Fermentation Production of Ganoderma lucidum by Bacillus subtilis Ameliorated Ceftriaxone-induced Intestinal Dysbiosis and Improved Intestinal Mucosal Barrier Function in Mice

Objective This study aimed to develop a type of Ganoderma lucidum(G.lucidum)-probiotic fermentation broth that can effectively improve the intestinal mucosal barrier function of mice with ceftriaxone-induced intestinal dysbiosis.Methods By means of absorbance of optical density(OD)value and phenol-concentrated sulfuric acid measurement of polysaccharide content,the probiotic species can grow on the medium of G.lucidum were screened out,and the concentration of the medium of G.lucidum was determined,and the fermentation broth was prepared for subsequent experiments.Thirty-two SPF grade male BALB/c mice were randomly divided into four groups(eight mice in each group),namely control group(CON),intestinal mucosal barrier damage model group(CS),fermentation broth intervention group(FT)and G.lucidum medium intervention group(GL),respectively.The intestinal dysregulation model was induced by intra-gastric administration of 0.2 mL ceftriaxone sodium(twice a day for seven consecutive days).From day 8,the FT group and GL group were gavage with 0.2 mL fermentation broth and G.lucidum medium,respectively.On day 15,all mice were sacrificed.To draw the weight curve and measure the cecal index;pathological examination of colon tissues with HE staining;serum levels of LPS,IL-10,TNF and IL-6 were detected by ELISA.Flow cytometry was used to analyze the changes of CD3+T cells,CD4+T cells,CD8+T cells and macrophages in spleen.16S rRNA sequencing was performed to detect the intestinal microbiota structure of mice.Results Bacillus subtilis can decompose and utilize G.lucidum fruiting body medium,and the suitable concentration of G.lucidum fruiting body medium is 33.2 mg/mL.The effect of Bacillus subtilis-G.lucidum fermentation broth on the damage of intestinal mucosal barrier caused by ceftriaxone sodium was reduced,the body weight of mice recovered and colon swelling improved,colon histopathological injury was alleviated,inflammatory cell infiltration was alleviated,serum IL-10 increased significantly,LPS、TNF-αand IL-6 decreased significantly compared with model group,and the proportion of T cells and intestinal dysbiosis was improved.Conclusions The experimental results suggest that Bacillus subtilis-G.lucidum fermentation broth can effectively improve the intestinal barrier function damage,immune dysfunction and intestinal dysbiosis caused by antibiotic overdose,and has a certain regulatory effect on intestinal mucosal barrier function.

Protective effect of perioperative recombinant human growth hormone application on intestinal mucosal barrier function in patients with intestinal obstruction and the assessment of immune inflammatory response

Objective:To study the protective effect of perioperative recombinant human growth hormone (r-hGH) application on intestinal mucosal barrier function in patients with intestinal obstruction and the influence on the immune inflammatory response.Methods:60 patients with intestinal obstruction who underwent surgical treatment in our hospital between February 2013 and July 2016 were selected as the research subjects and divided into the control group (n=34) who received conventional surgical treatment and the observation group (n=26) who received surgery combined with perioperative r-hGH treatment. The serum levels of intestinal mucosal barrier indexes, immunoglobulin and inflammatory response indicators were compared between two groups of patients before and after treatment.Results: Before treatment, differences in serum levels of intestinal mucosal barrier indexes, immunoglobulin and inflammatory response indicators were not statistically significant between the two groups of patients. After treatment, serum intestinal mucosal barrier indexes Endotoxin, D-Lactate and DAO levels in observation group were lower than those in control group, immunoglobulin IgA, IgM and IgG levels were higher than those in control group, and inflammatory response indicators IL-1, IL-6, PCT and TNF-α levels were lower than those in control group patients. Conclusion:Perioperative r-hGH application in patients with intestinal obstruction can protect the intestinal mucosal barrier, also optimize the humoral immunity and suppress the systemic inflammatory response.

Intestinal mucosal barrier in functional constipation:Dose it change?

