早期急性重症胰腺炎患者肠黏膜屏障失功能与免疫应答的相关性研究  

Relationship between gut mucosal barrier dysfunction and immune response in patients with early severe acute pancreatitis

作　　者：杨军[1] 顾元龙[1] 姜东林[1] 张峰[1] 钱毅[1] 李建平[1] 

机构地区：[1]南通大学附属无锡市第三人民医院肝胆外科,无锡214014

出　　处：《中华肝胆外科杂志》2014年第4期269-273,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：基金项目：国家973计划基础项目（2009CB522703）;无锡市医院管理中心重点项目（YGZX1110）

摘　　要：目的研究早期急性重症胰腺炎（SAP）患者肠黏膜屏障功能障碍与机体免疫应答的相关性。方法对2010年1月至2012年12月入选本研究的46例SAP患者，在入选后第1天、第3天、第7天和第14天测定其内毒素水平、尿液中乳果糖与甘露醇之比（L／M）、D（-）-乳酸盐含量、Th1／Th2比、HIJA—DR和CD4＋CD25＋Treg细胞百分比。结果早期SAP（最初的14d内）患者的内毒素含量、L／M之比、D（-）-乳酸盐浓度、HLA—DR百分比均有所降低，而调节性CD4＋CD25＋Treg细胞频率有所增强。在第1周，Th1／Th2之比随Th1的降低、Th2的增加而降低，但后期它会随着Th1的增加而增加。结论早期SAP患者存在的免疫抑制及免疫失衡与肠黏膜屏障失功能呈正相关。重视早期保护肠黏膜屏障是有效治疗SAP的重要因素。Objective To explore the relationship between gut mucosal barrier dysfunction and immune response in patients with early severe acute pancreatitis （SAP）. Method 46 patients with early SAP were enrolled into this study from January 2010 to December 2012. Results The levels of endotoxin, the lactulose/mannitol （L/M） ratio, the D（ -）-lactate concentration, and the proportion of HLA-DR-positive monocytes all decreased from a high level, while the frequency of Tregs increased during the first 14 days. The Th1/Th2 ratio decreased, with a decreased Thl and an increased Th2 profile in the first week, but it subsequently increased, with an increased Thl profile. Conclusions The data from this study showed that immunosuppression and immune imbalance happened in patients with early SAP, and showed a positive relationship with gut mucosal barrier dysfunction in patients with early SAP. Thus, early protection of the function of intestinal mucosal barrier is important in the treatment of SAP.

关 键 词：急性重症胰腺炎 肠黏膜屏障 免疫反应 

分 类 号：R657.51[医药卫生—外科学]