大黄附子汤对重症急性胰腺炎早期大鼠肠黏膜机械屏障的影响及其意义  

Effect of Dai-Huang-Fu-Zi-Tang on intestinal mechanical barrier in rats with severe acute pancreatitis

作　　者：杨轶仑 路晓光[2] 战丽彬[3] 康新[2] 宋健博 张栎婧 Yang Yilun;Lu Xiaoguang;Zhan Libin;Kang Xin;Song Jianbo;Zhang Lijing(Department of Clinical Nutrition,the Second Hospital of Dalian Medical University,Dalian 116027,China;Department of Emergency Medicine,Zhongshan Hospital,Dalian University,Dalian 116001,China;Basic Medical College,Nanjing University of Chinese Medicine,Nanjing 210029,China)

机构地区：[1]大连医科大学附属第二医院临床营养科,116027 [2]大连大学附属中山医院急诊医学科,116001 [3]南京中医药大学基础医学院,210029

出　　处：《中华实验外科杂志》2021年第1期47-52,共6页Chinese Journal of Experimental Surgery

基　　金：国家自然科学基金(81673801、30971626、30672767)。

摘　　要：目的观察大黄附子汤(DHFZT)对早期重症急性胰腺炎肠黏膜机械屏障的影响。方法24只雄性SD大鼠采用随机数字表法分为4组:假手术(SH)组、假手术-DHFZT(SH-DHFZT)组、重症急性胰腺炎(SAP)组、DHFZT治疗(SAP-DHFZT)组,每组6只。SH组、SH-DHFZT组大鼠开腹后,翻动胰腺数次后关腹;SAP、SAP-DHFZT组经胰胆管缓慢逆行注入4%牛磺胆酸钠(1 ml/kg)诱导SAP模型。术后SH、SAP和SH-DHFZT组与SAP-DHFZT组分别用2 ml生理盐水或DHFZT于术后12、24、36 h保留灌肠。检测大鼠血淀粉酶、血钙、内毒素、白细胞介素(IL)-1β,肠黏膜二胺氧化酶(DAO)浓度变化。比较肠黏膜机械屏障紧密连接蛋白Claudin-1、Occludin、ZO-1的表达及肠道病理组织学评分。采用SPSS 22.0软件中单因素方差分析(One-way ANOVA)对数据进行分析。结果SAP组血清内毒素、淀粉酶、DAO及IL-1β水平高于SH组[内毒素(132.40±8.00)ng/L比(31.70±8.40)ng/L,淀粉酶(1163.00±71.88)U/L比(174.20±8.89)U/L,DAO(23.11±2.98)μg/L比(10.76±2.42)μg/L,IL-1β(82.20±7.14)μg/L比(25.37±2.38)μg/L,F=452.162、1118.302、62.099、342.100,P值均<0.05],差异均有统计学意义,SAP组血钙含量低于SH组[(1.25±0.16)mmol/L比(1.99±0.10)mmol/L,F=92.292,P<0.05],差异有统计学意义。SAP-DHFZT组血清内毒素、淀粉酶、DAO及IL-1β水平低于SAP组[内毒素(68.80±5.30)ng/L比(132.40±8.00)ng/L,淀粉酶(500.70±54.67)U/L比(1163.00±71.88)U/L,DAO(13.79±2.93)μg/L比(23.11±2.98)μg/L,IL-1β(63.03±7.27)μg/L比(82.20±7.14)μg/L,F=263.544、322.707、29.841、21.235,P值均<0.05],差异均有统计学意义,血钙含量高于SAP组[(1.72±0.08)mmol/L比(1.25±0.16)mmol/L,F=41.419,P<0.05],差异有统计学意义。SAP组大鼠48 h后胰腺及回肠组织结构均发生不同程度破坏,ZO-1、Occludin、Claudin-1表达减弱。经DHFZT治疗后,胰腺及回肠组织结构破坏有修复,肠上皮紧密连接蛋白ZO-1、Occludin、Claudin-1表达高于SAP组(ZO-1为0.80±0.12比0.09±0.02,OccObjective To observe the effect of Dai-Huang-Fu-Zi-Tang(DHFZT)on the intestinal mechanical barrier in the early stage of severe acute pancreatitis(SAP).Methods Male SD rats(n=24,aged 7weeks)were randomly divided into sham(SH)group,sham-DHFZT(SH-DHFZT)group,SAP group,DHFZT treatment(SAP-DHFZT)group,6 rats per group.After laparotomy,the pancreas of rats in the SH group and the SH-DHFZT group was turned several times and then abdomen closed.SAP model was induced in SAP group and SAP-DHFZT group by slow retrograde injection of 4%sodium taurocholate(1 ml/kg)through pancreatic bile duct.After operation,the SH group,SAP group,SH-DHFZT group and SAP-DHFZT group were treated with 2 ml normal saline or DHFZT for retention enema at 12,24 and 36 h after operation,respectively.Serum amylase,serum calcium,endotoxin,interleukin-1β(IL-1β),and intestinal mucosal diamine oxidase(DAO)concentrations were measured.The expression levels of Claudin-1,Occludin,zonula occludens 1(ZO-1),and intestinal histopathological scores were compared.Data were analyzed using one-way ANOVA in SPSS 22.0 software.Results Serum levels of endotoxin,amylase,DAO and IL-1βin SAP group were significantly higher than those in SH group[endotoxin(132.40±8.00)ng/L vs.(31.70±8.40)ng/L;amylase(1163.00±71.88)U/L vs.(174.20±8.89)U/L;DAO(23.11±2.98)μg/L vs.(10.76±2.42)μg/L;IL-1β(82.20±7.14)μg/L vs.(25.37±2.38)μg/L,F=452.162,1118.302,62.099,342.100,all P<0.05].Serum calcium content in SAP group was lower than in SH group[(1.25±0.16)mmol/L vs.(1.99±0.10)mmol/L,F=92.292,P<0.05].Serum endotoxin,amylase,DAO and IL-1βlevels in SAP-DHFZT group were lower than those in SAP group[endotoxin(68.80±5.30)ng/L vs.(132.40±8.00)ng/L;amylase(500.70±54.67)U/L vs.(1163.00±71.88)U/L;DAO(13.79±2.93)μg/L vs.(23.11±2.98)μg/L;IL-1β(63.03±7.27)μg/L vs.(82.20±7.14)μg/L,F=263.544,322.707,29.841,21.235,all P<0.05],and blood calcium was higher than that in SAP group[(1.72±0.08)mmol/L vs.(1.25±0.16)mmol/L,F=41.419,P<0.05].The structure of pancreatic tissue,lung t

关 键 词：急性胰腺炎 肠黏膜 大黄附子汤 

分 类 号：R285.5[医药卫生—中药学]