔镜胃癌术后(脾胃虚寒证)患者胃肠激素、炎症反应、营养参数和血清MIP-3α、Stathmin的影响

目的:观察附子理中汤联合足三里穴位注射配合循经热熨法对腹腔镜胃癌术后(脾胃虚寒证)患者胃肠激素、炎症反应、营养参数和血清微管解聚蛋白(Stathmin)、巨噬细胞炎性蛋白-3α(MIP-3α)的影响。方法:选择2021年1月至2023年3月该院收治的胃癌患者126例,分组方式为随机数字表法。对照组42例患者(脱落2例,最终纳入40例)给予常规西医治疗,观察1组42例患者(脱落3例,最终纳入39例)在对照组的基础上给予足三里穴位注射配合循经热熨法治疗,观察2组42例患者(脱落2例,最终纳入40例)在观察1组的基础上给予附子理中汤治疗。比较三组患者的临床疗效,记录肛门首次排气时间、首次经口进食时间和首次排便时间;术后1、15 d测定三组患者营养参数(血清血红蛋白、转铁蛋白和白蛋白),检测炎症反应指标[血红素加氧酶-1(HO-1)、缺氧诱导因子-1α(HIF-1α)和白细胞介素6(IL-6)]、胃肠激素指标[胃泌素17(G-17)、胃动素(MTL)]及MIP-3α、Stathmin水平。结果:观察1组、观察2组患者的总有效率分别为94.87%(37/39)、97.50%(39/40),高于对照组的75.00%(30/40),差异有统计学意义(P<0.05);而观察2组与观察1组患者总有效率的差异无统计学意义(P>0.05)。观察2组患者肛门首次排气时间、首次经口进食时间和首次排便时间短于对照组、观察1组,且观察1组患者短于对照组,差异均有统计学意义(P<0.05)。术后15 d,观察2组患者转铁蛋白、血红蛋白和白蛋白水平高于对照组、观察1组,且观察1组患者高于对照组;观察2组患者HO-1、HIF-1α和IL-6水平低于对照组、观察1组,且观察1组患者低于对照组;观察2组患者G-17、MTL水平高于对照组、观察1组,且观察1组患者高于对照组;观察2组患者Stathmin、MIP-3α水平低于对照组、观察1组,且观察1组患者低于对照组,上述差异均有统计学意义(P<0.05)。结论:附子理中汤联合足三里穴位注射配合循经热熨法治疗腹腔镜胃癌术后患者,可减少炎症反应,调节胃肠激素和营养参数,降低Stathmin、MIP-3α水平,促进疾病康复,提高临床疗效。

四磨汤加味方联合多潘立酮对老年胃癌根治术后胃肠功能紊乱的影响

目的:探讨四磨汤加味方联合多潘立酮对老年胃癌根治术后胃肠功能紊乱的影响。方法:纳入2021年1月—2023年5月于长治市人民医院就诊的胃癌根治术后胃肠功能紊乱患者80例,按随机数表方式分为观察组和对照组,每组40例。对照组给予多潘立酮治疗,观察组在对照组基础上加用四磨汤加味方。比较两组临床疗效,同时评估其中医证候积分以及胃肠功能恢复情况,另外评估两组胃激素指标[胃动素(MTL)、胃泌素(GAS)、血管活性肽肠(VIP)],比较两组不良反应发生情况。结果:观察组、对照组总有效率分别为95.00%(38/40)、80.00%(32/40),观察组高于对照组(P<0.05);两组治疗后各中医证候积分较治疗前降低(P<0.01),且观察组低于对照组(P<0.01);观察组胃肠功能恢复时间短于对照组(P<0.01);两组治疗后MTL、GAS升高而VIP降低(P<0.01),观察组治疗后MTL、GAS高于对照组(P<0.01),VIP低于对照组(P<0.01);两组不良反应总发生率差异无统计学意义(P>0.05)。结论:四磨汤加味方联合多潘立酮用于治疗老年胃癌根治术后胃肠道紊乱疗效显著,不仅能有效改善患者临床症状、体征,还能调节其胃肠道激素水平,具备安全性。

