肠内营养中添加膳食纤维对重症急性胰腺炎患者炎症反应、免疫应答及肠黏膜屏障的影响
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摘要
目的:研究肠内营养中添加膳食纤维对重症急性胰腺炎患者炎症反应、免疫应答及肠黏膜屏障的影响。方法:选择我院收治的重症急性胰腺炎患者并随机分为两组,观察组接受基础治疗联合添加膳食纤维的肠内营养、对照组接受基础治疗联合常规肠内营养。治疗前及治疗后7天,分别测定血清中炎症细胞因子及肠黏膜屏障标志物的含量、外周血中免疫细胞的数目、粪便中肠道菌群的数目。结果:两组治疗后的血清细胞介素-8(IL-8)、单核细胞趋化蛋白(MCP-1)、可溶性细胞间黏附分子-1(sICAM-1)、可溶性髓样细胞触发受体-1(sTREM1)、内毒素、D-乳酸、二胺氧化酶(DAO)含量、外周血CD8~+T细胞数目、粪便肠球菌及肠杆菌数目数目均明显降低,外周血CD3~+T细胞、CD4~+T细胞、CD19~+B细胞、CD16~+CD56~+NK细胞数目及粪便中双歧杆菌、乳酸杆菌数目均明显升高且观察组治疗后的血清IL-8、MCP-1、sICAM-1、sTREM1、内毒素、D-乳酸、二胺氧化酶(DAO)含量、外周血CD8~+T细胞数目、粪便肠球菌及肠杆菌数目数目均明显低于对照组,外周血CD3~+T细胞、CD4~+T细胞、CD19~+B细胞、CD16~+CD56~+NK细胞数目及粪便中双歧杆菌、乳酸杆菌数目均明显高于对照组。结论:肠内营养中添加膳食纤维用于重症急性胰腺炎患者能够减轻炎症反应、改善免疫应答、纠正肠黏膜屏障功能紊乱。
Objective:To study the effects of dietary fiber in enteral nutrition on inflammatory reaction,immune response and intestinal mucosal barrier in patients with severe acute pancreatitis.Methods:The patients with severe acute pancreatitis treated in our hospital between February 2015 and February 2018 were selected and randomly divided into two groups.The observation group received basic treatment combined with enteral nutrition containing dietary fiber,and the control group received basic treatment combined with conventional enteral nutrition.The contents of inflammatory cytokines and intestinal mucosal barrier markers in serum,the number of immune cells in peripheral blood as well as the number of intestinal flora in feces were measured respectively before treatment and 7days after treatment.Results:Interleukin-8(IL-8),monocyte chemoattractant protein(MCP-1),soluble intercellular adhesion molecule-1(sICAM-1),soluble triggering receptor expressed on myeloid cells-1(sTREM1),endotoxin,D-lactic acid and diamine oxidase(DAO)contents in serum,the number of CD8~+T cells in peripheral blood as well as the number of enterococcus and enterobacterium in feces of both groups were significantly lower while the number of CD3~+T cells,CD4~+T cells,CD19~+B cells and CD16~+CD56~+NK cells in peripheral blood as well as the number of bifidobacteria and lactobacillus in feces were significantly higher after treatment,and IL-8,MCP-1,sICAM-1,sTREM1,endotoxin,D-lactic acid and DAO contents in serum,the number of CD8~+T cells in peripheral blood as well as the number of enterococcus and enterobacterium in feces of observation group after treatment were significantly lower than those of control group while the number of CD3~+T cells,CD4~+T cells,CD19~+B cells and CD16~+CD56~+NK cells in peripheral blood as well as the number of bifidobacteria and lactobacillus in feces were significantly higher than those of control group.Conclusion:Dietary fiber in enteral nutrition can alleviate inflammatory reaction,improve immune response and correct intestinal mucosal barrier dysfunction in patients with severe acute pancreatitis.
