早期腸內(nèi)營養(yǎng)不同時(shí)段對(duì)重癥急性胰腺炎鼠腸粘膜屏障功能的影響及機(jī)制研究
發(fā)布時(shí)間：2019-07-04 14:45
【摘要】：目的： 本課題采用大鼠模型通過不同時(shí)段啟動(dòng)早期腸內(nèi)營養(yǎng)（EEN），研究重癥急性胰腺炎（SAP）時(shí)對(duì)腸粘膜屏障（IMB）結(jié)構(gòu)和功能的影響機(jī)制和探討其保護(hù)措施，為臨床治療提供多方面的理論基礎(chǔ)及實(shí)驗(yàn)基礎(chǔ)。 方法： 選取75只健康雄性SD大鼠隨機(jī)分3大組：實(shí)驗(yàn)組（EN組/SAP+EN），n=45只）（EN1、EN2、EN3組分別為3個(gè)啟動(dòng)時(shí)機(jī)，各15只），對(duì)照組（TPN組/SAP+TPN）（n=15只），空白組（S組/假手術(shù)組）（n=15只）。各組均行空腸置管造瘺，頸部靜脈置管。假手術(shù)組中僅翻動(dòng)內(nèi)臟，實(shí)驗(yàn)組、對(duì)照組采用胰膽管逆行注射3.5%�；悄懰徕c溶液建立重癥急性胰腺炎模型。造模成功后用對(duì)照組行全腸外營養(yǎng)（TPN）治療，實(shí)驗(yàn)組分EN1、EN2、EN3組（n=15只），分別在SAP造模后第1、2、4天三個(gè)時(shí)間行腸內(nèi)營養(yǎng)；觀察各自對(duì)SAP大鼠腸粘膜屏障的保護(hù)作用并進(jìn)行比較，于三個(gè)實(shí)驗(yàn)節(jié)點(diǎn)后的1天，即第2、3、5天，各組分別處死大鼠5只，心臟采血測(cè)白細(xì)胞計(jì)數(shù)（WBC）和淀粉酶（AMS），ELISA法檢測(cè)血清內(nèi)毒素（ET）、腫瘤壞死因子-α（TNF-α）、白細(xì)胞介素-2（IL-2）、白細(xì)胞介素-10（IL-10），取胰腺及空腸粘膜切片染色作病理組織學(xué)檢查。 結(jié)果： 1.一般情況： 空白組的大鼠術(shù)后反應(yīng)良好，各時(shí)間點(diǎn)無明顯區(qū)別；實(shí)驗(yàn)組大鼠較對(duì)照組明顯好轉(zhuǎn)，但較空白組大鼠差。 2.血液學(xué)指標(biāo)： 空白組血清淀粉酶水平較低，各時(shí)間點(diǎn)無明顯變化；實(shí)驗(yàn)組（EN）各時(shí)間段與對(duì)照組（TPN）之間水平比較，血淀粉酶、血常規(guī)值隨時(shí)間變化，各指標(biāo)變化趨勢(shì)一致，總體上AMS、WBC等均呈下降趨勢(shì)并逐漸恢復(fù)正常；在各時(shí)間點(diǎn)前，EN組與TPN組之間差異無統(tǒng)計(jì)學(xué)意義，但均顯著高于S組；在各時(shí)間點(diǎn)后，實(shí)驗(yàn)組（EN）各時(shí)間段均明顯低于對(duì)照組（TPN）；EN組間比較，各組AMY、WBC水平隨時(shí)間逐漸降低，EN1組明顯低于EN2組、EN3組。 3.血清ET、TNF-α、IL-2、IL-10變化： 各組變化顯示：空白組血清水平明顯低于實(shí)驗(yàn)組和對(duì)照組，實(shí)驗(yàn)組和對(duì)照組之間無差異；TPN、EN組前1天無明顯差別，，第3天的空白組的ET、TNF-α、IL-2、IL-10水平明顯低于其它各組，EN組較TPN組治療后降低。EN組第2天后開始下降，與腸外營養(yǎng)組相比有顯著差異。EN1、EN2組較EN3組有顯著差異。 4.胰腺、空腸組織學(xué)觀察： TPN、EN組各時(shí)間點(diǎn)的胰腺組織學(xué)評(píng)分均明顯高于S組；EN組的胰腺組織學(xué)評(píng)分低于相應(yīng)時(shí)間點(diǎn)TPN組；EN3組的評(píng)分高于EN1、EN2組。第3天、第5天EN1組、EN2組的空腸病理評(píng)分明顯低于EN3和其他組。 結(jié)論： 1.EEN在大鼠SAP基本穩(wěn)定后，越早啟動(dòng)對(duì)腸粘膜屏障功能越有利。 2.EEN可以減輕局部組織損傷，降低炎癥反應(yīng)程度，防止腸道菌群移位，有利于保護(hù)腸粘膜屏障結(jié)構(gòu)及功能。
[Abstract]:Purpose: The effects of early enteral nutrition (EEN) on the structure and function of intestinal mucosa barrier (IMB) in severe acute pancreatitis (SAP) and its protective measures were studied by using rat model to study the effect of early enteral nutrition (EEN) on the structure and function of intestinal mucosa barrier (IMB) in severe acute pancreatitis (SAP). To provide a variety of theoretical basis and experimental basis for clinical treatment No, no, no. Methods:75 healthy male SD rats were randomly divided into 3 groups: experimental group (EN group/ SAP + EN), n = 45) (EN1, EN2, EN3 group,3 start-up time,15 only), control group (TPN group/ SAP + TPN) (n = 15), blank group (S group/ sham operation group) (n = 15). The jejunum placing tube, neck and neck of each group In the sham operation group, only the internal organs, the experimental group and the control group were used for the retrograde injection of 3.5% taurocholate sodium solution in the pancreatic bile duct to establish the severe acute pancreatitis. The rats were treated with total parenteral