Résumé
Objective:To explore the regulation effect and possible mechanism of transcutaneous electrical acustimulation (TEA) on the improvement of gastrointestinal motility and inflammation in patients with acute pancreatitis (AP).Methods:A randomized, single-blinded, sham-controlled study was performed. A total of 62 AP patients were randomly divided into the TEA group ( n=31) and sham-TEA group ( n=31), on the basis of regular treatment, who received TEA treatment at Neiguan (PC6) and Zusanli (ST36) or sham-TEA treatment at corresponding pseudo stimulation acupoints for 2 days. Abdominal distension score, time to first defecation, gastric slow wave, heart rate variability (low frequency and high frequency, reflecting sympathetic and vagal activity, respectively), serum level of tumor tecrosis factor (TNF)-α, plasma levels of motilin, ghrelin and vasoactive intestinal peptide(VIP) tested by enzyme linked immunosorbent assay were compared before and after the treatment. Wilcoxon rank test, Mann-Whitney U test, t-test and two factor repeated measurement analysis of variance were used for statistical analysis. Results:After the treatment, abdominal distension score of TEA group was lower than that of sham-TEA group(1 (0 to 2) vs.5(3 to 6)) and time to first defecation was earlier than that of sham-TEA group((55.00±24.27) h vs.(67.95±23.84) h), the percentage of normal gastric slow wave was higher than that of sham-TEA group((57.42±11.16)% vs. (40.92±8.52)%), and the differences were statistically significant ( Z=-4.95、 t=-2.12、 F=61.53, all P<0.05). After the treatment, the serum level of TNF-α of TEA group was significantly lower than that of sham-TEA group((4.27±1.28) ng/L vs.(6.19±2.03) ng/L), and the difference was statistically significant ( F=28.65, P<0.05). The ratio of post/pre-treatment of low frequency heart rate variability of the TEA group was significantly lower than that of sham-TEA group, however, the result of high frequency was opposite (0.87±0.18 vs.1.14±0.16, 1.19±0.18 vs.0.96±0.13), and the differences were statistically significant ( t=-6.22 and 5.74, both P<0.05). After the treatment, the plasma level of ghrelin of TEA group was higher than that of sham-TEA group ((2.02±0.62) μg/L vs. (0.93±0.49) μg/L), the VIP level was lower than of sham-TEA group ((30.58±12.20) μg/L vs.(44.35±29.52) μg/L), and the differences were statistically significant ( F=59.22 and 5.50, both P<0.05). However, there was no significant difference in motilin levels between two groups ((24.57±9.58) ng/L vs. (22.75±9.58) ng/L, P>0.05). Conclusion:TEA treatment can improve gastrointestinal motility and inhibit the inflammation in early AP, which may be related with the regulation of autonomic function, gastrointestinal hormone ghrelin and VIP.
Résumé
Biliary infection is a common disease in the digestive system, can cause serious complications including sepsis. Among them, patients with severe biliary infections often have poor prognosis. It is reported that ghrelin play important roles in regulating inflammatory response, gastrointestinal motility, appetite, and endocrine. Recently the therapeutic role of ghrelin in the biliary infection has been studied. This article reviews the effects of ghrelin on inflammatory reaction and gastrointestinal dysmotility in biliary infections.
Résumé
Objective To investigate the differences of anorectal manometry (ARM) parameters in different position (left lateral position and seated position) in patients with functional constipation (FC),and the value of rectoanal pressure gradient (RAPG) was assessed in seated position in the evaluation of anorectal motility disorder in patients with FC.Methods From March 2015 to July 2016,at Clinical Gastrointestinal Motility Center of Ningbo Yinzhou People's Hospital,66 consecutive patients with FC aged 18 to 75 who met Rome Ⅲ criteria were recruited.The questionnaires of patient assessment of constipation symptom (PAC-SYM)and patient assessment of constipation quality of life (PAC-QoL) were recorded.Patients randomly underwent ARM examination in left lateral or seated positions,and then followed by a balloon expulsion test (BET) in seated position.The differences of ARM parameters in different positions were compared.The correlation between ARM parameters and BET results,constipation symptoms and quality of life scores were analyzed.T-test,Spearman correlation analysis and Kappa coefficient were performed for statistical analysis.Results ARM parameters including rectal resting pressure,rectal defecation pressure and RAPG in seated position were both higher than those of left lateral position ((30.83 ±7.89) mmHg (1 mmHg =0.133 kPa) vs.(10.53 ± 3.94) mmHg,(78.86±22.25) mmHg vs.(54.92±21.26) mmHg,(17.53 ±27.40) mmHg vs.(-7.80 ±26.88) mmHg),and the differences were statistically significant (t =-21.10,-12.35 and-8.84,all P ＜ 0.01).However,there was no significant difference in anal-related pressure parameters (P ＞ 0.05).The RAPG in seated position was highly consistent with BET,with a maximum Kappa-value of 0.643,which was higher than the maxium Kappa-value of 0.349 in left lateral position.The optimal RAPG threshold of seated position was 10 mmHg,the sensitivity of RAPG in the prediction of BET was 85.71％ and the specificity was 79.17％.According to the optimal RAPG threshold in seated position,the patients were divided into high RAPG group and low RAPG group.The frequency of weekly spontaneous defecation of high RAPG group was higher than that of low RAPG group (2.88 ±2.16 vs.1.66 ±0.96),and the difference was statistically significant (t=2.65,P=0.01).The satisfaction score of PAC-QoL questionnaire of high RAPG group was lower than that of low RAPG group (2.05 ±0.55 vs.2.83 ±0.78),and the difference was statistically significant (t =-4.72,P ＜0.01).Conclusion It may be more reasonable to perform ARM in the seated position in FC patients,especially for the RAPG in seated position is better correlated with BET results,constipation symptoms and quality of life scores which may have more clinical value in the evaluation of anorectal motility disorder in FC patients.
Résumé
Objective To assess the effects of zinc protoporphyrin (ZnPP), an inhibitor of the heme oxygenase (HO), on the colonic interstitial cells of Cajal (ICC) of diabetic rats with colonic slow transit. Methods Diabetes mellitus (DM) model was induced by intraperitoneal injection of streptozotocin (STZ) in Sprague-Dawley rats. Twenty four successfully established DM rats were selected, and 16 healthy rats were served as controls. Six weeks later, gastrointestional (GI) dysfunction was observed by charcoal propulsion experiment in 8 DM rats and 8 controls. The rest rats in DM group were divided into 2 groups: DM rats intraperitoneal injected with PBS (n=8) or with 10 μmol/kg of ZnPP (n = 8) every other day for 3 weeks. The rats in control group (n = 8) were intraperitoneally injected with PBS. The levels of HO and c-kit (the special receptor of ICC) expression were detected by Western blotting. The distribution of ICC was observed by immunohistochemistry and the area of c-kit positive cells was counted. Results The GI propulsion rate in DM rats interfered with PBS was significantly declined compared to that in the controls (63.0%± 1.2% vs 71.8%±2.0%, P<0.05). But it was improved in DM rats interfered with ZnPP (72.5± 2.6%, P<0.05), which showed no significant differentee with that in control group (P>0.05). The expression of HO-1 in close and distant colon of DM rats interfered with ZnPP was decreased (P< 0.05). The expression of HO-2 in close colon and the area of c-kit positive cells of DM rats interfered with PBS was reduced compared with that in controls (P<0.05), but both were improved in DM rats interfered with ZnPP (P<0. 05). Conclusion Administration of ZnPP might be able to protect ICC by its blockage of HO-1 in DM rats with gastrointestinal dysfunction.