BACKGROUND The intestinal mucosal barrier is the first line of defense against numerous harmful substances,and it contributes to the maintenance of intestinal homeostasis.Recent studies reported that structural and functional changes in the intestinal mucosal barrier were involved in the pathogenesis of several intestinal diseases.However,no study thoroughly evaluated this barrier in patients with functional constipation(FC).AIM To investigate the intestinal mucosal barrier in FC,including the mucus barrier,intercellular junctions,mucosal immunity and gut permeability.METHODS Forty FC patients who fulfilled the Rome IV criteria and 24 healthy controls were recruited in the Department of Gastroenterology of China-Japan Friendship Hospital.The colonic mucus barrier,intercellular junctions in the colonic epithelium,mucosal immune state and gut permeability in FC patients were comprehensively examined.Goblet cells were stained with Alcian Blue/Periodic acid Schiff(AB/PAS)and counted.The ultrastructure of intercellular junctional complexes was observed under an electron microscope.Occludin and zonula occludens-1(ZO-1)in the colonic mucosa were located and quantified using immunohistochemistry and quantitative real-time polymerase chain reaction.Colonic CD3+intraepithelial lymphocytes(IELs)and CD3+lymphocytes in the lamina propria were identified and counted using immunofluorescence.The serum levels of D-lactic acid and zonulin were detected using enzyme-linked immunosorbent assay.RESULTS Compared to healthy controls,the staining of mucus secreted by goblet cells was darker in FC patients,and the number of goblet cells per upper crypt in the colonic mucosa was significantly increased in FC patients(control,18.67±2.99;FC,22.42±4.09;P=0.001).The intercellular junctional complexes in the colonic epithelium were integral in FC patients.The distribution of mucosal occludin and ZO-1 was not altered in FC patients.No significant differences were found in occludin(control,5.76E-2±1.62E-2;FC,5.17E-2±1.80E-2;P=0.240)and ZO-1(control,2.29E-2±0.93E-2;FC,2.68E-2±1.60E-2;P=0.333)protein expression between the two groups.The mRNA levels in occludin and ZO-1 were not modified in FC patients compared to healthy controls(P=0.145,P=0.451,respectively).No significant differences were observed in the number of CD3+IELs per 100 epithelial cells(control,5.62±2.06;FC,4.50±2.16;P=0.070)and CD3+lamina propria lymphocytes(control,19.69±6.04/mm^(2);FC,22.70±11.38/mm^(2);P=0.273).There were no significant differences in serum D-lactic acid[control,5.21(4.46,5.49)mmol/L;FC,4.63(4.31,5.42)mmol/L;P=0.112]or zonulin[control,1.36(0.53,2.15)ng/mL;FC,0.94(0.47,1.56)ng/mL;P=0.185]levels between FC patients and healthy controls.CONCLUSION The intestinal mucosal barrier in FC patients exhibits a compensatory increase in goblet cells and integral intercellular junctions without activation of mucosal immunity or increased gut permeability.

Value of serum procalcitonin content in severe acute pancreatitis for evaluating the infection degree and intestinal mucosal barrier function

Objective: To explore the value of serum procalcitonin content in severe acute pancreatitis for evaluating the infection degree and intestinal mucosal barrier function. Methods: A total of 68 patients with severe acute pancreatitis who were treated in our hospital between January 2015 and September 2017 were selected as pancreatitis group, and 50 healthy volunteers who underwent physical examination in this hospital during the same period were selected as normal control group. The differences in serum levels of PCT, inflammatory factors and intestinal mucosal barrier function indexes were compared between the two groups, and Pearson test was used to evaluate the correlation between PCT content and severe acute pancreatitis. Results: Serum PCT content of pancreatitis group was higher than that of control group;serum IL-6, IL-10 and TNF-α contents were higher than those of control group;serum D-Lactate, DAO and Endotoxin contents were higher than those of control group. Pearson test showed that the serum PCT content of patients with severe acute pancreatitis was directly correlated with the degree of infection and intestinal mucosal barrier dysfunction. Conclusion:Serum PCT content abnormally increases in severe acute pancreatitis, and the specific content is directly correlated with the degree of infection and intestinal mucosal barrier dysfunction.

