严重烧伤后肠道损伤与肠源性高代谢的关系

Relationship between enterogenous hypermetabolism and intestine injury after severe burn injury

目的 探讨烧伤后肠道损害与“肠源性高代谢”的关系。方法 在建立严重烧伤加清洁肠道动物模型的基础上 ,将 96只Wistar大鼠随机分为烧伤对照 (B)组和烧伤加清洁肠道 (SDD)组。观察了伤后 0～ 10d大鼠静息能量代谢率(REE)的变化 ,同时检测了伤后 0、1、3、5、7、10d血中内毒素 (LPS)、肿瘤坏死因子 (TNF)和二胺氧化酶 (DAO)的含量 ,并进行相关分析。结果 烧伤后两组大鼠的REE、TNF、LPS和DAO均明显高于伤前 ,两组相比 ,SDD组的REE、TNF和LPS较B组均有不同程度的降低 ,而DAO则明显高于B组。相关分析显示 ,REE同LPS和TNF呈显著正相关 (r1 =0 .77,P <0 .0 5 ,r2 =0 .81,P <0 .0 5 ) ,与DAO相关不显著 (r >0 .0 5 )。结论 烧伤后肠源性高代谢与血中炎症介质含量呈正比 ,但肠道损伤程度加重并不引起代谢率相应增加 。

Objective To explore the relationship between enterogenous hypermetabolism and intestine injury after burn injury. Methods A total of 96 Wistar rats inflicted with 30% total body surface area full thickness burn were randomly divided into two groups: namely burn control (B) and selective decontamination of digestive tract (SDD) group. Indices including the resting energy expenditure (REE), plasma lipopolysaccharide (LPS), tumor necrosis factor (TNF) level and diamine oxidase (DAO) activity were determined. Results Increased levels of REE, TNF, LPS and DAO were found in the two groups following burn injury. Compared with those in group B, the levels of REE, TNF and LPS were decreased in different degree in SDD group. The plasma DAO activity in SDD group was remarkably higher than that in group B. Correlation analyses showed that REE had a positive correlation to LPS and TNF ( r 1=0.77, P <0.05; r 2=0.81, P <0.05). Conclusion SDD can reduce the hypermetabolic reaction after burn injury. It is inflammatory reaction rather than intestine injury that directly causes enterogenous hypermetabolism following burn injury.