丙氨酰谷氨酰胺对创伤后肠粘膜屏障的修复作用研究  

The repairing effects of Alanyl-Glntamic supplemented total parenteral nutrition on gut mucosal immune barrier function following hemorrhage

作　　者：王涛[1] 黎沾良[1] 陆连荣 王亚平 于勇 于燕 

机构地区：[1]北京解放军第三○四医院,北京100037

出　　处：《中国危重病急救医学》1998年第3期170-172,共3页Chinese Critical Care Medicine

基　　金：全军八五医学技术攻关重点项目

摘　　要：目的：利用SPF大鼠模型，观察失血后低血容量性休克后全胃肠外营养（TPN）、TPN液中添加Ala－Gln（TPN加Ala－Gln）和经口进食（TEN）3种营养模式对肠粘膜免疫系统、肠粘膜菌群双歧杆菌／大肠杆菌比值和血浆内毒素（LPS）水平的影响，探讨Ala－Gln是否对损伤后肠粘膜屏障有修复作用。方法：24只SPFWistar大鼠实施失血后低血容量性休克，复苏后以TPN、TPN加Ala－Gln和TEN3种营养方式支持7日后剖杀。以回肠内容物细菌S－IgA包被率、肠固有层淋巴细胞和浆细胞计数、回肠革兰氏阴性细菌粘附率及血浆LPS水平为观察指标。结果：上述各项指标在TEN组变化最轻；，在TPN组变化最重，表现为肠固有层CD3+、CD4+、CD8+淋巴细胞和IgA浆细胞明显减少，肠腔细菌S－lgA包被率下降，肠道微生态发生紊乱，细菌粘附率和易位率上升，血浆LPS水平升高，死亡率高；TPN加Ala－Gln组各参数接近TEN组。结论：标准TPN能削弱肠粘膜免疫系统，加重粘膜屏障损伤；而适量补充Ala－Gln能减轻这种损害，有利于肠粘膜屏障的修复。篛bjective:To observe the effects of different routes and formulae of nutrition on intestinal mucosal immune system, Bifidobacterium/E. colt ratio of intestinal mucosal flora, and lipopolysaccharide concentration following hypovolemic shock. Methods:Following shock and resuscitation, 24 SPFWistar rats were randomized to total parenteral nutrition (TPN, n= 8), TPN - Alanyl - Glutamine(TPN - Ala - Gin,n= 8) and total enteral nutrition (TEN,n= 8) groups. Animals were given respectivenutritional regimen for 7 days,and then sacrificed at the end of observation period. Percentage of intestinal bacteria coated by S - IgA+ IgA+ plasma cells in intestinal lamina propria,CD3+,CD4+,CD8+ lymphocytes in intestinal lamina propria,adherence of G-bacteria to intestinal epithelial cells,and lipopolysaccharide levels were assayed. Results:After 7 days with standard TPN,there was a significant decrease inCDs,CD3+,CD8+ lymphOGytes and IgA -containing plasma cells in lamina propria as compared with TENgroup. MeanWhile,in TPN group the percentage of intestinal bacteria coated by S - IgA declined,bacterial adherence to intestinal epithelia cells increased,together with a high incidence of bacteria translocation and high concentration of lipopolysaccharide. All these adverse effects could be attenuated by addition of Ala - Gin to TPN solutions. Conclusions：The results suggest that TPN after hypovolemic shockaggravates damage to the gut immune barrier,and addition of Ala - Gin has significant benefits to gutbarrier repairing.

关 键 词：全胃肠外营养 肠粘膜屏障功能 全肠内营养 创伤 

分 类 号：R641[医药卫生—外科学]