生态免疫肠内营养对重症胰腺炎大鼠肠屏障功能和胰腺炎症的影响

Effects of ecoimmunonutrition on intestinal barrier and pancreas in rats with severe acute pancreatitis

目的评估生态免疫肠内营养对重症胰腺炎（SAP）大鼠肠屏障功能和胰腺的影响。方法64只SPF大鼠随机分为对照组、SAP组、SAP普通肠内营养组（EEN组）和SAP生态免疫肠内营养组（EIN组），分别于造模后第4天和第7天检测各组大鼠的多脏器细菌易位情况、血浆内毒素水平、肠黏膜通透性，并进行胰腺病理评分和回肠末端病理检查等。结果SAP组、EEN组和EIN组大鼠的总细菌易位率明显高于对照组（P〈0．05），EEN组和EIN组明显低于SAP组（P〈0．05），EIN组明显低于EEN组（P〈0．05）。SAP组、EEN组和EIN组大鼠的血浆内毒素水平和肠系膜上静脉血FD．40浓度均明显高于对照组（P〈0．01），EEN组和EIN组均明显低于SAP组（P〈0．01），EIN组的血内毒素水平亦低于EEN组（P〈0．05）。SAP组、EEN组和EIN组大鼠病理各单项及总评分均明显高于对照组（P〈0．01）；EEN和EIN组则明显低于SAP组（P〈0．01）；EIN组的各单项评分与EEN组差异无统计学意义（P〉0．05），但总评分明显低于EEN组（P〈0．05）。EIN组大鼠肠黏膜较其他组明显增厚，绒毛茂盛。结论早期肠内营养对SAP大鼠肠屏障和胰腺具有保护作用，其中生态免疫肠内营养较普通肠内营养效果更佳。

Objective To explore the effects of ecoimmunonutrition support on the intestinal barrier function and pancreas in rats with severe acute pancreatitis （SAP）. Methods Totally 64 SPF rats were randomly divided into sham operation group （ control group）, SAP without enteral nutrition support group （ SAP group）, SAP with early enteral nutrition support group （ EEN group ）, and SAP with early ecoimmunonutrition support group （EIN group）. Bacteria translocation （BT） , plasma endotoxin （ET） , gut permeability, pancreas pathology score, and distant ileum pathology were determined on the 4^th and 7^th post-modeling day. Results The BT rate was significandy higher in SAP group, EEN group, and EIN group than in control group （ P 〈 0. 05 ）, was significantly lower in EEN group and EIN group than in SAP group （ P 〈 0. 05） , and was significantly lower in EIN group than in EEN group （ P 〈 0.05 ）. ET and FD-40 levels in blood were both significantly higher in SAP group, EEN group, and EIN group than in control group （ P 〈 0.01 ） and were significantly lower in EIN group and EEN group than in SAP group （ P 〈 0.01 ） ; ET was significantly lower in EIN group than in control group （ P 〈 0. 05 ）. Pathological scores were significantly higher in SAP group, EEN group, and EIN group than in control group （P 〈 0. 01 ） and were significantly lower in EEN group and EIN group than in SAP group （ P 〈 0. 01 ）. The individual pathological scores of EIN group were not significantly different from EEN group （ P 〉 O. 05 ）, while the total score was significantly lower in EIN group than in EEN group （ P 〉 0.05 ）. Distant iliac mueosa was significantly thicker in EIN group than in other groups. Conclusions Early enteral nutrition support protects the intestinal barrier and pancreas in rats with SAP. Eeoimmunonutrition has better nutritional effectiveness than the normal enteral nutrition.