Effect of somatostatin combined with omeprazole on serum inflammatory factors and intestinal mucosal barrier function in severe acute pancreatitis

Objective:To investigate the effect of somatostatin combined with omeprazole on serum inflammatory factors and intestinal mucosal barrier function in severe acute pancreatitis. Methods: patients with severe acute pancreatitis who were treated in Zigong Third People's Hospital between August 2014 and December 2017 were chosen and divided into two groups by random number table method. Control group received conventional + omeprazole treatment, combined group received conventional + somatostatin + omeprazole treatment and the treatment lasted for 1 week. The differences in serum levels of inflammatory factors, chemokines and intestinal mucosal barrier function indexes were compared between the two groups immediately after admission and after 1 week of treatment.Results: After 1 week of treatment, serum IL-1β, IL-8, IL-18, hs-CRP, MCP-1, FKN, CINC, D-Lactate, DAO, Endotoxin and FABP levels of both groups significantly decreased and serum IL-1β, IL-8, IL-18, hs-CRP, MCP-1, FKN, CINC, D-Lactate, DAO, Endotoxin and FABP levels of combined group were significantly lower than those of control group.Conclusion: Somatostatin combined with omeprazole therapy for severe acute pancreatitis can effectively alleviate the inflammatory response and protect the intestinal mucosal barrier function.

Effects of adjuvant raw rhubarb enema therapy on systemic inflammatory stress response and intestinal mucosal barrier function in patients with severe pancreatitis

Objective: To investigate the effects of adjuvant raw rhubarb enema therapy on systemic inflammatory stress response and intestinal mucosal barrier function in patients with severe pancreatitis. Methods: A total of 78 patients with severe pancreatitis treated in the Second People's Hospital of Neijiang, Sichuan, China between December 2016 and September 2018 were included in the study. The patients were divided into control group (n=39) and raw rhubarb group (n=39) by simple randomization. The control group of patients received conventional treatment of severe pancreatitis with western medicine, while the raw rhubarb group of patients received raw rhubarb enema on the basis of the treatment of control group, and the efficacy was evaluated after continuous treatment for 1 week. The differences in serum levels of inflammatory mediators (high mobility group protein B1, C-reactive protein, prostaglandin E2 and tumor necrosis factor α), stress hormones (cortisol and epinephrine) as well as intestinal mucosal barrier function indicators (D-lactate, endotoxin and diamine oxidase) were compared between the two groups of patients before and after treatment. Results: Before treatment, there was no statistically significant difference in serum levels of inflammatory mediators, stress hormones and intestinal mucosal barrier function indicators between the two groups (P>0.05). After treatment, serum high mobility group protein B1, C-reactive protein, prostaglandin E2 and tumor necrosis factor levels of the observation group were significantly lower than those of the control group;cortisol and epinephrine levels were significantly lower than those of the control group;D-lactate, endotoxin and diamine oxidase levels were significantly lower than those of the control group (P<0.05). Conclusions:Adjuvant raw rhubarb enema therapy on the basis of western medicine can help alleviate the inflammatory stress response and optimize the intestinal mucosal barrier function in patients with severe pancreatitis.

Effects of cefixime on the systemic inflammatory stress response and intestinal mucosal barrier injury in children with infective enteritis

Objective:To investigate the effects of cefixime on the systemic inflammatory stress response and intestinal mucosal barrier injury in children with infective enteritis.Methods:A total of 80 children with infective enteritis who were treated in the hospital between March 2016 and August 2017 were divided into group A (n=40) and group B (n=40) according to the random number table method. Group A received cefaclor anti-infective therapy, group B received cefixime therapy, and both therapies lasted for 1 week. The differences in serum levels of inflammatory mediators, oxidative stress indexes and intestinal mucosal injury markers were compared between the two groups before and after treatment.Results: Before treatment, the differences in serum levels of inflammatory mediators, oxidative stress indexes and intestinal mucosal injury markers were not statistically significant. After 1 week of treatment, serum inflammatory mediators IL-8 and TNF-α levels of group B were lower than those of group A whereas IL-10 level was higher than that of group A;serum oxidative stress indexes ROS and MDA levels were lower than those of group A whereas GSH-Px and CAT levels were higher than those of group A;serum intestinal mucosal injury markers DAO, D-Lactate, FABP and GST levels were lower than those of group A.Conclusion: Cefixime anti-infective therapy can effectively inhibit the inflammatory stress response and reduce the intestinal mucosal barrier injury in children with infective enteritis.