nutrition (TPN) in the control group, and the experimental components EN1, EN2 and EN3 (n = 15) were divided into three groups:1,2 and 4 days after the injection of the SAP, and the protection of the intestinal mucosa barrier in the SAP rats was observed. The serum endotoxin (ET), tumor necrosis factor-1 (TNF-1) and interleukin-2 (IL-2) were detected by ELISA. IL-2, interleukin-10 (IL-10), and biopsy of the pancreas and the jejunum. Histology Check. Results 1. General situation: The rats in the blank group had good response after operation and there was no significant difference between the time points, and the experimental group was more obvious than the control group. Improved, but smaller group 2. Hematology index: the serum amylase level in the blank group was low and there was no significant change in each time point; the level of serum amylase and blood routine value of the experimental group (EN) and the control group (TPN) were relatively low, and the blood amylase and blood routine value varied with time. The change trend of the indexes was consistent, and the overall AMS, WBC, and the like showed a downward trend and gradually returned to normal; the difference between the EN group and the TPN group was not statistically significant before each time point, but was significantly higher than that of the S group; after each time point, each time period of the experimental group (EN) was significantly lower than that of the control group (TP N); compared between the EN groups, the levels of AMY and WBC in each group were gradually decreased with time, EN 1 group was significantly lower than that of EN2 group and EN3 group.3. Serum ET, T Changes in NF-1, IL-2, and IL-10: The level of serum in the blank group was significantly lower than that of the experimental group and the control group. There was no difference between the experimental group and the control group, and there was no significant difference in the first day of the TPN and EN group, and the third The level of ET, TNF-1, IL-2 and IL-10 in the blank group of the day was significantly lower. In other groups, the EN group was reduced after treatment with the TPN group. EN group, day 2 There was a significant difference in the start-up, compared to the parenteral nutrition group. EN1, EN2 and EN3 There was a significant difference in the group.4. The histological observation of the pancreas and jejunum: the histological score of the pancreas in the time points of the TPN and EN groups was significantly higher than that of the S group; the histological grade of the pancreas in the EN group was lower than that of the corresponding time Point TPN group; EN3 group score was higher than EN1, EN2 group. Day 3, Day 5 EN1 group ,EN The pathological scores of jejunum in group 2 were significantly lower than that of EN3 and other groups. Conclusion:1. EEN After the basic stabilization of SAP in rats, the better the early start-up of the intestinal mucosa barrier function.
