早期肠内营养对胆道闭锁幼鼠的肠道黏膜结构及微生态保护作用的研究

Study on the protective effect of early enteral nutrition on intestinal mucosal structure and microecology of young rats with biliary atresia

目的探讨早期肠内营养对胆道闭锁(biliary astresia,BA)幼鼠的肠道黏膜功能及微生态保护作用的研究。方法40只造模成功的BA幼鼠,按随机数字法分为假手术组、肠外营养(parenteral nutrition,PN)组、肠内营养(enteral nutrition,EN)组、抗生素组,每组10只;另选10只幼鼠作为假手术组。所有组均予以常规自由饮水,假手术组予以普通饲料灌胃治疗,抗生素组予以普通饲料联合氨苄青霉素灌胃治疗,PN组全肠外营养制剂治疗,EN组全肠内营养制剂治疗;造模前后分别称量各组幼鼠体重,造模10 d后处死幼鼠,采血检测血清总蛋白(total protein,TP)、白蛋白(albumin,ALB),取小肠组织进行苏木素-伊红染色,取肠系膜淋巴结进行细菌培养,比较各组动物体重、营养状况、小肠黏膜形态学(厚度、深度、高度)、肠系膜淋巴结细菌培养。结果造模成功后,各组幼鼠的体重均先减轻后增长,与假手术组比较,抗生素组、EN组和PN组体重减轻后增长的较为缓慢,4组组间、时点间、组间·时点间交互作用差异均有统计学意义(P<0.05)。治疗10 d后,与假手术组比较,抗生素组和PN组TP、ALB水平下降,与抗生素组、PN组比较,EN组TP、ALB水平升高(P<0.05);与假手术组比较,抗生素组和PN组黏膜厚度、腺隐窝深度、绒毛高度下降,与抗生素组、PN组比较,EN组黏膜厚度、腺隐窝深度、绒毛高度水平升高(P<0.05);系膜淋巴结细菌培养示,与假手术组比较,抗生素组、PN组大肠埃希菌、阴沟肠杆菌、铜绿假单胞菌、肺炎克雷伯杆菌数量升高,与抗生素组和PN组比较,EN组上述细菌数量均下降(P<0.05)。结论早期肠内营养治疗可增加BA幼鼠体重,改善营养状态和肠道结构,促进肠黏膜修复和稳定微生态平衡。

Objective To investigate the protective effect of early enteral nutrition on intestinal mucosal function and microecology in young rats with biliary atresia(BA).Methods In total,40 successfully established BA rat models were divided into the sham operation group,parenteral nutrition(PN)group,enteral nutrition(EN)group and antibiotic group by random number method,with 10 mice in each group.Another 10 young rats were selected as sham operation group.All groups had free access to water,the sham operation group was fed with common diet by gavage,and the antibiotic group was given common diet combined with ampicillin by gavage;The PN group was treated with total parenteral nutrition,and the EN group was treated with total enteral nutrition.The weight of the rats in each group was weighed before and after modeling.At 10 d after modeling,young rats were sacrificed,and blood was collected to detect total protein(TP)and albumin(ALB)in serum.Small intestinal tissue was stained with hematoxylin-eosin staining,and the mesenteric lymph nodes were cultured for bacteria.Body weight,nutritional status,small intestinal mucosa morphology(thickness,depth,height)and mesenteric lymph node bacterial culture were compared among the groups.Results After the success of modeling,the weight of young rats in each group decreased first and then increased.Compared with the sham operation group,the weight of antibiotic group,EN group and PN group increased slowly after weight loss.There were significant differences in the interaction between the four groups,time points and time points between groups(P<0.05).At 10 d after treatment,compared with the sham operation group,the levels of TP and ALB in the antibiotic group and PN group decreased,and compared with the antibiotic group and PN group,the levels of TP and ALB in the EN group increased(P<0.05).Compared with the sham operation group,the mucosal thickness,the depth of glandular recess and the height of villi in the antibiotic group and PN group decreased,which,however,increased in the EN group compared with the antibiotic group and PN group(P<0.05).Mesangial lymph node bacterial culture showed that compared with the sham operation group,the number of Escherichia coli,Enterobacter cloacae,Pseudomonas aeruginosa and Klebsiella pneumoniae in the antibiotic group and PN group increased,and the number of the above bacteria in the EN group decreased compared with the antibiotic group and PN group(P<0.05).Conclusion Early enteral nutrition therapy can increase the body weight of BA young rats,improve nutritional status and intestinal structure,promote intestinal mucosal repair and stabilize microecological balance.