Effects of permissive hypocaloric vs standard enteral feeding on gastrointestinal function and outcomes in sepsis

BACKGROUND Intestinal mucosal barrier injury and gastrointestinal dysfunction are important causes of sepsis.However,few studies have investigated the effects of enteral underfeeding on gastrointestinal function in sepsis.Moreover,no consensus on goal enteral caloric intake has been reached in sepsis.AIM To investigate the effects of different goal caloric requirements of enteral nutrition on the gastrointestinal function and outcomes in the acute phase of sepsis.METHODS Patients were randomly assigned to receive 30%(defined as group A),60%(group B),or 100%(group C)of goal caloric requirements of enteral nutrition in this prospective pilot clinical trial.The acute gastrointestinal injury(AGI)grades,incidence of feeding intolerance(FI),daily caloric intake,nutritional and inflammatory markers,and biomarkers of mucosal barrier function were collected during the first 7 d of enteral feeding.The clinical severity and outcome variables were also recorded.RESULTS A total of 54 septic patients were enrolled.The days to goal calorie of group C(2.55±0.82)were significantly longer than those of group A(3.50±1.51;P=0.046)or B(4.85±1.68;P<0.001).The FI incidence of group C(16.5%)was higher than that of group A(5.0%)or B(8.7%)(P=0.009).No difference in the incidence of FI symptoms was found between groups A and B.The serum levels of barrier function biomarkers of group B were significantly lower than those of group A(P<0.05)on the 7th day of feeding.The prealbumin and IL-6 levels of group A were lower than those of group B(P<0.05)on the 7th day of feeding.No significant differences in the clinical outcome variables or 28-d mortality were found among the three groups.CONCLUSION Early moderate enteral underfeeding(60%of goal requirements)could improve the intestinal barrier function and nutritional and inflammatory status without increasing the incidence of FI symptoms in sepsis.However,further large-scale prospective clinical trials and animal studies are required to test our findings.Moreover,the effects of different protein intake on gastrointestinal function and outcomes should also be investigated in future work.

益生菌肠内营养支持联合经颅磁刺激在脑卒中后吞咽障碍康复中的应用

目的探讨益生菌肠内营养支持联合经颅磁刺激在脑卒中后吞咽障碍康复中的临床应用效果。方法选取2019-01—2022-12上海中医药大学附属第七人民医院收治的98例脑卒中吞咽障碍患者,分为观察组和对照组各49例。对照组实施经颅磁刺激疗法+营养支持干预,观察组辅助应用益生菌肠内营养干预。对比2组间疗效、吞咽功能、营养健康状况、免疫功能、肠道屏障功能。结果观察组临床疗效优于对照组(P<0.05)。治疗后,观察组洼田饮水试验(KWST)、功能性吞咽障碍量表(FDS)、EAT-10评分均低于对照组(P<0.05),血红蛋白(Hb)、白蛋白(ALB)、前白蛋白(PAB)水平均高于对照组(P<0.05),免疫球蛋白A(IgA)、免疫球蛋白G(IgG)、免疫球蛋白M(IgM)水平均高于对照组(P<0.05),ET、DAO、D-LA低于对照组(P<0.05)。结论益生菌肠内营养支持结合经颅磁刺激对脑卒中吞咽障碍有较好干预效果,能提高吞咽功能和营养水平,提升免疫水平,提高患者肠黏膜屏障功能。