Objective:To study the effects of dietary fiber in enteral nutrition on inflammatory reaction,immune response and intestinal mucosal barrier in patients with severe acute pancreatitis.Methods:The patients with severe acute pancreatitis treated in our hospital between February 2015 and February 2018 were selected and randomly divided into two groups.The observation group received basic treatment combined with enteral nutrition containing dietary fiber,and the control group received basic treatment combined with conventional enteral nutrition.The contents of inflammatory cytokines and intestinal mucosal barrier markers in serum,the number of immune cells in peripheral blood as well as the number of intestinal flora in feces were measured respectively before treatment and 7days after treatment.Results:Interleukin-8(IL-8),monocyte chemoattractant protein(MCP-1),soluble intercellular adhesion molecule-1(sICAM-1),soluble triggering receptor expressed on myeloid cells-1(sTREM1),endotoxin,D-lactic acid and diamine oxidase(DAO)contents in serum,the number of CD8~+T cells in peripheral blood as well as the number of enterococcus and enterobacterium in feces of both groups were significantly lower while the number of CD3~+T cells,CD4~+T cells,CD19~+B cells and CD16~+CD56~+NK cells in peripheral blood as well as the number of bifidobacteria and lactobacillus in feces were significantly higher after treatment,and IL-8,MCP-1,sICAM-1,sTREM1,endotoxin,D-lactic acid and DAO contents in serum,the number of CD8~+T cells in peripheral blood as well as the number of enterococcus and enterobacterium in feces of observation group after treatment were significantly lower than those of control group while the number of CD3~+T cells,CD4~+T cells,CD19~+B cells and CD16~+CD56~+NK cells in peripheral blood as well as the number of bifidobacteria and lactobacillus in feces were significantly higher than those of control group.Conclusion:Dietary fiber in enteral nutrition can alleviate inflammatory reaction,improve immune response and correct intestinal mucosal barrier dysfunction in patients with severe acute pancreatitis.
引文
1 Grover AS,Kadiyala V,Banks PA,et al.The utility of the systemic inflammatory respsonse syndrome score on admission in children with acute pancreatitis[J].Pancreas,2017,46(1):106-109.
2 Portelli M,Jones CD.Severe acute pancreatitis:pathogenesis,diagnosis and surgical management[J].Hepatobiliary Pancreat Dis Int,2017,16(2):155-159.
3何丛,祝荫,吕农华.肠道菌群失衡对急性胰腺炎发生发展的影响及意义[J].中华胰腺病杂志,2018,18(1):5-7.
4刘一丹,杜梅,王跃生,等.重症急性胰腺炎早期肠内营养与肠外营养联合的临床疗效分析[J].微量元素与健康研究,2018,35(2):21-22.
5中华医学会消化病学分会胰腺疾病学组,中华胰腺病杂志编辑委员会中华消化杂志编辑委员会.中国急性胰腺炎诊治指南(2013年)[J].中华消化杂志,2013,33(4):217-222.
6陈晓,王鹏,张静,等.肠内营养支持治疗对重症急性胰腺炎合并肠源性感染患者免疫功能和炎症指标的影响研究[J].中华医院感染学杂志,2018,28(5):722-725.
7张利东,武华.复合膳食纤维对大鼠急性胰腺炎时肠粘膜屏障的保护研究[J].中国卫生产业,2014,9:22-23,26.
8 Han X,Wang Y,Chen H,et al.Enhancement of ICAM-1via the JAK2/STAT3signaling pathway in a rat model of severe acute pancreatitis-associated lung injury[J].Exp Ther Med,2016,11(3):788-796.
9 Yang YZ,Xiang Y,Chen M,et al.Clinical significance of dynamic detection for serum levels of MCP-1,TNF-αand IL-8in patients with acute pancreatitis[J].Asian Pac J Trop Med,2016,9(11):1111-1114.
10张国平,汪东树,张从雨,等.血清TREM-1和CA-125对早期急性胰腺炎严重程度的评估价值[J].安徽医学,2017,38(8):990-993.
11黄玺,吕德超,叶宁,等.T淋巴细胞亚群和C反应蛋白对急性胰腺炎严重程度与预后的早期预测价值[J].中国临床保健杂志,2016,19(6):605-607.
12桂海波,杜晓刚,陈雪梅.淋巴细胞亚群在急性胰腺炎患者中的变化及意义[J].中国急救医学,2016,36(8):686-691.
13 Liu Y,Wang L,Cai Z,et al.The decrease of peripheral blood CD4+T cells indicates abdominal compartment syndrome in severe acute pancreatitis[J].PLoS One,2015,10(8):e0135768.
