GUT BARRIER FUNCTION DAMAGE FOLLOWING MULTIPLE FIREARM INJURIES IN A PORCINE MODEL

Objective. To study the characteristics and pathogenesis of gut barrier damage following multiple firearm injuries in a porcine model. Methods. Twenty four small pigs were divided into 4 groups: control group (n=6, group C), group H (n=6, gunshot induced tangential fracture of parietal bone), group L (n=6, gunshot induced comminuted fracture of bilateral femora) and group M (n=6, combined group H+L). Gastric intramucosal pH (pHi), plasma endotoxin levels in portal vein, and plasma D lactate levels were measured and blood samples were cultured at different intervals after trauma. The animals were sacrificed at 72 h following trauma and intestinal tissues were harvested for pathological examination and diamine oxidase (DAO) activity measurement. Results. In group M at 72 h, pHi was significantly lower than that of group H and L (P< 0.01), and plasma endotoxin level was significantly higher than that of group H (P< 0.01) and group L (P< 0.05). Simultaneously, in groupM, D lactate level was markedly higher than that of group H (P< 0.01), and incidence of positive blood culture was much higher than that of group H and L (P<0.05). Necrosis and exfoliation were revealed at ileum villus top in all traumagroups, especially in group M, in which ileum DAO activity declined most significantly as well. Conclusion. Multiple trauma is prone to cause gastrointestinal ischemia even without hemorrhagic shock. The damage of gut barrier in multiple trauma appears to be more severe than that in one site trauma, thereby promoting gut derived endotoxemia and bacterial translocation and contributing to the development of endogenous infection.SURGICAL TREATMENT OF MALIGNANTESOPHAGEAL TUMORS IN PUMC HOSPITAL Guo Huiqin,Li Zejian ,Zhang Fan1 ,Zhang Zhiyong,Xu Letian ,Li Weidong2,Wang Xiuqin2and Wu Min2Department of Thoracic Surgery, PUMC Hospital, CAMS &PUMC, Beijing 100730Key words malignant esophageal tumors; early diagnosis; FHIT geneTo study how to prolong the postoperative survival time of the patientswith malignant esophageal tumors. The clinical data of 1098 patients with malignant esophageal tumors from 1961 to 1992 were retrospectively analyzed. The deletion of fragile histamine triplet (FHIT) gene (a tumor suppressor gene) in 30 fresh esophageal samples obtained in 1996 was detected with PCR and RT PCR method. The resectability was raised gradually and the operative morbidity and mortality decreased year by year, but there was no significant improvement on the postoperative 5 year survival rate. Delayed diagnosis and irradical resection influenced the long term survival. The deletion of cDNA of FHIT gene was 64.2%in esophageal cancer and 20%in the resected margin of the cancer. We believe that high grade atypical hyperplasia in esophageal epithelium and deletion of FHIT gene in esophageal cancer and its resected margin are pathological and molecular markers for early diagnosis of esophageal cancer respectively, and the latter may be one of the molecular markers for the resection. Early diagnosis and treatment, radical resection, and postoperative nutritional support are very important for the improvement of the postoperative survival time of the patients.

Dietary ferulic acid and vanillic acid on inflammation,gut barrier function and growth performance in lipopolysaccharide-challenged piglets

Ferulic acid(FA)and vanillic acid(VA)are considered as major phenolic metabolites of cyanidin 3-glucoside,a polyphenol that widely exists in plants that possess a protective effect against oxidative stress and inflammation in our previous study.This study aimed to investigate the effect of FA and VA on inflammation,gut barrier function,and growth performance in a weaned piglet model challenged with lipopolysaccharide(LPS).Thirty-six piglets(PIC 337×C48,28 d of age)were randomly allocated into 3 treatments with 6 replicate pens(2 piglets per pen).They were fed with a basal diet or a diet containing 4,000 mg/kg of FA or VA.Dietary supplementation of VA significantly increased average daily gain(ADG)(P<0.05).Both FA and VA decreased serum levels of thiobarbituric acid reactive substances(TBARS),interlukin(IL)-1β,IL-2,IL-6,and tumor necrosis factor(TNF)-α(P<0.05),and enhanced the expression of tight junction protein oclaudin(P<0.05).Analysis of gut microbiota indicated that both FA and VA increased the Firmicutes/Bacteroidetes ratio alongside reducing the relative abundance of the Prevotellaceae family including Prevotella 9 and Prevotella 2 genera,but enriched the Lachoiraceaea family including the Lachnospiraceae FCS020 group(P<0.05).Moreover,VA reduced the relative abundance of Prevotella 7 and Prevotella 1 but enriched Lachnospira,Eubacterium eligens group,and Eubacterium xylanophilum group(P<0.05),while FA showed a limited effect on these genera.The results demonstrated that both VA and FA could alleviate inflammation and oxidative stress,but only VA has a significant positive effect on the growth performance of LPS-challenged piglets potentially through modulating gut microbiota.