维得利珠单抗治疗中重度溃疡性结肠炎的临床疗效及对患者炎症反应、肠道黏膜屏障功能的影响

目的:探讨维得利珠单抗治疗中重度溃疡性结肠炎(UC)的临床疗效及对患者炎症反应、肠道黏膜屏障功能的影响。方法:选取2021年8月~2023年12月期间于某院消化内科就诊的106例中重度UC患者作为研究对象,采用随机数字表法分为对照组和观察组,每组53例。对照组患者给予美沙拉嗪肠溶片治疗,观察组患者在对照组治疗基础上联合注射用维得利珠单抗治疗。比较两组患者肠道屏障功能指标(D-乳酸、二胺氧化酶)、炎症指标[黏蛋白1(MUC1)、嗜酸性粒细胞趋化因子(CCL11)、肿瘤坏死因子-α(TNF-α)和红细胞沉降率(ESR)]、Th17/Treg平衡指标(Th17、Treg和Th17/Treg)、临床症状(腹痛、腹泻、黏液脓血便、里急后重)消失时间、ESR、C反应蛋白(CRP)恢复正常时间、临床疗效及不良反应发生情况。结果:治疗后,两组患者D-乳酸、二胺氧化酶、MUC1、CCL11、ESR和TNF-α水平均降低(P<0.05),且观察组低于对照组(P<0.05);Th17、Th17/Treg均降低(P<0.05),且观察组低于对照组(P<0.05);Treg均升高(P<0.05),且观察组高于对照组(P<0.05);观察组患者腹痛、腹泻、黏液脓血便、里急后重等临床症状消失时间及ESR、CRP恢复正常时间均短于对照组(P<0.05);观察组患者治疗总有效率(88.68%)高于对照组(73.58%,P<0.05)。两组患者不良反应总发生率比较无统计学差异(P>0.05)。结论:维得利珠单抗联合美沙拉嗪治疗中重度UC患者临床疗效较佳,可显著促进临床症状消退,改善肠道黏膜屏障功能,抑制炎症反应,且未增加不良反应的发生风险。

丙氨酰-谷氨酰胺联合微生态制剂对食管早癌ESD术后肠黏膜屏障功能的影响

目的:探究丙氨酰-谷氨酰胺联合微生态制剂对食管早癌内镜粘膜下剥离术(ESD)术后肠黏膜屏障功能的影响。方法:选取2020年3月至2022年12月入新乡医学院第一附属医院行ESD术的食管早癌病人96例,随机分为对照组(n=48)和干预组(n=48)。对照组病人予以常规术前禁食、术后基础治疗及营养支持,干预组术前第3天予开始注射丙氨酰-谷氨酰胺和口服微生态制剂(双歧杆菌四联活菌片),术后第1~7天同时予以丙氨酰-谷氨酰胺和微生态制剂。比较两组病人早期肠内营养耐受性、肠道菌群分布、肠黏膜屏障功能、营养指标、炎症因子、免疫功能及术后康复情况。结果:术后7 d,干预组病人肠道不耐受症状的发生率显著低于对照组的(14.58%vs 37.50%,P<0.05)。术后,干预组双歧杆菌、乳酸杆菌较对照组增多,大肠杆菌较对照组少,二胺氧化酶、内毒素和D-乳酸水平较对照组低,总蛋白(TP)、白蛋白(Alb)和前白蛋白(PA)水平较对照组高,白细胞介素(IL-1β、-6、-8)水平较对照组低,CD3^(+)和CD4^(+)/CD8^(+)水平较对照组高(P<0.05);干预组术后首次排气时间、排便时间及住院时间短于对照组(P<0.05)。结论:给予丙氨酰-谷氨酰胺联合微生态制剂可有效提高食管早癌病人术后早期肠内营养耐受性,减轻肠黏膜屏障功能损伤,改善营养状况,提升免疫力。

白头翁汤合益脾祛湿理肠汤加减对大肠湿热型溃疡性结肠炎患者的临床疗效

目的:探讨大肠湿热型溃疡性结肠炎(UC)患者给予白头翁汤合益脾祛湿理肠汤加减的临床疗效。方法:选取2022年3月—2023年2月江西中医药大学附属医院收治的大肠湿热型UC患者共计86例,以随机数字表法分成研究组(43例)与对照组(43例),对照组给予白头翁汤治疗,研究组给予白头翁汤合益脾祛湿理肠汤加减治疗,两组均治疗6周。比较两组临床疗效、肠黏膜屏障功能、炎症因子水平及不良反应。结果:研究组治疗总有效率(90.70%)较对照组(74.42%)更高,差异有统计学意义(P<0.05);两组治疗后D-乳酸(D-LA)、内毒素(BT)、二胺氧化酶(DAO)水平均降低,研究组均较对照组更低,差异均有统计学意义(P<0.05);两组治疗后白细胞介素-17(IL-17)、白细胞介素-23(IL-23)水平均降低,研究组均较对照组更低,差异均有统计学意义(P<0.05);研究组不良反应发生率(6.98%)与对照组(2.33%)比较差异无统计学意义(P>0.05)。结论:大肠湿热型UC患者给予白头翁汤合益脾祛湿理肠汤加减治疗,能够提升临床效果,改善患者肠黏膜屏障功能、炎症因子水平,安全性较高。

