肠内营养中应用谷氨酰胺对重症急性胰腺炎大鼠继发感染的影响

Effect of Glutamine in Enteral Nutrition on Secondary Infection of Severe Acute Pancreatitis Rat △

目的探讨早期肠内营养中应用谷氨酰胺(Gln)对重症急性胰腺炎(SAP)大鼠继发感染的影响。方法雄性SD大鼠95只,随机分成模型1天组、对照组、SAP+肠外营养(PN)组、SAP+肠内营养(EN)组、SAP+EN+Gln组,除模型1天组外,各组又分为4天喂养组和7天喂养组。分别在第4、7天检测各组各项指标,主要包括细菌移位、血浆内毒素、二胺氧化酶、肠转运功能。结果肠系膜淋巴结和肝培养出的细菌多为革兰氏阴性杆菌,以大肠杆菌为主,SAP+EN、SAP+EN+Gln组显著低于SAP+PN组(P<0.01),SAP+EN+Gln组低于SAP+EN组(P<0.05)。各SAP组血浆内毒素水平显著高于对照组,以SAP+PN组最高,SAP+EN、SAP+EN+Gln组显著低于SAP+PN组(P<0.01),SAP+EN组高于SAP+EN+Gln组(P<0.05)。SAP+PN7天组明显高于4天组(P<0.05)。各SAP组发病4天后血浆DAO活性明显下降(P<0.01);7天后SAP+EN+Gln组回升和对照组无差异,其余各SAP组继续下降,以SAP+PN组为甚(P<0.01)。各SAP组的肠转运系数显著降低(P<0.05,P<0.01);SAP+EN、SAP+EN+Gln组显著高于SAP+PN组(P<0.05,P<0.01);SAP+EN+Gln和SAP+EN组之间差异无显著性。结论肠内营养中应用谷氨酰胺能更有效地降低SAP大鼠肠道细菌移位,从而减少胰腺继发感染的发生。

Objective To evaluate the effect of glutamine （Gin） in enteral nutrition （EN） on secondary infection of severe acute pancreatitis （SAP） rat. Methods Ninety-five Sprague-Dawley rats were randomly assigned into control group, 1 s, day model group, SAP ＋ parenteral nutrition （PN） group, SAP ＋ EN, and SAP ＋ EN ＋ Gin group. Each group except model group was divided into four-day and seven-day groups again. Each index was tested on the 4th day or the 7th day, including bacteria translocation, plasm endotoxin, diamine oxidase, and gut transfer function. Results Bacteria culture in mesenteric lymph node and liver were almost Gram-negative bacillus. Bacteria translocation number was significantly higher in SAP ＋ PN group than in SAP ＋ EN and SAP ＋ EN ＋ Gin groups （P 〈 0.01 ）. The bacterial translocation rate in SAP ＋ EN ＋ Gin group was significantly lower than in SAP ＋ EN group （ P 〈 0.05 ）. The plasma endotoxin level in SAP group was significantly higher than in control group, in SAP ＋ EN group was significantly lower than in SAP ＋ PN group, and in SAP ＋ EN ＋ Gin was lower than SAP ＋ EN. （ P 〈 0.05 ） There was an increasing trend for the endotoxin level in 7 day SAP ＋ EN group compared with in corresponding 4 day group. The level in 7 day SAP ＋ PN group was significantly higher than in 4 day SAP ＋ PN group. （P 〈 0.05 ）. Diamine oxidase （DAO） in every SAP group decreased significantly after the 4th day （ P 〈 0.01 ） ; DAO in 7 day SAP ＋ EN ＋ Gin group increased and approached that of control group. DAO in SAP groups except SAP ＋ EN ＋ Gin dropped, and was lowest in the SAP ＋ PN group （ P 〈 0.01 ）. Gut transfer index decreased significantly in every SAP group （P 〈 0.05, P 〈 0.01 ） ; the level in SAP ＋ EN group was significantly higher than in SAP ＋ PN group （ P 〈 0.05 ）, while there was no significant difference between SAP ＋ EN ＋ Gin group and SAP ＋ EN group. Conclusion Using glutamine in enteral nutrition may prevent gut bacterial translocation in severe acute pancreatitis rat and therefore to reduce secondary infection.