Fulminant gastrointestinal graft-versus-host disease concomitant with cytomegalovirus infection:Case report and literature review

Here,we report a case of fulminant gastrointestinal graft-versus-host disease(GI-GVHD) with cytomegalovirus(CMV) infection in 44-year-old woman.Despite the difficulties associated with the treatment of GIGVHD and GI-CMV disease,the mucosal findings and the clinical course showed marked improvements during long-term clinical observation.The endoscopic findings were remarkable,with diffuse sloughing mucosa in the stomach and highly active inflammation and deep discrete ulcers throughout the colon.Changes in the CMV quantitative polymerase chain reaction results were correlated with the endoscopic mucosal findings and were useful for assessing the efficacy of the treatment.Although a definite diagnosis of GI-GVHD is generally made by endoscopy with biopsy,the gross appearance of this disease can vary depending on the endoscopy.In this paper,we also conduct a literature review of patients with GI-GVHD.

Gene expression of cytokines after allogeneic peripheral stem cell transplantation and its relationship with acute graft-versus-host disease

Objective: To investigate the role of cytokines IL-2, IL-4, IL-10, IL-12, and IFN-γ in pathogenesis of acute graft-versus-host disease (aGVHD) after allogeneic peripheral blood stem cell transplantation (allo-PBSCT). Methods: Forty-two patients undergoing allo-PBSCT were included in this study. Reverse-transcriptase polymerase chain reaction (RT-PCR) was used to analyze gene expression of cytokines IL-2, IL-4, IL-10, IL-12, and IFN-γ. Results: All patients achieved engraftment, 18 patients developed grade ⅠGVHD, 6 patients developed grade Ⅱ-Ⅳ GVHD. The gene expression of IL-2, IL-12, and IFN-γ increased, the gene expression of IL-4 and IL-10 decreased. Conclusion: Cytokines IL-2, IL-12, and IFN-γ lead to a positive regulation of the development in human aGVHD, and IL-4 and IL-10 play negative regulatory roles.

Intestinal expressions of eNOSmRNA and iNOSmRNA in rats with acute liver failure

AIM: To observe the gene expression change of eNOSmRNA and iNOSmRNA in the small and large intestines with acute liver failure (ALF), and to reveal the biological function of NO on the pathogenesis of ALF and multiple organs dysfunction at the molecular level. METHODS: Sixty male Wistar rats were selected, weighing from 250g to 350g, and divided into 5 groups randomly: SO, ALF (6h, 12h), L-Arg, L-NAME, L-Arg and L-NAME, each group with 10 rats. The dose of L-Arg was 300mg.kg(-1), and L-NAME was 30mg.kg(-1), the reagents diluted by normal saline were injected through tail vein 30 minutes pre and post operation. The rats in the ALF group were respectively sacrificed postoperatively at 6h, 12h, and the rats in the other groups were sacrificed postoperatively at 6h. The tissues of small and large intestines were harvested in 4% paraforaldehyde containing the reagent of DEPC and fixed at 6h, embedded in paraffin, and 4 microm section was cut. The expression of eNOSmRNA and iNOSmRNA in these tissues was determined with in situ hybridization, and analyzed with the imaging analysis system of CMM-3 and SPSS statistical software. RESULTS: The expression of eNOSmRNA in the large intestine and iNOSmRNA in the small and large intestines increased significantly at 6h after ALF, but the expression of iNOSmRNA in the small and large intestines reduced notably at 12h after ALF (P【0.05); the expression of eNOSmRNA in the large intestine and iNOSmRNA in the small and large intestines decreased significantly with the reagents of L-Arg at 6h ALF, but the expression of eNOSmRNA and iNOSmRNA in the small and large intestines decreased totally with the reagents of L-NAME or association with L-Arg 6h ALF. CONCLUSION: The expression of eNOSmRNA in the large intestine increased notably at the early stage of ALF, NO induced by the enzyme of eNOS from the transplantation of eNOSmRNA can protect the function of the large intestine, the high expression of iNOSmRNA is involved in the damaged function of the small and large intestines. NO precursor can reduce the expression of iNOSmRNA in the small and large intestines and the damage to intestines; NOS inhibitor or association with NO pre-cursor can totally lower the expression of eNOSmRNA and iNOSmRNA in the small and large intestines, it cannot notably influence the NOS inhibitor in the gene expression of eNOSmRNA and iNOSmRNA to supply the additional NO precursor.