微生态制剂联合依达拉奉注射液对急性重症胰腺炎的疗效及肠道菌群、肠黏膜屏障功能改变

目的探讨复方嗜酸乳杆菌片联合依达拉奉对重症急性胰腺炎患者的临床效果。方法选取河南科技大学第一附属医院收治的172例重症急性胰腺炎患者,利用随机数字表法将其分为甲、乙、丙与丁4组,各43例。4组均接受常规综合治疗,乙组另接受依达拉奉治疗,丙组另接受复方嗜酸乳杆菌片治疗,丁组另接受复方嗜酸乳杆菌片联合依达拉奉治疗。对比治疗前后肠道菌群和肠黏膜屏障功能相关指标、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)及住院时间、并发症、病死率。结果4组双歧杆属、乳酸杆菌属相对丰度在治疗前、治疗7 d及14 d后均依次升高(P<0.05),丙组、丁组治疗7、14 d后均高于甲组、乙组(P<0.05),丁组治疗7、14 d后高于丙组(P<0.05);4组肠杆菌属、葡萄球菌属、肠球菌属相对丰度在治疗前、治疗7 d及14 d后均依次降低(P<0.05),丙组、丁组治疗7、14 d后均低于甲组、乙组(P<0.05),丁组治疗7、14 d后低于丙组(P<0.05);4组D-乳酸、内毒素、二胺氧化酶(DAO)水平在治疗前、治疗7 d及14 d后均依次降低(P<0.05),乙组、丙组、丁组治疗7、14 d后均低于甲组(P<0.05),乙组、丁组治疗7、14 d后均低于丙组(P<0.05),丁组治疗7、14 d后低于乙组(P<0.05);丁组住院时间短于甲组、乙组、丙组(P<0.05),丁组并发症发生率、病死率低于甲组(P<0.05);4组APACHEⅡ评分在治疗前、治疗7及14 d后均依次降低(P<0.05),乙组、丙组、丁组治疗7、14 d后均低于甲组(P<0.05),丁组治疗7、14 d后低于乙组、丙组(P<0.05)。结论在常规综合治疗的基础上接受复方嗜酸乳杆菌片能够调节重症急性胰腺炎患者机体肠道菌群,改善肠黏膜屏障功能,给予依达拉奉可改善肠黏膜屏障功能,二者均可减轻病情,且二者联合可增强对肠黏膜屏障功能的改善作用和对病情的控制作用,还可显著缩短住院时间,减少并发症,改善预后。

双歧杆菌四联活菌片联合小麦纤维素颗粒治疗儿童功能性便秘的效果

目的:探究双歧杆菌四联活菌片联合小麦纤维素颗粒治疗儿童功能性便秘的效果。方法:选取2022年6月—2023年6月于德阳市人民医院治疗的102例功能性便秘患儿作为研究对象,采用随机数表法将其分为对照组和研究组,各51例。对照组采用乳果糖口服溶液治疗,研究组在对照组基础上给予双歧杆菌四联活菌片联合小麦纤维素颗粒治疗,比较两组治疗效果、肠黏膜屏障功能[二胺氧化酶(DAO)、降钙素原(PCT)]、肠神经递质[血管活性肠肽(VIP)、P物质(SP)]、肠道菌群及便秘症状评分。结果:治疗后,与对照组比较,研究组临床总有效率更高,差异有统计学意义(P<0.05)。治疗前,两组黏膜屏障功能、肠神经递质、肠道菌群及便秘症状评分比较,差异无统计学意义(P>0.05);治疗后,两组DAO、PCT、VIP水平、排便频次评分、排便困难评分降低,且研究组更低,两组SP、双歧杆菌、乳酸菌水平升高,且研究组更高,差异有统计学意义(P<0.05)。结论:双歧杆菌四联活菌片联合小麦纤维素颗粒可以调节儿童功能性便秘患儿的肠道菌群和肠神经递质水平,保护肠黏膜屏障,促进症状改善,提高临床疗效。

