Effect of enteral nutrition and ecoimmunonutrition on bacterial translocation and cytokine production in patients with severe acute pancreatitis
Effect of enteral nutrition and ecoimmunonutrition on bacterial translocation and cytokine production in patients with severe acute pancreatitis
复制标题
肠内营养和生态免疫营养对重症急性胰腺炎患者细菌移位和细胞因子产生的影响
DOI：
10.1016/j.jss.2012.12.010
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发表时间：
2013-08-01
影响因子：
2.2
通讯作者：
Xiao, Xianzhong
中科院分区：
文献类型：
--
作者：
Wang, Guiliang;Wen, Jianbo;Xiao, Xianzhong
背景资料：重症急性胰腺炎（SAP）常伴有多器官功能衰竭、坏死、脓肿和胰腺假性囊肿形成等严重并发症，尽管加强治疗，仍有很高的死亡率。肠外营养（PN）、肠内营养（EN）和生态免疫营养（EIN）可促进SAP患者的恢复，刺激胃肠动力，减轻全身炎症反应综合征的程度。本研究旨在探讨肠内营养（EN）和EIN对SAP患者细菌移位和细胞因子产生的影响。方法：将183例SAP患者随机分为PN组、EN组和EN + EIN组。急性生理学和慢性健康评估II评分，并发症（全身炎症反应综合征、多器官衰竭和感染）、粪便肠道细菌菌株和内毒素、肿瘤坏死因子α的血浆浓度结果：EN组胰腺脓毒症、多器官功能障碍综合征和死亡率显著低于PN组，EN + EIN组进一步低于PN组。EN组血浆TNF-α、IL-6浓度及APACHE II评分均显著降低，EN + EIN组进一步降低。结论：EN可降低SAP患者血浆中内毒素、TNF-α、IL-6的表达，促进细菌移位，增强IL-10的表达，对SAP具有治疗作用，EIN联合EN治疗效果优于单纯EN治疗。(c)2013年由Elsevier Inc.出版
Background: Severe acute pancreatitis (SAP) with severe complications such as multiple organ failure, necrosis, abscess, and formation of pancreatic pseudocysts often gives rise to a high mortality despite intensive treatment. Parenteral nutrition (PN), elemental enteral nutrition, and ecoimmunonutrition (EIN) hastened the recovery of SAP patients, stimulated gastrointestinal motility, and alleviated the degree of systemic inflammatory response syndrome. This study aimed to examine the effects of enteral nutrition (EN) and EIN on bacterial translocation and cytokine production in patients with SAP.Methods: One hundred eighty-three SAP patients were randomly divided into three groups receiving PN, EN, or EN + EIN. Acute Physiology and Chronic Health Evaluation II scores, complications (systemic inflammatory response syndrome, multiorgan failure, and infections), intestinal bacterial strains of stool, and plasma concentrations of endotoxin, tumor necrosis factor alpha (TNF-alpha), and interleukin (IL) 6 and IL-10 were evaluated.Results: The percentage of pancreatic sepsis, multiple organ dysfunction syndrome, and mortality was significantly lower in the EN group and was further lower in the EN + EIN group than that in the PN group. The plasma concentrations of TNF-alpha and IL-6 and APACHE II scores were significantly decreased in the EN group and were further lowered in the EN + EIN group than those in the PN group. The plasma concentration of IL-10 was higher in the EN group and was further increased in the EN + EIN group than that in the PN group.Conclusions: EN plays effective roles in the treatment of SAP by decreasing the expression of endotoxin, TNF-alpha, and IL-6 and the bacterial translocation, enhancing the expression of IL-10, and the combination of EIN with EN results in more therapeutic benefits than EN alone. (c) 2013 Published by Elsevier Inc.