Therapeutic strategies in Crohn’s disease in an emergency surgical setting

Crohn’s disease(CD)remains a chronic,incurable disorder that presents unique challenges to the surgeon.Multiple factors must be considered to allow development of an appropriate treatment plan.Medical therapy often precedes or complements the surgical management.The indications for operative management of CD include acute and chronic disease complications and failed medical therapy.Elective surgery comes into play when patients are refractory to medical treatment if they have an obstructive phenotype.Toxic colitis,acute obstruction,perforation,acute abscess,or massive hemorrhage represent indications for emergency surgery.These patients are generally in critical conditions and present with intra-abdominal sepsis and a preoperative status of immunosuppression and malnutrition that exposes them to a higher risk of complications and mortality.A multidisciplinary team including surgeons,gastroenterologists,radiologists,nutritional support services,and enterostomal therapists are required for optimal patient care and decision making.Management of each emergency should be individualized based on patient age,disease type and duration,and patient goals of care.Moreover,the recurrent nature of disease mandates that we continue searching for innovative medical therapies and operative techniques that reduce the need to repeat surgical operations.In this review,we aimed to discuss the acute complications of CD and their treatment.

Prospective evaluation of intestinal decompression in treatment of acute bowel obstruction from Crohn’s disease

Background:Conservative therapy for Crohn’s disease(CD)-related acute bowel obstruction is essential to avoid emergent surgery.The present study aimed to evaluate the efficacy of using a long intestinal decompression tube(LT)in treatment of CD with acute intestinal obstruction.Methods:This is a prospective observational study.Comparative analysis was performed in CD patients treated with LT(the LT group)and nasogastric tube(the GT group).The primary outcome was the avoidance of emergent surgery.Additionally,predictive factors for failure of decompression and subsequent surgery were investigated.Results:There were 27 and 42 CD patients treated with LT and GT,respectively,in emergent situations.Twelve(44.4%)patients using LT were managed conservatively without laparotomy,while only nine(21.4%)patients in the GT group were spared from emergent surgery(P<0.05).Both in surgery-free and in surgery patients,the time to alleviation of symptoms was significantly shorter in the LT groups than in the GT groups(both P<0.01).C-reactive protein decrease after intubation and 48-hour drainage volume>500mL were predictors of unavoidable surgery(both P<0.05).The rate of temporary stoma and incidence of incision infection in the LT surgery group were significantly lower than those in the GT group(both P<0.05).No significant differences were observed in the frequency of medical and surgical recurrences between the LT and GT groups(all P>0.05).Conclusions:Endoscopic placement of LT could improve the emergent status in CD patients with acute bowel obstruction.The drainage output and changes in C-reactive protein after intubation could serve as practical predictive indices for subsequent surgery.Compared to traditional GT decompression,LT decompression was associated with fewer short-term complications and did not appear to affect long-term recurrence.

Acute respiratory distress syndrome associated with severe ulcerative colitis

Various extraintestinal manifestations including pulmonary abnormalities have been reported in patients with ulcerative colitis. Acute respiratory distress syndrome (ARDS) is a serious and fatal pulmonary manifestation. We have experienced a 67-year-old male patient with ARDS associated with a severe type of ulcerative colitis (UC). Severe dyspnea symptoms occurred during the treatment of UC in a previous hospital and the patient was transferred to our hospital on June 27, 2007. Both blood and sputa cultures for bacteria and fungi were negative. Cytomega-lovirus antigenemia was also not detected. From the clinical and radiological [Chest X-ray, computed tomography (CT)] findings, the patient was diagnosed with ARDS on the basis of the def inition of ARDS developed by the European-American Consensus Conference on ARDS. Both colonic inflammations and ARDS symptoms of the patient were resistant to any medical treatment includingcorticosteroids and antibiotics. However, ARDS symptoms were dramatically improved after surgical colectomy. We believe that severe colonic inflammation from UC was closely associated with the onset of ARDS of the patient. Our case report suggests that a severe type of ulcerative colitis might be taken into consideration as one of the predisposing factors of ARDS.

