CAJ | 학술논문

目的观察肠内免疫微生态营养(EIN)对实验性坏死性胰腺炎猪的肝损害的影响.方法20头普通江淮猪胰管注射5％牛磺胆酸钠1 ml/kg制备急性坏死性胰腺炎(ANP)模型,造模后24 h有2头死亡,18头猪按随机数字分组法分为全肠外营养组(TPN)、肠内要素营养组(EEN)和肠内免疫微生态营养组( EIN),分别进行相应的营养8d.于造模前,造模后24h,营养支持第1、2、4、8天检测外周血内毒素、谷草转氨酶(AST)、谷丙转氨酶(ALT)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6).营养支持8d后剖腹测定腹水量、肝脏丙二醛(MDA)含量及超氧化物歧化酶(SOD)活力、肝组织TNF-α mRNA和IL-6 mRNA的表达以及肝脏病理学改变,进行病理评分.结果造模后24 h EIN组外周血内毒素、AST、ALT、TNF-α、IL-6均较造模前明显增高(P均＜0.01),但与其他两组的差异无统计学意义.营养支持8d后,EIN组上述5项指标均明显低于TPN组和EEN组(P均＜0.05).营养8d后,EIN组的腹水量、肝脏MDA含量、TNF-α mRNA表达、IL-6 mRNA表达及肝脏病理学评分均明显低于TPN组和EEN组,而肝脏SOD活力则明显高于TPN组和EEN组(P均＜0.05).结论早期给予EIN能从多方面保护ANP引起的肝损害.
목적관찰장내면역미생태영양(EIN)대실험성배사성이선염저적간손해적영향.방법20두보통강회저이관주사5％우광담산납1 ml/kg제비급성배사성이선염(ANP)모형,조모후24 h유2두사망,18두저안수궤수자분조법분위전장외영양조(TPN)、장내요소영양조(EEN)화장내면역미생태영양조( EIN),분별진행상응적영양8d.우조모전,조모후24h,영양지지제1、2、4、8천검측외주혈내독소、곡초전안매(AST)、곡병전안매(ALT)、종류배사인자-α(TNF-α)、백개소-6(IL-6).영양지지8d후부복측정복수량、간장병이철(MDA)함량급초양화물기화매(SOD)활력、간조직TNF-α mRNA화IL-6 mRNA적표체이급간장병이학개변,진행병리평분.결과조모후24 h EIN조외주혈내독소、AST、ALT、TNF-α、IL-6균교조모전명현증고(P균＜0.01),단여기타량조적차이무통계학의의.영양지지8d후,EIN조상술5항지표균명현저우TPN조화EEN조(P균＜0.05).영양8d후,EIN조적복수량、간장MDA함량、TNF-α mRNA표체、IL-6 mRNA표체급간장병이학평분균명현저우TPN조화EEN조,이간장SOD활력칙명현고우TPN조화EEN조(P균＜0.05).결론조기급여EIN능종다방면보호ANP인기적간손해.
Objective To evaluate the effect of enteral ecoimmunonutrition (EIN) on hepatic injury in swine with acute necrotizing pancreatitis (ANP).Method With 20 pigs,swine model of ANP was induced by injecring 5％ sodium taurocholate into the pancreatic duct.24 hours after the ANP models were established,2 pig were dead,and the remaining 18 pigs were randomly divided into total parenteral nutrition (TPN) group ( n =6),elemental enteral nutrition (EEN) group ( n =6 ),and EIN group ( n =6 ),and received nutrition support for 8 days.The level of plasma endotoxin and serum concentrations of AST,ALT,TNF-α,and IL-6 were measured at different time points ( before model establishment,24 hours after model establishment,and the 1,2,4,8 days of nutrition support).All the pigs were sacrificed after the 8-day nutrition support,and ascites quantity,hepatic malondialdehyde (MDA),superoxide dismutase (SOD) were measured.The mRNA expression of TNF-α and IL-6 in hepatic tissue were detected by RT-PCR.Pathologic changes of the livers were analyzed.Results 24 hours after the ANP models were established,the plasma endotoxin,AST,ALT,TNF-α,IL-6 in EIN group were significantly higher than the levels before model establishment ( all P ＜ 0.01 ),but not significantly different from the 9ther 2 groups.After 8 days of nutrition support,the above 5 indexes in EIN group were significantly lower than those in TPN group and EEN group ( all P ＜ 0.05 ).In addition,the ascites quantity,hepatic concentration of MDA,the expression of TNF-α and IL-6,and hepatic pathological score in EIN group were lower than those of TPN group and EEN group,while hepatic SOD activity was higher in EIN group than in the other 2 groups (all P ＜ 0.05 ).Conclusion Early EIN could attenuate hepatic injury in ANP from various aspects.