早期急性重症胰腺炎患者免疫抑制及免疫失衡与肠黏膜屏障功能障碍的相关性

摘要

目的:研究早期急性重症胰腺炎患者免疫抑制及免疫失衡与肠黏膜屏障功能障碍的相关性.方法:选择2012年1月至2016年2月在陕西省渭南市中心医院诊治的早期急性重症胰腺炎患者130例,分别于入院后第1、第7、第14天检测患者尿中乳果糖与甘露醇比值、血浆内毒素、D-乳酸水平、Th 1/Th2细胞比例和人类白细胞抗原DR(HLA-DR)表达水平.结果:第7天的乳果糖与甘露醇比值、内毒素、D-乳酸和HLA-DR水平均明显低于第1天,高于第14天(均P＜0.05);第7天的Th1/Th2细胞比例明显降低,第14天明显升高(P＜0.05).乳果糖与甘露醇比值、内毒素和D-乳酸水平与HLA-DR均呈正相关关系(r =0.786、0.685、0.813,均P=0.000),与Th1/Th2细胞比例均呈负相关关系(r=-0.823、-0.796、0.682,均P=0.000).结论:早期急性重症胰腺炎患者存在免疫抑制和免疫失衡,并与肠黏膜屏障功能障碍之间具有相关性,早期对急性重症胰腺炎患者的肠黏膜屏障功能进行保护,有利于疾病的治疗.%Objective:To investigate the relationship between immune suppression,immune imbalance and intestinal mucosal barrier dysfunction in patients with early severe acute pancreatitis (ESAP).Methods:130 cases of patients with ESAP who were treated in our hospital from January 2012 to February 2016 were selected.The ratio of fructose to mannitol,plasma endotoxin,D-lactate,Thl/Th2,and human leucocyte antigen DR (HLA-DR) expression were detected on day 1,7 and 14.Results:The lactulose and mannitol ratio,endotoxin and D-lactic acid on day 7 were significantly lower than those on day 1,but higher than those on day 14 (P＜0.05);the level of Thl/Th2 on day 7 was significantly decreased,but on day 14 was increased significantly (P＜ 0.05);the level of HLA-DR on day 7 was significantly lower,but higher than those on day 14(P＜0.05);the ratio of lactulose and mannitol was positively correlated with HLA-DR (r=0.786,P=0.000),and was negatively correlated with Th1/Th2 (r=-0.823,P=0.000).Endotoxin was positively correlated with HLA-DR(r=0.685,P=0.000) and negatively correlated with Thl/Th2 (r=-0.796,P=0.000).D-lactic acid was positively correlated with HLA-DR (r=0.813,P=0.000) and negatively correlated with Th1/Th2 (r=-0.682,P=0.000).Conclusion:Immune suppression and immune imbalance existed in patients with ESAP,and were associated with intestinal mucosal barrier dysfunction.Early protection on intestinal mucosal barrier function of ESAP patients was helpful for the treatment.