CAJ | 학술논문

目的探讨早期不同肠内营养支持治疗对重症急性胰腺炎（ SAP ）患者肠道屏障功能及肝损害的影响。方法84例重症急性胰腺炎患者在发病72 h内随机分成肠内要素营养（EN）组（28例）、肠内免疫营养（IN）组（28例）及肠内免疫微生态营养（EIN）组（28例），分别进行相应的肠内营养治疗，并供给等氮量、等热量营养支持治疗，在营养治疗前、治疗后7 d、14 d测定外周血内毒素，二胺氧化酶（ DAO）、TNF-α、IL-6、超氧化物歧化酶（SOD）、丙二醛（MDA）、ALB、AST、ALT及尿乳果糖和甘露醇比值（L/M）。结果营养治疗前三组间血内毒素、DAO、TNF-α、IL-6、SOD、MDA、肝功能及尿L/M均无统计学差异（ P＞0.05）。营养支持14 d后EIN组血内毒素、DAO、TNF-α、IL-6、MDA及尿L/M分别为（0.68±0.21） EU/L、（4.82±1.15） U/L，（63.42±23.75）pg/ml、（45.32±18.87）pg/ml、（0.53±0.09）mmol/ml及（43.5±10.7）×10-3，较EN及IN组明显下降（P＜0.05），SOD值（482.43±123.82）U/ml，较EN、IN组明显升高（P＜0.05），EIN组营养治疗14 d后肝功能已恢复正常，与EN、IN组比较差异有统计学意义（ P＜0.05），而EN组、IN组营养治疗14 d后各指标比较无显著差异（ P＞0.05）。结论肠内免疫微生态营养能保护SAP患者肠道屏障功能，减轻内毒素血症及炎症因子水平，减少氧自由基生成，从而减轻肝损害。
목적탐토조기불동장내영양지지치료대중증급성이선염（ SAP ）환자장도병장공능급간손해적영향。방법84례중증급성이선염환자재발병72 h내수궤분성장내요소영양（EN）조（28례）、장내면역영양（IN）조（28례）급장내면역미생태영양（EIN）조（28례），분별진행상응적장내영양치료，병공급등담량、등열량영양지지치료，재영양치료전、치료후7 d、14 d측정외주혈내독소，이알양화매（ DAO）、TNF-α、IL-6、초양화물기화매（SOD）、병이철（MDA）、ALB、AST、ALT급뇨유과당화감로순비치（L/M）。결과영양치료전삼조간혈내독소、DAO、TNF-α、IL-6、SOD、MDA、간공능급뇨L/M균무통계학차이（ P＞0.05）。영양지지14 d후EIN조혈내독소、DAO、TNF-α、IL-6、MDA급뇨L/M분별위（0.68±0.21） EU/L、（4.82±1.15） U/L，（63.42±23.75）pg/ml、（45.32±18.87）pg/ml、（0.53±0.09）mmol/ml급（43.5±10.7）×10-3，교EN급IN조명현하강（P＜0.05），SOD치（482.43±123.82）U/ml，교EN、IN조명현승고（P＜0.05），EIN조영양치료14 d후간공능이회복정상，여EN、IN조비교차이유통계학의의（ P＜0.05），이EN조、IN조영양치료14 d후각지표비교무현저차이（ P＞0.05）。결론장내면역미생태영양능보호SAP환자장도병장공능，감경내독소혈증급염증인자수평，감소양자유기생성，종이감경간손해。
Objective To evolute the effect of early different enteral nutrition on intestinal barrier function and hepatic injury in patients with severe acute pancreatitis ( SAP ) .Methods 84 SAP patients were randomly divided into element enteral nutrition ( EN ) group ( n =28 ) , immunonutrition ( IN ) group ( n =28 ) and ecoimmunonutrition(EIN)group(n=28).Each of the three nutrition supports were given to each group respectively with 72 hours after onset.The concetration of plasmic endotoxin,diamine oxidase(DAO),TNF-α,IL-6,superoxide dismutase(SOD),malondialdehyde(MDA),and ALB,AST,ALT were measured before,7 d and 14 d after nutrition support as well as urinary excretion of lactulose ( L ) and mannitol ( M ) .Results Before nutrition support , the concentration of plasmic endotoxin DAO ,TNF-α,IL-6,SOD,MDA,ALB,AST,ALT and urinary excretion of L and M had no difference among three groups .14 days after nutrition support ,the level of plasmic endotoxin DAO ,TNF-α,IL-6,MDA and urinary excretion of L and M in EIN group were (0.68 ±0.21 ) EU/L,(4.82 ±1.15 ) U/L,(63.42 ± 23.75)pg/ml,(45.32 ±18.87)pg/ml,(0.53 ±0.09)mmol/ml and(43.5 ±10.7) ×10 -3,respectively,which all were significantly lower than those of EN and IN group ( P<0.05 ) .The plasmic SOD activity in EIN group were (482.43 ±123.82)U/ml,which were higher than those of EN and IN group (P<0.05).The hepatic function in the EIN group return to nomal levels after 14 days of nutrition support .The improvement in hepatic function better than those achieved in the EN and IN group ,but there were no difference between EN and IN group .Conclusions EIN could improve intestinal barrier function ,decrease the level of plasmic endotoxin and serum cytokines ,reduce oxygen free radicals and attenuate hepatic injury in patients with SAP .