免疫增强型肠内营养对重症急性胰腺炎大鼠炎症反应和免疫功能的影响

Effects of Immune-enhancing Enteral Nutrition on Inflammatory Reaction and Immune Function in the Early Phase of Severe Acute Pancreatitis in Rats

目的探讨免疫增强型肠内营养对重症急性胰腺炎大鼠炎症反应和免疫功能的影响。方法采用牛磺胆酸钠逆行注射法建立重症急性胰腺炎模型,将60只建模成功的胰腺炎大鼠分为全肠外营养组(TPN组)、普通肠内营养组(EN组)和免疫增强型肠内营养组(SEN组),每组20只。肠外营养和肠内营养分别采用经右颈内静脉插管输液和经胃造口空肠上段给液的方式。各组自建模成功后均应用乙酸奥曲肽皮下注射做基础治疗。于第24小时,第4、7、14天分别收集血液标本,测定血浆细胞因子TNFα、IL10及外周血中的CD3+、CD4+、CD8+淋巴细胞亚群。并于建模前取10只大鼠测定血清淀粉酶,作为正常对照,建模后24小时,第3、5、7、9、11、14天检测各组血清淀粉酶。结果(1)建模24小时,3组动物血浆TNFα水平均相对较高,而IL10处于相对较低水平;第4天时,3组TNFα均明显下降,而IL10浓度升高并达到最高水平,此时3组间的TNFα和IL10水平差异均无显著性(P>0.05);第7天和第14天时,3组的TNFα和IL10均呈不同程度下降趋势,其中SEN组TNFα和IL10水平明显低于TPN组和EN组(P<0.05),而后两组间差异无显著性(P>0.05)。(2)建模24小时,3组的CD3+、CD4+和CD4+/CD8+均升高;第7天和第14天时SEN组的CD3+、CD4+和CD4+/CD8+均明显高于TPN组和EN组(P<0.05),但CD8+变化不大。(3)建模24小时,3组血淀粉酶明显升高,此后均逐渐下降;第7天时,SEN组的血淀粉酶达正常范围,而TPN组和EN组的血淀粉酶在第9天才接近正常水平。SEN组14天死亡率明显低于TPN组和EN组(P<0.05)。结论免疫增强型肠内营养能有效调节重症急性胰腺炎大鼠细胞因子水平,增强免疫功能,缩短病程,降低死亡率。

Objective To evaluate the effects of immune-enhancing enteral nutrition therapy on the inflammatory reaction and immune function in the early phase of severe acute pancreatitis （SAP） in rats. Methods SAP rat model was established by retrograde injection of sodium taurocholate into the biliopancreatic duct. Sixty SAP rats were randomly divided into total parenteral nutrition group （ TPN group, n = 20） , traditional enteral nutrition group （ EN group, n = 20） , and immune-enhancing enteral immunonutrition group （ SEN group, n = 20）. After a baseline therapy with octreotide for 14 days, specimen were collected at different time points. Serum amyl- ase, plasma cytokines including TNF-α, and IL-10, as well as CD3 ＋ , CD4 ＋ , CD8 ＋ in peripheral blood were measured. Results （ 1 ） After 24 h of modeling, TNF-α levels in all three groups were high while IL- 10 levels were low. At the fourth day, TNF-α levels decreased sharply, while IL-10 levels increased to the highest level; after that, IL-10 levels also decreased. At the seventh day, TNF-α and IL-10 levels were significantly lower in the SEN group than those in the TPN and EN groups （ all P 〈 0.05 ）. There was no significant difference between TPN group and EN group （ P 〉 0.05 ）. （2） CD3 ＋ , CD4 ＋ , and CD4 ＋ / CD8 ＋ were all significantly higher in the SEN group than those in the TPN group and EN group at the seventh day and at the fourteenth day （ P 〈 0.05 ）. （ 3 ） Blood amylase level was normal in the SEN group at the seventh day and was significantly lower than those in TPN group and EN group （ P 〈 0.05 ）. At the ninth day, blood amylase levels were also normal in the TPN group and EN group. At the fourteen day, the mortality of severe acute pancreatitis rats was also significantly lower in the SEN group than those in TPN group and EN group. Conclusion Immune-enhancing enteral nutrition can reduce cytokines, strengthen immune function, shorten disease course, and decrease the mortality in rats with severe acute pancreatitis.