肠内营养联合中药干预对兔重症急性胰腺炎炎症反应和肠黏膜屏障功能的影响

Influences of enteral nutrition combined with TCM intervention on inflammation and intestinal barrier function in severe acute pancreatitis in rabbits

目的探讨肠内营养联合中药干预对兔重症急性胰腺炎(SAP)炎症反应和肠黏膜屏障功能的影响。方法日本大耳白兔36只,随机分为3组(n=12):对照组(A组)、SAP组(B组)和SAP肠道干预组(C组),B、C两组采用胰管结扎联合胆汁注射法制成兔SAP模型,C组造模后滴注肠毒清和百普力。造模前及造模后6、12、24、72、120 h取静脉血测定并比较血清淀粉酶(AMY)、肿瘤坏死因子-α(TNF-α)和白介素-6(IL-6)水平。动物于实验后死亡或第5天处死动物,收集胰腺和小肠组织,观察胰腺和小肠组织病理学改变并进行病理学评分。制备小肠组织匀浆,测定并比较TNF-α、IL-6、和丙二醛(MDA)水平。结果除造模后120 h的IL-6水平,B、C组造模后各时点的血清AMY、TNF-α和IL-6水平均显著高于A组(P<0.05);造模12 h后的血清AMY水平、24 h后的血清TNF-α水平以及24 h和72 h的血清IL-6水平,C组均显著低于B组(P<0.05)。胰腺和小肠组织病理学改变以B组最为严重,C组较B组明显减轻。C组小肠组织中TNF-α、IL-6和MDA水平较B组显著降低(P<0.05)。结论肠内营养联合中药干预可抑制SAP炎症介质的释放,减轻肠黏膜损伤程度,从而保护肠黏膜屏障,有助于SAP的治疗及预后改善。

Objective To investigate the influences of enteral nutrition combined with Traditional Chinese Medicine（TCM） intervention on inflammation and intestinal barrier function in severe acute pancreatitis（SAP） in rabbits.Methods Thirty-six rabbits were randomly divided into three groups（n=12）,control group（group A）,SAP group（group B） and SAP intervention group（group C）.SAP model was induced by pancreatic duct ligation and bile injection.Changduqing and Peptison were administered to rabbits in group C.Serum levels of amylase（AMY）,tumor necrosis factor-α（TNF-α） and interleukin-6（IL-6） were measured and compared pre-modeling and 6,12,24,72 and 120 h after modeling.Tissues from pancreas and intestine were obtained for pathological evaluation after the rabbits died or being sacrificed at the 5th day after modeling.Intestinal tissue homogenates were prepared and levels of TNF-α,IL-6 and malondialdehyde（MDA）in tissues of intestine were measured and compared. Results Except the serum level of IL-6 at 120 h after modeling,those of AMY,TNF-α and IL-6 at each time point after modeling in group B and C were significantly higher than those in group A（P〈0.05）.The serum levels of AMY from 12 h after modeling,TNF-α from 24 h after modeling,IL-6 at 24 h and 72 h after modeling were significantly lower in group C than in group B（P〈0.05）.More severe pathological changes were observed in group B than in group C.The levels of TNF-α,IL-6 and MDA in tissues of intestine were significantly lower in group C than in group B（P〈0.05）. Conclusion The releasing of inflammation mediators in SAP can be inhibited by the combination therapy of enteral nutrition and TCM intervention.The injury of intestinal mucous membrane can be relieved and the intestinal barrier be protected.The earlier intervention with enteral nutrition and TCM may be beneficial for the treatment of SAP and may improve the prognosis.