肠易激综合征患者胆囊排空功能研究

目的:研究肠易激综合征(IBS)患者胆囊排空功能.方法:用二维B超测量47例肠易激综合征(腹泻型25例,便秘型22例)患者胆囊排空功能,并与对照组比较.结果:空腹时腹泻型IBS患者胆囊平均体积大于对照组和便秘组(P＜0.01),脂肪餐后其排空率明显下降(P＜0.05),而便秘型IBS与对照组无显著性差异(P＞0.05).结论:腹泻型IBS患者存在胆囊排空功能障碍.     

肥大细胞与嘌呤受体在IBS发病机制中的作用研究进展

到目前为止,肠易激综合征(irritable bowel syndrome,IBS)的发病机制仍不十分清楚,还没有一种确切的治疗措施.随着其发病机理研究的进展,肥大细胞的作用越来越受重视.肥大细胞脱颗粒能释放强有力的神经介质和免疫调节物质,可以影响肠黏膜神经丛的活性从而导致IBS临床症状的发生.研究表明,嘌呤受体在肥大细胞上表达并且与其脱颗粒有关,本文就肥大细胞与嘌呤受体在IBS发病机理中的可能作用进行阐述.     

洛哌丁胺联合阿米替林治疗腹泻型肠易激综合征临床观察

肠易激综合征(IBS)是常见的消化系统疾病之一,根据症状分为腹泻型、便秘型和腹泻便秘交替型,IBS的病理生理学研究结果发现,几乎所有的IBS患者都有结肠动力紊乱表现,腹泻型IBS患者结肠转运速度加快,结肠反射亢进,并存在明显的内脏高敏感性,但临床单独使用抑制肠道平滑肌、抑制肠黏膜感受器类的药物治疗效果不理想,我院2005年3月～2006年8月应用洛哌丁胺(商品名:易蒙停)联合阿米替林治疗腹泻型IBS患者50例,现报道如下.     

洛哌丁胺联合阿米替林治疗腹泻型肠易激综合征临床观察

肠易激综合征（IBS）是常见的消化系统疾病之一，根据症状分为腹泻型、便秘型和腹泻便秘交替型，IBS的病理生理学研究结果发现，几乎所有的IBS患者都有结肠动力紊乱表现，腹泻型IBS患者结肠转运速度加快，结肠反射亢进，并存在明显的内脏高敏感性，但临床单独使用抑制肠道平滑肌、抑制肠黏膜感受器类的药物治疗效果不理想，我院2005年3月～2006年8月应用洛哌丁胺（商品名：易蒙停）联合阿米替林治疗腹泻型IBS患者50例，现报道如下。     

腹泻型肠易激综合征与胆碱酯酶水平的相关性

目的 研究腹泻型肠易激综合征患者血清中胆碱酯酶水平与腹泻型肠易激综合征的关系,为腹泻型肠易激综合征的诊断提供依据.方法 选取2011年10月至2012年10月我院消化科收治的肠易激综合征患者60例,其中腹泻型32例,便秘型28例,选取健康体检者40例为对照组,根据临床特征将其分为腹泻型肠易激综合征(IBS-D)组、便秘型肠易激综合征(IBS-C)组和对照组.抽取3组受检查者空腹静脉血3 ml,分离血清,进行胆碱酯酶水平检测.结果 IBS-D组血清胆碱酯酶水平为(11 053±647) U/L,IBS-C组为(8 470±538) U/L,对照组为(8 721±715) U/L,IBS-D组患者血清中胆碱酯酶水平明显高于IBS-C组和对照组,差异均有统计学意义(P＜0.05);IBS-C组患者血清中胆碱酯酶水平与对照组比较,差异无统计学意义( P＞0.05).结论 腹泻型肠易激综合征与胆碱酯酶水平存在相关性.     

