急性重症胰腺炎肠粘膜屏障功能改变的临床研究

The change of intestinal mucosal barrier in severe acute pancreatitis

目的 :探讨急性重症胰腺炎 (SAP)时肠粘膜屏障功能改变机制。方法 :2 0例SAP入院当天采血检测二胺氧化酶 (DAO)、内毒素 (endotoxin ,ET)、肿瘤坏死因子 (TNFα)、一氧化氮 (NO)的浓度。并用带特殊电化学检测器的高压液相色谱法 (HPLC)检测尿中乳果糖与甘露醇排泄率比值。以 10名健康志愿者作为正常对照组。结果 :同正常对照组相比较 ,SAP患者尿中乳果糖与甘露醇排泄率比值明显升高(P <0 .0 1) ;血中ET、NO、TNFα、DAO的水平显著增加 (P <0 .0 1)。结论 :在急性重症胰腺炎患者中 ,肠粘膜屏障受损 ,肠粘膜通透性增高。ET、NO、TNFα 单独或协同参与肠粘膜屏障的损害。

Objective:To investigate the mechanism of the changes of the intestinal mucosal barrier in Severe acute pancreatitis.Methods:Twenty patients with Severe acute pancreatitis were admitted and 10 volunteers as the control group.The levels of serum tumor necrosis factor alpha(TNF_α)、nitric oxide(NO)、diamine oxidase(DAO) and the concentration of plasma endotoxin(ET) were measured.The ratio of lactulose to mannitol in urine was detected by HPLC with Pulsed Electrochemical Detection.Results:Compared with the control group,significantly increasing parameters could be seen in all the patients with Severe acute pancreatitis,including the ratio of lactulose to mannitol in urine (P<0.01) and the levels of blood ET、NO、TNF_α and DAO(P<0.01).Conclusion:It is concluded that in the patients with Severe acute pancreatitis,intestinal mucosal barrier was injured and gut permeability was increased.Blood endotoxin、TNF_α and NO may play important roles in the damage of gut barrier alone or together.While DAO can reflect the integrity of the intestinal mucosa.