中华胃肠外科杂志
中華胃腸外科雜誌
중화위장외과잡지
CHINESE JOURNAL OF GASTROINTESTINAL SURGERY
2012年
5期
484-489
,共6页
何桂珍%董良广%崔晓雨%陈雪峰%张睿
何桂珍%董良廣%崔曉雨%陳雪峰%張睿
하계진%동량엄%최효우%진설봉%장예
肠道缺血再灌注%谷氨酰胺%ω-3多不饱和脂肪酸%淋巴管结扎%肠道通透性
腸道缺血再灌註%穀氨酰胺%ω-3多不飽和脂肪痠%淋巴管結扎%腸道通透性
장도결혈재관주%곡안선알%ω-3다불포화지방산%림파관결찰%장도통투성
Intestinal ischemia-reperfusion%Glutamine%ω-3 polyunsaturated fatty acids%Lymph duct ligation%Intestinal permeability
目的 研究大鼠肠道缺血再灌注损伤时,肠淋巴管结扎和不同肠内营养对肠道通透性、系统炎性反应和肺损伤的影响.方法 SPF级雄性大鼠胃造瘘术后随机分为正常饮食组、普通肠内营养组、谷氨酰胺(Gln)肠内营养组、ω-3多不饱和脂肪酸(ω-3PUFA)肠内营养组和假手术组,前4组根据淋巴管是否结扎又各分为结扎和不结扎组,共9组,每组8只.所有肠内营养组均经胃造瘘给予等氮(1.8 gN·kg-1 ·d-1)等热卡(1046 kJ·kg-1 ·d-1)的营养支持,7d后除假手术组外其他8组实施肠道缺血60 min,结扎组在缺血前同时进行淋巴管结扎；然后继续原营养再灌注3d.在胃造瘘术后第5、7和9天测定肠道通透性(尿中乳果糖/甘露醇浓度值,L/M)；术后第11天取血检测血清二胺氧化酶、内毒素、细胞因子及ALT、AST的水平；取小肠黏膜检测黏膜厚度和绒毛高度;取肺组织检测髓过氧化物酶(MPO)、NO和NO合酶(NOS)浓度及细胞凋亡指数.结果 肠道缺血60 min可引起肠道损伤;缺血后第1天,各组L/M均显著增加(P＜0.05)；缺血后第3天L/M明显下降(P＜0.05),其中Gln肠内营养组和ω-3PUFA肠内营养组已恢复至接近缺血前水平(P＞0.05),且淋巴管结扎组L/M明显低于不结扎组(P＜0.05).在肠道缺血再灌注损伤时,与普通肠内营养和正常饮食组比较,Gln肠内营养组和ω-3PUFA肠内营养组血清内毒素和细胞因子水平显著降低,小肠黏膜厚度和绒毛高度明显增高(P＜0.05)；且淋巴管结扎后效果更为明显(P＜0.05).予以Gln或ω-3PUFA肠内营养以及淋巴管结扎后,肺组织MPO、NO、NOS及细胞凋亡指数都有不同程度的下降(P＜0.05).结论 肠道缺血再灌注损伤引起的肺等远隔组织损伤及系统性炎性反应可能与肠淋巴液中的某些因子有关,阻断“肠-淋巴途径”和(或)补充Gln和ω-3PUFA的肠内营养可以降低缺血引起的肠道通透性增加,降低循环内毒素水平,增加肠黏膜的厚度,减轻系统炎性反应和肺组织损伤.
目的 研究大鼠腸道缺血再灌註損傷時,腸淋巴管結扎和不同腸內營養對腸道通透性、繫統炎性反應和肺損傷的影響.方法 SPF級雄性大鼠胃造瘺術後隨機分為正常飲食組、普通腸內營養組、穀氨酰胺(Gln)腸內營養組、ω-3多不飽和脂肪痠(ω-3PUFA)腸內營養組和假手術組,前4組根據淋巴管是否結扎又各分為結扎和不結扎組,共9組,每組8隻.所有腸內營養組均經胃造瘺給予等氮(1.8 gN·kg-1 ·d-1)等熱卡(1046 kJ·kg-1 ·d-1)的營養支持,7d後除假手術組外其他8組實施腸道缺血60 min,結扎組在缺血前同時進行淋巴管結扎；然後繼續原營養再灌註3d.在胃造瘺術後第5、7和9天測定腸道通透性(尿中乳果糖/甘露醇濃度值,L/M)；術後第11天取血檢測血清二胺氧化酶、內毒素、細胞因子及ALT、AST的水平；取小腸黏膜檢測黏膜厚度和絨毛高度;取肺組織檢測髓過氧化物酶(MPO)、NO和NO閤酶(NOS)濃度及細胞凋亡指數.結果 腸道缺血60 min可引起腸道損傷;缺血後第1天,各組L/M均顯著增加(P＜0.05)；缺血後第3天L/M明顯下降(P＜0.05),其中Gln腸內營養組和ω-3PUFA腸內營養組已恢複至接近缺血前水平(P＞0.05),且淋巴管結扎組L/M明顯低于不結扎組(P＜0.05).在腸道缺血再灌註損傷時,與普通腸內營養和正常飲食組比較,Gln腸內營養組和ω-3PUFA腸內營養組血清內毒素和細胞因子水平顯著降低,小腸黏膜厚度和絨毛高度明顯增高(P＜0.05)；且淋巴管結扎後效果更為明顯(P＜0.05).予以Gln或ω-3PUFA腸內營養以及淋巴管結扎後,肺組織MPO、NO、NOS及細胞凋亡指數都有不同程度的下降(P＜0.05).結論 腸道缺血再灌註損傷引起的肺等遠隔組織損傷及繫統性炎性反應可能與腸淋巴液中的某些因子有關,阻斷“腸-淋巴途徑”和(或)補充Gln和ω-3PUFA的腸內營養可以降低缺血引起的腸道通透性增加,降低循環內毒素水平,增加腸黏膜的厚度,減輕繫統炎性反應和肺組織損傷.
