益生菌联合大剂量维生素C在重症急性胰腺炎中的应用及潜在机制分析  

Application and potential mechanism of probiotics combined with high-dose vitamin C in severe acute pancreatitis

作　　者：黄燕平 HUANG Yanping(Zigong Fourth People's Hospital of Sichuan Province,Zigong,Sichuan,643000)

机构地区：[1]四川省自贡市第四人民医院,四川自贡643000

出　　处：《实用临床医药杂志》2024年第17期56-61,共6页Journal of Clinical Medicine in Practice

基　　金：2020年四川省医学(青年创新)科研课题(S20193)。

摘　　要：目的 探讨益生菌联合大剂量维生素C对重症急性胰腺炎(SAP)患者免疫功能、肠道黏膜功能及预后的影响。方法 选取108例SAP患者作为研究对象,根据治疗方案的不同分为对照组(大剂量维生素C辅助治疗)53例和观察组(益生菌联合大剂量维生素C辅助治疗)55例。观察2组患者的疗效、预后情况及治疗前后炎症指标[肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、白细胞介素-6(IL-6)]、免疫功能指标(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+))、肠道菌群、肠道黏膜功能指标[二胺氧化酶(DAO)、D-乳酸、内毒素]、单核细胞p38MAPK/核因子-κB(NF-κB)信号通路变化。结果 观察组总有效率为89.09%,高于对照组的69.81%,差异有统计学意义(P<0.05);治疗3、7 d后,观察组IL-6、TNF-α、CRP水平低于对照组,CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平高于对照组,肠球菌、大肠埃希菌水平低于对照组,乳酸杆菌、双歧杆菌水平高于对照组,DAO、D-乳酸、内毒素水平低于对照组,p38MAPK、p-p38MAPK蛋白相对表达量低于对照组,差异有统计学意义(P<0.05);观察组住院时间、ICU停留时间均短于对照组,差异有统计学意义(P<0.05);2组患者自动出院及死亡的发生率比较,差异无统计学意义(P>0.05)。结论 益生菌联合大剂量维生素C对SAP患者疗效确切,能够有效减轻机体炎症反应,调节免疫功能,促进肠道黏膜功能修复,有利于患者早日康复,这可能与其抑制p38MAPK/NF-κB信号通路有关。Objective To investigate the effects of probiotics combined with high-dose vitamin C on immune function,intestinal mucosal function,and prognosis in patients with severe acute pancreatitis(SAP).Methods A total of 108 SAP patients were selected as study subjects and divided into control group(treated with high-dose vitamin C as adjuvant therapy,n=53) and observation group(treated with probiotics combined with high-dose vitamin C as adjuvant therapy,n=55) based on different treatment regimens.The efficacy,prognosis,and changes in inflammatory markers [tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),interleukin-6(IL-6)],immune function indicators(CD3~+,CD4~+,CD4~+/CD8~+),intestinal flora,intestinal mucosal function indicators [diamine oxidase(DAO),D-lactic acid,endotoxin],and monocyte p38MAPK/nuclear factor-κB(NF-κB) signaling pathway were observed before and after treatment in both groups.Results The total effective rate in the observation group was 89.09%,which was significantly higher than the 69.81%in the control group(P <0.05).After 3 and 7 days of treatment,the levels of IL-6,TNF-α,and CRP in the observation group were lower,while the levels of CD3~+,CD4~+,and CD4~+/CD8+were higher than those in the control group(P <0.05).The levels of Enterococcus and Escherichia coli in the observation group were lower,while the levels of Lactobacillus and Bifidobacterium were higher than those in the control group(P <0.05).Additionally,the levels of DAO,D-lactic acid,and endotoxin were lower in the observation group,and the relative expression levels of p38MAPK and p-p38MAPK proteins were also lower(P <0.05).The length of hospital stay and ICU stay in the observation group were shorter compared to the control group(P <0.05).There was no statistically significant difference in the incidence of voluntary discharge and death between the two groups(P> 0.05).Conclusion The combination of probiotics and high-dose vitamin C has a definite therapeutic effect in SAP patients,effectively reducing inflammatory response,reg

关 键 词：重症急性胰腺炎 维生素C 益生菌 免疫功能 肠道黏膜功能 信号通路 

分 类 号：R657.5[医药卫生—外科学] R574.4[医药卫生—临床医学] R97