腹泻型肠易激综合征患者肠黏膜细胞因子的表达

目的研究腹泻型肠易激综合征(D-IBS)患者结肠黏膜组织中细胞因子白细胞介素(IL)-10、IL-18及肿瘤坏死因子(TNF)-α的表达,进一步探讨D-IBS的发病机制。方法选取沧州市中心医院门诊及住院的D-IBS患者68例,另选30例结肠息肉切除术后半年复查无异常表现者为对照组,于内镜下取回盲部及乙状结肠肠黏膜组织各2块,用免疫组织化学法测定回盲部及乙状结肠肠黏膜中IL-10、IL-18及TNF-α的表达水平。结果 TNF-α在D-IBS患者回盲部及乙状结肠肠黏膜的表达水平高于对照组,差异有统计学意义[(87.95±26.03)%vs(50.14±24.52)%,(71.15±26.12)%vs(52.04±25.62)%;P0.01)]。IL-18在D-IBS患者回肠末端及乙状结肠肠黏膜的表达与对照组比较,差异无统计学意义[(62.18±25.41)%vs(55.79±24.61)%,(60.46±24.73)%vs(59.12±24.57)%;P0.05];IL-10的表达低于对照组[(61.63±22.05)%vs(8 7.44±24.27)%,(76.25±23.14)%vs(89.43±25.81)%;P0.05)]。同时发现TNF-α在回盲部的表达高于乙状结肠,差异有统计学意义(t=3.76,P0.01);而IL-10的黏膜表达比乙状结肠低(t=3.77,P0.01),IL-18在两个部位的表达,差异均无统计学意义。感染后IBS患者IL-10表达下降不明显,但IL-18和TNF-α的在回盲部和乙状结肠的表达均明显升高,与非感染组比较,差异有统计学意义[IL-18:(70.23±24.37)%vs(51.79±24.61)%,(82.93±25.67)%vs(60.18±26.21)%;P0.01);TNF-α:(95.34±25.56)%vs(62.91±23.78)%;(103.14±22.76)vs(84.42±26.14)%;P0.01)]。结论 D-IBS患者回盲部及乙状结肠黏膜炎性细胞因子表达水平升高,抗炎细胞因子的表达降低,存在促炎细胞因子与抑炎细胞因子失衡,并且在回盲部的表现明显,在感染后的D-IBS患者更加突出,细胞因子的平衡紊乱参与了D-IBS的发生和发展。     

中西医结合治疗腹泻型肠易激综合征临床观察

肠易激综合征（IBS）是一种颇为常见的慢性非器质性肠功能紊乱性疾病，其临床特点是病程较长，临床以腹痛、腹胀、腹泻或便秘为主要症状，采用单纯的西医治疗方法效果不佳。临床上，常将本病分为腹泻型、便秘型、混合型3型。2006年7月-2009年2月，采用中西医结合的方法治疗腹泻型肠易激综合征，并与单纯西药治疗比较，疗效满意。现报告如下。     

肠易激综合征患者中小肠细菌过度生长的研究

目的:分析肠易激综合征(IBS)患者小肠细菌过度生长(SIBO)情况。方法:选取正常对照30人;腹泻型-IBS(IBS-D)30人,便秘型-IBS(IBS-C)患者30人;测定小肠细菌过度生长情况,并将结果加以比较。结果:(1)IBS-D组SIBO发生率47.7%,IBS-C组SIBO发生率43.3%,正常对照SIBO发生率6.7%组,IBS组的SIBO发生率高于正常对照组(P<0.05)。意义:(1)肠易激综合征患者中有较高的SIBO发生率。     

曲美布汀治疗肠易激综合征99例疗效分析

肠易激综合征(irritable bowel syndrome.IBS)是临床常见的功能性肠道疾病.主要症状有腹痛、腹泻、便秘、腹胀等.临床分为三个亚型:腹泻型、便秘型、腹泻便秘交替型.为寻求IBS新的治疗方法,我院采用马来酸曲美布汀片(援生力维片)治疗IBS99例,现报告如下.     

肠易激综合征时结肠黏膜一氧化氮含量的临床观察

目的　通过观察肠易激综合征 (IBS)患者结肠黏膜组织的一氧化氮含量 ,对一氧化氮 (NO)在IBS发病机制中的作用作一探讨。方法　确诊的IBS 5 9例 ,分为腹泻型组 36例和便秘型组 2 3例 ,正常对照组 2 0例。肠镜检查同时取直肠、乙状结肠黏膜组织各 2块 ,并测定组织中NO含量。结果　腹泻组的结肠黏膜NO测定值 (117.6 9± 5 .5 8) μmol/L ,较便秘组 (6 6 .2± 11.8) μmol/L和正常对照组 (6 5 .7± 15 .8) μmol/L明显升高 ,便秘组和正常对照组二者之间无显著性差异。结论　 36例腹泻型IBS 11例可追寻到发病前半年曾有急性肠道感染病史 ,腹泻型IBS结肠黏膜NO含量升高与NO的生物学作用有关 ,从而证实IBS的发病与炎症因子有关 ,NO和一氧化氮合酶 (NOS)参与了IBS的发病机制。肠道感染与IBS有一定关系。感染后IBS确实存在。     

Kiwifruit improves bowel function in patients with irritable bowel syndrome with constipation