Junshanyinzhen tea extract prevents obesity by regulating gut microbiota and metabolic endotoxemia in high-fat diet fed rats

Obesity is associated with gut dysbiosis and metabolic endotoxin.Junshanyinzhen tea extract(JSTE)reduced fat accumulation and body weight in obese mice.However,the effects and mechanism of JSTE in preventing obesity were unclear.Therefore,we used different doses of JSTE(75,150 and 300 mg/(kg·day))to evaluate the effect on high-fat diet(HFD)-induced rats under 8 weeks of intervention.Here,our results showed that JSTE could significantly reduce body weight gain,blood lipid levels and fat accumulation,improve fatty damage in liver tissue(P<0.05).In addition,JSTE increased the expression of intestinal tight junction proteins(P<0.05),relieved metabolic endotoxemia(P<0.05)and chronic low-grade inflammation in HFD rats.Sequencing of fecal samples showed that JSTE could effectively reverse the microbial diversity and the ratio of Firmicutes to Bacteroidetes to normal levels in HFD-fed rats.Desulfovibrioceae and Erysipelotrichaceae,which are positively related to obesity,were decreased by JSTE intervention(P<0.05).while Bifidobacteriaceae,Bacteroidaceae,Akkermansia,and Clostridium,which are negatively related to obesity,were increased.Together,these results suggested that JSTE might effectively prevent obesity by modulating gut microbiota dysbiosis,intestinal barrier dysfunction,metabolic endotoxemia and chronic low-grade infl ammation in HFD-induced rats.

Gut microbiota remodeling drived by dietary millet protein prevents the metabolic syndrome

Metabolic syndrome(Met S)is a chronic disease associated with the disturbance of gut microbiota homeostasis.Metabolites derived from gut microbes play essential roles in Met S prevention and therapy.Here,we focused on the inhibitory effect of the extract of millet bran protein(EMBP)on a high-fat diet(HFD)-induced Met S,aiming to identify gut microbiota and their metabolites that involve in the anti-Met S activity of EMBP.The obesity,chronic inflammation,insulin resistance in Met S mouse models were abolished after EMBP treatment.The protective mechanism of EMBP against HFD-induced Met S may depend on improved gut barrier function.Using microbiome analysis,we found that EMBP supplementation improved gut microbiome dysbiosis in Met S mice,specifically upregulating Bacteroides acidifaciens.The fecal microbiota transplantation(FMT)also demonstrated this phenomenon.In addition,metabolomic analysis showed that EMBP mediates metabolic profiling reprogramming in Met S mice.Notably,a microbiota-derived metabolite,gamma-aminobutyric acid(GABA),is enriched by EMBP.In addition,exogenous GABA treatment produced a similar protective effect to EMBP by improving NRF2-dependent gut barrier function to protect HFDinduced Met S.The results suggest that EMBP suppress host Met S by remodeling of gut microbiota as an effective candidate for next-generation medicine food dual purpose dietary supplement to intervene in MetS.

Influences of enteral nutrition combined with probiotics on gut microflora and barrier function of rats with abdominal infection