Acute GvHD and the cutaneous ultrastructural changes in mismatched bone marrow transplantation

Six patients treated with human leukocyte antigen (HLA)-mismatched bone marrow transplantation (BMT) suffered from grade I to IV acute graft-versus-host disease (aGvHD) after engrafting. Up to date, 4 patients with grade I to II GvHD have lived for over 2920, 910, 740 and 680 days, respectively. Two other patients died of grade IV hyperacute GvHD. The results seem to indicate that patients in mismatched BMT have a high incidence of aGvHD within a month. The severity of aGvHD is positively correlated with the degree of HLA mismatching. The higher the degree of mismatch of HLA, the earlier and the more severe the aGvHD occurrs. The cutaneous lesion of the patient with GvHD is severe and of ten complicated by mucositis. Lethal hyperacute GvHD must be considered when a patient shows following signs at beginning: (1) The symptoms appear early (within 2weeks) ;(2) peripheral white blood cell count does not recover (<0. 5×109/L) to normal; and (3) high fever persists. In the epidermal ultrastructure of patients, besides acantholysis, autophagic degeneration of keratinocytes,and satellite cell dyskeratosis, there were scattered necrotic keratinocytes, breaking and thickening of basal membrane and presence of a lot of pigment in the intercellular space. These imply that the ultrastructural damages in the skin of patients with aGvHD after mismatched transplantation are more severe than after matched ones.

Arsenic trioxide alleviates acute graft-versus-host disease by modulating macrophage polarization

This study aimed to explore macrophage polarization in acute graft-versus-host disease after hematopoietic stem cell transplantation, and investigated if arsenic trioxide(ATO) could correct this imbalance. In the colon of GVHD mice, we found that the number of F4/80+iNOS+ cells as well as the expression intensity of TNF-α and IL-1β was greater in the GVHD group than in the BM group, whereas the number of F4/80+CD206+ cells and the expression intensity of IL-10 and TGF-β was greater in the BM group than in the GVHD group. We investigated the effect of ATO on GVHD mice, and found that ATO treatment clearly improved the survival of the mice and reduced the severity of GVHD. In addition, ATO reduced the number of F4/80+iNOS+ cells, and increased the number of F4/80+CD206+ cells in the colon of GVHD mice. Furthermore, ATO sharply decreased CD86 and CD80 expression, and increased CD163 and CD206 expression in macrophages induced from aGVHD patients. Therefore,ATO can modulate the M1 and M2 phenotype in GVHD mice or in macrophages from aGVHD patients. Our data suggest that macrophage polarization is involved in the pathogenesis of aGVHD, and ATO treatment modulates macrophage polarization toward an M2 phenotype.

Risk factors for chronic graft-versus-host disease after anti-thymocyte globulin-based haploidentical hematopoietic stem cell transplantation in acute myeloid leukemia

Chronic graft-versus-host disease(cGVHD)is a major complication following unmanipulated haploidentical hematopoietic stem cell transplantation(haplo-HSCT).We aimed to identify the risk factors for cGVHD in patients who underwent anti-thymocyte globulin-based haplo-HSCT for acute myeloid leukemia(n=280).The diagnosis of cGVHD was in accordance with the National Institutes of Health consensus criteria.A total of 169 patients suffered from cGVHD.The patients who had 3 loci mismatched had a higher 8-year incidence of cGVHD(total,66.0%vs.53.7%,P=0.031;moderate to severe,42.4%vs.30.1%,P=0.036)than the patients who had 1 to 2 loci mismatched.The patients who had maternal donors had a higher 8-year incidence of moderate to severe cGVHD(49.2%vs.32.9%,P=0.024)compared with the patients who had other donors.The patients who had grades III to IV acute GVHD(aGVHD)had higher 8-year incidence of cGVHD(total,88.0%vs.50.4%,P<0.001;moderate to severe,68.0%vs.27.0%,P<0.001)compared with the patients without aGVHD.In multivariate analysis,grades III to IV aGVHD was the only independent risk factor for cGVHD.Thus,further interventions should be considered in patients with severe aGVHD to prevent cGVHD.