胃息肉切除术前GAS、MTL、PGs及Ghrelin水平特征对术后胃息肉复发的预测价值

目的探讨胃息肉切除术前胃泌素(GAS)、胃动素(MTL)、胃蛋白酶原(PGs)及胃饥饿素(Ghrelin)水平对术后胃息肉复发的预测价值。方法选择2019年5月—2021年12月新疆维吾尔自治区人民医院消化内科诊治胃息肉切除术后患者128例作为研究对象,患者均在术后持续随访2年,根据胃息肉是否复发划分为未复发组(n=86)和复发组(n=42)。检测并比较2组患者手术治疗前GAS、MTL、PGs及Ghrelin等胃肠激素水平;通过Spearman相关性分析、单因素及多因素Logistic回归分析筛选出胃息肉患者术后复发的独立危险因素,并通过受试者工作特征(ROC)曲线评估各危险因素独立及联合预测胃息肉复发的价值。结果复发组患者内镜下手术时间、存在多个胃息肉比例、最大胃息肉直径>2 cm比例均显著高于未复发组(Z/χ^(2)/P=3.453/0.001、5.965/0.015、7.342/0.007);术前血清GAS、MTL、PGⅠ、PGⅡ及Ghrelin均显著高于未复发组患者(t/P=7.736/<0.001、5.984/<0.001、6.326/<0.001、6.420/<0.001、6.326/<0.001);Spearman相关性分析表明,胃息肉切除术治疗患者内镜下手术时间、存在多个胃息肉、最大胃息肉直径>2 cm、血清GAS、MTL、PGⅠ、PGⅡ及Ghrelin均与术后胃息肉复发呈正相关(r/P=0.306/<0.001、0.216/0.014、0.239/0.006、0.563/<0.001、0.453/<0.001、0.486/<0.001、0.484/<0.001、0.458/<0.001);多因素Logistic回归分析发现,血清GAS、MTL、PGⅠ、PGⅡ及Ghrelin升高均是胃息肉术后患者疾病复发的重要独立危险因素[OR(95%CI)=1.394(1.086~1.789)、1.098(1.031~1.169)、1.081(1.026~1.139)、1.793(1.264~2.542)、1.059(1.007~1.114)];血清GAS、MTL、PGⅠ、PGⅡ、Ghrelin及五项联合预测胃息肉切除术后患者疾病复发的AUC分别为0.846、0.778、0.799、0.798、0.781及0.984,五项联合预测的价值大于各指标独立预测的价值(Z/P=3.014/<0.001、3.666/<0.001、3.354/<0.001、3.355/<0.001、3.462/<0.001)。结论胃息肉术后患者血清GAS、MTL、PGs及Ghrelin水平与胃息肉复发存在显著相关性,密切监测患者胃肠激素水平变化对于早期预测胃息肉复发、及时干预、改善患者预后均具有重要临床意义。

胃复春对不同NLR水平的胃早癌ESD术后患者的消化道症状、胃肠激素、胃功能指标和血常规指标的影响

背景胃复春可治疗内镜下剥离术(endoscopic submucosal dissection,ESD)后的胃早癌患者,中性粒细胞-淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)可作为评估此类患者活动度和预后的指标.目前尚未确定不同NLR水平的ESD术后胃早癌患者是否存在与之相关的胃复春疗效差异.目的探讨胃复春对不同NLR水平的胃早癌ESD术后患者的治疗效果.方法选取本院2020-01/2022-12收治的160例胃早癌ESD术后患者,将其分为常规治疗组(n=40)和常规治疗+胃复春治疗组(n=120).将胃复春治疗组再按照NLR水平进行三分位分组,分为高三分位组(NLR≥3.23)40例,低三分位组(NLR≤1.74)40例,中三分位组(NLR:1.74-3.23)40例.比较以上各组治疗前后的主要的消化道症状评分、胃肠激素水平、胃功能指标及血常规指标水平,并计算治疗的总有效率.结果与治疗前比较,治疗后各组患者的胃脘灼热、胃脘胀满、胃脘疼痛和胃纳呆滞评分均降低(P<0.05),其中以低三分位组治疗效果最佳(P<0.05),总有效率最高(P<0.05).常规治疗不能改变患者NLR与血小板-淋巴细胞比值(platelet to lymphocyte ratio,PLR)水平,而常规治疗+胃复春治疗能降低患者的NLR与PLR水平(P<0.05).治疗后,与常规治疗组比较,胃复春治疗组(低、中和高三分位组)的抑胃肽、胃动素、胃泌素、胃蛋白酶原Ⅰ和胃蛋白酶原比值水平均增高(P<0.05)、白细胞、胃蛋白酶原Ⅱ和癌胚抗原均降低(P<0.05),其中以低三分位组最为明显.结论胃复春在不同NLR水平的胃早癌ESD术后患者中均显示出改善消化道症状、胃肠激素、胃功能指标和血常规指标的作用,尤其对于低NLR水平患者而言,治疗效果最为显著.在选择治疗方法时,建议优先考虑低NLR水平的胃早癌ESD术后患者使用胃复春进行治疗.

