重症急性胰腺炎术后早期肠内营养支持治疗人体肠粘膜的形态学变化

The Morphological Alterations of Jejunal Mucosa Accepting Early Enteral Nutrition for Post-operative Patients with Severe Acute Pancreatitis

目的研究重症急性胰腺炎(SAP)患者术后肠内营养(EN)和肠外营养(TPN)支持治疗后人体肠粘膜结构的形态学变化,并探讨其临床意义。方法40例接受手术治疗的SAP患者随机分成EN组(20例)和TPN组(20例),在分别采用肠内外营养支持治疗后,采用全自动速率散射比浊法测定前白蛋白(PAB)和转铁蛋白(TRF)水平,比较营养支持效果;并用新的微创方法获取活体肠粘膜标本,用普通光镜和透射电镜观察肠粘膜结构的变化。结果EN组患者PAB水平在术后7d和14d时高于TPN组(P<0.05),而TRF水平在观察期内各组没有明显差别;光镜下观察,术后14dEN组空肠绒毛高度高于TPN组(P<0.05),电镜下,术后14dEN组空肠上皮细胞微绒毛高度也高于TPN组(P<0.05),同时也高于自身的营养支持前的微绒毛高度(P<0.05)。在TPN组术后14d还观察到空肠粘膜上皮细胞内线粒体肿胀、脊变粗、粗面内质网和核仁肿胀,细胞紧密联结处出现异物沉淀等病理学改变,而EN组则无上述现象。结论对SAP患者术后早期实施EN能够保护肠粘膜结构,其治疗效果优于单纯的TPN。

Objective To investigate the morphological alterations and significances of jejunal mucosa responsible to post-operative patients with severe acute pancreatitis treated with enteral nutrition （EN） or total parenteral nutrition （TPN）. Methods 40 patients were divided randomly into EN group and TPN group. The serum levels of prealbumin （PAB） and transferrin （TRF） were detected at a given time. Jejunal mucosa specimens were acquired through a new technique and observed in detail both under general microscope and electronic microscope. Results On seventh and fourteenth post-operative day, the serum level of PAB in EN group was remarkably higher than it in TPN group （P〈0. 05）. No difference was seen in TRF levels of 2 groups. On 14th post-operative day, it was found by general microscope that the height of jejunal mucosa villi was significantly higher in EN group than in TPN group （P〈0.05）, and meantime it was also found by electronic microscope that the height of microvilli on jejunal mucosa epithelial cells in EN group was remarkably higher than it in TPN group （P〈0. 05） and was higher than microvilli itself before EN start （P〈0. 05）. In TPN group, some pathological alterations could beseen in jejunal mucosa epithelial cells on 14th post-operative day, such as mitochondrial edema, crista swelling, dilation of rough endoplasmic reticulum and nucleolus, and the appearance of abnormal substances in intercellular attachments. However, none of above these pathological changes could be seen in EN group. Conclusion Early enteral nutrition could protect the jejunal mucosa in post-operative patients with severe acute pancreatitis and have its results better than TPN alone.