目的探讨FasL在重症急性胰腺炎（SAP）大鼠肺泡巨噬细胞（AM）凋亡机理中的作用。 方法SD大鼠按数字表法随机分为对照组、SAP组及氯化钆（GdCl3）组3组，每组16只。SAP模型制成6 h后，经支气管肺泡灌洗获取AM。取右肺下叶行HE染色检查，透射电镜观察和双染色法检测AM凋亡情况，用蛋白免疫印迹法（Western blot法）检测各组AM中FasL蛋白表达水平。 结果GdCl3组电镜下可见AM典型凋亡形态学特征，AM凋亡率为（22.48±1.44）%，明显高于对照组〔（11.28±1.01）%〕及SAP组〔（6.86±1.35）%〕，其差异有统计学意义（P＜0.05）；GdCl3组FasL蛋白相对表达量为（1.230±0.041）%，较对照组〔（0.936±0.024）%〕和SAP组〔（0.704±0.011）%〕明显增高（P＜0.05）。AM凋亡率与AM中FasL蛋白表达水平呈线性正相关关系（R2=0.766，P＜0.01）。 结论GdCl3可能通过激活FasL蛋白表达诱导SAP大鼠AM发生凋亡。
Objective To systematically review perioperative safety and middle-term and long-term complications of Roux-en-Y anastomosis and Billroth-Ⅰ anastomosis after distal subtotal gastrectomy by a meta-analysis. Methods Literatures about Roux-en-Y and Billroth-Ⅰ anastomoses after distal subtotal gastrectomy in Embase, PubMed, MedLine, and the Cochrane Library databases were searched. Retrieval time was from December 1, 2015 to March 1, 2016. According to the inclusion and exclusion criteria, two reviewers independently screened literatures, extracted data, and evaluated the qualities of the included studies. Then meta-analysis was performed using Review Manager Version 5.1 software. Results Five randomized controlled trials (RCTs) were finally included involving 600 patients, of which 302 patients were underwent Roux-en-Y anasomosis, 298 patients were underwent Billroth-Ⅰ anasomosis. The results of meta-analysis showed that the Billroth-Ⅰ anastomosis operation had more advantages in the operative time 〔WMD: 38.95; 95%CI: (19.86, 58.04);P<0.000 1〕 and the intraoperative bleeding 〔WMD: 34.85; 95%CI: (2.13, 67.56);P=0.04〕. However, the Roux-en-Y anastomosis had more significant effects in the prevention of bile reflux 〔OR: 0.03; 95%CI: (0.01, 0.11);P<0.000 01〕 and the residual gastritis 〔OR: 0.37; 95%CI: (0.25, 0.54);P<0.000 01〕. There were no differences in the hospital stay 〔WMD: 2.96; 95%CI: (–0.00, 5.93);P=0.05〕, anastomotic leakage 〔OR: 0.43; 95%CI: (0.11, 1.68);P=0.23〕, anastomotic stricture 〔OR: 1.84; 95%CI: (0.61, 5.53);P=0.27〕, reflux esophagitis〔OR: 0.63; 95%CI: (0.28, 1.44);P=0.27〕, and delayed gastric emptying 〔OR: 1.24; 95%CI: (0.46, 3.30);P=0.67〕 between the Roux-en-Y anastomosis and Billroth-Ⅰ anastomosis. Conclusions Billroth- I anastomosis and Roux-en-Y anastomosis have their own advantages and disadvantages, in term of safety of Billroth- I anastomosis is better, but it’s quality of life is worse as compared with Roux-en-Y anastomosis. However, more high-quality, well-designed, adequate RCTs data are needed to validate.