艾司奥美拉唑镁联合瑞巴派特与康复新液治疗老年胃溃疡出血患者的效果

目的:观察艾司奥美拉唑镁联合瑞巴派特与康复新液治疗老年胃溃疡出血患者的效果。方法:选取2020年10月至2023年10月该院收治的97例老年胃溃疡出血患者进行前瞻性研究,按照随机数字表法将其分为对照组48例与观察组49例。对照组给予康复新液联合瑞巴派特治疗,观察组在对照组基础上增加艾司奥美拉唑镁治疗,比较两组临床疗效,治疗前后血管内皮功能指标[表皮生长因子(EGF)、前列腺素E_(2)(PGE_(2))]水平、胃肠激素[胃泌素(GAS)、胃动素(MTL)、生长抑素(SS)、降钙素基因相关肽(CGRP)]水平,以及不良反应发生率。结果:观察组治疗总有效率为95.92%(47/49),高于对照组的81.25%(39/48),差异有统计学意义(P<0.05);治疗后,两组EGF、PGE_(2)水平均高于治疗前,且观察组高于对照组,差异有统计学意义(P<0.05);治疗后,两组MTI、GAS水平均低于治疗前,且观察组低于对照组,两组SS、CGRP水平均高于治疗前,且观察组高于对照组,差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:艾司奥美拉唑镁联合瑞巴派特与康复新液治疗老年胃溃疡出血患者可提高治疗总有效率和血管内皮功能指标水平,以及改善胃肠激素水平的效果优于康复新液联合瑞巴派特治疗。

Jianqu,a traditional Chinese medicine,alleviates functional dyspepsia in high-calorie and high-protein diet mice

Background:Jianqu has been used to alleviate symptoms in patients with functional dyspepsia,but its specific anti-functional dyspepsia effect is still unclear.Therefore,our study aimed to investigate the impact of Jianqu on functional dyspepsia in mice.Methods:The phytochemical profile of Jianqu was analyzed by UPLC-Q-TOF-MS.Subsequently,Kunming mice were fed a high-calorie or high-protein diet(HCHP)for 7 days,and then orally treated with vehicle or Jianqu(1.62 g/kg body weight(b.w.)and 3.25 g/kg b.w.)for 10 days.A carbon powder solution was used to detect the gastric emptying and intestinal transit rate.The pathological changes in stomach and duodenum were evaluated by hematoxylin-eosin staining.The occludin,claudin-1,ZO-1 and CD45 expression was measured by immunocytochemical staining.Importantly,the serum gastrointestinal hormones were detected by ELISA.In addition,the gut microbiota composition was determined using 16S rRNA gene sequencing.The cecal short chain fatty acids were assessed by gas chromatography.Results:In general,17 phytochemical compounds were identified from Jianqu,which significantly improved the gastric emptying rate and intestinal transit rate(p<0.01),increased the body weight and food intake(p<0.0001)in HCHP mice as well.Though HCHP did not cause significant pathological lesions in the gastrointestinal tract,increased the expression of CD45 in the duodenum(p<0.05)was observed.Notably,Jianqu attenuated this abnormal expression of CD45(p<0.05).The levels of serum gastrointestinal hormones were significantly normalized by Jianqu intervention(p<0.05).Moreover,Jianqu increased the relative abundance of Roseburia as well as short chain fatty acids levels in cecum(p<0.05).Conclusion:The present results showed that Jianqu alleviated dyspeptic symptoms in HCHP mice possibly through reducing the duodenal leukocyte infiltration,and regulating the expression of gastrointestinal hormones.These effects may be partly related to the increasing cecal short chain fatty acids levels probably via gut microbial modulation.

