重症急性胰腺炎患者早期肠屏障失功能与炎症反应

目的 探讨早期重症急性胰腺炎（SAP）患者肠屏障功能障碍与机体炎症反应的相关性.方法 对2010年1月至2012年12月入选本研究的46例SAP进行研究.在入选后第1天、第3天、第7天和第14天测定患者内毒素水平,尿液中乳果糖与甘露醇之比（L/M）,D-乳酸盐含量,肿瘤坏死因子（TNF）-α,白介素（IL）-6和IL-10水平.结果 早期SAP（最初的14 d内）患者的内毒素含量、L/M、D-乳酸盐浓度及TNF-α、IL-6和IL-10均降低.至第14天均降至最低水平,与第3、7天比较,存在显著差异（P＜0.01）.Spearman Rank Corre1ation分析发现肠屏障功能指标（内毒素含量、L/M、D-乳酸盐浓度）与炎症因子（TNF-α、IL-6和IL-10）之间存在正相关性（P＜0.01）.结论 早期SAP患者存在的炎症反应与肠黏膜屏障失功能有直接相关性.重视早期保护肠黏膜屏障功能是有效治疗SAP的重要因素.

Study on the correlation between gut mucosal barrier dysfunction and inflammatory response in patients with early severe acute pancreatitis

Objective To explore the correlation between gut mucosal barrier dysfunction and inflammatory response in patients with early severe acute pancreatitis.Methods Forty-six patients with severe acute pancreatitis were enrolled in this study from Jan.2010 to Dec.2012.The level of endotoxin,the ratio of urinary lactulose/mannitol （L/M）,and levels of D-Lactate and TNF-α,IL-6,IL-10 in peripheral blood were measured on the 1 st,3rd,7th and 14th day after admission.Results The results showed that the levels of endotoxin,the lactulose/mannitol （L/M） ratio,the D-lactate concentration,levels of TNF-α,IL-6 and IL-10,all decreased from a high level during the first 14 d.On 14th day,all the observed parameters decreased to the lowest level,when compared with that on 7th or 3rd day （P＜0.01）.Spearman rank correlation analysis showed that there was a positive correlation between the index of intestinal barrier function （endotoxin,L/M ratio,D-lactate concentration） and inflammatory cytokines （TNF-α,IL-6 and IL-10） （P＜0.01）.Conclusion The inflammatory response in patients with early severe acute pancreatitis has the positive relationship with gut mucosal barrier dysfunction.Early protection of the intestinal mucosal barrier function is important for the treatment of severe acute pancreas.