瞄准：为了调查肠内的的、非肠道的营养和专业版的影响，生命学与腹的感染在肠的微生态学，上皮的紧密的连接，免疫者和老鼠的障碍功能上由内脏交付了。方法：与盲肠的结扎和穿孔方法建立的老鼠腹的感染模型，被划分成三个组：非肠道的营养(PN 组， n = 7 ) ， PN+enteral 营养(在组， n = 7 ) 并且在 + 职业人员生命学的 PN +( 职业人员生命学组， n = 7 ) 经由为五天的针空肠造口术和颈静脉。三个组的全部的营养的补充是 isonitrogenic 和 isocaloric。Probiotics 被空肠造口术交付 10 mL/d (1 x 10 (8 ) cfu/mL ) 。老鼠在第六天被打死。在盲肠的排汇物为厌氧的细菌的生长是有教养的并且与随机的放大多态的 DNA 与细菌的组 DNA 指纹侧面分析了。transmembrane 绑定蛋白质(occludin ) 和在在冒号和终端回肠的肠上皮的浆细胞的 IgA 水平被一个免疫组织化学方法测量。在冒号和小肠的肠的上皮的紧密的连接的超微结构被电子显微镜学观察。维纳腔血和肝，肺和 mes 伤寒淋巴结的 homogenated 织物是有教养的决定细菌的 translocations，并且在从门静脉的血的内毒素被检测。结果：(1 ) 内脏种类在的细菌的数量在组和职业人员，关於生命的组在 PN 是比那高级的组。DNA 侧面在在组和职业人员，关於生命的组类似于正常老鼠的。在职业人员生命学组的 DNA 侧面的数字在 PN 组并且在组是多于那的大部分。而且，在 PN 有奇怪的条纹组。( 2 ) occludin 和 IgA 在的表示小并且大肠在在组( 2.309 +/- 0.336 ， 15.440 +/- 2.383 )并且专业版关於生命的组( 2.938 +/- 0.515 ， 16.230 +/- 3.183 )作为与 PN 组相比被改进( 1.207 +/- 0.587 ， P 【 0.05 ， 11.189 +/- 2.108 ， P 【 0.01 )。在专业版的 occludin 的表达式关於生命的组(肠：2.93 +/- 0.515；盲肠：3.40 +/- 0.617 ) 比那高在在组(肠：2.309 +/- 0.336；盲肠：2.076 +/- 0.670；P 【 0.05 ) 。IgA 的表示，在特别在组(肠：15.440 +/- 2.383 ) 并且在组关於生命的专业版(大肠：12.516 +/- 1.542 ) 显著地作为与 PN 组相比增加了(肠：11.189 +/- 2.108；盲肠：10.160 +/- 1.643；P【0.01 ) 。肠的上皮的紧密的连接和职业人员的微绒毛关於生命的组是比在 PN 组的那些更未经触动的。( 3 )在内毒素的血，肝，肺和 mes 伤寒淋巴节点，和层次的细菌的 translocations 显著地在专业版被减少关於生命( 0.082 +/- 0.029 )并且在( 0.125 +/- 0.040 )作为与 PN 组相比组织( 0.403 +/- 0.181 ， P 【 0.05 )。结论：申请在与专业版生命学结合了能改进 transmembrane 绑定蛋白质(occludin ) 和 IgA 的表达式，改正肠内菌丛骚乱，维持内脏障碍函数和紧密的连接，并且减少出现毁坏细菌的易位。

Effect of lactobacillus on the gut microflora and barrier function of the rats with abdominal infection

AIM: TO investigate the effect of probiotics supplemented by gut on the tight junctions of epithelial cells, barrier function and the microflora of rats with abdominal infection.METHODS: After the model of cecal ligation and perforation established, SD rats were divided into two groups:parenteral nutrition (PN) group and PN+probiotics (probiotics) group, PN solution was supplemented by neck vein and probiotics was delivered via the jejunostomy tube for five days. Vena cava blood and the homogenated tissue of liver, lung and mesenteric lymph nodes were cultured to determine the bacterial translocation rate (BTR). The ultrastructure of epithelial light junctions and microvilli of the gut were observed by electron microscopy; ocduding expression was measured by indirect-immune fluorescence method;anaerobic bacterial growth by anaerobic culture and DNA fingerprint of bacterial colonies of the feces by PCR.RESULTS: The quantity of lactobacteria and bifydobacteria in probiotics group was higher than that of PN group. The profiles of DNA fingerprint expression in probiotics group were similar to that in the normal group, a new 16S rDNA sequence appeared in the profile in PN group. The occludin expression, the integrality of the gut epithelial tight junction and microvilli in probiotics group were improved as compared with PN group. The BTR and endotoxin in blood we rereduced more significantly in probiotics group as compared with PN group.CONCLUSION: The probiotics could improve the gut microflora disturbance, increase occludin expression,maintain the gut epithelial tight junction and decrease the bacterial translocations rate.