大承气汤加味联合连续肾脏替代疗法、乌司他丁治疗重症急性胰腺炎临床研究

目的:观察大承气汤加味联合连续肾脏替代疗法(CRRT)、乌司他丁治疗重症急性胰腺炎(SAP的临床疗效及对肠黏膜屏障功能及血清可溶性白细胞分化抗原CD14亚型(sCD14-st)水平的影响。方法:选择140例SAP患者,随机分为对照组和观察组各70例。期间对照组脱落2例、观察组脱落3例。对照组采用CRRT联合乌司他丁治疗,观察组在对照组基础上加用大承气汤加味治疗。2组均治疗2周。比较2组临床疗效,以及治疗前后中医证候评分、急性生理与慢性健康状况(APACHE)-Ⅱ评分、肠黏膜屏障功能指标[D-乳酸、二胺氧化酶(DAO)、淀粉酶(AMS)]、血清因子[sCD14-st、单核细胞趋化蛋白-1 (MCP-1)]水平。结果:治疗后,观察组总有效率为94.03%,对照组为82.35%,2组比较,差异有统计学意义(P<0.05)。治疗后,2组中医证候评分、 APACHE-Ⅱ评分均较治疗前降低(P<0.05),且观察组2项评分均低于对照组(P<0.05)。治疗后,2组D-乳酸、DAO、AMS水平均较治疗前降低(P<0.05),且观察组3项指标均低于对照组(P<0.05)。治疗后,2组血清sCD14-st、MCP-1水平均较治疗前降低(P<0.05),且观察组2项指标均低于对照组(P<0.05)。结论:大承气汤加味联合CRRT、乌司他丁治疗SAP疗效显著,可明显下调sCD14-st、MCP-1水平,改善肠黏膜屏障功能及中医证候,有效控制病情发展。

半夏泻心汤治疗化疗性肠黏膜炎的治疗效果分析

目的:分析化疗性肠黏膜炎治疗中半夏泻心汤的治疗效果。方法:回顾性选取2020年2月-2023年2月本院化疗性肠黏膜炎患者100例,依据用药方法分为半夏泻心汤组、洛哌丁胺组两组,各50例。统计分析两组中医症候积分、肠道菌群相对丰度、肠黏膜屏障功能、血清炎症细胞因子水平、临床疗效、腹泻发生情况。结果:半夏泻心汤组患者的大便泄泻、腹痛腹胀、口干口苦、食欲不振、倦怠乏力、畏寒积分及中医症候总积分、肠球菌、肠杆菌、D-乳酸、ET、DAO、TNF-α、IL-1β、IL-6水平均低于洛哌丁胺组(P<0.05),乳酸杆菌、双歧杆菌、IL-10水平均高于洛哌丁胺组(P<0.05)。半夏泻心汤组患者的总有效率90.00%(45/50)高于洛哌丁胺组62.00%(31/50)(χ^(2)=10.746,P<0.05)。半夏泻心汤组患者的腹泻发生率6.00%(3/50)低于洛哌丁胺组50.00%(25/50)(χ^(2)=24.008,P<0.05)。结论:化疗性肠黏膜炎治疗中半夏泻心汤的治疗效果较洛哌丁胺好。

肠脂肪酸结合蛋白在肠黏膜屏障损伤相关疾病中的作用研究进展

肠道是人体持续暴露于外部环境的最大器官之一,发挥着重要的物理及化学屏障作用保护人体免受致病菌侵害,肠黏膜屏障作为肠道的重要组成部分,其完整性对维持肠道微生态平衡起关键作用,肠黏膜屏障破坏可导致肠道菌群失调及易位,与多种疾病的发生发展相关。肠脂肪酸结合蛋白(intestinal fatty acid binding protein,I‑FABP)是脂肪酸结合蛋白家族中的一种,对肠道损伤具有特异性,在肠道发生损伤、缺血、肠黏膜屏障损伤及通透性增加时会迅速释放入血液循环,I‑FABP水平升高是反映肠道损伤的重要标志物,临床上很多疾病常合并肠道功能障碍,本文主要对I‑FABP的结构特征、功能及其与肠黏膜屏障相关疾病的关系进行综述。