黄芩汤调控肠道菌群治疗小鼠肠道急性移植物抗宿主病的机制

背景:肠道急性移植物抗宿主病是异基因造血干细胞移植后最凶险的并发症之一,具有较高的致死率,如何通过应用中药改善肠道炎症、调节自噬以治疗肠道急性移植物抗宿主病是当下值得研究的问题。目的:探讨黄芩汤调控肠道菌群治疗肠道急性移植物抗宿主病的机制。方法:CB6F1小鼠经总剂量8 Gy的60Co X射线照射后通过尾静脉输入Balb/c H-2d小鼠的单个核细胞悬液(骨髓+脾)制备急性移植物抗宿主病模型,随机分为模型组及黄芩汤高、中、低剂量组。造模后分别给予不同剂量黄芩汤或等体积生理盐水连续灌胃14 d,进行临床急性移植物抗宿主病评分并记录生存时间,取小肠组织做苏木精-伊红染色行小肠黏膜病理分级评分。使用16S rDNA测序检测各组小鼠肠道菌群,行免疫荧光、免疫组化染色、PCR等检测自噬相关标志物的表达。结果与结论:(1)与模型组相比,黄芩汤中、高剂量组小鼠存活时间显著延长(P<0.01),临床急性移植物抗宿主病评分显著降低(P<0.01),小肠黏膜病理分级评分显著降低(P<0.01),小肠组织炎症因子肿瘤坏死因子α、白细胞介素1β、白细胞介素6水平显著下降(P<0.01),小鼠小肠黏膜上皮结构完整性部分恢复;(2)肠道菌群研究发现,与模型组相比,黄芩汤中剂量组促炎菌株肠球菌显著减少(P<0.05),而有益菌如梭状芽孢杆菌及促自噬的红球菌显著增多(P<0.05);(3)与模型组相比,黄芩汤中剂量组的自噬标志物显著升高(P<0.05);透射电镜下,黄芩汤中剂量组自噬泡数量显著增多;(4)结果表明:黄芩汤显著降低条件性致病菌丰度和小肠组织炎症因子水平,并提高有益菌相对丰度,同时促进小肠黏膜自噬的表达,从而明显改善急性移植物抗宿主病小鼠肠道症状。

Impact of cytomegalovirus intestinal disease on the prognosis in patients with severe intestinal graft-versus-host disease

Objective To explore risk factors,clinical characteristics and prognosis of CMV enteritis combined with severe intestinal graft-versus-host disease(GVHD).Methods The data of 80 intestinal gradeⅢ/ⅣGVHD patients from January 2005 to September 2015 in hematology of PKUPH were retrospectively analyzed.All patients received colonoscopy and all GVHD diagnoses

Effect and mechanism of acute graft versus host disease on early diffuse murine lung injury following allogeneic stem cell transplantation

To explore the effect and pathogenssis of acute graft-versus-host disease (aGVHD) on early diffuse lung injury in allogeneic hematopoietic stem cell transplantation (allo-HSCT), we established an aGVHD model of C57BL/6→BALB/c mice. Chest computed tomography (CT) scans, histopathology and the levels of cytokines including tumor necrosis factor α (TNFα) and Interferon (IFNγ) in lungs were dynamically detected in recipient mice after transplantation. The incidence of aGVHD was respectively 0%, 0% and 100% in simple irradiation group (A), syngeneic transplant group(B) and allogeneic transplant group (C). Chest CT scans of recipient mice were normal in 3 groups on days +3 and +7 after transplantation. CT showed that two of ten mice had bilateral lung diffuse infiltrate on day +12 (on the brink of death) in group A and 6 of 10 mice had bilateral lung diffuse infiltrate on day +14 (3 d after aGVHD occurring) in group C, and were normal on days +12 and +14 in group B after transplantation. Histopathology of lungs in the 3 groups was similar, consisting of minor interstitial pneumonitis on day +3. Group A showed edema, hyperplasia of epithelial cells and widened alveolar interval on day +7, and epithelial cell necrosis, lymphocyte infiltration, hemorrhage, protein leakage, and local consolidation on day +12. The histopathology of group B showed slight edema of epithelial cells on +7 day, which were slighter than that on day +3, and virtually normal on day +14. The histopathology in group C was characterized by the significant expansion and congestion of capillaries, and lymphocyte infiltration on day +7, the acute pneumonitis was present involving tissue edema, lymphocyte and macrophage infiltration, protein leakage and perivascular inflammation on day +14. In group A, the levels of TNFα were lower on day +7 than on day +3. In group B, the levels of TNFα attained a peak on day +3, which decreased on days +7 and +14. In group C, the levels of TNFα were highest on day +7 and there was a significant difference between those on days +7 and +14 (P=0.816). In group A, the levels of IFNγ on day +7 were higher than on day +3. In group B, the levels of IFNγ increased progressively, but the comparison of IFNγ levels in different times had no statistical significance (P=0.521, 0.118, 0.340). In group C, the levels of IFNγ attained a peak by day +7 and decreased on day +14. aGVHD is the main cause of early non-infectious lung injury. T lymphocytes and TNFα are possibly implicated in the pathogenesis of acute GVHD-induced lung injury. The decreased levels of IFNγ in lung tissues following transplantation might be associated with pulmonary fibrosis in late non-infectious pulmonary complications.