Clinical Studies Evaluating Effects of Probiotics on Parameters of Intestinal Barrier Function

The intestinal barrier is important in preventing translocation of bacteria, toxins and antigens from the lumen of the gut into the body. Enhanced permeability, or gut leakiness, has been associated with different diseases. Probiotics can, strain-specifically, improve the epithelial barrier function. However, so far most researches have used cell lines or animal models due to the difficulty of measuring the effects of products on the epithelial barrier function in vivo in humans. Here a systematic literature search was performed to find articles addressing the effects of probiotics on the barrier function in human trials. The Pubmed database was searched (January 2013) to identify human in vivo studies with probiotic products in which parameters for epithelial barrier function were measured. In total 29 studies were identified, but patients, bacterial characteristics and methods to measure intestinal barrier function caused large heterogeneity among these studies. About half of the studies showed positive results of probiotics on the epithelial barrier function, indicating a clear potential of probiotics in this field. In a case series of 14 patients using Ecologica825, a probiotic food supplement with known effect on epithelial barrier function, different markers of intestinal integrity improved significantly. Further studies in this field should consider strain(s), dose and duration of the probiotic supplementation as well as the markers used to measure epithelial barrier function. Besides the lactulose/mannitol test, zonulin and α1-antitrypsin might be valuable markers to measure epithelial barrier function in future experiments.

Probiotics and gut health:A special focus on liver diseases

Probiotic bacteria have well-established beneficial ef-fects in the management of diarrhoeal diseases.Newer evidence suggests that probiotics have the potential to reduce the risk of developing inflammatory bowel diseases and intestinal bacterial overgrowth after gut surgery.In liver health,the main benefits of probiotics might occur through preventing the production and/or uptake of lipopolysaccharides in the gut,and therefore reducing levels of low-grade inflammation.Specific immune stimulation by probiotics through processes involving dendritic cells might also be beneficial to the host immunological status and help prevent pathogen translocation.Hepatic fat metabolism also seems to be influenced by the presence of commensal bacteria,and potentially by probiotics;although the mechanisms by which probiotic might act on the liver are still unclear.However,this might be of major importance in the fu-ture because low-grade inflammation,hepatic fat infil-tration,and hepatitis might become more prevalent as a result of high fat intake and the increased prevalence of obesity.

Gut-liver axis and probiotics: Their role in non-alcoholic fatty liver disease

The incidence of obesity and its related conditions, including non-alcoholic fatty liver disease(NAFLD), has dramatically increased in all age groups worldwide. Given the health consequences of these conditions, and the subsequent economic burden on healthcare systems, their prevention and treatment have become major priorities. Because standard dietary and lifestyle changes and pathogenically-oriented therapies(e.g., antioxidants, oral hypoglycemic agents, and lipid-lowering agents) often fail due to poor compliance and/or lack of efficacy, novel approaches directed toward other pathomechanisms are needed. Here we present several lines of evidence indicating that, by increasing energy extraction in some dysbiosis conditions or small intestinal bacterial overgrowth,specific gut microbiota and/or a"low bacterial richness"may play a role in obesity,metabolic syndrome,and fatty liver.Under conditions involving a damaged intestinal barrier("leaky gut"),the gut-liver axis may enhance the natural interactions between intestinal bacteria/bacterial products and hepatic receptors(e.g.,toll-like receptors),thus promoting the following cascade of events:oxidative stress,insulinresistance,hepatic inflammation,and fibrosis.We also discuss the possible modulation of gut microbiota by probiotics,as attempted in NAFLD animal model studies and in several pilot pediatric and adult human studies.Globally,this approach appears to be a promising and innovative add-on therapeutic tool for NAFLD in the context of multi-target therapy.

植物精油对鸡抵御沙门氏菌感染作用的研究进展

沙门氏菌病严重危害家禽养殖业,造成重大经济损失,并引发公共卫生安全问题。植物精油能够显著抑制病原菌生长繁殖,并通过改善机体抗氧化能力、免疫性能以及肠道黏膜屏障功能等方式,发挥抵御鸡沙门氏菌感染的作用。本文综述了植物精油的抗菌活性、抗菌机制及其对鸡抵御沙门氏菌感染的作用,以期为植物精油应用于防治鸡沙门氏菌病提供参考。

