不同时机早期肠内营养对重症急性胰腺炎大鼠肠黏膜屏障的影响

Effect of early enteral nutrition at different periods on intestinal mucosa barrier in rats with severe acute pancreatitis

目的研究不同时机启动早期肠内营养(enteral nutrition,EN)对重症急性胰腺炎(severe acute pancreatitis,SAP)大鼠肠黏膜屏障功能和结构的影响。方法将75只健康雄性大鼠随机分为空白组(S组,n=15)、实验组(EN组,又分为EN-1、EN-2和EN-3组,各n=15)和对照组(TPN组,n=15)。S组仅翻动内脏,余组建立SAP模型。造模后,S组正常喂食;TPN组采用肠外营养;EN-1、EN-2和EN-3组分别于建模后第1、2、4天启动EN。各组于建模后第2、3、5天分别处死5只大鼠,心脏采血检测淀粉酶(amylase,AMS)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-10(interleukin-10,IL-10)、血清内毒素(endotoxin,ET)的变化,取末端回肠作病理组织学检查并评分。结果建模后第2天,空白组与EN组、对照组各指标差异有统计学意义(P<0.01),EN组和对照组四组之间差异均无统计学意义(P均>0.05);建模后第3、5天,EN组各指标低于对照组,随着治疗持续,四组指标水平均呈下降趋势(P<0.05),EN-1组下降最明显。结论启动早期EN利于控制胰腺炎和保护肠道黏膜屏障,越早启动越有利。

Objective To investigate the effect of early enteral nutrition（EN） at different period on intestinal mucosa barrier and pathology in rats with severe acute pancreatitis（SAP）. Methods A total of 75 male rats were randomly allocated into following groups： blank group（S group, n=15）, experimental group（EN group, 45 rats were then randomly divided into EN-1, EN-2 and EN-3 sub group, each n=15） and control group（TPN group,n=15）. Rats in S group only had their viscera turned, while rats in other two groups were used to establish severe acute pancreatitis model. After successful modeling, the S group received normal diet, the TPN group received support and treatment by total parenteral nutrition. EN-1, EN-2 and EN-3 subgroup respectively started enteral nutrition at day 1, day 2 and day 4 after modeling. At the day 2, day 3 and day 5 after modeling, 5 rats in each group were sacrificed. Then the heart blood sampling were taken to detect serum levels of amylase（AMS）, tumor necrosis factor-α（TNF-a）, interleukin-10（IL-10） and endotoxin（ET）, and the terminal ileum tissue was taken for histopathologic examination and evaluation. Results At day 2, compared with EN subgroups and TPN group,indexes in S group were significantly different（P〈0.01）, and there was no significant difference between EN groups and TPN group（P〉0.05）. At day 3 and day 5, indexes in EN group were lower than those in TPN group,and these four groups showed a downward trend along with the treatment（P〈0.05）. The EN-1 group decreased most significantly. Conclusion Starting early enteral nutrition can control the progress of SAP in rats, and protect intestinal mucosal barrier, the sooner the better.