早期肠内营养对SAP患者肠通透性及血清炎症因子的影响

Effect of early enteral nutrition on intestinal permeability and serum inflammatory factors in patients with severe acute pancreatitis

目的探讨早期肠内营养(EN)对急性重症胰腺炎(SAP)患者肠通透性及血清炎症因子[肿瘤坏死因子(TNF)-α、白细胞介素(IL)-1β、IL-6、IL-8]的影响。方法选取2017年1月至2018年1月于该院急诊科住院治疗的70例SAP患者作为研究对象。将研究对象随机分为两组:肠外营养组(PN组,35例)、EN组(35例)。主要评价指标为血清内毒素、尿乳果糖/甘露醇比值、血清炎症因子。比较两组以上指标在治疗前,治疗后1周及2周的差异。结果治疗前两组血清内毒素水平、尿乳果糖/甘露醇比值、TNF-α、IL-1β、IL-6、IL-8水平比较,差异均无统计学意义(P>0.05)。治疗后1、2周,PN组血清内毒素水平及尿乳果糖/甘露醇比值显著高于EN组,差异均有统计学意义(P<0.05)。治疗后1周EN组血清TNF-α、IL-1β、IL-6、IL-8水平明显低于PN组,差异有统计学意义(P<0.05)。结论对于SAP患者早期进行EN干预,不仅可以降低肠道通透性、减少肠源性感染的发生,亦可抑制SAP的炎性反应。因此,对于无绝对禁忌证的SAP患者,应早期进行EN支持。

Objective To study the effect of early enteral nutrition(EN)on the intestinal permeability and serum inflammatory factors(TNF-α,IL-1β,IL-6,IL-8)in the patients with severe acute pancreatitis(SAP).Methods Seventy patients with SAP in the emergency department of this our hospital from January 2017 to January 2018 were selected as the study subjects and randomly divided into the two groups:the parenteral nutrition(PN group,n=35)and EN group(n=35).The main evaluation indicators were serum endotoxin level,urine lactulose/mannitol ratio and serum inflammatory factors level.Then the differences of these indicators before treatment and at 1,2 weeks after treatment were compared between the two groups.Results The levels of serum endotoxin,urine lactulose/mannitol ratios,TNF-α,IL-1β,IL-6 and IL-8 before treatment had no statistical differences between the two groups(P>0.05).The serum endotoxin level and urine lactulose/mannitol ration at 1,2 weeks after treatment in the PN group were significantly higher than those in the EN group,and the difference was statistically significant(P<0.05).The levels of serum TNF-α,IL-1β,IL-6 and IL-8 at 1 week after treatment in the EN group were significantly lower than those in the PN group,and the difference was statistically significant(P<0.05).Conclusion Conducting the EN intervention in the SAP patients not only can reduce the intestinal permeability and enterogenous infection occurrence,but also can inhibit the inflammatory reaction of SAP.Therefore for the SAP patients without absolute contraindications,it is necessary to conduct early EN support.