补肾化痰方通过调控肠道菌及PPARγ通路治疗多囊卵巢综合征的机制

目的:探究补肾化痰方对多囊卵巢综合征(PCOS)模型小鼠肠道菌群多样性的调节作用及其治疗PCOS的相关机制。方法:24只无特定病原体级成年雌性C57BL/6J小鼠随机分为三组:空白对照组、模型对照组(使用来曲唑联合高脂饲料诱导)、中药治疗组(造模结束后连续灌服补肾化痰方混悬液35 d)。采用酶联免疫吸附测定法检测小鼠性激素水平;苏木精-伊红染色后光镜下观察卵巢形态;收集各组小鼠结肠内粪便,采用16S rRNA测序进行肠道菌群检测;气相色谱-质谱法检测短链脂肪酸含量;免疫组织化学法检测结肠过氧化物酶体增殖物激活受体(PPARγ)表达;实时逆转录聚合酶链反应法检测肠道上皮黏蛋白2、闭合蛋白1和紧密连接蛋白1(ZO-1)、PPARγ的mRNA表达;蛋白质印迹法检测诱导型一氧化氮合酶(iNOS)、PPARγ蛋白表达。结果:与空白对照组比较,模型对照组体重、血清卵泡刺激素、黄体生成素和睾酮水平均升高,血清雌二醇水平降低(均P<0.01),光镜下卵巢结构符合PCOS病理特征;中药治疗组血清性激素水平和卵巢结构较模型对照组改善。模型对照组肠道菌群多样性较空白对照组发生变化。与空白对照组比较,在门水平,模型对照组厚壁菌丰度下降,疣微菌、变形菌、放线菌丰度升高(均P<0.05);在属水平,模型对照组乳酸菌丰度显著下降,阿克曼菌、乳梭菌、乳球菌、产粪甾醇真细菌丰度升高(均P<0.05)。补肾化痰方治疗后小鼠肠道菌群紊乱状态得到一定程度的改善。与空白对照组比较,模型对照组粪便中乙酸、丙酸、丁酸含量均下降(均P<0.05),而中药治疗组乙酸、丙酸、丁酸含量较模型对照组均增加,其中丙酸和丁酸含量与模型对照组差异有统计学意义(均P<0.05)。与空白对照组比较,模型对照组肠道PPARγ表达降低,ZO-1 mRNA表达增加,黏蛋白2、闭合蛋白1 mRNA表达减少,iNOS蛋白表达增加(均P<0.05);与模型对照组比较,中药治疗组PPARγ蛋白表达增加,闭合蛋白1、黏蛋白2 mRNA表达显著增加(均P<0.05),ZO-1 mRNA表达减少,iNOS蛋白表达减少。结论:来曲唑联合高脂饲料诱导的PCOS小鼠存在菌群失调状态,补肾化痰方通过调节肠道菌群种属分布可能有助于提高短链脂肪酸水平从而激活肠PPARγ通路,改善肠屏障功能,达到治疗PCOS的目的。

中药清胰汤治疗急性坏死性胰腺炎的实验研究

目的 :观察中药清胰汤对急性坏死性胰腺炎 (ANP)治疗效果。方法 :杂种犬 2 3只 ,分3组 :对照组 (7只 )、ANP组 (8只)和中药组 (8只 ,术后每天经胃管灌服清胰汤 2 0ml/kg,连用 7天 )。测定血中淀粉酶 (AMY)、内毒素 (LPS) ,作脏器细菌培养、病理检查和肠粘膜菌群分析。结果 :ANP组胰、肠病理损害严重 ,肠粘膜大肠杆菌数量增加 ,双歧杆菌和乳杆菌减少 ,肠道微生态紊乱 ,脏器细菌移位率 1 0 0 % ,AMY和LPS明显升高。中药组与ANP组比较 ,上述变化明显减轻 ,脏器细菌移位率下降 5 0 % ,血AMY和LPS水平下降 2～ 3倍。结论 :清胰汤可明显减轻ANP的病理和病理生理损害 ,调整菌群失调 ,保护肠屏障功能 ,对防治ANP后肠道细菌移位和肠源性感染具有重要作用。