肺肠同治理论下宣白承气汤结合肠内营养支持在慢性阻塞性肺疾病急性加重期治疗中的应用价值

【目的】探析肺肠同治理论指导下宣白承气汤结合肠内营养支持在慢性阻塞性肺疾病急性加重(AECOPD)治疗中的应用价值。【方法】将92例AECOPD肺热腑实型患者随机分为观察组和对照组,每组各46例。2组患者均给予常规对症治疗,在此基础上,对照组给予肠内营养支持干预,观察组给予宣白承气汤结合肠内营养支持干预,疗程为2周。观察2组患者治疗前后血清白蛋白(albumin,ALB)、前白蛋白(prealbumin,PA)、转铁蛋白(transferrin,TF)等营养指标及肠道菌群分布的变化情况,并比较2组患者的临床疗效及不良反应发生率。【结果】(1)疗效方面,治疗2周后,观察组的总有效率为97.83%(45/46),对照组为82.61%(38/46),组间比较(χ^(2)检验),观察组的疗效明显优于对照组,差异有统计学意义(P<0.05)。(2)营养指标方面,治疗后,2组患者的血清ALB、PA、TF水平均较治疗前明显升高(P<0.05),且观察组对血清ALB、PA、TF水平的升高幅度均明显优于对照组,差异均有统计学意义(P<0.05或P<0.01)。(3)肠道菌群分布方面,治疗后,2组患者的乳杆菌、双歧杆菌菌种数量均较治疗前明显升高(P<0.05),肠球菌菌种数量均较治疗前明显降低(P<0.05),且观察组对肠道乳杆菌、双歧杆菌菌种数量的升高幅度及对肠球菌菌种数量的降低幅度均明显优于对照组,差异均有统计学意义(P<0.05或P<0.01)。(4)不良反应方面,观察组的不良反应发生率为4.35%(2/46),明显低于对照组的19.57%(9/46),组间比较,差异有统计学意义(P<0.05)。【结论】肺肠同治理论指导下宣白承气汤结合肠内营养支持应用于AECOPD肺热腑实型患者临床效果显著,可有效改善患者营养状态及肠道菌群失衡,降低不良反应发生风险。

