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目的:研究大黄四君子汤对重症胰腺炎(SAP)大鼠肠黏膜屏障的保护作用。方法:采用胰管逆行注射牛磺胆酸钠建立大鼠SAP模型。60只大鼠随机分为空白对照组(A组),SAP组(B组),SAP+肠外营养(TPN)组(C组),SAP+TPN+谷氨酰胺(Gln)组(D组),SAP+肠内营养(EN)组(E组),SAP+TPN+中药组(F组);分别给予相应处理:肠内和肠外营养液等热卡为250kcal.kg-1.d-1,氮热卡比值为1∶100,Gln浓度为2g/100ml,大黄四君子汤浓度为1g/ml。术后第5天处死大鼠,检测胰腺、空肠黏膜形态学变化,观察肝脾及肠系膜淋巴结细菌培养结果。结果:B、C组黏膜厚度、绒毛高度及隐窝深度较D、E、F组均明显降低(P<0.01);E组高于D、F组(P<0.05);D组与F组比较,无统计学差异(P>0.05)。B、C组脏器细菌培养阳性率明显高于D、E、F组(P<0.05),以肠系膜淋巴结培养阳性率最高;检出细菌多数为革兰阴性肠道杆菌。结论:大黄四君子汤可减少SAP大鼠肠源性细菌移位,起到保护肠黏膜屏障的作用。
Objective: To study the protective effect of Dahuang Sijunzi decoction on intestinal mucosal barrier in rats with severe acute pancreatitis (SAP). METHODS: A rat model of SAP was established by retrograde injection of sodium taurocholate into the pancreatic duct. 60 rats were randomly divided into blank control group (A group), SAP group (B group), SAP+ parenteral nutrition (TPN) group (C group), SAP+TPN+glutamine (Gln) group (D group), SAP+ enteral nutrition (EN) group (E group), SAP+TPN+ Chinese medicine group (F group); corresponding treatment was given separately: enteral and parenteral nutrient solution and other calories were 250kcal.kg-1.d-1, nitrogen The caloric ratio was 1:100, the Gln concentration was 2 g/100 ml, and the rhubarb Sijunzi Decoction concentration was 1 g/ml. The rats were sacrificed on the 5th day after operation and the morphological changes of pancreatic and jejunal mucosa were observed. The results of bacterial culture of liver, spleen and mesenteric lymph nodes were observed. Results: The mucosal thickness, villus height, and crypt depth in group B and C were significantly lower than those in groups D, E, and F (P<0.01). E group was higher than that in group D and F (P<0.05); D and F groups. There was no statistical difference (P>0.05). The positive rates of bacterial culture in group B and C were significantly higher than those in groups D, E, and F (P<0.05). The positive rate of mesenteric lymph node culture was the highest. Most of the detected bacteria were Gram-negative enterobacteria. Conclusion: Dahuang Sijunzi Decoction can reduce the intestinal bacterial translocation of SAP rats and protect the intestinal mucosal barrier.