日粮锌、硒水平对肉鸡肠道黏膜屏障结构的影响

为了探讨微量元素锌和硒相互作用对肉鸡肠道黏膜屏障结构的影响 ,将 2 4只 1日龄AA肉鸡随机分 3组 ,分别饲喂添加有高锌高硒(锌 1 0 0 0 mg/kg、硒 5mg/kg)、低锌低硒 (锌 3 4mg/kg、硒 0 .0 8mg/kg)或常锌常硒 (锌 50 mg/kg、硒 0 .1 5mg/kg)的日粮 45d后 ,观察肠黏膜上皮细胞、上皮内淋巴细胞和盲肠扁桃体的形态结构变化。结果表明 :高锌高硒或低锌低硒组肉鸡的肠黏膜结构有明显的损伤 ,表现为肠黏膜上皮细胞萎缩 ,绒毛长度下降 ,上皮内淋巴细胞数量减少 ;盲肠扁桃体的弥散淋巴组织和淋巴小结中 ,淋巴细胞数量减少 ,细胞出现肿胀 ,有的核消失 ,结缔组织增生 ,淋巴小结萎缩。尤其是高锌高硒组的损伤最为严重。而常锌常硒组肉鸡肠黏膜和盲肠扁桃体的形态结构正常。结论 :日粮中按锌 50 mg/kg、硒 0 .1 5mg/kg的比例添加 ,对于维持肠道黏膜的正常屏障结构是合适的。过高或过低的锌和硒对小肠黏膜有毒性作用 ,破坏其屏障功能 ;

腹泻型肠易激综合征患者内脏敏感性、肠屏障功能及自主神经功能的评价

目的:评价腹泻型肠易激综合征(diarrhea-predominant irritable bowel syndrome,IBS-D)患者的内脏敏感性、肠屏障功能和自主神经功能(autonomic nerve function,ANF),探索它们在IBS-D病理生理学中的作用。方法:以2015年10月至2016年3月就诊于中日友好医院消化内科的46例IBS-D患者(IBS-D组)和20例健康志愿者(对照组)为研究对象,采用问卷评估其临床及精神心理症状,并检测内脏敏感性、肠屏障功能及ANF,比较两组上述各指标的差异,并分析IBS-D组中各指标间的相关性。结果:IBS-D组的病情尺度调查表(IBS symptom severity scale,IBS-SSS)、汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)、汉密尔顿抑郁量表(Hamilton depression scale,HAMD)和内脏敏感指数(visceral sensitivity index,VSI)评分均显著高于对照组(P<0.01)。内脏敏感性检测中,IBS-D组对直肠扩张刺激的最大耐受阈值显著低于对照组(P<0.01),初始感觉阈值和持续排便阈值两组差异无统计学意义(P>0.05)。肠屏障功能血清标志物二胺氧化酶(diamine oxidase,DAO)和D-乳酸在IBS-D组中均显著升高(均P<0.05)。IBS-D组的ANF总分和副交感计分以及两者的异常比例均显著高于对照组(均P<0.05)。在IBS-D组各指标相关性分析中,HAMA,VSI和血清DAO与IBSSSS呈显著正相关(分别r=0.528,0.575,0.507;P<0.01),3个内脏感觉阈值均与IBS-SSS呈显著负相关(分别r=–0.636,–0.476,–0.697,P<0.01);与内脏感觉阈值呈显著负相关的指标除IBS-SSS外,还有HAMA,HAMD,VSI和血清DAO(均P<0.05);ANF与其他指标间未发现关联。结论:IBS-D患者存在精神心理异常、内脏高敏感、肠屏障受损和以副交感神经功能异常为主的ANF失调,前三者均与病情程度相关,可能在IBS-D病理生理学中发挥了重要作用。

不同营养支持途径对外科创伤应激后相关肠黏膜形态和屏障功能影响的实验研究

目的探讨肠外和肠内营养对外科创伤应激大鼠肠上皮细胞紧密连接、屏障功能及微生态环境的影响。方法SD大鼠随机分成对照组、全肠外营养组(TPN)和普通肠内营养组(EN)。建立创伤应激模型,接受等氮、等能量营养支持后光镜和电镜下观察肠黏膜形态,比较肠道细菌脏器移位率、肠黏膜occludin蛋白免疫组化表达及肠道菌群数量等。结果电镜下TPN组肠上皮损伤程度较严重,而EN组损伤程度较轻,肠上皮紧密连接、微绒毛较完整;光镜下Chiu分级,TPN组和EN组比较差异有统计学意义(P<0.05)。EN组肠道跨膜结合蛋白表达优于TPN组(P<0.05)。EN组肝、肺和肠系膜淋巴结的肠道细菌移位率低于TPN组(P<0.05)。EN组肠道内乳酸杆菌和双歧杆菌数量均高于TPN组,但差异未达到统计学意义。结论肠内及标准肠外营养都不能完全维持创伤大鼠肠黏膜屏障不受损害及阻止肠道细菌移位,但肠内营养组肠黏膜屏障损害较轻,肠道细菌移位率低,且增加了肠上皮occludin蛋白表达,与肠外营养比较,有利于改善肠道屏障,从而减少细菌移位的可能。

