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目的研究早期肠道营养对烧伤大鼠肠粘膜损伤和修复的影响及其可能的机制.方法采用30%体表面积Ⅲ度烧伤大鼠模型,随机分成伤前对照(C),静脉营养(PN)及肠道营养(EN)组,EN 和 PN 组给予等氮、等热卡、等体积的营养液.在此基础上动态观察了肠组织中肠三叶因子(ITF)含量、血浆二氨氧化酶(DAO)活性、肠粘膜跨膜电位差(PD)及增殖细胞核抗原(PCNA)的变化,并进行相关分析.结果烧伤后肠粘膜组织结构受损,血浆 DAO 活性明显增高,从伤前的0.32±0.02(10~3U·L~(-1))增为1.23±0.53(10~3U·L~(-1)),相差显著(P<0.01).而 PD,PCNA 值及 ITF 含量分别从伤前的13.53±0.41(mV),823.46±240.56(A),369±65(ng·g~(-1))降至伤后的5.27±0.17(mV),247.39±112.23(A)和15±4(ng·g~(-1)),相差显著(P<0.05～0.01).两组相比EN 组大鼠肠道受损程度明显低于 PN 组,同时其 ITF 含量、PD,PCNA 值均高于 PN 组[EN组分别为129±46(ng·g~(-1)),6.02±0.17(mV)和612.66±188,27(A)而 PN 组分别为15±4(ng·g~(-1)),5.27±0.17(mV)和247.39±112.23(A)];而 EN 组大鼠血浆 DAO 活性为0.61±0.14(10~3U·L~(-1))显著低于 PN 组的0.90±0.16(10~3U·L~(-1))(P<0.01).相关分析显示,ITF 含量同血浆 DAO 活性呈显著负相关(r_1=-0.964,P<0.01),而同 PCNA 及 PD 值呈显著正相关(r_2=0.884,P<0.05;r_3=0.983.P<0.01).结论严重烧伤后肠粘膜结构受损与肠道合成和分泌 ITF 的能力大幅下降有关,肠道营养可降低伤后 ITF 下降的幅度可能是其在减轻肠粘膜损伤,促进肠粘膜修复方面优于静脉营养的重要原因.
Objective To study the effect of early enteral nutrition on intestinal mucosa injury and repair in burned rats and its possible mechanism.Methods 30% body surface area of third degree burn rat model was randomly divided into pre-injury control (C), parenteral nutrition (PN) And enteral nutrition (EN) group, EN and PN group were given equal volume of nitrogen, heat card, and other nutrients on the basis of dynamic observation of the intestine intestinal trefoil factor (ITF) content, plasma diammine (DAO) activity, intestinal mucosal transmembrane potential difference (PD) and proliferating cell nuclear antigen (PCNA) were analyzed and analyzed.Results The histological changes of intestinal mucosa were impaired and the plasma DAO activity was significantly increased from the pre-injury 0.32 ± 0.02 (10 ~ 3U · L -1) increased to 1.23 ± 0.53 (10 ~ 3U · L -1), the difference was significant (P <0.01), while the values of PD, PCNA and ITF were (A) and (B) decreased from 13.53 ± 0.41 (mV), 823.46 ± 240.56 (A) and 369 ± 65 (ng · g -1) before injury to 5.27 ± 0.17 (mV) and 247.39 ± 112.23 15 ± 4 (ng · g -1), the difference was significant (P <0.05 ~ 0.01) .Compared with PN group, the intestinal damage of EN group was significantly lower than that of PN group PCNA values were higher than those in PN group [129 ± 46 (ng · g -1), 6.02 ± 0.17 (mV) and 612.66 ± 188.27 (A) and PN group were 15 ± 4 (ng · g -1), 5.27 ± 0.17 (mV) and 247.39 ± 112.23 Was 0.61 ± 0.14 (10 ~ 3U · L -1), which was significantly lower than that of the PN group (0.90 ± 0.16 10 ~ 3U · L -1) (P <0.01) .The correlation analysis showed that the content of ITF was Plasma DAO activity was significantly negatively correlated (r_1 = -0.964, P <0.01), but positively correlated with PCNA and PD (r_2 = 0.884, P <0.05; r_3 = 0.983.P <0.01) Impaired intestinal mucosal structure and the ability of intestinal synthesis and secretion of ITF decreased significantly, intestinal nutrition can reduce the extent of postoperative ITF decline may be its important role in reducing intestinal mucosal damage and promote intestinal mucosal repair superior to parenteral nutrition .