谷氨酰胺对猪急性重症胰腺炎后肠源性细菌/内毒素易位的影响

Influence of glutamine on gut bacteria/endotoxin translocation in acute severe pancreatitis

目的：观察静脉内滴注谷氨酰胺（Ｇｌｎ）对急性重症胰腺炎（ＡＳＰ）后肠源性细菌／内毒素易位的保护作用。方法：选健康长白种猪２１头，体重１６～２２ｋｇ，雌雄不限，随机分为四组。Ⅰ组：假手术对照组（ｎ＝５）；Ⅱ组：ＡＳＰ对照组（ｎ＝５）；Ⅲ组：ＡＳＰ＋甘氨酸（Ｇｌｙ）组（ｎ＝５）；Ⅳ组：ＡＳＰ＋Ｇｌｎ组（ｎ＝６）。在麻醉状态下，进腹向胰管内注入５％牛磺胆酸钠混合液１ｍｌ／ｋｇ（内含８０００～１００００ＢＡＥＥ单位胰蛋白酶／ｍｌ，ｐＨ７．６）诱导ＡＳＰ。以０．９％ＮａＣｌ磷酸盐缓冲液取代５％牛磺胆酸钠混合液即为假手术对照组。采集腔静脉血作内毒素测定（鲎试剂法）。ＡＳＰ后７２ｈ，采集门、腔静脉血作细菌定量培养和细菌鉴定。然后静脉推注１０％氯化钾２０ｍｌ处死后，立即进胸腹取大小肠系膜淋巴结、肺组织、肺门淋巴结、胰腺组织，称重后研磨成组织匀浆，并作细菌定量培养和细菌鉴定。结果：静脉内输注Ｇｌｎ后可使血浆中Ｇｌｎ浓度较Ⅰ组、Ⅱ组明显升高（Ｐ均＜０．０１）。静脉内Ｇｌｎ支持可明显降低血浆内毒素水平，且使血液和组织器官中易位的细菌数量均出现非常显著的下降。结论：静脉内Ｇｌｎ支持可显著地升高血浆Ｇｌｎ水平，可显著地减轻ＡＳＰ后肠?

Objectives:To observe the protection of intravenous glutamine(Gln) on gut originated bacteria/endotoxin translocation following acute severe pancreatitis(ASP) induced by sodium taurocholate. Methods:There were 21 pigs weighing 16￣22 kg,which were divided into four groups.Group Ⅰ( n =5):sham control;Group Ⅱ( n =5):ASP control;Group Ⅲ( n =5):ASP+glycine(Gly);Group Ⅳ( n =6):ASP+Gln;Anesthesized pigs were subjected ASP induced by injecting 1 ml/kg of combined solution of 5% sodium taurocholate and 8 000 ￣10 000 BAEE units trypsin/ml into pancreas via pancreatic duct.Plasma glutamine were measured by the high performance liquid phase technique(the product of Waters,U.S.A.).Systemic plasma endotoxin levels was quantified by the chromogenic limulus amebocyte lysate(LAL) technique.Both portal and systemic blood samples were obtained before and 72 h following ASP and cultured for aerobic as well as anaerobic bacterial growth.Subsequently,all pigs were sacrificed by injecting 20 ml of 10% KCl intravenously.Specimens of tissue from mesenteriolum and mesocolon lymph nodes,lung,pulmonary portal lymph nodes and pancreas were removed,weighed and homogenized in grinding tubes.Aliquots of the homogenate were cultured as blood mentioned above.Positive specimens were subcultured and identified by standard procedure. Results:Intravenous glutamine could effectively prevent the decrease of plasma glutamine levels following acute severe pancreatitis.Intravenous admission of glutamine reduced significantly the levels of systemic plasma endotoxin and the magnitude of bacteria translocation to the portal and blood and the distant organs. Conclusions:Intravenous admission of glutamine can enhance plasma glutamine concentrations.Intravenous admission of glutamine can effectively decrease gutoriginated bacteria/endotoxin translocation.