小肠屏障功能监测的实验研究

目的 通过对创伤后小肠屏障功能几种监测方法的对比分析，试图找到一种适合临床推广的快速敏感的监测方法。方法 北京地区雄性成年山羊 ３２只，随机分为创伤失血性休克组（Ｈ组，ｎ＝６），创伤内毒素血症组（Ｅ组，ｎ＝６）和创伤失血再灌注复合内毒素组（Ｍ组，ｎ＝２０），模拟临床创伤、缺血再灌注（Ｉ／Ｒ）、感染脓毒症的实验模型。同时监测二胺氧化酶（ＤＡＯ）、肠粘膜下ｐＨ（ｐＨｉ）和尿乳果糖／甘露醇比值，并参照血浆内毒素（ＬＰＳ）、ＴＮＦ和病理形态学结果进行对比分析。结果 创伤和失血性休克后当日血浆ＤＡＯ活性可呈一过性升高，Ｍ组在输入内毒素后再度升高呈双峰型用组术后第一天开始ＤＡＯ渐趋下降，Ｅ组自手术当日开始逐渐升高。Ｍ组 Ｌ／Ｍ较 Ｅ组增加显著；创伤、休克末和输内毒素后小肠 ｐＨｉ持续降低。血浆ＤＡＯ的变化与Ｌ／Ｍ和肠粘膜ｐＨｉ的变化呈高度相关（ｒ＝０．９５１和－０．５５３、Ｐ＜０．０１～０．０５），三种肠功能指标与血浆ＬＰＳ和ＴＮＦ的变化高度相关，并与病理形态学变化相一致。结论 创伤缺血再灌流，单纯输内毒素均可导致肠屏障功能损伤，这种损伤是短暂和可逆的；创伤缺血再灌流复合内毒素血症对肠屏障功能的损伤程度明显加重；ＤＡＯ活性、Ｌ?

通腑颗粒对多器官功能障碍综合征胃肠功能障碍患者病情严重程度的影响

目的：观察通腑颗粒治疗多器官功能障碍综合征（MODS）胃肠功能障碍的临床疗效。方法：采用前瞻性、多中心、临床随机对照研究方法，将140例MODS患者随机分为莫沙必利组和通腑颗粒组，于试验开始时（Oh）以及用药后48h和7d或死亡前对患者进行胃肠功能评分、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分和Marshall评分;记录患者机械通气时间、住重症监护室（ICU）时间及28d的转归情况。结果：两组治疗后胃肠功能评分、APACHEⅡ评分及Marshall评分均有所降低，且通腑颗粒组较莫沙必利组改善更为明显，差异均有显著性（P〈0．05或P〈0．01）。与莫沙必利组比较，通腑颗粒组机械通气时问明显缩短（P〈0．05）；住ICU时间有所缩短，但差异无显著性。APACHEⅡ≤8分时两组患者病死率均为0，8～20分时差异有显著性，〉20分时差异无显著性。通腑颗粒组28d总病死率较莫沙必利组显著降低（P〈0．05）；且随受累器官数目的增加病死率逐渐增高。结论：通腑颗粒能够改善MODS患者的病情严重度及预后。

肠内生态免疫营养对SIRS大鼠肠黏膜结构及免疫细胞的影响

目的 :探讨生态免疫肠内营养对全身炎症反应综合征 (SIRS)大鼠小肠黏膜形态结构及免疫细胞的影响。 方法 :将 6 0只雄性SD大鼠随机分为四组 ,即标准组、免疫增强组、生态组、生态免疫组。通过大鼠尾静脉注射脂肪多糖建立SIRS大鼠模型 ,分别给予不同成分的肠内营养剂行肠内营养 7天 ,观察各组大鼠小肠黏膜形态 ,免疫组化检测小肠黏膜CD3+ 、CD4 + 、CD8+ 细胞。 结果 :标准组小肠黏膜萎缩明显 ,肠壁明显变薄 ,肠腺明显减少 ,肠绒毛短而稀疏 ;免疫增强组和生态组小肠肠壁较标准组明显增厚 ,肠腺数量增多 ,肠绒毛高而密集 ;生态免疫组小肠肠壁厚度、肠腺密度及绒毛的高度和密度 ,均明显高于免疫增强组和生态组 ;相关形态学参数测值显示 ,免疫增强组和生态组小肠的黏膜厚度、肠腺隐窝深度、绒毛高度和表面积 ,均显著大于标准组 (P <0 .0 1) ,而生态免疫组以上形态学指标测值又显著大于免疫增强组和生态组 (P <0 .0 1) ;免疫组化结果显示 ,标准组CD3+ 细胞明显低于其他三组 ,而且免疫增强组与生态组和生态免疫组相比也有显著性差异 ;免疫增强组CD4 + 细胞明显高于标准组 ,但与生态组、生态免疫组相比无显著性差异 ;标准组CD8+ 细胞、CD4 + /CD8+ 比值明显低于其他三组。 结论