Irritable bowel syndrome (IBS) is a common functional disorder of the gastrointestinal system, and is characterized by abdominal pain, diarrhea (IBS/D), constipation (IBS/C), and alternating diarrhea and constipation (IBSC/A). The purpose of this study was to examine the impact of a four week kiwifruit intervention on bowel function in patients diagnosed with IBS/C. Fifty-four patients with IBS/C and 16 healthy adults participated in this study. All subjects participated in the 6 week, three phase study, which included a baseline phase (1 week), a dietary intervention period (4 weeks), and a post-intervention phase (1 week). Forty-one IBS/C patients and all healthy adults consumed two Hayward green (Actinida deliciosa var) kiwifruits per day for 4 weeks. Thirteen IBS/C patients in the control group took two placebo capsules per day for 4 weeks. Colon transit time was measured immediately prior to and following the intervention period. All subjects completed daily defecation records. After the 4-week intervention, weekly defecation frequency significantly increased in the IBS/C group of participants who consumed kiwifruit (p<0.05). Colon transit time significantly decreased (p=0.026) in the IBS/C group that consumed kiwi fruit. These findings suggest that kiwifruit consumption for 4 weeks shortens colon transit time, increases defecation frequency, and improves bowel function in adults diagnosed with IBS/C.     

RELATIONSHIP BETWEEN MAST CELL AND INOS EXPRESSION IN TESTICULAR TISSUE ASSOCIATED WITH INFERTILITY

The objective of this study was to investigate mast cells and iNOS expression in testis tissue, and to correlate these results with spermatogenetic disorders. A total of 136 testicular biopsies were obtained from the testes of 80 patients with infertility. Their age ranged from 21 to 45 years. The biopsy specimens were immunohistochemically stained with antihuman tryptase for mast cells. In each section, all interstitial fields were evaluated for the total number of mast cells as well as the total number of Leydig cells. The number of mast cells per Leydig cell was calculated and recorded as mast cell index. Immunohistochemical iNOS staining was evaluated semiquantitatively according to intensity and the proportion of the stained cells. There was a significant increase of the mast cell index in all groups with testicular disorder compared with normal spermatogenesis group (p < 0.05). Increase of the index was in the order of hypospermatogenesis, maturation arrest and SCO, and index of SCO group was especially higher, i.e., more than twice than other groups. iNOS score was significantly higher in the SCO group than in the men with normal spermatogenesis, hypospermatogenesis, and maturation arrest (p < 0.05). Finally, a significant statistical correlation was found between the iNOS score and mast cells index (r = 0,758, p = 0,001). Increase of mast cell index was observed in the groups of infertile testis, and high expression of iNOS in Leydig cells was associated with the highest mast cell index in SCO, the lesion with the most severe damage of the germ cell.     

匹维溴铵联合酪酸梭菌活菌治疗肠易激综合征的疗效观察

目的探讨匹维溴胺联合酪酸梭菌活菌（米桑）治疗肠易激综合征（IBS）的临床疗效。方法选择54例IBS患者,随机分为对照组和治疗组各27例。对照组口服匹维溴胺50mg,3次／d;治疗组在此基础上加服酪酸梭菌活菌400mg,32．／d;疗程均为4周;观察两组治疗后腹痛、腹泻、便秘等症状变化及临床疗效。结果治疗组总有效率为92．6％,对照组总有效率为66．7％,治疗组优于对照组,差异有统计学意义（P〈0．05）。结论匹维溴胺联合酪酸梭菌活菌可有效改善IBS患者的临床症状,提高疗效。     

Environmental estrogens induce mast cell degranulation and enhance IgE-mediated release of allergic mediators

BACKGROUND: Prevalence and morbidity of allergic diseases have increased over the last decades. Based on the recently recognized differences in asthma prevalence between the sexes, we have examined the effect of endogenous estrogens on a key element of the allergic response. Some lipophilic pollutants have estrogen-like activities and are termed environmental estrogens. These pollutants tend to degrade slowly in the environment and to bioaccumulate and bioconcentrate in the food chain; they also have long biological half-lives. OBJECTIVES: Our goal in this study was to identify possible pathogenic roles for environmental estrogens in the development of allergic diseases. METHODS: We screened a number of environmental estrogens for their ability to modulate the release of allergic mediators from mast cells. We incubated a human mast cell line and primary mast cell cultures derived from bone marrow of wild type and estrogen receptor alpha (ER-alpha)-deficient mice with environmental estrogens with and without estradiol or IgE and allergens. We assessed degranulation of mast cells by quantifying the release of beta-hexosaminidase. RESULTS: All of the environmental estrogens tested caused rapid, dose-related release of beta-hexosaminidase from mast cells and enhanced IgE-mediated release. The combination of physiologic concentrations of 17beta-estradiol and several concentrations of environmental estrogens had additive effects on mast cell degranulation. Comparison of bone marrow mast cells from ER-alpha-sufficient and ER-alpha-deficient mice indicated that much of the effect of environmental estrogens was mediated by ER-alpha. CONCLUSIONS: Our findings suggest that estrogenic environmental pollutants might promote allergic diseases by inducing and enhancing mast cell degranulation by physiologic estrogens and exposure to allergens.     

