腹腔感染病人肠黏膜通透性的变化  

Gut mucosal permeability in patients with peritoneal sepsis and clinical implication

作　　者：刘海燕[1] 李维勤[1] 黎介寿[1] 刘放南[1] 于宝军[1] 

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)解放军普通外科研究所,江苏南京210002

出　　处：《肠外与肠内营养》2008年第6期332-334,共3页Parenteral & Enteral Nutrition

基　　金：全军十一五科研计划基金资助项目(06G041)

摘　　要：目的:观察腹腔感染病人肠黏膜通透性的变化,了解腹腔感染对肠黏膜屏障功能的影响。方法:将20例病人在确诊腹腔感染24h内测定肠道乳果糖与甘露醇吸收比值(L/M)、血清内毒素和肿瘤坏死因子α(TNF-α)水平,并同期采集病情严重度(APACHEⅡ评分和SOFA评分)、ICU滞留时间、住院时间和病情转归等。结果:腹腔感染组LMR水平较正常组明显升高(P<0.01);血清内毒素和TNF-α水平与LMR间呈显著正相关(P<0.01,P<0.05);肠黏膜通透性与病人病情严重程度有显著相关性(P<0.01);腹腔感染病人肠黏膜通透性变化程度与病死率也有明显相关性(P<0.05)。结论:腹腔感染病人的肠黏膜通透性显著增加,腹腔感染可导致肠黏膜屏障功能损害。Objective： To investigate the gastrointestinal mucosal permeability in patients attacked by peritoneal sepsis. Methods： Twenty patients were studied with peritoneal sepsis. LMR, blood endotox- in, and TNF-α were detected and clinical data （severity score, length of stay in ICU and hospital and outcome） was collected. Results： L/M increased in patients with peritoneal sepsis （0. 477±0. 525 vs 0. 024 ± 0.010, P 〈 0.01 ）. Endotoxin and TNF-αserum concentration were positively correlated with L/M （ r = 0. 682, P 〈 0.01 ; r = 0. 590, P 〈 0.05 ）. We also observed a significant positive correlation between the LMR and APACHEⅡ score （r=0.938,P 〈0.01） and SOFA score （r=0.863,P 〈 0.01 ）. High gut mucosal permeability in peritoneal septic patients was associated with poor outcome（ r = 0.780, P 〈0.05）. Conclusion： Intestinal mucosal permeability is significantly increased in patients with peritoneal sepsis.

关 键 词：腹腔感染 肠黏膜屏障 内毒素 肿瘤坏死因子-Α 

分 类 号：R574.4[医药卫生—消化系统] R572.2[医药卫生—内科学]