急性胰腺炎患者肠黏膜屏障功能损害相关研究

目的探讨急性胰腺炎(AP)患者肠黏膜屏障功能改变机制。方法 61例AP患者按病情程度分为重症组(n=31)和轻型组(n=30),另选肠镜检查志愿者作为对照组(n=30),电镜观察肠黏膜超微结构变化,比较血清内毒素、白细胞介素-18(IL-18)及肠黏膜ZO-1、Occludin的变化。结果对照组ZO-1和Occludin蛋白为棕黄色,染色较强,成点状聚集;轻型组和重症组患者肠黏膜ZO-1和Occludin蛋白的染色变浅。轻型组和重症组患者肠黏膜ZO-1和Occludin蛋白光密度水平较对照组下降(P<0.05,0.01)。与轻型组比较,重症组患者肠黏膜光密度水平降低(P<0.05)。轻型组和重症组患者肠黏膜ZO-1、Occludin基因水平较对照组下降(P<0.05,0.01);重症组患者肠黏膜ZO-1、Occludin基因水平较轻型组下降(P<0.05)。轻型组和重症组患者内毒素和IL-18水平均高于对照组,差异有统计学意义(P<0.05,P<0.01)。重症组患者肠黏膜内毒素和IL-18水平高于轻型组,差异有统计学意义(P<0.05)。血清内毒素、IL-18水平与ZO-1蛋白和Occludin蛋白表达均呈负相关(r=-0.79、-0.64、-0.71、-0.61,P<0.05)。结论 AP患者早期肠黏膜受损,肠黏膜通透性增加。内毒素和IL-18可能协同或单独参与肠黏膜的破坏。

Study on intestinal mucosal barrier dysfunction in patients with acute pancreatitis

Objective To explore the mechanism of changes of intestinal mucosal barrier function in acute pancreatitis （AP） patients. Methods Sixty-one patients with AP were divided into severe group （n = 31 ）and mild group （n = 30 ） accord- ing to disease severity, another eolonoscopy volunteers were selected as control group （ n = 30 ）. The uhrastructural changes of intestinal mueosa were observed by electron microscope. The content of serum endotoxin and interleukin-18 （IL-18） ,ZO-1 and Occludin in the intestinal mueosa was compared. Results ZO-1 and Oceludin protein staining was brown and strong with punctate aggregation in the control group and the staining was shallow in mild group and severe group. The optical density of ZO-1 and Occludin protein in mild group and severe group were significantly lower than those in the control group（ P 〈 0.05, 0.01 ）. The optical density of ZO-1 and Occludin protein in severe group were significantly lower than those in mild group（ P 〈 0.05）. Compared with the control group ,the levels of ZO-1 and Occludin gene in mild group and severe group decreased（ P 〈 0. 05 ,P 〈 0.01 ） ;compared with mild group,the levels of ZO-1 and Occludin gene in severe group decreased（P 〈0.05 ）. The serum endotoxin and IL-18 content in mild group and severe group were significantly higher than those in control group（P 〈 0. 05, P 〈 0.01 ）. The serum endotoxin and IL-18 content in severe group were significantly higher than that in mild group （P 〈 0.05）. There were significant negative correlations between serum endotoxin, IL-18 and ZO-1, Occludin （r = -0.79, -0. 64, - 0.71, - 0. 61, P 〈 0.05 ）. Conclusion The intestinal mucosal membrane of patients with AP is damaged, and the intestinal mucosal membrane permeability is increased. Endotoxin and IL-18 may take part in the intestinal mucosa damage through syn- ergism or alone.