结构脂肪乳对重症急性胰腺炎患者肠黏膜屏障功能、肠道菌群和细胞因子的影响  

Effect of structured lipid on intestinal mucosal barrier function,intestinal flora and cytokines in patients with severe acute pancreatitis

作　　者：李启梁 李慧晨 朱恒 徐志鹏 郑传明[1] 王振杰[1] Li Qiliang;Li Huichen;Zhu Heng;Xu Zhipeng;Zheng Chuanming;Wang Zhenjie(Department of Emergency Surgery,The First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,Anhui,China)

机构地区：[1]蚌埠医学院第一附属医院急诊外科,安徽蚌埠233004

出　　处：《右江民族医学院学报》2023年第6期886-891,共6页Journal of Youjiang Medical University for Nationalities

基　　金：安徽省科研编制计划项目(2022AH051437);安徽省医学会急诊医学临床研究项目(Ky2021024)。

摘　　要：目的 探讨结构脂肪乳对重症急性胰腺炎(SAP)患者肠黏膜屏障功能、肠道菌群和细胞因子影响。方法 选择2021年8月至2023年1月某院急诊外科EICU救治的SAP患者120例,根据随机表法分为研究组与对照组,各60例。两组患者入院后在采取常规治疗(维持水电解质酸碱平衡、抗感染、抑酶、胃肠减压等)的基础上分别给予ω-3鱼油脂肪乳+结构脂肪乳(研究组)和ω-3鱼油脂肪乳+中长链脂肪乳(对照组)应用,检测对比两组患者的肠黏膜屏障功能[肠脂肪酸结合蛋白(I-FABP)、血浆内毒素、二胺氧化酶(DAO)、血浆D-乳酸];治疗前和治疗第5天肠道菌群数目(乳酸杆菌、双歧杆菌、葡萄球菌和大肠埃希菌);细胞因子(TNF-α、IL-6和IL-8);TG和TC的变化,同时观察对比两组患者临床症状和体征的恢复时间。结果 研究组患者腹痛、肠鸣音和体温恢复正常时间比对照组缩短(P<0.05)。两组患者治疗5 d后的血清I-FABP、血浆内毒素、DAO、血浆D-乳酸水平比入院时下降(P<0.05);研究组患者治疗5 d血清I-FABP、血浆内毒素、DAO、血浆D-乳酸水平低于对照组(P<0.05)。两组治疗5 d的葡萄球菌和大肠埃希菌比入院时下降(P<0.05),而乳酸杆菌、双歧杆菌则比入院时上升(P<0.05);研究组治疗5 d的葡萄球菌和大肠埃希菌低于对照组,而乳杆菌和双歧杆菌则比对照组上升(P<0.001)。两组治疗5 d血清细胞因子水平比入院时下降(P<0.05);两组患者治疗5 d后血清细胞因子水平差异无统计学意义(P>0.05)。两组患者入院时TG和TC水平差异无统计学意义(P>0.05)。治疗5 d后,研究组患者TG水平较入院时差异无统计学意义(P>0.05),对照组患者TG水平较入院时升高(P<0.05)。两组患者治疗治疗5 d TG水平比较差异有统计学意义(P<0.001)。结论 结构脂肪乳肠外营养对重症急性胰腺炎患者效果较好,它可以改善患者肠黏膜屏障功能和肠道菌群,稳定血脂水平,是重症�Objective To investigate the effect of structured lipid on intestinal mucosal barrier function,intestinal flora,and cytokines in patients with severe acute pancreatitis(SAP).Methods A total of 120 SAP patients treated in the Emergency Intensive Care Unit(EICU)of the emergency surgery department of a hospital from August 2021 to January 2023 were randomly divided into two groups:study and control(60 patients each).Both groups received routine treatment upon admission(maintaining water-lectrolyte acid-base balance,anti-infection,enzyme inhibition,gastrointestinal decompression,etc.)and were administeredω-3 fish oil fat emulsion+structured lipid(study group)orω-3 fish oil fat emulsion+medium and long-chain fat emulsion(control group).We compared intestinal mucosal barrier function(intestinal fatty acid binding protein(I-FABP),plasma endotoxin,diamine oxidase(DAO),plasma D-lactic acid),intestinal flora counts(lactobacillus,bifidobacterium,staphylococcus and escherichia coli),cytokines(TNF-α,IL-6,and IL-8),TG,TC changes,and observed the recovery time of clinical symptoms and signs between the two groups.Results The study group demonstrated shorter recovery times for abdominal pain,bowel sounds and normalization of body temperature compared to the control group(P<0.05).both groups exhibited decreased levels of serum I-FABP,plasma endotoxin,DAO and plasma D-lactic acid compared to admission after 5 days of treatment(P<0.05).The study group showed lower levels of these indicators than the control group after 5 days of treatment(P<0.05).Staphylococcus and escherichia coli decreased in both groups after 5 days of treatment compared to admission(P<0.05),while lactobacillus and bifidobacterium increased(P<0.05).The study group had lower levels of staphylococcus and escherichia coli but higher levels of lactobacillus and bifidobacterium than the control group after 5 days of treatment(P<0.001).Both groups exhibited decreased serum cytokine levels after 5 days of treatment(P<0.05).There was no significant difference in the

关 键 词：胰腺炎 脂肪乳 肠黏膜屏障功能 肠道菌群 细胞因子 血脂 

分 类 号：R657.5[医药卫生—外科学]