非血缘脐血移植后肠道急性移植物抗宿主病的特点分析

背景:尽管非血缘脐血移植有望成为治愈恶性血液病的重要方法,但移植后肠道急性移植物抗宿主病方面的表现及临床特点仍然需要深入研究。目的:分析非血缘脐血移植后发生肠道急性移植物抗宿主病的临床特点。方法:2016年12月至2020年12月中国科学技术大学附属第一医院血液科造血干细胞移植亚专科668例恶性血液病患者接受非血缘脐血移植治疗,其中138例发生肠道急性移植物抗宿主病,男性76例,女性62例,移植时中位年龄13(1-62)岁。所有患者采取清髓性不含抗人胸腺细胞球蛋白方案进行预处理,以及采用环孢素A联合霉酚酸酯预防移植物抗宿主病。结果与结论:①非血缘脐血移植后肠道急性移植物抗宿主病患者均出现不同程度的腹泻,粪便为黄绿色以及黄褐色水样便或者黏液便,其中53例(38.4%)患者出现血便,82例(57.9%)患者伴有皮肤受累,18例(13.0%)患者继发肠道细菌感染,90例(65.2%)患者合并巨细胞病毒血症;②进一步比较1-2级肠道急性移植物抗宿主病(70例,50.7%)与3-4级肠道急性移植物抗宿主病(68例,49.3%)患者的临床特点,发现3-4级肠道急性移植物抗宿主病患者年龄大于1-2级肠道急性移植物抗宿主病患者(P<0.001),更易合并巨细胞病毒血症(P=0.035),腹泻持续时间更长(P=0.00),住院时间也明显增加(P<0.001),而两组患者在性别、移植前疾病状态、供受者HLA匹配度、疾病诊断、合并皮肤急性移植物抗宿主病、继发肠道感染率等方面无显著差异;③结果表明:非血缘脐血移植后肠道急性移植物抗宿主病的临床特点比较复杂,严重影响患者的预后和生活质量,需要及早识别,精准治疗。

新型冠状病毒感染相关急性肌肉减少症的研究进展

新型冠状病毒感染(COVID-19)可造成骨骼肌质量和功能的改变,导致急性肌肉减少症的发生。急性肌肉减少症对COVID-19的治疗和康复也会产生不利影响,它们之间可形成恶性循环。在COVID-19治疗过程中及早发现急性肌肉减少症并进行有效的干预,是阻断这种恶性循环的关键。本文就COVID-19相关急性肌肉减少症的病因和机制、不良影响、评估和诊断手段、预防和治疗措施进行综述。

Loss of Lkb1 impairs Treg function and stability to aggravate graft-versus-host disease after bone marrow transplantation

Accumulating evidence suggests that a reduction in the number of Foxp3^(+) regulatory T cells(Tregs)contributes to the pathogenesis of acute graft-versus-host disease(aGVHD),which is a major adverse complication that can occur after allogeneic hematopoietic stem cell transplantation(allo-HSCT).However,the precise features and mechanism underlying the defects in Tregs remain largely unknown.In this study,we demonstrated that Tregs were more dramatically decreased in bone marrow compared with those in peripheral blood from aGVHD patients and that bone marrow Treg defects were negatively associated with hematopoietic reconstitution.Tregs from aGVHD patients exhibited multiple defects,including the instability of Foxp3 expression,especially in response to IL-12,impaired suppressor function,decreased migratory capacity,and increased apoptosis.Transcriptional profiling revealed the downregulation of Lkb1,a previously identified critical regulator of murine Treg identity and metabolism,and murine Lkb1-regulated genes in Tregs from aGVHD patients.Foxp3 expression in human Tregs could be decreased and increased by the knockdown and overexpression of the Lkb1 gene,respectively.Furthermore,a loss-of-function assay in an aGVHD murine model confirmed that Lkb1 deficiency could impair Tregs and aggravate disease severity.These findings reveal that Lkb1 downregulation contributes to multiple defects in Tregs in human aGVHD and highlight the Lkb1-related pathways that could serve as therapeutic targets that may potentially be manipulated to mitigate aGVHD.

异基因造血干细胞移植后患者口腔及肠道菌群与早期胃肠道急性移植物抗宿主病的关系

目的 初步探讨异基因造血干细胞移植(allogeneic hematopoietic stem cell transplantation, allo-HSCT)患者肠道菌群及口腔菌群的变化与早期胃肠道急性移植物抗宿主病(acute graft versus host disease, aGVHD)之间的关联,寻找可能有效的生物学标志物。方法 选取2021年9月至2023年6月在四川省人民医院血液内科接受allo-HSCT后1个月内发生胃肠道aGVHD的10例急性白血病患者,收集其aGVHD前后粪便样本与唾液样本,采用16S rRNA测序分析方法,研究早期胃肠道aGVHD发生前后肠道菌群、口腔菌群的差异性改变。结果 (1)肠道菌群中拟杆菌属减少、肠球菌属及肠杆菌科增加与早期上消化道aGVHD发生呈正相关(P<0.05),而口腔菌群整体微生物多样性无显著差异(P>0.05)。(2)胃肠道aGVHD前后肠道菌群LEfSe分析发现克雷伯杆菌属、肠球菌属增加,大肠埃希菌减少;口腔菌群LEfSe分析发现存在差异显著10个微生物标志物,其中γ-变形菌纲的差异较为显著。(3)肠道菌群β多样性差异显著(P=0.03),而口腔菌群α、β多样性无显著差异。结论 Allo-HSCT患者发生早期胃肠道aGVHD前后肠道菌群存在显著差异,可能与口腔菌群变化有关。

