早期肠内营养对重症急性胰腺炎患者肠黏膜屏障功能的影响

Influence of early enteral nutrition on the function of intestinal mucosa barrier in patient with severe acute pancreatitis

目的:研究早期肠内营养(EN)对重症急性胰腺炎(SAP)患者血清内毒素、炎症细胞因子和肠黏膜通透性等的影响。方法:符合条件的43例患者入院24～48h后随机分为早期肠内营养组(EN组,22例)和肠外营养组(PN组,21例),行营养支持。检测两组患者治疗前,治疗后3d和14d的血清内毒素,炎症细胞因子,淀粉酶等生化指标,治疗前和治疗后14d尿液乳果糖与甘露醇排泄率比值(L/M);观察其APACHE-Ⅱ评分、MODS和胰腺及胰周感染发生率。结果:EN组患者均能良好耐受早期EN治疗。两组营养支持治疗前血清内毒素、炎症细胞因子水平和APACHE-Ⅱ评分差异均无显著性(P>0.05)。与PN组相比,EN组3d、14d后血清内毒素水平均显著降低(P<0.05)。营养支持治疗后3d两组血清各细胞因子水平均差异无显著性(P>0.05),14d后EN组显著低于PN组(P<0.05)。治疗前两组尿中(L/M)比值差异无显著性,14d后EN组L/M比值较PN组显著降低(P<0.05)。与PN组相比,EN组14d后APACHE-Ⅱ评分显著降低(P<0.05),MODS和胰腺及胰周感染发生率明显降低(P<0.05)。结论:早期EN可促进SAP患者肠黏膜屏障功能恢复,减轻肠源性内毒素血症,缓和急性期炎症反应,降低MODS和胰腺及胰周感染发生率。

Objective：To study the effects of early enteral nutrition （EN） on serum endotoxin, inflammatory cytokines and function of intestinal mucosa barrier in patients with severe acute psncreatitis （SAP）. Methods：Forty-three patients with severe acute pancreatitis were divided randomly into enteral nutrition group （n=22,Group EN） and parenteral nutrition group （n=21,Group PN） within 24 to 48 hours of admission. Serum concentrations of endotoxin, inflammatory cytokines, amylolytic enzyme, CRP and serum albumin were detected in all patients before nutritional support and on 3, 14 days after nutritional support. The ratio of lactulose to mannitol in urine （L/M） before and on 14 days after nutritional support were detected by HPLC. APACHE-Ⅱ score. Incidences of multiple organ dysfunction syndrome （MODS） and infection of pancreas and peripancreas were observed. Results：All patients in group EN tolerated early enteral nutrition well. The serum concentrations of endotoxin, inflammatory cytokines, the urinary L/M ratio and APACHE-Ⅱ score before nutritional support were no significant differences between two groups （P〉0.05）. On 3,14 days after nutritional support, serum concentrations of endotoxin of group EN were lower than those of group PN （P〈0.05）. There were no significant differences between two groups in serum concentrations of inflammatory cytokines on 3 days after nutritional support （P〉0.05）.However, concentrations of all inflammatory cytokines in group EN on 14 days were lower than those of group PN （P〈0.05）, Compared with group PN, the urinary L/M ratio deceased significantly on 14 day after nutritional support in group EN. Compared with group PN, APACHE-Ⅱ score decreased significantly on 14 day after nutritional support. Incidences of MODS and infection of pancreas and peripancreas decreased significantly in group EN（P 〈0.05）. Conclusion：Early EN may promote the recovery of function of barrier of intestinal mucosa, attenuate intestinal endotoxemia, moderate the acute inflammatory response, decrease the incidences of MOBS and the infection of pancreas and peripancreas in patients with severe acute pancreatitis.