早期肠内营养不同时段对重症急性胰腺炎鼠肠粘膜屏障功能的影响及机制研究

发布时间：2019-07-04 14:45

【摘要】：目的：本课题采用大鼠模型通过不同时段启动早期肠内营养（EEN），研究重症急性胰腺炎（SAP）时对肠粘膜屏障（IMB）结构和功能的影响机制和探讨其保护措施，为临床治疗提供多方面的理论基础及实验基础。方法：选取75只健康雄性SD大鼠随机分3大组：实验组（EN组/SAP+EN），n=45只）（EN1、EN2、EN3组分别为3个启动时机，各15只），对照组（TPN组/SAP+TPN）（n=15只），空白组（S组/假手术组）（n=15只）。各组均行空肠置管造瘘，颈部静脉置管。假手术组中仅翻动内脏，实验组、对照组采用胰胆管逆行注射3.5%牛磺胆酸钠溶液建立重症急性胰腺炎模型。造模成功后用对照组行全肠外营养（TPN）治疗，实验组分EN1、EN2、EN3组（n=15只），分别在SAP造模后第1、2、4天三个时间行肠内营养；观察各自对SAP大鼠肠粘膜屏障的保护作用并进行比较，于三个实验节点后的1天，即第2、3、5天，各组分别处死大鼠5只，心脏采血测白细胞计数（WBC）和淀粉酶（AMS），ELISA法检测血清内毒素（ET）、肿瘤坏死因子-α（TNF-α）、白细胞介素-2（IL-2）、白细胞介素-10（IL-10），取胰腺及空肠粘膜切片染色作病理组织学检查。结果： 1.一般情况：空白组的大鼠术后反应良好，各时间点无明显区别；实验组大鼠较对照组明显好转，但较空白组大鼠差。 2.血液学指标：空白组血清淀粉酶水平较低，各时间点无明显变化；实验组（EN）各时间段与对照组（TPN）之间水平比较，血淀粉酶、血常规值随时间变化，各指标变化趋势一致，总体上AMS、WBC等均呈下降趋势并逐渐恢复正常；在各时间点前，EN组与TPN组之间差异无统计学意义，但均显著高于S组；在各时间点后，实验组（EN）各时间段均明显低于对照组（TPN）；EN组间比较，各组AMY、WBC水平随时间逐渐降低，EN1组明显低于EN2组、EN3组。 3.血清ET、TNF-α、IL-2、IL-10变化：各组变化显示：空白组血清水平明显低于实验组和对照组，实验组和对照组之间无差异；TPN、EN组前1天无明显差别，，第3天的空白组的ET、TNF-α、IL-2、IL-10水平明显低于其它各组，EN组较TPN组治疗后降低。EN组第2天后开始下降，与肠外营养组相比有显著差异。EN1、EN2组较EN3组有显著差异。 4.胰腺、空肠组织学观察： TPN、EN组各时间点的胰腺组织学评分均明显高于S组；EN组的胰腺组织学评分低于相应时间点TPN组；EN3组的评分高于EN1、EN2组。第3天、第5天EN1组、EN2组的空肠病理评分明显低于EN3和其他组。结论： 1.EEN在大鼠SAP基本稳定后，越早启动对肠粘膜屏障功能越有利。 2.EEN可以减轻局部组织损伤，降低炎症反应程度，防止肠道菌群移位，有利于保护肠粘膜屏障结构及功能。
[Abstract]:Purpose: The effects of early enteral nutrition (EEN) on the structure and function of intestinal mucosa barrier (IMB) in severe acute pancreatitis (SAP) and its protective measures were studied by using rat model to study the effect of early enteral nutrition (EEN) on the structure and function of intestinal mucosa barrier (IMB) in severe acute pancreatitis (SAP). To provide a variety of theoretical basis and experimental basis for clinical treatment No, no, no. Methods:75 healthy male SD rats were randomly divided into 3 groups: experimental group (EN group/ SAP + EN), n = 45) (EN1, EN2, EN3 group,3 start-up time,15 only), control group (TPN group/ SAP + TPN) (n = 15), blank group (S group/ sham operation group) (n = 15). The jejunum placing tube, neck and neck of each group In the sham operation group, only the internal organs, the experimental group and the control group were used for the retrograde injection of 3.5% taurocholate sodium solution in the pancreatic bile duct to establish the severe acute pancreatitis. The rats were treated with total parenteral nutrition (TPN) in the control group, and the experimental components EN1, EN2 and EN3 (n = 15) were divided into three groups:1,2 and 4 days after the injection of the SAP, and the protection of the intestinal mucosa barrier in the SAP rats was observed. The serum endotoxin (ET), tumor necrosis factor-1 (TNF-1) and interleukin-2 (IL-2) were detected by ELISA. IL-2, interleukin-10 (IL-10), and biopsy of the pancreas and the jejunum. Histology Check. Results 1. General situation: The rats in the blank group had good response after operation and there was no significant difference between the time points, and the experimental group was more obvious than the control group. Improved, but smaller group 2. Hematology index: the serum amylase level in the blank group was low and there was no significant change in each time point; the level of serum amylase and blood routine value of the experimental group (EN) and the control group (TPN) were relatively low, and the blood amylase and blood routine value varied with time. The change trend of the indexes was consistent, and the overall AMS, WBC, and the like showed a downward trend and gradually returned to normal; the difference between the EN group and the TPN group was not statistically significant before each time point, but was significantly higher than that of the S group; after each time point, each time period of the experimental group (EN) was significantly lower than that of the control group (TP N); compared between the EN groups, the levels of AMY and WBC in each group were gradually decreased with time, EN 1 group was significantly lower than that of EN2 group and EN3 group.3. Serum ET, T Changes in NF-1, IL-2, and IL-10: The level of serum in the blank group was significantly lower than that of the experimental group and the control group. There was no difference between the experimental group and the control group, and there was no significant difference in the first day of the TPN and EN group, and the third The level of ET, TNF-1, IL-2 and IL-10 in the blank group of the day was significantly lower. In other groups, the EN group was reduced after treatment with the TPN group. EN group, day 2 There was a significant difference in the start-up, compared to the parenteral nutrition group. EN1, EN2 and EN3 There was a significant difference in the group.4. The histological observation of the pancreas and jejunum: the histological score of the pancreas in the time points of the TPN and EN groups was significantly higher than that of the S group; the histological grade of the pancreas in the EN group was lower than that of the corresponding time Point TPN group; EN3 group score was higher than EN1, EN2 group. Day 3, Day 5 EN1 group ,EN The pathological scores of jejunum in group 2 were significantly lower than that of EN3 and other groups. Conclusion:1. EEN After the basic stabilization of SAP in rats, the better the early start-up of the intestinal mucosa barrier function.
【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R657.51

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