肠内免疫微生态营养对实验性坏死性胰腺炎猪的肝损害的影响  

Effect of enteral ecoimmunonutrition on hepatic injury in swine with acute necrotizing pancreatitis

作　　者：陈磊[1] 邹晓平[2] 王璐[1] 朱振[1] 田觅[2] 顾超[2] 

机构地区：[1]江苏省苏北人民医院消化科,扬州225001 [2]南京市鼓楼医院消化科,210008

出　　处：《中华临床营养杂志》2011年第5期325-329,I0001,共6页Chinese Journal of Clinical Nutrition

摘　　要：目的观察肠内免疫微生态营养（EIN）对实验性坏死性胰腺炎猪的肝损害的影响。方法20头普通江淮猪胰管注射5％牛磺胆酸钠1ml/kg制备急性坏死性胰腺炎（ANP）模型，造模后24h有2头死亡，18头猪按随机数字分组法分为全肠外营养组（TPN）、肠内要素营养组（EEN）和肠内免疫微生态营养组（EIN），分别进行相应的营养8d。于造模前，造模后24h，营养支持第1、2、4、8天检测外周血内毒素、谷草转氨酶（AST）、谷丙转氨酶（ALT）、肿瘤坏死因子-α（TNF-α）、白介素-6（IL-6）。营养支持8d后剖腹测定腹水量、肝脏丙二醛（MDA）含量及超氧化物歧化酶（SOD）活力、肝组织TNF-αmRNA和IL-6mRNA的表达以及肝脏病理学改变，进行病理评分。结果造模后24hEIN组外周血内毒素、AST、ALT、TNF-α、IL-6均较造模前明显增高（P均〈0．01），但与其他两组的差异无统计学意义。营养支持8d后，EIN组上述5项指标均明显低于TPN组和EEN组（P均〈0．05）。营养8d后，EIN组的腹水量、肝脏MDA含量、TNF-α mRNA表达、IL-6mRNA表达及肝脏病理学评分均明显低于TPN组和EEN组，而肝脏SOD活力则明显高于TPN组和EEN组（P均〈0．05）。结论早期给予EIN能从多方面保护ANP引起的肝损害。Objective To evaluate the effect of enteral ecoimmunonutrition （EIN） on hepatic injury in swine with acute necrotizing panereatitis （ANP）. Method With 20 pigs, swine model of ANP was induced by injecting 5% sodium taurocholate into the pancreatic duct. 24 hours after the ANP models were established, 2 pig were dead, and the remaining 18 pigs were randomly divided into total parenteral nutrition （TPN） group （n = 6 ）, elemental enteral nutrition （EEN） group （n =6）, and EIN group （n =6）, and received nutrition support for 8 days. The level of plasma endotoxin and serum concentrations of AST, ALT, TNF-α, and IL-6 were measured at different time points （ before model establishment, 24 hours after model establishment, and the 1,2, 4, 8 days of nutrition support）. All the pigs were sacrificed after the 8-day nutrition support, and aseites quantity, hepatic ma- londialdehyde （MDA）, superoxide dismutase （SOD） were measured. The mRNA expression of TNF-α and IL-6 in hepatic tissue were detected by RT-PCR. Pathologic changes of the livers were analyzed. Results 24 hours after the ANP models were established, the plasma endotoxin, AST, ALT, TNF-α, IL-6 in EIN group were significantly higher than the levels before model establishment （ all P 〈 0.01 ） , but not significantly different from the other 2 groups. After 8 days of nutrition support, the above 5 indexes in EIN group were significantly lower than those in TPN group and EEN group （ all P 〈 0. 05 ）. In addition, the ascites quantity, hepatic concentration of MDA, the expression of TNF-α and IL-6, and hepatic pathological score in EIN group were lower than those of TPN group and EEN group, while hepatic SOD activity was higher in EIN group than in the other 2 groups （ all P 〈 0.05 ）. Conclusion Early EIN could attenuate hepatic injury in ANP from various aspects.

关 键 词：急性坏死性胰腺炎 肠内营养 肠外营养 肝脏 内毒素 细胞因子 

分 类 号：R576[医药卫生—消化系统]