不同类型早期肠道营养对重症急性胰腺炎大鼠细胞因子平衡和免疫状态的影响

Effect of Different Types of Early Nutrition on Cytokines Balance and Immune Function in Severe Acute Pancreatitis Rats

目的 评价早期免疫增强型肠内营养对重症急性胰腺炎 (severeacutepancreatitis,SAP)大鼠血浆细胞因子和免疫功能的影响。方法 170只SD大鼠随机分为正常对照组、 2 4h组、SAP对照组、传统肠外营养组 (TPN组 )、增强型肠外营养组 (S TPN组 )、传统肠内营养组 (EN组 )和免疫增强型肠内营养组 (S EN组 ) ,胰胆管逆行注射2 5 %牛磺胆酸钠建立SAP模型。检测各时点血浆TNF α、IL 10水平及T细胞分类情况。结果 建模第 4天 ,与EN组比较 ,S EN组TNF α、IL 10水平高 ,IL 10 /TNF α比值低 (P均 <0 0 5 ) ;第 7天 ,S EN组上述指标较其它各组均低 (P均 <0 0 5 )。S EN组外周血CD3+ 、CD4 + 计数及CD4 + /CD8+ 比值在各时点均高于EN组及肠外营养组 ,CD8+ 变化不大。结论 早期免疫增强型肠内营养在调节SAP大鼠促抗炎平衡及机体免疫功能方面明显优于肠外和传统肠内营养 ,但过早应用可能不利于炎症控制。

Objective To investigate the effect of early immune strengthened enteral nutrition on cytokines in plasma and immune function of severe acute pancreatitis (SAP) rats. Methods 170 SAP rats were divided randomly into normal group, 24 h group, SAP control group, traditional parenteral nutrition group (TPN group), strengthened parenteral nutrition group (S TPN group), traditional enteral nutrition group (EN group) and immune strengthened enteral nutrition group (S EN group), and SAP was induced in rats by retrograde injection of 2.5 % deoxycholate into biliopancreatic. The levels of TNF α, IL 10 were determined and the T cells classified at different time points. Results At 4th day after the operation, in S EN group, TNF α and IL 10 levels were higher, and IL 10 /TNF α was lower than in EN group; at 7th day, the above items were the lowest. CD3 + , CD4 + lymphocytes and the CD4 + /CD8 + in peripheral blood in S EN group were increased as compared with those in EN group and PN groups at any scheduled time points, while no changes in CD8 + were found. Conclusion Early immune strengthened enteral nutrition was obviously superior to parenteral nutrition and traditional enteral nutrition in modulating the balance of pro and anti inflammation and the immune function of body, but applied prematurely may go against controlling inflammation.