早期肠内营养+丙氨酰谷胺酰胺对SAP患者肠道菌群、炎症及氧化反应的影响

摘要

目的:探讨早期肠内营养(EEN)+丙氨酰谷胺酰胺对重症急性胰腺炎(SAP)患者肠道菌群、炎症及氧化反应的影响.方法:收集2013年2月~2017年7月间在本院接受治疗的SA P患者90例,根据营养方式不同分为常规 EEN 组、强化 EEN 组,各45例.常规EEN 组接受早期 EEN 干预,强化EEN组在早期EEN基础上加入丙氨酰谷胺酰胺干预.对比两组干预前后肠道排泄物中菌群分布,血清中炎症因子及氧化应激指标含量的差异.结果:干预前,两组患者肠道排泄物中菌群分布,血清中炎症因子及氧化应激指标含量的差异无统计学意义(P>0.05).干预后,强化EEN组肠道排泄物中双歧杆菌、乳酸杆菌计数高于常规EEN组,肠球菌、大肠杆菌计数低于常规EEN组(P<0.05);血清中炎症因子IL-1β、IL-17、IL-23的含量低于常规EEN组(P<0.05);血清中氧化应激指标M PO、XO的含量低于常规EEN组(P<0.05),SOD、CAT的含量高于常规EEN组(P<0.05).结论:SAP患者接受EEN联合丙氨酰谷胺酰胺治疗,可有效均衡肠道菌群并抑制全身炎症及氧化应激反应.%Objective:To investigate the effects of early enteral nutrition + alanyl-glutamine on intestinal flora,inflam-mation and oxidative response in patients with severe acute pancreatitis(SAP).Methods:90 patients with SAP who were trea-ted in the hospital between February 2013 and July 2017 were divided into normal EEN group and enhanced EEN group accord-ing to different nutritional modes.Normal EEN group received early EEN intervention,and enhanced EEN group received ala-nyl-glutamine intervention based on early EEN.The differences in the flora distribution in intestinal excreta as well as the con-tents of inflammatory factors and oxidative stress indexes in serum were compared between the two groups.Results:Before in-tervention,the differences in the flora distribution in intestinal excreta as well as the contents of inflammatory factors and oxi-dative stress indexes in serum were not statistically significant between the two groups of patients.After intervention,the bifidobacterium and lactobacillus count in intestinal excreta of enhanced EEN group were higher than those of normal EEN group whereas the enterococcus and escherichia coli count were lower than those of normal EEN group;serum inflammatory cytokines IL-1β,IL-17 and IL-23 contents were lower than those of normal EEN group;serum oxidative stress indexes MPO and XO contents were lower than those of normal EEN group while SOD and CAT contents were higher than those of normal EEN group.Conclusion:EEN combined with alanyl-glutamine therapy can effectively balance the intestinal flora and inhibit the systemic inflammatory response and oxidative stress response in patients with SAP.