早期肠内营养联合锦红汤对重症急性胰腺炎患者肠黏膜屏障的影响

摘要

目的:探讨早期肠内营养联合锦红汤对重症急性胰腺炎(SAP)患者血浆中炎性介质的影响.方法:选取66例SAP患者,随机分为肠外营养(PN)组、肠内营养(EN)组、锦红汤合EN组各22例.分别测定治疗前及治疗后3 d和8 d的血浆炎症介质TNF-α、IL-6、降钙素原、C-反应蛋白、D-乳酸和血浆淀粉酶与脂肪酶的水平.结果:3组治疗后血浆各炎症介质及淀粉酶、脂肪酶均较治疗前明显改善(P<0.05);D乳酸水平较治疗前明显升高(P<0.05).EN组治疗后3 d及8 d血浆IL-6、TNF-α、降钙素原、C-反应蛋白、淀粉酶、脂肪酶分别为(68.85±15.99)ng/L、(29.11±9.15)ng/L、(2.88±2.27)ng/mL、(279.23±87.43)mg/L、(817±264)U/L、(1399±288)U/L和(41.97±11.11)ng/L、(12.37±8.01)ng/L、(1.86±1.05)ng/mL、(120.78±34.45)mg/L、(250±78)U/L、(305±91)U/L,均较PN组显著降低(P<0.05).锦红汤合EN组治疗后3 d、8 d血浆IL-6、TNF-a、降钙素原、C-反应蛋白、淀粉酶、脂肪酶分别为(59.42±12.62)ng/L、(26.21±9.74)ng/L、(2.01±1.87)ng/mL、(246.32±70.74)mg/L、(621±204)U/L、(1266±223)U/L和(29.11±9.11)ng/L、(10.91±6.91)ng/L、(0.98±0.75)ng/mL、(109.34±27.58)mg/L、(196±59)U/L、(216±74)U/L,亦均较PN组和EN组显著降低(P<0.05);D-乳酸治疗后3 d 3组水平无明显差异(P>0.05),治疗后8 d,EN组为(12.20±2.47)mg/L较PN组明显降低,锦红汤合EN组为(10.01±2.36)mg/L较EN组明显降低(P<0.05).结论:早期肠内营养联合锦红汤能降低SAP患者血浆中炎性介质的水平,改善肠黏膜屏障,促进患者康复.%Objective To investigate the effect of intestinal mucosal barrier in the early enteral nutrition (EN) supplemented with Jinhong decoction in patients with severe acute pancreatitis (SAP). Methods Sixty-six SAP cases were randomly assigned into parenteral nutrition (PN) group , enteral nutrition(EN) group and Jin-hong decoction added EN(J+EN) group. In J+EN group, patients were given the nutrition same as that of EN, but added by Jinhong decoction .Blood samples were collected for the measurements of interleukin-6(IL-6)and tu-mor necrosis factor(TNF-α)by enzyme linked immunosorbent assay, and for C-reactive protein(CRP), procalcito-nin(PCT), amylase and lipase by biochemical assay the day before intervention of nutrition and on the 3rd and 8th days after intervention. Results The plasma levels of inflammatory mediators, amylase and lipase were sig-nificantly reduced after nutritional intervention as compared with their levels on the day before intervention in all three groups. The plasma levels of IL-6, TNF-α, CRP, PCT, amylase and lipase in EN group were(68.85± 15.99)ng/L、(29.11±9.15)ng/L、(2.88±2.27)ng/mL、(279.23±87.43)mg/L、(817±264)U/L、(1399±288)U/L at the third day after treatment, and (41.97 ± 11.11) ng/L、(12.37 ± 8.01) ng/L、(1.86 ± 1.05) ng/mL、(120.78 ± 34.45)mg/L、(250±78)U/L、(305±91)U/L at the eighty day after treatment, respectively. They were significant-ly less than those in PN group on the 3rd and 8th days. The plasma levels of IL-6, TNF-α, CRP, PCT, amylase(621 ± 204) U/L、(1266 ± 223) U/L, and (29.11 ± 9.11) ng/L、(10.91 ± 6.91) ng/L、(0.98 ± 0.75) ng/mL、(109.34 ± 27.58) mg/L、(196±59) U/L、(216±74) U/L at the eight day. They were significantly less than those in PN group and EN group. The levels of D-lactic acid in three groups had no significant difference at the 3rd day after treatment. The D-lactic acid level in EN group at the 8th day was(12.20±2.47) mg/L, less than that in J+EN group(10.01± 2.36) mg/L. Conclusion Early EN with Jinhong decoction would result in significant lowering levels of pro-in-flammatory cytokines and improve intestinal mucosal barrier, promote the recovery of SAP patients.