14刘吟,沈佳庆.CD3-CD16+CD56+NK细胞水平变化在急性胰腺炎严重程度预测中的作用[J].胃肠病学和肝病学杂志,2017,26(1):93-95.
15黄志寅,唐承薇.肠道微生态与急性胰腺炎[J].临床内科杂志,2016,33(10):659-661.
16廖应英,孙泽群,陈俊,等.急性重症胰腺炎患者早期肠黏膜屏障功能与T细胞亚群的相关性分析[J].临床消化病杂志,2017,29(5):267-270.
17 Hamada S,Masamune A,Nabeshima T,et al.Differences in gut microbiota profiles between autoimmune pancreatitis and chronic pancreatitis[J].Tohoku J Exp Med,2018,244(2):113-117.
18 Memba R,Duggan SN,Ni Chonchubhair HM,et al.The potential role of gut microbiota in pancreatic disease:A systematic review[J].Pancreatology,2017,17(6):867-874.
2 Portelli M,Jones CD.Severe acute pancreatitis:pathogenesis,diagnosis and surgical management[J].Hepatobiliary Pancreat Dis Int,2017,16(2):155-159.
3何丛,祝荫,吕农华.肠道菌群失衡对急性胰腺炎发生发展的影响及意义[J].中华胰腺病杂志,2018,18(1):5-7.
4刘一丹,杜梅,王跃生,等.重症急性胰腺炎早期肠内营养与肠外营养联合的临床疗效分析[J].微量元素与健康研究,2018,35(2):21-22.
5中华医学会消化病学分会胰腺疾病学组,中华胰腺病杂志编辑委员会中华消化杂志编辑委员会.中国急性胰腺炎诊治指南(2013年)[J].中华消化杂志,2013,33(4):217-222.
6陈晓,王鹏,张静,等.肠内营养支持治疗对重症急性胰腺炎合并肠源性感染患者免疫功能和炎症指标的影响研究[J].中华医院感染学杂志,2018,28(5):722-725.
7张利东,武华.复合膳食纤维对大鼠急性胰腺炎时肠粘膜屏障的保护研究[J].中国卫生产业,2014,9:22-23,26.
8 Han X,Wang Y,Chen H,et al.Enhancement of ICAM-1via the JAK2/STAT3signaling pathway in a rat model of severe acute pancreatitis-associated lung injury[J].Exp Ther Med,2016,11(3):788-796.
9 Yang YZ,Xiang Y,Chen M,et al.Clinical significance of dynamic detection for serum levels of MCP-1,TNF-αand IL-8in patients with acute pancreatitis[J].Asian Pac J Trop Med,2016,9(11):1111-1114.
10张国平,汪东树,张从雨,等.血清TREM-1和CA-125对早期急性胰腺炎严重程度的评估价值[J].安徽医学,2017,38(8):990-993.
11黄玺,吕德超,叶宁,等.T淋巴细胞亚群和C反应蛋白对急性胰腺炎严重程度与预后的早期预测价值[J].中国临床保健杂志,2016,19(6):605-607.
12桂海波,杜晓刚,陈雪梅.淋巴细胞亚群在急性胰腺炎患者中的变化及意义[J].中国急救医学,2016,36(8):686-691.
13 Liu Y,Wang L,Cai Z,et al.The decrease of peripheral blood CD4+T cells indicates abdominal compartment syndrome in severe acute pancreatitis[J].PLoS One,2015,10(8):e0135768.
14刘吟,沈佳庆.CD3-CD16+CD56+NK细胞水平变化在急性胰腺炎严重程度预测中的作用[J].胃肠病学和肝病学杂志,2017,26(1):93-95.
15黄志寅,唐承薇.肠道微生态与急性胰腺炎[J].临床内科杂志,2016,33(10):659-661.
16廖应英,孙泽群,陈俊,等.急性重症胰腺炎患者早期肠黏膜屏障功能与T细胞亚群的相关性分析[J].临床消化病杂志,2017,29(5):267-270.
17 Hamada S,Masamune A,Nabeshima T,et al.Differences in gut microbiota profiles between autoimmune pancreatitis and chronic pancreatitis[J].Tohoku J Exp Med,2018,244(2):113-117.
18 Memba R,Duggan SN,Ni Chonchubhair HM,et al.The potential role of gut microbiota in pancreatic disease:A systematic review[J].Pancreatology,2017,17(6):867-874.