목적 연구대서장도결혈재관주손상시,장림파관결찰화불동장내영양대장도통투성、계통염성반응화폐손상적영향.방법 SPF급웅성대서위조루술후수궤분위정상음식조、보통장내영양조、곡안선알(Gln)장내영양조、ω-3다불포화지방산(ω-3PUFA)장내영양조화가수술조,전4조근거림파관시부결찰우각분위결찰화불결찰조,공9조,매조8지.소유장내영양조균경위조루급여등담(1.8 gN·kg-1 ·d-1)등열잡(1046 kJ·kg-1 ·d-1)적영양지지,7d후제가수술조외기타8조실시장도결혈60 min,결찰조재결혈전동시진행림파관결찰；연후계속원영양재관주3d.재위조루술후제5、7화9천측정장도통투성(뇨중유과당/감로순농도치,L/M)；술후제11천취혈검측혈청이알양화매、내독소、세포인자급ALT、AST적수평；취소장점막검측점막후도화융모고도;취폐조직검측수과양화물매(MPO)、NO화NO합매(NOS)농도급세포조망지수.결과 장도결혈60 min가인기장도손상;결혈후제1천,각조L/M균현저증가(P＜0.05)；결혈후제3천L/M명현하강(P＜0.05),기중Gln장내영양조화ω-3PUFA장내영양조이회복지접근결혈전수평(P＞0.05),차림파관결찰조L/M명현저우불결찰조(P＜0.05).재장도결혈재관주손상시,여보통장내영양화정상음식조비교,Gln장내영양조화ω-3PUFA장내영양조혈청내독소화세포인자수평현저강저,소장점막후도화융모고도명현증고(P＜0.05)；차림파관결찰후효과경위명현(P＜0.05).여이Gln혹ω-3PUFA장내영양이급림파관결찰후,폐조직MPO、NO、NOS급세포조망지수도유불동정도적하강(P＜0.05).결론 장도결혈재관주손상인기적폐등원격조직손상급계통성염성반응가능여장림파액중적모사인자유관,조단“장-림파도경”화(혹)보충Gln화ω-3PUFA적장내영양가이강저결혈인기적장도통투성증가,강저순배내독소수평,증가장점막적후도,감경계통염성반응화폐조직손상.
Objective To investigate the impact of intestinal lymphatic vessels ligation and different enteral nutrition support during ischemia/reperfusion on intestinal permeability,systemic inflammatory response and pulmonary dysfunction in a rat model Methods Seventy-two Sprague-Dawley male rats were randomized into normal diet group,regular enteral nutrition group,glutamine-enriched group,ω-3 polyunsaturated fatty acids (ω-3PUFA) group,and sham control after gastrostomy.All the enteral nutrition group were isocaloric (1046 kJ· kg-1· d-1) and isonitrogenous (1.8 g N· kg-1 ·d-1).After enteral nutrition for 7 days,the rats were subjected to intestinal ischemia for 60 min,or ischemia plus mesenteric lymph duct ligation except for the sham group followed by 3 days of nutrition (72 h).Intestinal permeability (lactose/mannitol ratio in the urine,L/M) was determined on the 5th,7th and 9th day after gastrostomy.The levels of serum diamine oxidase,endotoxin,cytokines,ALT and AST were detected at the 11th day after gastrostomy.Mucosal thickness was measured using small intestine and villus height.Myeloperoxidase (MPO),nitric oxide (NO),NO synthase,and apoptotic index were detected in lung tissue.Results Ischemia for 60 min could cause intestinal injury.Intestinal permeability(L/M)was increased significantly in every group on the first day after isehemia (P＜0.05).However,L/M decreased significantly 3 days after ischemia (P＜0.05).The groups with Glu and ω-3PUFA-enriched nutrition almost restored to normal level (P＞0.05).The level of L/M in lymphatic ligation group was significantly lower than non-ligation group (P＜0.05).The levels of endotoxin and cytokine were reduced,mucosal thickness and villous height were significantly higher (P＜0.05) in the groups of Glu and ω-3PUFA-enriched nutrition compared with enteral nutrition and normal diet groups during intestinal ischemia-repeffusion injury.MPO,NO,NOS and the apoptosis index of lung tissue decreased in the groups of Glu and ω-3PUFA-enriched as well as after lymph duct ligation (P＜0.05).Conclusions The distant tissue-lung damage and systemic inflammation caused by intestinal ischemiareperfusion injury may be related to some factors in the intestinal lymph.Blocking the gut-lymph pathway and/or adding Glu and ω-3PUFA in enteral nutrition may reduce intestinal permeability and endotoxin,increase mucosal thickness,attenuate the systemic inflammatory reaction,and prevent lung injury.
