益生菌联合谷氨酰胺的肠内营养对重症急性胰腺炎肠黏膜屏障恢复的作用

Effects of Enteral Nutrition Supplemented Probiotics and Glutamine on the Intestinal Mucosal Barrier Recovery in Patients with Severe Acute Pancreatitis

目的研究了益生菌联合谷氨酰胺的肠内营养治疗对恢复重症急性胰腺炎(SAP)的肠道屏障功能的作用。方法将74例重症急性胰腺炎患者随机分为3组:常规肠内营养组(EN组),肠内营养+谷氨酰胺组(G1n组),肠内营养+谷氨酰胺+益生菌制剂组(益生菌组)。治疗第1、7、14、21天进行APACHEⅡ评分,并取血测定血清中的谷氨酰胺、内毒素、CRP、D-乳酸水平。结果三组病人APACHEⅡ评分、CRP均逐渐下降,在第7天,Gln组和益生菌组CRP水平下降,并且与EN组对比,差异有统计学意义,而益生菌组和Gln组在第14天的APACHEⅡ评分与EN组差异有统计学意义。三组患者血清Gln浓度在第7天测定均成不同程度下降,Gln组与益生菌组分别与EN组比较,差异无统计学意义。在第14天,三组Gln水平均上升,益生菌组与EN组对比,差异有统计学意义(P<0.05)。在第7天,益生菌组的血清内毒素、D-乳酸水平低于EN组,差异有统计学意义。在第14天,Gln组和益生菌组的内毒素水平和D-乳酸水平均低于EN组,差异有统计学意义,益生菌组的DAO水平低于EN组,差异有统计学意义(P<0.05)。结论应用益生菌制剂和Gln的肠内营养能更好地维护肠道黏膜屏障的完整,应用前景广阔。但益生菌制剂和Gln免疫制剂间的协同作用需要进一步论证。

Objective To evaluate the effect of enteral nutrition supplemented probioties and glutamine on the intestinal mueosal barrier recovery in patients with severe acute panereatitis. Methods 74 patients with severe acute panereatitis were randomly divided into 3 groups： enteral nutrition （EN group）, enteral nutrition ＋ glutamine （Gln group ）, enteral nutrition ＋ glutamine ＋ probioties （probiotiesgroup）. APACHE II score was used to evaluate the patients. Blood samples were collected on day 1, 7, 14, 21 after treatment for the concentration of glutamine, plasma endotoxi, plasma diamine oxidase （DAO）, C - reactive protein （CRP）. Results 7 day after treatment, the CRP level of Gin group and probiotics group wers decreasd, there were significance statistical difference when compared with the EN group. There was significant difference among the three groups in APACHE II score, the concentration of glutamine were decreased in the three group on the 7th day after treatment. There was no significant difference among the three groups. The levels of Gin in three groups were rise on the 14th day after treatment. There was significant difference between EN group and probiotics group. The level of plasma endotoxi and D - lactic acid of probiotics group were lower than EN group on 7th day after treatment, The difference was statistically significant. The level of plasma endotoxi and D -lactic acid of probiotics group and Gin group were lower than EN group on 14th day after treatment, the difference was statistically significant. Conclusion Application of probiotics and Gin enteral nutrition can better maintain the intestinal barrier integrity and have broad application prospects. But the synergistic effect between probiotics and Clnimmune need for further study.