早期应用微生态制剂对急性重症胰腺炎患者血清炎性介质水平的影响

[BT(2+2]Early enteral application of probiotics improved the changes of inflammatory mediators and its relationship with the prognosis in the patients with severe acute pancreatitis

目的:探讨早期肠道应用微生态制剂双歧杆菌三联活菌胶囊(培菲康)对急性重症胰腺炎患者血清炎性介质白细胞介素-8(IL-8)和肿瘤坏死因子α(TNF-α)水平的影响及可能的临床意义。方法:45例患者随机分为两组,试验组(培菲康+肠内营养,n=20)和对照组(肠内营养,n=25),两组患者入院确诊后对症支持、肠内营养、抗感染、抑酸及抑制胰腺分泌等处理均相同,试验组加用培菲康,每隔12 h 1次,每次4粒,每粒210 mg,疗程14 d。治疗前1 d、治疗后7 d和14 d抽血,ELISA法检测血清IL-8和TNF-α水平,同时观察血淀粉酶、血白细胞及预后变化。结果:两组患者治疗后7 d及14 d血清IL-8和TNF-α水平均显著降低,试验组的炎症介质水平在14d时低于对照组(P<0.05)。另外,血淀粉酶及白细胞总数14 d时试验组较对照组为低(P<0.05),胃肠功能评分有所降低,多器官衰竭、感染、上消化道出血试验组稍低,死亡率两组间无统计学差异。结论:肠道微生态制剂培菲康可明显降低血中炎性介质的量,并由此调整肠内菌群平衡,改善肠道黏膜屏障和胃肠功能,减少感染等并发症的发生,值得进一步研究。

Objective： To observe the changes in serum interleukin-8 （IL-8） and tumor.necrosis factor-α （TNF-α） in the patients with severe acute pancreatitis followed early enteral probiotics（EEP） compared with early enteral nutrition（EEN） and its possible mechanism of effect on prognosis. Methods：Fourty-five patients with severe pancreatitis were randomized equally into two groups （EEP group, n = 20 and EEN group, n = 25 ） which received standard therapeutic procedures except the use of probiotics. Serum IL-8 and TNF-α were measured pretherapy,7^th day,and 14^th day by ELISA. The blood amylase and WBC account were also monitored at the same time. Patients＇ prognoses with SAP were observed. Results：At 7^th and 14^th day after EEP and EEN,all the inflammatory mediators decreased, but the EEP group offered significant differences compared with EEN groups on 14^th day （ P 〈 0.05 ）. And the Amylase level and WBC account showed the similar results between two groups on 14^th day. GI function score showed EEP group was better than EEN group. For EEP group, the infection peripancreas and upper GI bleeding seemed lower than that of EEN group. Conclusion：Early enteral use of probiotics in the patients with SAP could significantly decrease the level of inflammatory mediators and improved the patients＇ prognoses. Early enteral use of probiotics might maintain the GI barrier,inhibit the bacteria translocation and improve the GI tract ＆ host defense ability which plays an important role in SAP patients＇ recovery and further investigation is needed.