Effects of linseeds on the symptoms of irritable bowel syndrome: a pilot randomised controlled trial

Background: Manipulation of dietary fibre intake represents a longstanding treatment for patients with irritable bowel syndrome (IBS), particularly for those with constipation. Linseeds are often recommended by both clinicians and dietitians as a source of dietary fibre to alleviate symptoms. Recent guidance on the management of irritable bowel syndrome (IBS) advises that linseeds may reduce wind and bloating, although there is limited clinical evidence to support this recommendation. The present pilot study aimed to compare the clinical effectiveness of: (i) whole linseeds versus ground linseeds; (ii) whole linseeds versus no linseeds; and (iii) ground linseeds versus no linseeds in the management of IBS symptoms. Methods: In an open randomised controlled trial, subjects with IBS (n = 40) were allocated to one of three intervention groups: two tablespoons of whole linseeds per day (n = 14), two tablespoons of ground linseeds per day (n = 13) and no linseeds as controls (n = 13). Symptom severity (primary outcome) and bowel habit were assessed before and after a 4‐week intervention and statistical differences between the groups were compared. Results: Thirty‐one subjects completed the present study. Between‐group analysis comparing the improvement in symptom severity did not reach statistical significance for whole linseeds (n = 11) versus ground linseeds (n = 11; P = 0.62), whole linseeds versus controls (n = 9; P = 0.12) and ground linseeds versus controls (P = 0.10). There were no significant changes in stool frequency or stool consistency for any of the groups. Conclusions: Linseeds may be useful in relief of IBS symptoms. Further research is needed to detect clear differences between the effects of whole and ground linseeds.     

Effects of ionizing radiation on differentiation of murine bone marrow cells into mast cells

Mast cells, immune effector cells produced from bone marrow cells, play a major role in immunoglobulin E–mediated allergic responses. Ionizing radiation affects the functions of mast cells, which are involved in radiation-induced tissue damage. However, whether ionizing radiation affects the differential induction of mast cells is unknown. Here we investigated whether bone marrow cells of X-irradiated mice differentiated into mast cells. To induce mast cells, bone marrow cells from X-irradiated and unirradiated mice were cultured in the presence of cytokines required for mast cell induction. Although irradiation at 0.5 Gy and 2 Gy decreased the number of bone marrow cells 1 day post-irradiation, the cultured bone marrow cells of X-irradiated and unirradiated mice both expressed mast cell–related cell-surface antigens. However, the percentage of mast cells in the irradiated group was lower than in the unirradiated group. Similar decreases in the percentage of mast cells induced in the presence of X-irradiation were observed 10 days post irradiation, although the number of bone marrow cells in irradiated mice had recovered by this time. Analysis of mast cell function showed that degranulation of mast cells after immunoglobulin E–mediated allergen recognition was significantly higher in the X-irradiated group compared with in the unirradiated group. In conclusion, bone marrow cells of X-irradiated mice differentiated into mast cells, but ionizing radiation affected the differentiation efficiency and function of mast cells.     