极低蛋白日粮补充不同形式氮营养素对生长猪回肠食糜菌群、代谢产物和屏障功能的影响

[目的]本试验旨在研究极低蛋白(ELP)日粮下,补充不同形式氮营养素(氨基酸或酪蛋白)对生长猪回肠微生物、代谢产物和屏障功能的影响。[方法]试验选用80头PIC阉公猪(体质量约15.57 kg,48日龄),随机分为4组:中等蛋白组(MP)、低蛋白组(LP)、极低蛋白+氨基酸组(ELP-AA)和极低蛋白+酪蛋白组(ELP-CAS),日粮粗蛋白(CP)水平分别为17%、15%、13%和13%。每个处理5个重复,每个重复4头仔猪。试验期28 d。MP和LP两组添加必需氨基酸(AA),ELP-AA组添加非必需AA以达到LP组日粮水平,ELP-CAS组使用3%酪蛋白部分替代ELP-AA组的单体AA,使其满足营养需要。于第29天每个重复挑选1头接近栏平均体质量的猪屠宰,采集回肠食糜和肠道组织样品,用于各项指标测定。[结果]与MP组相比,ELP-AA组回肠食糜中双歧杆菌属(Bifidobacterium)、乳酸杆菌属(Lactobacillus)和消化链球菌属(Peptostreptococcus)的数量显著降低(P<0.05),短链脂肪酸、氨态氮和生物胺的含量均显著下降(P<0.05),而补充酪蛋白后,乙酸、丁酸、氨态氮、腐胺和精胺的含量得到显著恢复(P<0.05)。基因表达方面,与LP组相比,ELP-AA组部分肠道屏障功能相关基因(MUC-1、MUC-2和Occludin)的表达量均显著下调(P<0.05),而MUC-1和Occludin的表达量在ELP-CAS组和MP或LP组之间无显著差异(P>0.05)。相关性分析结果表明,Lactobacillus数量与丁酸和生物胺含量、MUC-1、MUC-2和Occludin基因表达量显著正相关。[结论]饲喂极低蛋白日粮补充单体氨基酸对回肠微生物数量、代谢以及肠道组织屏障均产生不利影响,而补充酪蛋白能部分改善回肠有益微生物的生长并恢复部分肠道屏障相关基因的表达,提示在极低蛋白质水平下,补充酪蛋白对维持机体正常氮利用、肠道微生物生长代谢和肠道屏障功能具有重要作用。

肠内免疫营养和生态营养对创伤后大鼠肠屏障功能及免疫功能的影响

目的探讨肠内免疫营养和生态营养对创伤后大鼠肠黏膜屏障和免疫屏障的影响。方法将40只Wistar大鼠随机分为4组:对照组、普通肠内营养组、肠内免疫营养组和生态营养组。通过胃造瘘术建立大鼠创伤模型,分别给予不同成分的肠内营养7d,观察各组大鼠小肠黏膜形态,免疫组化检测肠黏膜CD3+、CD4+、CD8+和IgA+细胞。结果肠内营养组、免疫营养组和生态营养组的小肠黏膜绒毛高度、肠腺隐窝深度、黏膜厚度及绒毛表面积均明显高于对照组(P<0.05),而肠内免疫营养组与生态营养组之间差异无显著性(P>0.05)。对照组和普通肠内营养组的小肠CD3+、CD4+、CD8+和IgA+细胞数明显低于肠内免疫营养组和生态营养组(P<0.01,P<0.05)。结论肠内营养,尤其是肠内免疫营养和生态营养能较好地改善创伤后大鼠的小肠机械屏障和免疫屏障功能,促进肠黏膜屏障功能的恢复。肠内免疫营养和生态营养在保护肠屏障功能方面具有相同的作用。