中药清胰汤及双歧杆菌合剂对急性坏死性胰腺炎肠道细菌移位影响的比较研究

Effect of Chinese medicine “Qing Yi Tang” and bifidobacterium mixture on intestinal bacterial translocation following acute necrotizing pancreatitis

目的观察中药清胰汤（ＣＭ）及双歧杆菌合剂（ＢＭ）对犬急性坏死性胰腺炎（ＡＮＰ）肠道细菌移位（ＢＴ）的影响．方法杂种犬３１只，分对照组（ｎ＝７）、ＡＮＰ组（ｎ＝８）、中药治疗组（ＣＭ，ｎ＝８）和双歧杆菌合剂治疗组（ＢＭ，ｎ＝８）．对照组犬仅行剖腹术；经主胰管注入５％牛磺胆酸钠（０５ｍＬ／ｋｇ）和胰蛋白酶（３０００ｕ／ｋｇ）复制ＡＮＰ模型，ＣＭ组和ＢＭ组犬术后每日分别经胃管灌服中药清胰汤及双歧杆菌合剂结果与ＡＮＰ组比较，ＣＭ及ＢＭ组肠粘膜损害明显减轻；肠粘膜菌群中大肠杆菌、类杆菌数量减少，双歧杆菌、乳杆菌数量显著增加（Ｐ＜００５），肠道微生态趋于平衡；ＣＭ组脏器细菌移位率减少５０％，ＢＭ组减少３７５％，两组移位细菌数量减少１０～４０倍；两组血培养阳性率均由１００％降为３７５％；两组血中内毒素水平下降１～２倍，淀粉酶水平下降２～３倍，磷脂酶Ａ２活性亦显著下降，并均于ｄ７后接近正常；肠通透性下降．结论中药清胰汤及双歧杆菌合剂具有减轻ＡＮＰ后肠粘膜损害，调节肠道菌群微生态平衡、保护肠屏障功能。

AIM To observe the effect of Chinese medicine “Qing Yi Tang ” and bifidobacterium mixture on intestinal bacterial translocation (BT) in acute necrotizing pancreatitis (ANP). METHODS The dogs were randomly divided into four groups. Control group ( n =7), received laparotomy only; ANP group ( n =8), ANP model was induced by injection of 0 5mL/kg 5% sodium taurocholate with 3000U/kg trypsin into the pancreatic duct; Chinese medicine group (CM, n =8) and bifidobacterium mixture group (BM, n =8), In CM and BM groups, dogs were fed every day with “Qing Yi Tang” and bifidobacterium mixture (containing bifidobacteria 10 9cfu/g , lactobacilli 10 8cfu/g and enterococci 10 8cfu/g ), respectively. RESULTS In CM and BM groups, histologic and ultrastructural damages in pancreas and ileal mucosa were much milder than those of ANP group. In ANP group, there was a significant increase of E.coli and bacteroids and a significant decrease of bifidobacteria, lactobacilli and enterococci in the intestinal mucosa and cecal content, while in CM and BM groups, these changes were alleviated significantly ( P <0 05). As compared with those of ANP group, the BT rate was reduced by 50% in CM group and 37 5% in BM group, and the counts of translocated bacteria were decreased 10-40 times as well. Intestinal permeability and the levels of LPS, AMY and PLA 2 were decreased 2-3 times significantly in CM and BM groups ( P <0 05). CONCLUSION Both Chinese medicinal formula “Qing Yi Tang” and bifidobacterium mixture showed their protective effects on gut barrier function by alleviating the damage of intestinal mucosa and microecologic disturbance following acute pancreatitis. As a result, the chances of BT and enterogenic infection declined. These two preparations might be promising in the prophylaxis and treatment of infection complicating ANP.