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目的探讨严重创伤后肠屏障功能损伤机制及谷氨酰胺(GLN)对肠屏障功能的保护.方法以烧伤、枪伤和缺血再灌流损伤作严重创伤的动物模型,并结合临床病例测定血和组织二胺氧化酶(DAO)活性以及小肠屏障功能的相关指标血乳酸、D-乳酸、肠 PHi,LPS,TNF和尿乳果糖/甘露醇(L/M)的变化,以早期口服 GLN 对肠屏障功能保护.结果严重创伤后血浆 DAO 活性从损伤早期即显著升高,组织 DAO 活性降低,血和小肠组织 DAO 的变化呈负相关(r=-0.937,P<0.001);血浆 DAO 的变化与血浆 TNF,LPS,D-乳酸、乳酸、PHi 和 L/M 的变化呈高度相关(r=0.817,0.842,0.887,0.872,-0.553和0.951,P<0.01～0.05);小肠组织病理变化与功能指标变化一致;早期口服 GLN 可不同程度地改善了肠屏障功能指标.结论严重创伤后肠屏障功能早期即有受损伤;血浆 DAO 活性的变化是反映小肠机械损伤的敏感指标;GLN 对创伤后小肠屏障功能损伤有保护性作用.
Objective To investigate the mechanism of gut barrier function after severe traumatic injury and the protective effect of glutamine (GLN) on gut barrier function.Methods The animal model of severe traumatic injury was treated with burn, gunshot wound and ischemia-reperfusion injury, The changes of DAO activity and intestinal barrier function were evaluated by the changes of blood lactate, D-lactate, intestinal PHi, LPS, TNF and lactulose / mannitol (L / M) Barrier function.Results Serum DAO activity was significantly increased from the early stage of injury, the activity of DAO decreased and the change of DAO in blood and intestinal tissue was negatively correlated (r = -0.937, P <0.001) The changes of plasma TNF, LPS, D-lactate, lactic acid, PHi and L / M were highly correlated (r = 0.817,0.842,0.887,0.872,0.553 and 0.951, P <0.01-0.05) Indicators of changes consistent; early oral GLN can improve the intestinal barrier function index to varying degrees.Conclusion Severe traumatic intestinal barrier function is damaged early; changes in plasma DAO activity is a sensitive indicator of mechanical damage in small intestine; GLN on post-traumatic small intestine Barrier function damage A protective effect.