肠外营养、肠内营养及益生菌对重症急性胰腺炎患者肠道细菌变化和细胞因子的影响  

Effect of parenteral nutrition,enteral nutrition and probiotics on intestinal bacterial changes and cytokines in patients with severe acute pancreatitis

作　　者：和庆章 王桂良 龚敏 邱萍 徐林芳 文剑波[1] 肖献忠[2] 谭斯品[2] HE Qingzhang;WANG Guiliang;GONG Min;QIU Ping;XU Linfang;WEN Jianbo;XIAO Xianzhong;TAN Sipin(Department of Gastroenterology,Pingxiang Hospital Affiliated to Gannan Medical University,Pingxiang 337000,China;Department of Pathophysiology,Xiangya School of Medicine,Central South University,Changsha 410078,China)

机构地区：[1]赣南医学院附属萍乡医院消化内科,江西萍乡337000 [2]中南大学湘雅医学院病理生理学系,湖南长沙410078

出　　处：《中国现代医生》2021年第4期5-8,F0003,共5页China Modern Doctor

摘　　要：目的探讨肠外营养(PN)、肠内营养(EN)及益生菌对重症急性胰腺炎患者肠道细菌变化和细胞因子的影响。方法收集赣南医学院附属萍乡医院2017年1月至2019年12月重症急性胰腺炎患者203例,随机分为三组:肠外营养(PN)组、肠内营养(EN)组、肠内营养+益生菌(EN+益生菌)组。并评估三组APACHEⅡ得分、脓毒血症、多器官功能障碍综合征(MODS)发生率、死亡率、大便菌群的变化、血浆内毒素、肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、IL-10的水平。结果EN组、EN+益生菌组与PN组比较,APACHEⅡ评分、MODS的发生率、死亡率、粪便致病菌数、血清内毒素、TNF-α和IL-6浓度显著降低(P<0.05);粪便有益菌和血清IL-10显著升高(P<0.05)。EN+益生菌组与EN组比较,APACHEⅡ评分、MODS的发生率、粪便致病菌、血清内毒素、TNF-α和IL-6浓度显著降低(P<0.05);粪便有益菌和血清IL-10显著升高(P<0.05);两组死亡率比较,差异无统计学意义(P>0.05)。结论EN可通过改善肠道屏障功能在SAP的治疗中发挥有效作用,益生菌可与EN起协同作用,提高治疗效果。Objective To explore the efficacies of parenteral nutrition(PN),enteral nutrition(EN)and probiotics on intestinal bacterial changes and cytokines in patients with severe acute pancreatitis.Methods A total of 203 patients with severe acute pancreatitis admitted to Pingxiang Hospital Affiliated to Gannan Medical University from January 2017 to December 2019 were randomLy divided into three groups,which were the PN group,the EN group and the EN combined with probiotics group.Meanwhile,the three group APACHEⅡscore,sepsis,MODS incidence,mortality,change of coliform,serum endotoxin,TNF-α,IL-6 and IL-10 levels were evaluated.Results Compared with the PN group,APACHEⅡscore,MODS incidence,mortality,fecal pathogenic bacteria,serum endotoxin,TNF-αand IL-6 concentrations in the EN group or EN combined with probiotics group decreased significantly(P<0.05),while the fecal beneficial bacteria and serum IL-10 increased significantly(P<0.05).Compared with the EN group,APACHEⅡscore,MODS incidence,fecal pathogenic bacteria,serum endotoxin,TNF-αand IL-6 concentrations in the EN combined with probiotics group decreased significantly,while the fecal beneficial bacteria and serum IL-10 increased significantly(P<0.05).There was no statistically significant difference of two group in mortality(P>0.05).Conclusion EN can play an effective role in the treatment of SAP by improving the intestinal barrier function,and probiotics can play a synergistic role with EN to improve the therapeutic efficacy.

关 键 词：重症急性胰腺炎 肠内营养 益生菌 肠道细菌变化 细胞因子 

分 类 号：R459.3[医药卫生—治疗学]