数字化音乐电胃肠起搏对食管癌术后肠道屏障功能、炎症和氧化应激的影响

Effect of digital music gastrointestinal electrical pacing on intestinal barrier function,inflammation and oxidative stress after esophageal cancer surgery

目的探讨数字化音乐电胃肠起搏对食管癌术后肠道屏障功能、炎症和氧化应激的影响。方法选取2016年3月至2018年6月于河北省胸科医院住院的120例食管癌病人作为研究对象,分为四组,即A、B、C和D组,A组病人给予胃肠减压等一般治疗措施,B组病人在A组的基础上给予足三里穴按摩,C组病人在A组的基础上给予胃肠起搏,D组在A组的基础上给予数字化音乐电胃肠起搏治疗,共治疗7 d。观察胃肠功能的恢复情况,包括肠鸣音恢复时间、排气时间、排便时间、胃管留置时间、胃液引流量;酶联免疫吸附试验检测血清中内毒素、二胺氧化酶(DAO)、紧密连接蛋白(Occludin)、闭锁小带蛋白(ZO-1)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)和白细胞介素-10(IL-10)的含量;蛋白质免疫印迹检测外周血单个核细胞中Toll样受体-4(TLR4)/核因子-κB(NF-κB)信号通路的表达;黄嘌呤氧化酶法检测超氧化物歧化酶(SOD)的活性,硫代巴比妥酸法检测丙二醛(MDA)的含量。结果 D组的肠鸣音恢复时间(36.20±5.15)h、排气时间(52.87±4.51)h、排便时间(73.42±6.92)h、胃管留置时间(80.95±7.65)h、胃液引流量(895.44±101.35)mL、内毒素(5.37±2.40)ng/L、DAO(2.71±0.70)U/L、Occludin(13.61±3.20)μg/L、ZO-1(23.55±3.60)μg/L、TNF-α(12.35±3.61)ng/L、IL-6(16.48±4.01)ng/L、IL-8(37.87±9.71)ng/L均低于A组[(48.72±5.93)h,(68.17±6.45)h,(87.20±6.67)h,(97.34±8.19)h,(1334.50±211.80)mL,(11.83±3.62)ng/L,(3.69±0.53)U/L,(21.56±3.94)μg/L,(31.01±4.33)μg/L,(26.31±4.29)ng/L,(33.72±5.44)ng/L,(82.67±12.55)ng/L]、B组[(45.62±5.50)h,(63.48±6.70)h,(79.95±7.69)h,(91.17±6.89)h,(1180.46±196.15)mL,(8.55±2.19)ng/L,(3.31±0.64)U/L,(19.49±2.88)μg/L,(27.36±4.02)μg/L,(20.70±3.88)ng/L,(25.09±4.85)ng/L,(72.63±11.44)ng/L]、C组[(41.04±6.11)h,(61.25±5.81)h,(77.29±7.13)h,(88.72±9.03)h,(1047.28±160.33)mL,(7.80±3.25)ng/L,(3.12±0.59)U/L,(15.51±3.49)μg/L,(28.11±4.52)μg/L,(17.65±3.24)ng/L,(26.67±5.03)ng/L,(65.51±13.10)ng/L],且B、C组低于A组(P<0.05),但是四组间IL-10的含量差异无统计学意义(P>0.05)。D组外周血单个核细胞中的TLR4(0.44±0.11)和NF-κB(0.28±0.13)蛋白表达量均低于A组[(1.00±0.24),(1.00±0.21)]、B组[(0.86±0.15),(0.84±0.22)]、C组[(0.75±0.20),(0.45±0.16)],且B、C组低于A组(P<0.05)。D组血清中的SOD含量(418.50±36.22)U/L均高于A组(363.62±24.01)U/L、B组(385.09±30.58)U/L、C组(391.33±27.44)U/L,且B、C组高于A组(P<0.05);D组血清中的MDA含量(5.11±0.66)μmol/L均低于A组(6.42±0.85)μmol/L、B组(5.89±0.74)μmol/L、C组(5.65±0.80)μmol/L,且B、C组低于A组(P<0.05)。结论数字化音乐电胃肠起搏能够改善食管癌术后病人的肠道屏障功能,下调血清炎性因子含量和外周血单个核细胞中TLR4/NF-κB信号通路的表达,降低氧化应激水平。