腹腔镜胃修补术治疗急性胃穿孔患者的效果

目的:观察腹腔镜胃修补术治疗急性胃穿孔患者的效果。方法:回顾性分析2021年8月至2023年8月该院收治的102例急性胃穿孔患者的临床资料,依据手术方法不同将其分为观察组(n=51)和对照组(n=51)。观察组行腹腔镜胃修补术治疗,对照组行开腹胃修补术治疗,比较两组围术期指标水平,手术前后胃肠激素指标[胃泌素(GAS)、胃蛋白酶原(PG)Ⅰ、PGⅡ、胃动素(MTL)]水平、炎性应激因子[白细胞介素-8(IL-8)、去甲肾上腺素(NE)、前列腺素E_(2)(PGE_(2))、C反应蛋白(CRP)]水平、疼痛程度[视觉模拟评分法(VAS)]评分,以及术后1周并发症发生率。结果:观察组手术时间、住院时间、首次排气时间均短于对照组,术中出血量少于对照组,差异有统计学意义(P<0.05);术后3 d,观察组GAS、PGⅠ、MTL和PGⅡ水平均高于对照组,差异有统计学意义(P<0.05);术后3 d,观察组IL-8、NE、CRP和PGE_(2)水平均低于对照组,差异有统计学意义(P<0.05);术后1、3 d,观察组VAS评分均低于对照组,差异有统计学意义(P<0.05);两组并发症发生率比较,差异无统计学意义(P>0.05)。结论:腹腔镜胃修补术治疗急性胃穿孔患者可提高胃肠激素指标水平,降低围术期指标水平、炎性应激因子水平和疼痛程度评分,效果优于开腹胃修补术治疗。

枳术宽中胶囊联合莫沙必利对脾虚气滞型功能性消化不良患者胃肠激素、胃排空情况的影响

目的探究枳术宽中胶囊联合莫沙必利对脾虚气滞型功能性消化不良(FD)患者胃肠激素、胃排空情况的影响。方法选择2019年12月至2022年3月我院收治的102例脾虚气滞型FD患者为研究对象,按照随机数字表法将其分为对照组和观察组,各51例。对照组口服莫沙必利,观察组在对照组治疗基础上加服枳术宽中胶囊,均持续治疗1个月。比较两组的临床疗效、胃肠激素、胃排空情况及不良反应发生情况。结果观察组的治疗总有效率高于对照组(P<0.05)。治疗后,两组的促胃泌素(GAS)、血管活性肽(VIP)、胆囊收缩素(CCK)水平低于治疗前,胃动素(MTL)水平高于治疗前,且观察组优于对照组(P<0.05)。治疗后,两组的胃排空率高于治疗前,且观察组高于对照组(P<0.05)。两组的不良反应总发生率比较,差异无统计学意义(P=0.402)。结论枳术宽中胶囊联合莫沙必利治疗脾虚气滞型FD患者效果显著,能够有效调节胃肠激素水平,加快胃排空,安全可靠,可于临床推广。

小柴胡汤合香砂六君子汤对肝郁脾虚型慢性萎缩性胃炎患者胃黏膜病理积分改变与胃肠激素的影响

【目的】探讨小柴胡汤合香砂六君子汤对肝郁脾虚型慢性萎缩性胃炎(CAG)患者胃黏膜病理积分改变与胃肠激素的影响。【方法】将156例肝郁脾虚型CAG患者随机分为对照组和观察组,每组各78例。对照组给予常规西医治疗,观察组在对照组的基础上给予小柴胡汤合香砂六君子汤治疗,疗程为4周。观察2组患者治疗前后中医证候积分(胃脘胀痛、纳差便溏、四肢乏力、嗳气泛酸)、胃黏膜病理积分、胃肠激素[胃动素(MTL)、胃泌素(GAS)]水平的变化情况,比较2组患者的幽门螺旋杆菌(Hp)转阴率,评价2组患者的临床疗效和安全性。【结果】(1)治疗4周后,观察组的总有效率为93.59%(73/78),显著高于对照组的82.05%(64/78),组间比较,差异有统计学意义(P<0.05)。(2)治疗后,2组患者的胃脘胀痛、纳差便溏、四肢乏力、嗳气泛酸等各项中医证候积分均较治疗前明显降低(P<0.05),且观察组的降低幅度均明显优于对照组(P<0.05)。(3)治疗后,2组患者的胃黏膜病理积分均较治疗前明显降低(P<0.05),且观察组的降低幅度明显优于对照组(P<0.01)。(4)治疗4周后,观察组的Hp转阴率为91.03%(71/78),明显高于对照组的75.64%(59/78),组间比较,差异有统计学意义(P<0.05)。(5)治疗后,2组患者的血清GAS水平均较治疗前明显降低(P<0.05),血清MTL水平均较治疗前明显升高(P<0.05);且观察组对血清GAS水平的降低幅度及对血清MTL水平的升高幅度均明显优于对照组(P<0.05)。(6)2组患者用药期间的血、尿、大便常规以及肾、肝功能和心电图等安全性指标均无明显异常,也均未出现头晕、皮疹、胸闷等不良反应,具有较高的安全性。【结论】小柴胡汤合香砂六君子汤对肝郁脾虚型GAS的治疗效果显著,可有效减轻患者临床症状与胃黏膜病理改变,促进Hp转阴,其作用机制可能与调节胃肠激素水平有关。