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 7 days 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.

R576

上海市科委(201840080)