肠内营养对长期禁食肠瘘患者肠黏膜上皮内淋巴细胞及黏液屏障功能的研究  

Effects of enteral nutrition on intestinal intraepithelial lymphocytes of intestinal mucosal and the barrier of mucus in patients with stomal type enteric fistula

作　　者：洪书剑[1] 顾国胜[1] 任建安[1] 李宁 黎介寿 

机构地区：[1]南京大学医学院临床学院南京军区南京总医院普通外科全军普通外科研究所,210002

出　　处：《中华胃肠外科杂志》2006年第6期527-529,共3页Chinese Journal of Gastrointestinal Surgery

基　　金：江苏省自然科学基金(BK2006719)

摘　　要：目的研究肠内营养对长期禁食的肠外瘘患者肠黏膜上皮内淋巴细胞(iIEL)及黏液屏障功能的影响。方法对2003年7月至2004年5月收治的10例唇状小肠外瘘病例,分别于实施肠内营养支持前和实施第5天及第10天,在肠镜下经小肠外瘘口距瘘口15～20 cm以活检钳取检肠黏膜,行常规苏木精-伊红染色计数iIEL,免疫组织化学染色测定CD8阳性淋巴细胞比例和黏蛋白基因2阳性细胞比例,特殊染色阿利新蓝(Alcian Blue,AB)结合法检测黏液层厚度。结果肠内营养实施5d后,各活检标本黏蛋白基因2阳性细胞比例及黏液层厚度较实施前显著增高(P＜0．05)；10 d后,iIEL及CD8阳性淋巴细胞比例也较肠内营养实施前显著增多(P＜0．05)。结论实施肠内营养对于长期禁食的肠外瘘患者的肠道黏膜具有保护作用,并可增强肠黏膜的免疫功能。Objective To investigate the effects of enteral nutrition on intestinal intraepithelial lymphocytes and the barrier of mucus in patients with stomal type enteric fistulas. Methods Ten patients with stomal type enteric fistulas after long-term fasting were observed. They received enteral nutrition of 146 kJ·kg^-1·d^-1 non-protein calorie and 0.25 g·kg^-1·d^-1 nitrogen per day. Intestinal mucosa were taken by endoscope through stoma of fistula before, 5 and 10 days after enteral nutrition support. Hematoxylin-eosin stain and immunohistochemlcal stain were performed to count the cell counts of intestinal intraepithelial lymphocytes （iIELs） and mucin-2 （MUC2） positive cells, specific stain （Alcian Blue） was performed to test the thickness of mucus. Results Five days after enteral nutrition, MUC2 positive cells and the thickness of mucus were significantly higher than that before enteral nutrition support （P 〈 0.05）. Ten days after enteral nutrition, iIEL cell and CD8 counts were also significantly higher than that before enteral nutrition support （P 〈 0.05）, MUC2 positive cells and the thickness of mucus showed a significant increase （P 〈 0.01）. Conclusion Enteral nutrition is effective in protecting the gut mucosal and improving the immune function of the intestinal intraepitbelial in patients with stomal type fistula.

关 键 词：肠黏膜上皮内淋巴细胞 唇状 肠瘘 黏蛋白基因 黏液屏障 

分 类 号：R459.3[医药卫生—治疗学]