早期肠内营养对重症急性胰腺炎大鼠肠道屏障功能的影响

目的探讨早期肠内营养对重症急性胰腺炎（SAP）大鼠肠道屏障功能的影响。方法将48只SD大鼠随机分为SAP模型对照组（Con组）、肠外营养组（TPN组）、造模后24h行肠内营养组（EN-2组）和造模后12h行肠内营养组（EN-1组）。从胰尾部开始被膜下多点缓慢均匀注入3．8％牛磺胆酸钠1mL建立SAP模型，于第3、6天2个时间点处死大鼠，取血检测外周血清二胺氧化酶（DAO）、肿瘤坏死因子（TNF-a）和白细胞介素10（IL-10）的变化；取空肠测量黏膜厚度及绒毛高度。结果建模第3、6天，血清TNF-a、IL-10、DAO水平EN-1、EN-2组较Con组明显降低（P〈0．05）；TPN组比Con组虽有下降趋势，但无显著性差异（P〉0．05）；EN-1、EN-2组比TPN组均明显下降（P〈0．05）。血清DAO测定EN-2组与EN-1组相比，差异有显著性意义（P〈0．05）。病理检查显示：EN-2组和EN-1组肠黏膜厚度和绒毛高度均较Con组、TPN组明显增高（P〈0．05）；EN-1组与EN-2组相比，也显著改善了肠黏膜厚度和绒毛高度（P〈0．05）。结论早期肠内营养可保护SAP大鼠肠道屏障及减轻炎症反应。

The Effect of Early Enteral Nutrition on the Intestinal Barrier Function of Rats with Severe Acute Pancreatitis

Objective To investigate the influence of early enteral nutrition on the intestinal barrier function of rats with severe acute pancreatitis. Methods Fourty-eight Sprague-Dawley （SD） rats of acute severe pancreatitis were divided into four groups： SAP control （Con）group, traditional parenteral nutrition（TPN） group, enteral nutrition in 24 hours after making model （EN-2） group, enteral nutrition in 12 hours after making model （EN-1） group. SAP was induced in rats by injection of 3.8% deoxycholate into pancrea, sacrifice on the thirdth and sixth day. The vein blood was tested for DAO,TNF-a,and IL-10. Specimens of jejunum were obtained to measure the height of villi and the thickness of mucosa. Results Compared with Con group,the levels of DAO,TNF-a, and IL-10 were significantly reduced in EN group at 3 and 6 days after the operation （P〈0.05）. There was decreasing tendency in TPN group than those in con group, but there was not significantly difference（P〉0.05）. There was obviously reduced of the levels of TNF-a, IL-10 and DAO in EN group than those in TPN group（P〈0.05）. Compared with TPN group,the levels of DAO were significantly reduced in EN group（P〉 0.05）. Compared with EN-2 group, the levels of DAO were significantly reduced in EN-1 group（P〈0.05）. The height of the villi and the thickness of mueosa in EN group was higher than those of TPN,Con group at 3 and 6 days after the operation（P〈0.05）. Compared with EN-2 group, the height of the villi and the thickness of mucosa were significantly higher in EN-1 group（P〈0.05）. Conclusion The results suggested that early enteral nutrition be effective in SAP in improving the gut barrier function and lessen inflammatory reaction.