清肺化痰逐瘀汤对COPD急性加重期合并胃肠功能障碍临床观察

目的 观察清肺化痰逐瘀汤对慢性阻塞性肺疾病急性加重期(AECOPD)合并胃肠功能患者的临床疗效,进一步探讨其体现肺肠同治的深层次机制。方法 98例患者随机分为两组,对照组实施西医常规治疗,观察组加用清肺化痰逐瘀汤治疗,疗程2周,记录治疗前后中医证候积分、胃肠道症状分级评分量表(GSRS)评分、呼吸困难量表(m MRC)评分、慢性阻塞性肺疾病评估测试(CAT)评分;比较两组患者治疗前后[1秒用力呼气量容积(FEV1),用力肺活量(FVC),FEV1/FVC(%),FEV1/预计值(FEV1/Pred)];检测血清胃泌素(GAS)、胃动素(MTL),二胺氧化酶(DAO)、丙二醛(MDA)情况。结果 治疗组患者总有效率为91.49%,高于对照组的74.47%(P<0.05)。与本组治疗前比较,两组治疗后临床症状相关评分(中医证候积分、GSRS评分、m MRC评分、CAT评分)、血气(Pa CO_(2))和血清GAS、DAO、MDA水平均较治疗前降低(P<0.05),肺功能指标(FEV1、FVC、FEV1/FVC、FEV1%pred)、PaO_(2)和血清MTL水平较治疗前明显提高(P<0.05)。治疗后组间比较,治疗组临床症状相关评分(中医证候积分、GSRS评分、m MRC评分、CAT评分)、血气(PaO_(2)、PaCO_(2))、肺功能(FEV1、FVC、FEV1%pred)和血清GAS、MTL、DAO、MDA改善均优于对照组(P<0.05),肺功能指标FEV1/FVC有所改善,但组间差异无统计学意义(P>0.05)。结论 清肺化痰逐瘀汤加减能有效提高AECOPD患者的临床效果,改善肺功能及氧合,调节胃肠激素,促进肠黏膜屏障修复和胃肠功能恢复,减轻病情。

aGVHD对小鼠肠道血管形态与结构的影响及其机制

为了探究急性移植物抗宿主病(acute graft-versus-host disease,aGVHD)发病进程对小鼠肠道组织血管的变化和肠道免疫稳态之间的关系和机制,我们建立小鼠aGVHD模型分析小鼠小肠绒毛血管内皮细胞和周细胞以及浸润免疫细胞在不同时间点的动态变化,并运用qPCR、Smart-seq技术分析寻找差异表达基因。发现在aGVHD的发病进程中,小肠绒毛血管的损伤及浸润免疫细胞的变化与疾病进程密切相关,随炎症反应、细胞凋亡及肠道屏障相关基因表达显著变化。研究结果表明,aGVHD诱发的小肠绒毛血管的严重损伤和结构紊乱可能是导致受体死亡的一个重要原因,小肠绒毛的aGVHD炎症反应可能主要通过影响与内皮细胞凋亡及肠道屏障相关的基因表达,从而破坏小肠绒毛血管的完整性和提高其通透性。

杭州市2003年急性肠道传染病暴发疫情分析

目的 分析杭州市 2 0 0 3年急性肠道传染病暴发疫情流行病学特征 ,提出预防措施 ,有效控制暴发疫情的发生。方法 将该市 2 0 0 3年间发生的 11起急性肠道传染病资料进行综合分析。结果 (1)水源或食物受污染是引起肠道传染病暴发疫情的主要因素。 (2 )肠道传染病暴发病种以细菌性痢疾多见。 (3)学校内暴发疫情较多 ,罹患对象为学生。结论 加快农村改水工作 ,加强校内饮食卫生管理是有效控制疫情发生的主要措施。