Intestinal Barrier Dysfunction in a Randomized Trial of a Specific Probiotic Composition in Acute Pancreatitis
Intestinal Barrier Dysfunction in a Randomized Trial of a Specific Probiotic Composition in Acute Pancreatitis
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DOI：
10.1097/sla.0b013e3181bce5bd
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发表时间：
2009-11-01
影响因子：
9
通讯作者：
Gooszen, Hein G.
中科院分区：
文献类型：
--
作者：
Besselink, Marc G.;van Santvoort, Hjalmar C.;Gooszen, Hein G.
目的：确定肠屏障功能障碍、细菌移位和预测的重症急性胰腺炎患者的临床结局之间的关系以及益生菌对这些过程的影响。背景资料概要：关于益生菌预防的随机、安慰剂对照、多中心试验（p.641）预测的重症急性胰腺炎患者方法：肠脂肪酸结合蛋白排泄（IFABP，肠细胞损伤的参数），聚乙二醇的回收率（PEG，肠通透性参数）和一氧化氮排泄（NOx，细菌易位的参数）在益生菌或安慰剂治疗开始后24至48小时以及此后7天收集的141名患者的尿液中进行评估。发生菌血症（P = 0.03）、感染性坏死（P = 0.01）和器官衰竭（P = 0.008）的患者在最初72小时内IFABP浓度较高。发生菌血症（PEG 4000，P = 0.001）、器官衰竭（PEG 4000，P < 0.0001）或死亡（PEG 4000，P = 0.009）的患者的PEG恢复率较高。益生菌预防与IFABP增加相关（中位数362 vs 199 pg/mL; P = 0.02），在器官衰竭患者中最明显（P = 0.001），并且不影响肠道通透性。总的来说，益生菌减少氮氧化物（P = 0.05），但在器官衰竭的患者，增加氮氧化物（P = 0.001）。结论：菌血症，感染性坏死，器官衰竭，死亡率都与肠屏障功能障碍的早期急性胰腺炎的过程中。总的来说，用这种特定的益生菌菌株组合进行预防减少了细菌移位，但与器官衰竭患者的细菌移位和肠上皮细胞损伤增加相关。(Ann Surg 2009;250：712-719）
Objectives: To determine the relation between intestinal barrier dysfunction, bacterial translocation, and clinical outcome in patients with predicted severe acute pancreatitis and the influence of probiotics on these processes.Summary of Background data: Randomized, placebo-controlled, multi-center trial on probiotic prophylaxis (Ecologic 641) in patients with predicted severe acute pancreatitis (PROPATRIA).Methods: Excretion of intestinal fatty acid binding protein (IFABP, a parameter for enterocyte damage), recovery of polyethylene glycols (PEGs, a parameter for intestinal permeability), and excretion of nitric oxide (NOx, a parameter for bacterial translocation) were assessed in urine of 141 patients collected 24 to 48 h after start of probiotic or placebo treatment and 7 days thereafter.Results: IFABP concentrations in the first 72 hours were higher in patients who developed bacteremia (P = 0.03), infected necrosis (P = 0.01), and organ failure (P = 0.008). PEG recovery was higher in patients who developed bacteremia (PEG 4000, P = 0.001), organ failure (PEG 4000, P < 0.0001), or died (PEG 4000, P = 0.009). Probiotic prophylaxis was associated with an increase in IFABP (median 362 vs. 199 pg/mL; P = 0.02), most evidently in patients with organ failure (P = 0.001), and did not influence intestinal permeability. Overall, probiotics decreased NOx (P = 0.05) but, in patients with organ failure, increased NOx (P = 0.001).Conclusions: Bacteremia, infected necrosis, organ failure, and mortality were all associated with intestinal barrier dysfunction early in the course of acute pancreatitis. Overall, prophylaxis with this specific combination of probiotic strains reduced bacterial translocation, but was associated with increased bacterial translocation and enterocyte damage in patients with organ failure. (Ann Surg 2009;250: 712-719)