连续性血液净化对重症急性胰腺炎患者早期诱导的肠黏膜屏障功能障碍的改善作用  

Continuous blood purifi cation improves intestinal mucosal barrier dysfunction in patients with severe acute pancreatitis

作　　者：张霞[1] 邵换璋[1] 

机构地区：[1]河南省人民医院重症医学科,河南省郑州市450000

出　　处：《世界华人消化杂志》2015年第29期4745-4749,共5页World Chinese Journal of Digestology

摘　　要：目的:探讨连续性血液净化(continuous blood purification,CBP)对急性重症胰腺炎(severe acute pancreatitis,SAP)患者早期诱导的肠黏膜屏障功能障碍的改善作用.方法:比较河南省人民医院重症医学科收治的52例SAP患者(实验组)经CBP治疗前后急性生理学与慢性健康状况评分Ⅱ(acute physiology and chronic health evaluationⅡ,A PA C H EⅡ)、血清淀粉酶、二胺氧化酶(diamine oxidase,DAO)、血浆D-乳酸、内毒素(endotoxin,ET)、血清肿瘤坏死因子?(tumor necrosis factor-alpha,TNF-?)、一氧化氮(nitric oxide,NO)及尿乳果糖/甘露醇(urinary lactulose/mannitol,L/M)水平变化情况,并与40例健康志愿者(对照组)相关指标进行比较.结果:实验组患者治疗后APACHEⅡ评分和血清淀粉酶水平与治疗前比较均明显下降(8.11分±2.66分vs 14.59分±4.67分)、(519.33 U/L±52.06 U/L v s 837.58 U/L±52.14 U/L),差异有统计学意义(P<0.05);实验组患者治疗后DAO、D-乳酸、ET、T N F-?、N O及L/M水平与治疗前比较均明显下降(5.83 U/L±1.33 U/L vs 7.99 U/L±1.03 U/L、0.91 m g/L±0.47 m g/L v s 1.63mg/L±0.55 mg/L、0.20 EU/L±0.04 EU/L v s 0.38 E U/L±0.06 E U/L、0.97 n g/m L±0.31 ng/m L vs 1.97 ng/m L±0.35 ng/m L、87.26?mol/m L±18.75?mol/m L vs 140.02?mol/m L±26.48?mol/m L、0.04±0.02 vs0.09±0.03),差异有统计学意义(P<0.05);实验组患者治疗后DAO、D-乳酸、ET、T N F-?、N O及L/M水平均明显高于对照组(P<0.05).结论:CBP能够有效改善肠黏膜屏障功能相关指标、改善SAP临床症状,对保护肠黏膜屏障功能具有重要意义.AIM：To evaluate the effect of continuous blood purification（CBP） on intestinal mucosal barrier dysfunction in patients with severe acute pancreatitis（SAP）.METHODS：Fifty-two patients with SAP treated by CBP were included into an experiment group,and 40 healthy volunteers were included into a control group.The score of Acute Physiology and Chronic Health Evaluation Ⅱ（APACHE Ⅱ）,serum amylase,diamine oxidase,plasma D-lactate,endotoxin（ET）,tumor necrosis factor-alpha（TNF-α）,nitric oxide（NO）,and urinary lactulose/mannitol（L/ M） ratio were compared between the two groups.RESULTS：APACHE Ⅱ score and the level of serum amylase for the experiment after treatment were significantly lower group than before treatment（8.11±2.66 vs 14.59±4.67,519.33 U/ L±52.06 U/ L vs 837.58 U/ L±52.14 U/ L,P0.05）;the levels of diamine oxidase,plasma D-lactate,ET,TNF-α,NO,and L/ M ratio were also significantly lower after treatment than before treatment（5.83U/ L±1.33 U/L vs 7.99U/L±1.03 U/ L,0.91 mg/ L±0.47 mg/ L vs 1.63 mg/ L±0.55mg/ L,0.20 EU/ L±0.04 EU/ L vs 0.38 EU/ L±0.06 EU/ L,0.97 ng/ mL±0.31 ng/ mL vs1.97 ng/ mL±0.35 ng/ mL,87.26 μmol/ mL±18.75μmol/ mL vs 140.02μmol/ mL±26.48μmol/ mL,0.04±0.02 vs 0.09±0.03,P0.05）.The levels of diamine oxidase,plasma D-lactate,ET,TNF-α,NO,and L/ M ratio for the experiment group after treatment were higher than those for the control group（P0.05）.CONCLUSION：CBP can improve the indexes of intestinal mucosal barrier dysfunction and the clinical symptoms of SAP,and is of important significance for protecting the intestinal mucosal barrier function.

关 键 词：连续性血液净化 急性重症胰腺炎 肠黏膜屏障功能障碍 

分 类 号：R576[医药卫生—消化系统]