早期肠内营养在大鼠重症急性胰腺炎肠道免疫屏障中的作用

Effect and mechanism of early enteral nutrition on intestinal immune barrier in rats with severe acute pancreatitis

[目的]探讨早期肠内营养在大鼠重症急性胰腺炎肠道屏障中的作用及机制。[方法]将60只SD大鼠随机分成3组:正常对照组即假手术组(SO组),肠外营养组(TPN组),肠内营养组(EEN组),每组20只。各组于造模后1d检测血清淀粉酶(AMY),第6天统计死亡率后处死大鼠并收集标本,回肠HE染色评估肠黏膜病理损伤,免疫组化法测定末端回肠Peyer结的MAdcAM-1、CD4+、CD8+的含量,检测内毒素含量和细菌移位率。[结果]1死亡率:SO组(0%)明显低于TPN组(50%)和EEN组(25%),EEN组明显低于TPN组,均P<0.05;2AMY含量:TPN组、EEN组与SO组比较,EEN组与TPN组比较,均差异有统计学意义(P<0.01);3回肠黏膜组织评分:TPN组、EEN组与SO组比较,EEN组与TPN组比较,均差异有统计学意义(P<0.05);4末端回肠Peyer结CD4+、CD8+、MAdcAM-1:TPN组、EEN组与SO组比较,EEN组与TPN组比较,均差异有统计学意义(P<0.05);5血内毒素水平:TPN组、EEN组与SO组比较,EEN组与TPN组比较,均差异有统计学意义(P<0.05);6各种细菌易位率:TPN组、EEN组与SO组比较,EEN组与TPN组比较,均差异有统计学意义(P<0.01)。[结论]早期肠内营养在维护大鼠重症急性胰腺炎肠道屏障方面的作用效果显著。

[Objective]To investigate the role of early enteral nutrition on intestinal immune barrier in rats with severe acute pancreatitis.[Methods]Sixty healthy SD male rats were randomly divided into three groups：sham operation group（SO group）,total parenteral nutrition group（TPN）,early enteral nutrition group（EEN）.Measurement of the AMY level was performed one day after the model was built.After calculating the mortality rate,all of the rats were sacrificed and the tissues were collected.Colon tissue stained with HE were observed to investigate intestinal mucosa morphology.Immunohistochemistry was performed on terminal ileum and peyers patches to measure MAdCAM-1,CD4^＋,CD8^＋content.The venous blood endotoxin content was also detected.The incidence of bacterial translocation was observed.[Results]1 Mortality rate of each group：there was significant difference between SO group and the other two groups（P〈0.01）.The same result was noted between EEN group and TPN group（P〈0.05）.2Changes of AMY：AMY of TPN and EEN group were significantly increased than SO group（P〈0.01）.AMY of EEN group was significantly lower than TPN group（P〈0.01）.3Ileum morphology：mucosal histological changes of TPN and EEN group were significantly increased than SO group（P〈0.05）.EEN group was significantly lower than TPN group（P〈0.05）.4MAdCAM-1,CD4^＋,CD8^＋content in terminal ileum peyers patches：CD4^＋,CD8^＋,MadcAM-1content in EEN and TPN group were significantly lower than SO group（P〈0.05）,and TPN group was significantly lower than EEN group（P〈0.05）.5Endotoxin content：endotoxin content of TPN and EEN group were significantly increased compared with SO group（P 0.05）.Endotoxin content of EEN group was significantly lower than TPN group（P〈0.05）.6Incidence of bacterial translocation：incidence of bacterial translocation in EEN group was significantly lower than TPN group（P〈0.01）.Both EEN and TPN group incidence of bacterial translocation were significantly higher than SO group（P〈0.01）.[Conclusions]EEN has a remarkable effect on the protection of intestinal immune barrier function.