早期肠内营养对急性胰腺炎的肠源性细菌移位及免疫应答功能的影响

目的 :探讨早期肠内营养在减缓急性胰腺炎细菌及内毒素移位以及改善宿主免疫应答功能中的作用。方法 :将 80只SD大鼠分 4组 ,6 0只用胆胰管注射法制成急性胰腺炎模型 ,其中 30只行肠造瘘进行肠内营养 ,30只行肠外营养 ;余 2 0只分别不形成急性胰腺炎模型 ,各用 1 0只行肠内外营养 ;检测的血内毒素水平 ,外周血、脾、肠系膜淋巴结CD4、CD8淋巴细胞亚群 ,并进行肠系膜淋巴结细菌培养。结果 :与AP/TPN组相比 ,AP/EN组回肠绒毛高度比AP/TPN组明显高 ,P <0 .0 5 ;内毒素水平AP/TPN组为 (0 .4 89± 0 .1 6 2 )EU·ml-1 ,比AP/EN组的 (0 .1 1 2± 0 .0 0 8)EU·ml-1 明显高 ,P <0 .0 5 ;AP/TPN及AP/EU中细菌种属无差别 ,均为肠内细菌 ,但与AP/TPN组相比AP/EN组细菌量显著减少 ;肠系膜淋巴结、脾及外血中CD4 /CD8比率AP/EN组比AP/TPN组明显高 ,P <0 .0 5 ,差异有显著性。结论 :AP中早期肠内营养能很好耐受 ,EN可维持正常肠结构从而减少细菌及内毒素移位 ,并可维持宿主的免疫应答功能。

The Effect of Enteral Nutrition on the Bacterial Translocation From Gut and on Immune Responsiveness of the Host in Acute Pancreatitis

Objective: To evaluate the effect of enteral nutrition(EN) in attenuating bacterial and/or endotoxin translocation, maintaining immune responsiveness in acute pancreatitis rats. Methods: Acute pancreatitis was induced in rats receiving total parenteral nutrition (TPN) (AP/TPN group)(n=30) and EN (AP/EN group)(n=30) by pressure injection of 1% deoxycholate into the biliopancreatic duct. Rats in the sham/TPN and sham/EN groups (n=10 each) under went laparotomy without induction of AP. Rats were infused with TPN or EN for 7 days. Blood endotoxin level, villus height, bacterial culture of mesenteric lymph nodes, and CD4/CD8 ratio of T cells in mesenteric lymph nodes, spleen, and peripheral blood were measured. Results: Villus height was significantly higher in the AP/EN group than those in the AP/TPN group(P<0.05).Colony-forming units of the mesenteric lymph nodes and the endotoxin level were significantly lower in the AP/EN group than in the AP/TPN group(P<0.05). Conclusion: Jejunal administration of EN is well tolerated in early AP, maintains immune responsiveness and gut integrity, and reduces bacterial and/or endotoxin translocation.