小儿急性肠梗阻肠黏膜免疫屏障损伤及细菌移位的研究  

Intestinal mucosal barrier damage and bacterial translocation in children with acute intestinal obstruction

作　　者：刘文跃[1] 王琳[1] 王建峰[1] 席红卫[2] 

机构地区：[1]山西医科大学儿科系,太原030001 [2]山西省儿童医院普外科

出　　处：《中华小儿外科杂志》2011年第8期577-580,共4页Chinese Journal of Pediatric Surgery

基　　金：山西省科技攻关项目（编号：20080311064-2）

摘　　要：目的探讨小儿急性肠梗阻细菌移位及机制。方法收集山西省儿童医院普外科2009年9月至2010年8月急性肠梗阻患儿共43例，依治疗方法分三组：肠切除肠吻合组（吻合组）22例，未切除肠管组14例，保守治疗组7例。另选择17例正常肠管及健康儿童10例分别作正常肠管、血清对照组。应用聚合酶链反应（PCR）定性检测细菌共有的16SrRNA和大肠杆菌特异性半乳糖苷酶基因BG；肠系膜淋巴结细菌培养；免疫组织化学方法检测肠黏膜固有层T细胞亚群、浆细胞计数；酶联免疫吸附试验（ELISA）定量检测血清TGF-β1浓度。结果吻合组16SrRNA、BG阳性率分别为86．4％、72．7％，淋巴结培养阳性率77．3％；未切除肠管组16SrRNA、BG阳性率分别为64．3％、42．8％，淋巴结培养阳性率57．1％；保守治疗组16SrRNA、BG阳性率分别为57．1％、28．5％，正常肠管血清对照组16SrRNA、／3（3均未检出；吻合组肠黏膜固有层T细胞亚群、浆细胞数量均低于正常对照组；吻合组、未切除肠管组术前血清TGF-β1浓度均高于保守治疗组与对照组，术后7d各组血清TGF-β1浓度与对照组比较无差异。结论急性肠梗阻患儿肠黏膜固有层T细胞亚群、浆细胞均降低，引起肠黏膜免疫屏障破坏，同时TGF-β1水平升高，参与机体免疫抑制，免疫功能紊乱，加重黏膜免疫屏障破坏，增加机体易感性，促进了细菌移位。Objective To investigate the mechanism of intestinal mucosal barrier damage and bacterial translocation in children with acute intestinal obstruction. Methods From September 2009 to August 2010, 43 patients with acute intestinal obstruction were treated at this center and recruited in this study. According to the treatment they underwent, they were divided into 3 groups.. Group1 included 22 patients who were performed bowel resection and anastomosis. Group 2 had 14 patients who underwent surgeries but without bowel resection. Group 3 had 7 patients who were cured without surgery. The other 17 healthy bowels and 10 healthy children＇s serum were selected as normal controls. Polymerase chain reaction （PCR） was performed to examine β-lactosidase gene （BG） of E. coli and 16SrRNA gene. Bacteria in mesenteric lymph nodes were cultured. Immunohistochemical staining was used to indentify the T cell subsets and plasma cells in the lamina propria of mucosa. TGF-β1 in serum was quantified using enzyme-linked immunoabsorbent assay （ELISA）. Results In group 1, 16SrRNA and BG were positive in 86. 4% and 72. 7% of the patients, respectively. Positive culture rate of E coli in mesenteric lymph nodes was 77. 3%. In group 2, 16SrRNA and 13（3 positive rates were 64. 3% and 42. 8%, respectively. Positive culture rate of E coli in mesenteric lymph nodes was 57. 1%. In group 3,16SrRNA and BG positive rates were 57. 1% and 28. 5%, respectively. 16SrRNA and BG were not detectable in normal control patients＇ serum and bowel. In the removed bowel, T cell subsets and plasma cells＇ population were significantly decreased compared with the control bowel. The serum TGF-β1 level of the patients underwent surgery was significantly higher than that of the healthy controls or the patients without surgery. But the difference was not significant between these 2 groups since 7 days after surgery. Conclusions In the children with acute intestinal obstruction, the reduction of T cell subsets and plasma cells in the lamina propria

关 键 词：肠梗阻 肠黏膜 免疫屏障 细菌移位 TGF-Β1 

分 类 号：R72[医药卫生—儿科]