Early gut mucosal dysfunction in patients with acute pancreatitis
Early gut mucosal dysfunction in patients with acute pancreatitis
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DOI：
10.1097/mpa.0b013e31815a399f
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发表时间：
2008-03-01
期刊：
影响因子：
2.9
通讯作者：
Yu, Wenkui
中科院分区：
文献类型：
--
作者：
Liu, Haiyan;Li, Weiqin;Yu, Wenkui
目的：探讨急性胰腺炎(AP)患者肠粘膜损害与内毒素血症、全身炎症反应、病情严重程度、败血症并发症及预后的关系。方法：将AP患者按严重程度分为3组：1级(26例，轻度)、2级(18例，无器官功能障碍的重症AP)和3级(18例，合并器官功能障碍)。20名健康志愿者作为对照组。结果：AP患者肠内乳果糖和甘露醇吸收率升高(1级：0.044+/-0.017，2级：0.39+/-0.16，3级：0.48+/-0.22，对照组：0.024+/-0.009；P<；对照组与AP，P<；0.01，P<；轻度与重度组P<；0.01)。D-木糖吸收减少在胰腺炎组(P<；0.01)，尤其是在重症组(P<；0.01，轻度和SAP之间)。我们还观察到粘膜通透性与内毒素(r=0.902，P<；0.001)和肿瘤坏死因子α变化(r=0.862，P<；0.001)显著正相关。结论：AP患者早期肠黏膜功能受损，尤其是合并器官功能障碍的患者，肠粘膜功能受损可能是AP患者发生多器官功能障碍的原因之一，与AP患者的不良预后密切相关。
Objectives: A clinical study was made to test the hypothesis that gut mucosal damage happens and correlates with endotoxemia, systemic inflammation, severity of disease, septic complication, and outcome in acute pancreatitis (AP) patients.Methods: Patients were divided into 3 groups according to severity: grade 1 (n = 26, mild), grade 2 ( n = 18, severe AP [ SAP] without organ dysfunction), and grade 3 ( n = 18, SAP with organ dysfunction). Twenty healthy volunteers were enrolled as control group. The intestinal lactulose and mannitol absorption ratio, D-xylose absorption, endotoxin, and tumor necrosis factor alpha were detected in parallel to clinical data collection.Results: Lactulose and mannitol absorption ratio increased in patients with AP, and the increase was more pronounced in SAP (grade 1: 0.044 +/- 0.017, grade 2: 0.39 +/- 0.16, grade 3: 0.48 +/- 0.22, control: 0.024 +/- 0.009; P < 0.01 between control and AP, P < 0.01 between mild and severe group). D-Xylose absorption decreased in pancreatitis groups (P < 0.01) especially in severe groups (P < 0.01 between mild and SAP). We also observed a significant positive correlation of mucosal permeability with endotoxin (r = 0.902, P < 0.001) and tumor necrosis factor alpha changes (r = 0.862, P < 0.001). The severity and septic complication in AP patients were different accompanied with severity of gut mucosal damage.Conclusions: Intestinal mucosal function is injured in early phase of AP especially in patients with organ dysfunction, which may be a stimulus for development of multiple organ dysfunction and correlate with bad outcome in AP patients.