Objective To explore the effect of digital music gastrointestinal electrical pacing on intestinal barrier function,inflammation and oxidative stress after esophageal cancer surgery.MethodsA total of 120 patients with esophageal cancer hospitalized in the Hebei Provincial Chest Hospital from March 2016 to June 2018 were selected as the research subjects and divided into 4 groups,namely group A,B,C and D.Patients in group A were given general treatment such as gastrointestinal decompression.Patients in group B were given Zusanli massage on the basis of group A.Patients in group C were given gastrointestinal pacing on the basis of group A.Patients in group D were given digital music gastrointestinal electrical pacing on the basis of group A.The therapy lasted for 7 days.The recovery of gastrointestinal function was observed,including recovery time of intestinal sound,exhaust time,defecation time,indwelling time of gastric tube and gastric juice drainage volume.The levels of endotoxin,diamine oxidase(DAO),Occludin,ZO-1,tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),interleukin-8(IL-8)and interleukin-10(IL-10)in serum were detected by enzyme linked immunosorbent assay.The expression of Toll-like receptor 4(TLR4)/Nuclear transcription factor-κB(NF-κB)signaling pathway in peripheral blood mononuclear cells was detected by Western blotting.The activity of superoxide dismutase(SOD)was detected by xanthine oxidase method and the content of malondialdehyde(MDA)was determined by thiobarbituric acid method.ResultsThe recovery time of bowel sound(36.20±5.15)h,exhaust time(52.87±4.51)h,defecation time(73.42±6.92)h,indwelling time of gastric tube(80.95±7.65)h,gastric drainage volume(895.44±101.35)mL,endotoxin(5.37±2.40)ng/L,DAO(2.71±0.70)U/L,Occludin(13.61±3.20)μg/L,ZO-1(23.55±3.60)μg/L,TNF-a(12.35±3.61)ng/L,IL-6(16.48±4.01)ng/L and IL-8(37.87±9.71)ng/L in group D were lower than those in group A[(48.72±5.93)h,(68.17±6.45)h,(87.20±6.67)h,(97.34±8.19)h,(1334.50±211.80)mL,(11.83±3.62)ng/L,(3.69±0.53)U/L,(21.56±3.94)μg/L,(31.01±4.33)μg/L,(6.31±4.29)ng/L,(33.72±5.44)ng/L,(82.67±12.55)ng/L],group B[(45.62±5.50)h,(63.48±6.70)h,(79.95±7.69)h,(91.17±6.89)h,(1180.46±196.15)mL,(8.55±2.19)ng/L,(3.31±0.64)U/L,(19.49±2.88)μg/L,(27.36±4.02)μg/L,(20.70±3.88)ng/L,(25.09±4.85)ng/L,(72.63±11.44)ng/L],group C[(41.04±6.11)h,(61.25±5.81)h,(77.29±7.13)h,(88.72±9.03)h,(1047.28±160.33)m L,(7.80±3.25)ng/L,(3.12±0.59)U/L,(15.51±3.49)μg/L,(28.11±4.52)μg/L,(17.65±3.24)ng/L,(26.67±5.03)ng/L,(65.51±13.10)ng/L],and the levels of above indicators in group B,C were lower than those in group A(P<0.05),but there was no statistical difference among the four groups(P>0.05).The expression of TLR4(0.44±0.11)and NF-κB(0.28±0.13)in peripheral blood mononuclear cells of group D were lower than those of group A[(1.00±0.24),(1.00±0.21)],group B[(0.86±0.15),(0.84±0.22)],group C[(0.75±0.20),(0.45±0.16)],and the expression of TLR4 and NF-κB in group B,C were lower than thosein group A(P<0.05).The level of SOD(418.50±36.22)U/L in group D were higher than that in group A(363.62±24.01)U/L,group B(385.09±30.58)U/L,group C(391.33±27.44)U/L,and the level of SOD in group B,C were higher than that in group A(P<0.05);the level of MDA(5.11±0.66)μmol/L in group D were lower than that in group A(6.42±0.85)μmol/L,group B(5.89±0.74)μmol/L,group C(5.65±0.80)μmol/L,and the level of MDA in group B,C were lower than those in group A(P<0.05).ConclusionDigital music gastrointestinal electrical pacing can improve the intestinal barrier function of patients with esophageal cancer after operation,down-regulate the level of serum inflammatory factors and the expression of TLR4/NF-κB signaling pathway in peripheral blood mononuclear cells,and reduce the level of oxidative stress.