布拉氏酵母菌联合熊去氧胆酸治疗直肠型溃疡性结肠炎的疗效及对肠黏膜屏障功能的影响

目的探讨布拉氏酵母菌联合熊去氧胆酸治疗直肠型溃疡性结肠炎(UC)的疗效及对肠黏膜屏障功能的影响。方法将88例直肠型UC患者随机分为观察组和对照组,每组44例。比较2组患者治疗前后主要症状(腹痛、腹泻、脓血便)评分、炎症性肠病问卷(IBDQ)评分、炎性因子指标[白细胞介素-6(IL-6)、白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)]水平及肠黏膜屏障功能指标[尿液乳果酸与甘露醇的比值(L/M)、血清D-乳酸(D-LA)、血清二胺氧化酶(DAO)、血清脂多糖(LPS)]水平。比较2组不良反应发生情况。结果治疗后,2组腹痛、腹泻和脓血便评分均较治疗前降低,IBDQ评分高于治疗前,且观察组腹痛、腹泻和脓血便评分低于对照组,IBDQ评分高于对照组,差异均有统计学意义(P<0.05)。治疗后,2组血清D-LA、DAO、LPS和尿中L/M均降低,且观察组上述指标水平低于对照组,差异均有统计学意义(P<0.05)。治疗后,2组血清IL-6、TNF-α和IL-1β水平降低,且观察组上述指标水平低于对照组,差异有统计学意义(P<0.05)。观察组治疗总有效率为86.36%,高于对照组的68.18%,差异有统计学意义(P<0.05)。2组下腹部疼痛、过敏、顽固型便秘等不良反应发生率比较,差异无统计学意义(P>0.05)。结论布拉氏酵母菌联合熊去氧胆酸治疗直肠型UC患者疗效显著,能够有效改善腹痛、腹泻和脓血便等症状,抑制机体炎症反应,缓解肠黏膜屏障受损。

基于肠道屏障探讨“脾主为卫”在溃疡性结肠炎发病与治疗中的作用机制

溃疡性结肠炎(UC)是一种以肠道屏障受损为特点,表现为直肠黏膜的持续性炎症反应、溃烂以及反复发作的炎症性肠病。脾与肠道屏障有密切联系,“脾主为卫”的功能失调是UC的重要病机,然而对UC中“脾主为卫”功能失调的微观机制尚不清楚。肠道屏障与“脾主为卫”的功能异曲同工,肠道屏障的破坏与UC互为因果,从肠道屏障的角度可以为中医“脾主为卫”理论做出新的科学阐释。现代医学尚缺乏对UC的有效治愈方法,药物治疗仍存在不良反应大、停药后加重、易复发等缺点。而中医基于“脾主为卫”理论的益气健脾治法可有效恢复肠道屏障功能,促进黏膜愈合,且无上述不良反应,对于促进UC的愈合以及防止其复发具有重要的临床价值。

锦红片联合西医治疗急性胰腺炎的疗效及对炎症反应和肠黏膜屏障功能的影响

目的:探讨锦红片联合西医治疗急性胰腺炎(AP)的疗效及对炎症反应和肠黏膜屏障功能的影响。方法:选取298例AP患者为研究对象,依据治疗方案不同分为西医组和锦红片组,每组各149例。西医组患者给予常规西医治疗;锦红片组患者给予锦红片联合西医治疗,疗程均为7 d。比较两组患者临床疗效、中医证候积分、血淀粉酶、尿淀粉酶水平、炎症因子[C反应蛋白(CRP)、降钙素原(PCT)、白细胞介素6(IL-6)]水平及肠黏膜屏障功能[二胺氧化酶(DAO)、内毒素水平]及不良反应发生情况。结果:治疗后,锦红片组患者临床总有效率高于西医组(91.95%vs.73.15%,P<0.05);中医证候积分、血淀粉酶、尿淀粉酶及血清CRP、PCT、IL-6、DAO、内毒素水平低于西医组(P<0.05)。治疗期间两组患者均未发生严重药物不良反应。结论:在西医治疗的基础上加用锦红片可提高AP临床疗效,改善临床症状,减轻炎症反应,保护肠黏膜屏障功能。