早期肠内营养和益生菌对急性胰腺炎肠黏膜屏障功能和免疫功能的影响  

Effect of early enteral nutrition and probiotics on maintenance of the intestinal mucosal barrier function and immunological function in acute pancreatitis patients

作　　者：顾新红 王亚民[3] 蔡海建 范辉[1] 徐伟松[1] 刘玉峰[1] GU Xinhong;WANG Yaming;CAI Haijian;FAN Hui;XU Weisong;LIU Yufeng(Department of Gastroenterology,The Second People's Hospital of Nan-tong City,Nantong,Jiangsu 226000,China;Emergency Department,The Second People's Hospital of Nan-tong City,Nantong,Jiangsu 226000,China;Department of Gastroenterology,The First People's Hospital of Nantong City,Nantong,Jiangsu 226000,China)

机构地区：[1]南通市第二人民医院消化内科,江苏南通226000 [2]南通市第二人民医院急诊科,江苏南通226000 [3]南通市第一人民医院消化内科,江苏南通226000

出　　处：《安徽医药》2022年第10期1977-1980,共4页Anhui Medical and Pharmaceutical Journal

基　　金：江苏省南通市科技局社会发展项目(MSZ18203)。

摘　　要：目的评价早期肠内营养、补充益生菌对急性胰腺炎(AP)病人肠黏膜屏障功能和免疫功能指标的疗效。方法选取2015年1月至2020年12月南通市第一人民医院及南通市第二人民医院收治的AP病人160例,按照给予肠内营养的不同时间点,按照随机数字表法随机分为早期肠内营养组(观察组1,n=85),常规营养组(观察组2,n=75)。观察组1予入院后48 h内给予益生菌、肠内营养;观察组2先给予肠外营养1周,再给予肠内营养;另选择健康体检人员72例为对照组。于病人入院第1、7、14天分别检测并比较3组间血清内毒素、D-乳酸水平、尿乳果糖/甘露醇排泄率、免疫球蛋白IgG、免疫球蛋白IgM的浓度。结果第1天,观察组1、观察组2血清内毒素、D-乳酸水平、尿乳果糖/甘露醇排泄率的浓度差异无统计学意义,但均显著高于对照组(P<0.05)[内毒素(0.69±0.08)比(2.06±0.39)比(2.08±0.38)µg/L,D-乳酸(3.06±0.90)比(13.48±0.75)比(13.39±1.23)µg/L、尿乳果糖/甘露醇排泄率(0.16±0.10)比(0.51±0.21)比(0.50±0.17)],观察组1、观察组2免疫球蛋白IgG、免疫球蛋白IgM的浓度显著低于对照组(P<0.05)[IgG(18.84±2.12)比(14.32±2.45)比(14.27±2.39)g/L,IgM(1.83±0.36)比(1.59±0.42)比(1.48±0.33)g/L]。第7天,观察组1、观察组2血清内毒素、D-乳酸水平、尿乳果糖/甘露醇排泄率有显著差别(P<0.05);第14天,观察组1血清内毒素、D-乳酸水平、尿乳果糖/甘露醇排泄率显著低于观察组2(P<0.05);观察组1免疫球蛋白IgG、免疫球蛋白IgM的浓度显著高于观察组(P<0.05)。结论早期给予肠内营养、补充益生菌可有效保护急性胰腺炎病人肠道黏膜屏障,改善免疫功能,有利于病人早期恢复。Objective To evaluate the curative effect of early enteral nutrition(EEN)and probiotics on maintenance of the intestinal mucosal barrier and immunological function in acute pancreatitis(AP)patients.Methods A total of 160 AP cases admitted to The Second People's Hospital of Nantong City and The First People's Hospital of Nantong City from Januarry 2015 to December 2020 were enrolled into this study.According to different time points of enteral nutrition,the patients were assigned into early enteral nutrition group(observation group 1,n=85)and routine nutrition group(observation group 2,n=75)by random number method.Early enteral nutrition and probiotics were started within 48h after admission in observation group 1.Parenteral nutrition was given to patients in observation group 2 for one week,and then enteral nutrition was administered.Another 72 healthy people were enrolled as the control group.The serum endotoxin,D-lactate,urine lactulose/mannitol excretion rate,immunoglobulin G and immunoglobulin M were determined and compared on the 1st,7th and 14th day after admission.Results On the 1st day of admission,there were no significant differences in serum endotoxin,D-lactate and urine lactulose/mannitol excretion rate between the two observation groups,but these indicators were significantly higher than those in the control group(P<0.05)[endotoxin:(0.69±0.08)vs.(2.06±0.39)vs.(2.08±0.38)µg/L,D-lactate:(3.06±0.90)vs.(13.48±0.75)vs.(13.39±1.23)µg/L,lactulose/mannitol excretion rate:(0.16±0.10)vs.(0.51±0.21)vs.(0.50±0.17)],while the concentrations of immunoglobulin G and immunoglobulin M were significantly lower[IgG:(18.84±2.12)vs.(14.32±2.45)vs.(14.27±2.39)g/L,IgM:(1.83±0.36)vs.(1.59±0.42)vs.(1.48±0.33)g/L].On the 7th day of admission,there were significant differences in serum endotoxin,D-lactic acid level and urinary lactulose/mannitol excretion rate between the two observation groups(P<0.05),On the 14th day of admission,the serum endotoxin,D-lactic acid and urinary lactulose/mannitol excretion rate

关 键 词：胰腺炎 肠道营养 肠黏膜屏障 益生菌 免疫球蛋白类 

分 类 号：R576[医药卫生—消化系统]