益生菌及肠内外营养对重症急性胰腺炎大鼠肠道黏附分子及免疫屏障的影响

Effects of probiotics and enteral and parenteral nutrition on intestinal mucosal addressin cell adhesion molecule-1 and immune barrier of rats with severe acute pancreatitis

目的:观察益生菌及肠外、肠内营养对重症急性胰腺炎(SAP)大鼠肠道黏附分子MAdCAM-1及免疫屏障的影响.方法:经胆胰管逆行注射50g/L牛磺胆酸钠制作SAP模型24h后,分别给予肠外营养(PN组),肠外+肠内营养(PN+EN组),肠外+肠内营养+益生菌(益生菌组),持续6d,7d时处死,检测腹腔脏器组织菌群易位率,免疫组化法测定末端回肠和Peyer结MAdCAM-1,CD4,CD8,IgA.结果:益生菌组、PN+EN组CD4、CD8T细胞数量及IgA,MAdCAM-1表达高于PN组(P<0.05);益生菌组Peyer结MAdCAM-1,CD8表达高于PN+EN组(P<0.05).PN组菌群易位率(70.2%)、7d死亡率(75.6%)高于益生菌组(27.5%,50.0%)、PN+EN组(30.5%,52.4%)(P<0.01或P<0.05),但后两组间差异无显著性意义.结论:EN能增加MAdCAM-1表达,提高SAP时肠免疫屏障,减少菌群易位,提高生存率.加用益生菌后总体改善不明显.

AIM： To investigate the effects of probiotics and enteral and parenteral nutrition （EN and PN） on peyer＇s patch, intestinal mucosal addressin cell adhesion molecule-1 （MAdCAM-1） and immune barrier of rats with severe acute pancreatitis （SAP）. METHODS： SAP model was established in 30 Sprague Dawley （SD） rats via biliary and pancreatic duct using sodium taurocholate and then were averagely divided into 3 groups： PN group, PN ＋ EN group, and PN ＋ EN ＋ probiotics group. Twenty-four hours after modeling, the rats in each group were treated with the corresponding methods for 6 days. The nutrition support in the 3 groups was isonitrogenic and isocaloric. At the 7^th day, all the rats were sacrificed. The expression of CD4, CD8, MadCAM-1 and IgA in the terminal ileum mucosa and peyer＇s patch were measured by immunohistochemistry. Vena cava blood and homogenated tissues of liver, lung and mesen- teric lymph nodes were cultured to determine bacterial translocations. RESULTS： The levels of CD4 and CD8 T cells, and the expression of MadCAM-1 and IgA in the terminal ileum mucosa and peyer＇s node were significantly higher in PN ＋ EN and PN ＋ EN ＋ probiotics group than those in PN group （P 〈 0.05）. The level of CD8 T cells and the expression of MadCAM-1 were markedly higher in PN ＋ EN ＋ probiotics group than those in PN ＋ EN group （P 〈 0.05）. Bacterial translocations and mortality appeared in PN group with higher rates （70.2%, 75.6%） in comparison with those in PN ＋ EN ＋ probiotics （27.5%, 50.0%） and PN ＋ EN group （30.5%, 52.4%）（P 〈 0.01 or P 〈 0.05）. But there were no significant differences between PN ＋ EN and PN ＋ EN ＋ probiotics group. CONCLUSION： EN can increase the expression of CD4, CD8, MadCAM-1 and IgA in the terminal ileum mucosa and peyer＇s patch, reduce bacterial translocations, and improve the survival rate in SAP. This effect becomes more obvious when EN is combined with probiotics. Probiotics seem to have litter effect in the protection of intestinal immune barrier.