肠内免疫微生态营养对重症急性胰腺炎模型猪肠道屏障功能的影响

Effect of ecoimmunonutrition on maintenance of the intestinal mucosal barrier function in severe acute poncreatitis Pigs

目的观察肠内免疫微生态营养（EIN）对重症急性胰腺炎（SAP）模型猪肠道屏障功能的影响。方法家养猪20头注入5％牛磺胆酸钠和胰蛋白酶建立SAP模型。24h后将18头成功造模猪均分为肠外营养（PN）组、肠内要素营养（EEN）组和EIN组，分别进行相应营养支持8d。分别于造模前、后各时间点检测各组血淀粉酶、外周血内毒素及肠道通透性。8d后处死动物取外周静脉血、胰、脾、肝、肺和肠系膜淋巴结进行细菌定性及定量检测，同时观察回肠末端黏膜形态及胰腺组织病理学改变并作病理评分。结果各组血淀粉酶均明显升高，但组间比较差异无统计学意义（P〉0．05）。营养8d后EIN组外周血内毒素为（1．50±0．18）EU／L，肠道通透性为（42．8±20．0）×10^-3，明显低于EEN组[（1．98±0．20）EU／L，（67．4±23．O）×10^-3]和PN组[（3．96±0．40）EU／L，（197．2±47．4）×10^-3]（P值均〈0．05）。EIN组胰腺和远隔脏器细菌数及细菌移位率亦明显低于PN组和EEN组（P〈0．05）；三组间胰腺病理评分差异无统计学意义（P〉0．05）。EIN组小肠绒毛高度、隐窝深度、黏膜厚度和绒毛形态正常率分别为（398．27±52．93）μm、（269．72±41．66）μm、（681．98±58．33）μm和79％，EEN组分别为（305．70±42．72）μm、（192．52±38．17）μm、（507．31±68．23）μm和47％，PN组分别为（218．32±35．81）μm、（145．76±23．34）μm、（376．20±48．23）μm和13％，EIN组以上指标值均高于EEN组和PN组（P值均〈0．05）。结论EIN能保护SAP猪肠道屏障功能，降低肠道通透性，减少细菌及内毒素移位。

Objective To evaluate the effect of ecoimmunonutrition on maintenance of the mucosal barrier function in pigs with severe acute pancreatitis（SAP）. Methods Twenty pigs were injected with 5 % sodium taurocholate and trypsin into the pancreatic duct to establish SAP models. Twenty four hours later, 18 suvival pigs were randomly given parenteral nutrition （PN group, n = 6）, elemental enteral nutrition（EEN group, n = 6）, or ecoimmunonutrition（EIN group, n = 6） for 8 days. The serum amyl- ase, endotoxin and intestinal permeability were determined on different times. All pigs were sacrificed 8 days later, and their venous blood, mesenteric lymph nodes（MLN）, liver, lung, spleen and pancreas specimens were cultured quantitatively and qualitatively with standard techniques. The morphology of small bowel was observed and pathological changes of the pancreas was analyzed. Results Serum amylase of all groups were obviously elevated, but there＇ was no significant difference among them（P 〉 0.05）. The plasma endotoxin and intestinal permeability were lower in EIN group i-（1. 50 ± 0. 18）EU/L and （42.8 ± 20.0） × 10^-3 respectively] compared to EEN group [（1.98 ± 0.20）EU/L and（67.4 ± 23.0） × 10^-3 respectively] and PN group [（3.96 ± 0.40） EU/L and （197.2 ± 47.4） × 10^-3 respectively] （ all P value 〈 0.05）. The incidence and the magnitude of bacterial translocation in EIN group were lower than those in PN and EEN groups. However, the ileum mucosa thickness, villus height, crypt depth and the rate of the normal intestinal villi in E1N group were（398.27 ± 52.93）μm, （269.72 ± 41.66）μm, （681.98 ± 58.33）μm and 79%, respectively, but in PN group were（218.32 ± 35.81）μm, （145.76 ± 23.34）μm, （376.20 ± 48.23）μm and 13%, respectively and in EEN group were（305.70 ± 42.72）μm, （192.52 ± 38.17）μm, （507.31 ± 68.23）μm and 47%, respectively. Conclusions EIN can maintain the integrity of intestinal mucosal barrier and decreasing intestinal bacterial and endotoxln translocatlon in SAP pigs.