褪黑激素调节Akt/mTOR信号通路对坏死性小肠结肠炎新生大鼠肠道屏障功能的影响

目的 探究褪黑素(Mel)是否能够通过调控蛋白激酶B(Akt)/哺乳动物雷帕霉素靶蛋白(mTOR)通路对坏死性小肠结肠炎(NEC)新生大鼠肠道屏障功能发挥保护作用。 方法 90只新生大鼠随机分为正常组、模型组、Mel低(15 mg/kg)、高剂量组(30 mg/kg)与Mel(30 mg/kg)+Akti(5 μmol/L)组,除正常组外,其余4组建立NEC模型。实验结束后,取眼静脉血分离血清,检测D-乳酸、二胺氧化酶(DAO)和内毒素含量;取回盲部肠组织,用于HE染色及检测IL-6、IL-1β、TNF-α含量与自噬基因(Beclin-1)、LC3B、p-Akt/Akt、p-mTOR/mTOR表达水平。结果 与正常组比较,模型组大鼠回盲部肠组织细胞出现变性坏死,黏膜肌层水肿,绒毛脱落、缺失等现象;血清中D-乳酸、DAO、内毒素含量与肠组织中IL-6、IL-1β、TNF-α含量和Beclin-1、LC3B蛋白阳性率均明显升高(P＜0.05),p-Akt/Akt、p-mTOR/mTOR明显降低(P＜0.05);与模型组比较,Mel低、高剂量组大鼠回盲部肠组织病变明显改善;D-乳酸、DAO、内毒素含量与IL-6、IL-1β、TNF-α含量和Beclin-1、LC3B蛋白阳性率均依次降低(P＜0.05),p-Akt/Akt、p-mTOR/mTOR升高(P＜0.05);与Mel高剂量组比较,Mel+Akti组大鼠回盲部肠组织病变加重;D-乳酸、DAO、内毒素含量与肠组织中IL-6、IL-1β、TNF-α含量和Beclin-1、LC3B蛋白阳性率均明显升高(P＜0.05),p-Akt/Akt、p-mTOR/mTOR明显降低(P＜0.05)。 结论 Mel能够通过上调Akt/mTOR信号通路蛋白表达,抑制自噬,对NEC新生大鼠肠道屏障功能发挥保护作用。     

Inhibitory effect of honeybee-collected pollen on mast cell degranulation in vivo and in vitro

Bee-collected pollen (bee pollen [BP]) has been used as a folk medicine for centuries against various diseases, including allergy. There is no study elucidating how BP exerts such an anti-allergic effect. Since mast cells play a central role in the pathogenesis of various allergic diseases, we investigated the effect of BP on mast cell activation elicited by the Fc immunoglobulin E (IgE) receptor (Fc epsilon RI)-mediated pathways. The in vivo effect of orally administered BP on cutaneous mast cell activation was examined by passive cutaneous anaphylaxis reaction. In vitro mast cell degranulation and IgE binding to mast cells and the status of protein tyrosine phosphorylation were examined using bone marrow-derived mast cells. Daily oral administration of BP to mice significantly reduced the cutaneous mast cell activation elicited by IgE and specific antigens. BP also reduced in vitro mast cell degranulation and tumor necrosis factor-alpha production by inhibiting IgE binding to Fc epsilon RI on mast cells. The inhibitory effect of BP on mast cell degranulation by preventing IgE binding was confirmed by the reduced levels of protein tyrosine phosphorylation, which occurred as downstream events in activated mast cells via Fc epsilon RI. These results first revealed that the anti-allergic action of BP was exerted by inhibiting the Fc epsilon RI-mediated activation of mast cells, which plays important roles, not only in the early phase, but also in the late phase of allergic reactions.     

Predictors of Symptom-Specific Treatment Response to Dietary Interventions in Irritable Bowel Syndrome

(1) Background: Predictors of dietary treatment response in irritable bowel syndrome (IBS) remain understudied. We aimed to investigate predictors of symptom improvement during the low FODMAP and the traditional IBS diet for four weeks. (2) Methods: Baseline measures included faecal Dysbiosis Index, food diaries with daily energy and FODMAP intake, non-gastrointestinal (GI) somatic symptoms, GI-specific anxiety, and psychological distress. Outcomes were bloating, constipation, diarrhea, and pain symptom scores treated as continuous variables in linear mixed models. (3) Results: We included 33 and 34 patients on the low FODMAP and traditional IBS diet, respectively. Less severe dysbiosis and higher energy intake predicted better pain response to both diets. Less severe dysbiosis also predicted better constipation response to both diets. More severe psychological distress predicted worse bloating response to both diets. For the different outcomes, several differential predictors were identified, indicating that baseline factors could predict better improvement in one treatment arm, but worse improvement in the other treatment arm. (4) Conclusions: Psychological, nutritional, and microbial factors predict symptom improvement when following the low FODMAP and traditional IBS diet. Findings may help individualize dietary treatment in IBS.     

Irritable bowel syndrome: from guideline to made-to-measure care?

The new guideline on irritable bowel syndrome (IBS) advocates distinguishing IBS patients who predominantly suffer from constipation from those who mainly suffer from diarrhoea or from alternating bouts of diarrhoea and constipation. In the latter two groups, coeliac disease should be excluded, as should lactose intolerance if at all possible. Since there is no gold standard for the treatment of IBS a thorough explanation of the condition to patients is recommended.