急性重症胰腺炎患者肠黏膜屏障功能的改变

The Analysis of the change about Intestinal Mucosal Barrier in Severe Acute Pancreatitis

目的:探讨急性重症胰腺炎(SAP)的肠道黏膜屏障功能改变的机制,以期提高对SAP的治疗策略。方法:36例SAP患者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(TNF-α)、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30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<0.01);血中ET、NO、TNFα、DAO的水平显著增加(P<0.01)。结论:急性重症胰腺炎患者的肠黏膜屏障受损,肠黏膜通透性增高。ET、NO、TNFα单独或协同参与肠黏膜屏障的损害。DAO升高提示肠道黏膜的完整性受到破坏。

Objective To explore the mechanism of the changes about the intestinal mucosal barrier in severe acute pancreatitis(SAP) in order to improve the treatment strategy.Methods Thirty-six patients diagnosed with SAP and 30 volunteers as the control group were enrolled into this research.The levels of serum tumor necrosis factor alpha(TNF-α),nitricoxide(NO),diamineoxidase(DAO) and plasma endotoxin(ET) were measured.The ratio of lactulose to mannitol(L/M) in urine was detected by HPLC with pulsed electroc hemical detection.Results Compared with the control group,there were significantly increasing about the parameters of serum TNF-α,NO,DAO and ET in the patients with SAP(P< 0.01),so was the ratio of lactulose to mannitol in urine(P< 0.01).Conclusion The intestinal mucosal barrier in the patients with SAP is injured and gut permeability is increased.Serum endotoxin,TNF-αand NO may play important roles in the damage of gut barrier,and DAO can reflect the integrity of the intestinal mucosa.