益生菌联合大剂量维生素C在重症急性胰腺炎中的应用及潜在机制分析

Application and potential mechanism of probiotics combined with high-dose vitamin C in severe acute pancreatitis

目的 探讨益生菌联合大剂量维生素C对重症急性胰腺炎(SAP)患者免疫功能、肠道黏膜功能及预后的影响。方法 选取108例SAP患者作为研究对象,根据治疗方案的不同分为对照组(大剂量维生素C辅助治疗)53例和观察组(益生菌联合大剂量维生素C辅助治疗)55例。观察2组患者的疗效、预后情况及治疗前后炎症指标[肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、白细胞介素-6(IL-6)]、免疫功能指标(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+))、肠道菌群、肠道黏膜功能指标[二胺氧化酶(DAO)、D-乳酸、内毒素]、单核细胞p38MAPK/核因子-κB(NF-κB)信号通路变化。结果 观察组总有效率为89.09%,高于对照组的69.81%,差异有统计学意义(P<0.05);治疗3、7 d后,观察组IL-6、TNF-α、CRP水平低于对照组,CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平高于对照组,肠球菌、大肠埃希菌水平低于对照组,乳酸杆菌、双歧杆菌水平高于对照组,DAO、D-乳酸、内毒素水平低于对照组,p38MAPK、p-p38MAPK蛋白相对表达量低于对照组,差异有统计学意义(P<0.05);观察组住院时间、ICU停留时间均短于对照组,差异有统计学意义(P<0.05);2组患者自动出院及死亡的发生率比较,差异无统计学意义(P>0.05)。结论 益生菌联合大剂量维生素C对SAP患者疗效确切,能够有效减轻机体炎症反应,调节免疫功能,促进肠道黏膜功能修复,有利于患者早日康复,这可能与其抑制p38MAPK/NF-κB信号通路有关。

Objective To investigate the effects of probiotics combined with high-dose vitamin C on immune function,intestinal mucosal function,and prognosis in patients with severe acute pancreatitis(SAP).Methods A total of 108 SAP patients were selected as study subjects and divided into control group(treated with high-dose vitamin C as adjuvant therapy,n=53) and observation group(treated with probiotics combined with high-dose vitamin C as adjuvant therapy,n=55) based on different treatment regimens.The efficacy,prognosis,and changes in inflammatory markers [tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),interleukin-6(IL-6)],immune function indicators(CD3~+,CD4~+,CD4~+/CD8~+),intestinal flora,intestinal mucosal function indicators [diamine oxidase(DAO),D-lactic acid,endotoxin],and monocyte p38MAPK/nuclear factor-κB(NF-κB) signaling pathway were observed before and after treatment in both groups.Results The total effective rate in the observation group was 89.09%,which was significantly higher than the 69.81%in the control group(P <0.05).After 3 and 7 days of treatment,the levels of IL-6,TNF-α,and CRP in the observation group were lower,while the levels of CD3~+,CD4~+,and CD4~+/CD8+were higher than those in the control group(P <0.05).The levels of Enterococcus and Escherichia coli in the observation group were lower,while the levels of Lactobacillus and Bifidobacterium were higher than those in the control group(P <0.05).Additionally,the levels of DAO,D-lactic acid,and endotoxin were lower in the observation group,and the relative expression levels of p38MAPK and p-p38MAPK proteins were also lower(P <0.05).The length of hospital stay and ICU stay in the observation group were shorter compared to the control group(P <0.05).There was no statistically significant difference in the incidence of voluntary discharge and death between the two groups(P> 0.05).Conclusion The combination of probiotics and high-dose vitamin C has a definite therapeutic effect in SAP patients,effectively reducing inflammatory response,regulating immune function,promoting intestinal mucosal function repair,and facilitating early recovery.The achievement of above efficacy may be related to its inhibition of the p38MAPK/NF-κB signaling pathway.