【學(xué)位授予單位】：南華大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R657.51
本文編號(hào)：2509994
[Abstract]:Purpose: The effects of early enteral nutrition (EEN) on the structure and function of intestinal mucosa barrier (IMB) in severe acute pancreatitis (SAP) and its protective measures were studied by using rat model to study the effect of early enteral nutrition (EEN) on the structure and function of intestinal mucosa barrier (IMB) in severe acute pancreatitis (SAP). To provide a variety of theoretical basis and experimental basis for clinical treatment No, no, no. Methods:75 healthy male SD rats were randomly divided into 3 groups: experimental group (EN group/ SAP + EN), n = 45) (EN1, EN2, EN3 group,3 start-up time,15 only), control group (TPN group/ SAP + TPN) (n = 15), blank group (S group/ sham operation group) (n = 15). The jejunum placing tube, neck and neck of each group In the sham operation group, only the internal organs, the experimental group and the control group were used for the retrograde injection of 3.5% taurocholate sodium solution in the pancreatic bile duct to establish the severe acute pancreatitis. The rats were treated with total parenteral nutrition (TPN) in the control group, and the experimental components EN1, EN2 and EN3 (n = 15) were divided into three groups:1,2 and 4 days after the injection of the SAP, and the protection of the intestinal mucosa barrier in the SAP rats was observed. The serum endotoxin (ET), tumor necrosis factor-1 (TNF-1) and interleukin-2 (IL-2) were detected by ELISA. IL-2, interleukin-10 (IL-10), and biopsy of the pancreas and the jejunum. Histology Check. Results 1. General situation: The rats in the blank group had good response after operation and there was no significant difference between the time points, and the experimental group was more obvious than the control group. Improved, but smaller group 2. Hematology index: the serum amylase level in the blank group was low and there was no significant change in each time point; the level of serum amylase and blood routine value of the experimental group (EN) and the control group (TPN) were relatively low, and the blood amylase and blood routine value varied with time. The change trend of the indexes was consistent, and the overall AMS, WBC, and the like showed a downward trend and gradually returned to normal; the difference between the EN group and the TPN group was not statistically significant before each time point, but was significantly higher than that of the S group; after each time point, each time period of the experimental group (EN) was significantly lower than that of the control group (TP N); compared between the EN groups, the levels of AMY and WBC in each group were gradually decreased with time, EN 1 group was significantly lower than that of EN2 group and EN3 group.3. Serum ET, T Changes in NF-1, IL-2, and IL-10: The level of serum in the blank group was significantly lower than that of the experimental group and the control group. There was no difference between the experimental group and the control group, and there was no significant difference in the first day of the TPN and EN group, and the third The level of ET, TNF-1, IL-2 and IL-10 in the blank group of the day was significantly lower. In other groups, the EN group was reduced after treatment with the TPN group. EN group, day 2 There was a significant difference in the start-up, compared to the parenteral nutrition group. EN1, EN2 and EN3 There was a significant difference in the group.4. The histological observation of the pancreas and jejunum: the histological score of the pancreas in the time points of the TPN and EN groups was significantly higher than that of the S group; the histological grade of the pancreas in the EN group was lower than that of the corresponding time Point TPN group; EN3 group score was higher than EN1, EN2 group. Day 3, Day 5 EN1 group ,EN The pathological scores of jejunum in group 2 were significantly lower than that of EN3 and other groups. Conclusion:1. EEN After the basic stabilization of SAP in rats, the better the early start-up of the intestinal mucosa barrier function.
【學(xué)位授予單位】：南華大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R657.51
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