摘要目的 探讨早期肠内营养对急性坏死性胰腺炎( ANP)大鼠肠黏膜TLR4信号通路的作用及机制. 方法 将60只SD大鼠按数字表法随机分成对照组、肠外营养组( TPN组)、肠内营养组( EEN组). 造模后1d检测血清淀粉酶活性. 肠外营养、肠内营养持续给予5d后处死大鼠,取血、胰腺及结肠组织. 采用ELISA法检测血清IL-6、TNF-α水平;HE染色观察胰腺病理改变;蛋白质印迹法检测大鼠结肠组织TLR4 NF-κB 表达. 结果 对照组、TPN组、EEN 组大鼠造模后5 d的死亡率分别为0、50%、25%;血清淀粉酶活性分别为(744 ±41)、(3 278 ±219)、(2 227 ±169) U/L;TNF-α水平为(81.57 ± 18 .25 )、( 465 .72 ±42 .47 )、( 223 .21 ±29 .94 ) ng/L;IL-6 为( 362 .83 ±41 .32 )、( 932 .46 ±57 .21 )、(628.62 ±142.24)ng/L;胰腺病理评分为(0.91 ±0.15)、(11.1 ±0.61)、(6.9 ±0.62)分;结肠组织TLR4蛋白表达量为0.7506 ±0.003、1.3404 ±0.004、0.9544 ±0.004;NF-κB蛋白表达量为1.33 ±0.50、6.92 ±1.06、2.93 ±0.89. TPN组、EEN组均显著高于对照组,EEN组又显著低于TPN组,差异均有统计学意义(P值均<0.05). 结论 早期肠内营养能抑制ANP大鼠肠道TLR4及NF-κB信号通路,下调血清TNF-α、IL-6水平,减轻胰腺炎症反应,降低死亡率.

abstractsObjective To investigate the role of early enteral nutrition on TLR 4 signaling pathway in rats with acute necrotizing pancreatitis (ANP).Methods Sixty SD rats were randomly divided into three groups:sham operation group ( SO group ) , total parenteral nutrition group ( TPN ) , early enteral nutrition group ( EEN ) .One day after ANP model induction , the serum level of amylase was measured .Nutrient solution was given for five days , then the rats were sacrificed , and the blood , pancreas and colon tissue were collected.The serum levels of IL-6, TNF-αwere detected by ELISA .Pathologic changes of pancreas were observed by HE staining.The intestinal TLR4, NF-κB expression was measured by Western blot .Results Mortality rates of SO group, TPN group, EEN group were 0, 50%, 25%, respectively; the serum levels of amylase were (744 ±41), (3 278 ±219), (2 227 ±169) U/L, respectively;the serum levels of TNF-αwere (81.57 ±18.25), (465.72 ±42.47), (223.21 ±29.94)ng/L, respectively; the serum levels of IL-6 were (362.83 ±41.32), (932.46 ±57.21), (628.62 ±142.24) ng/L, respectively; the pancreatic pathologic scores were (0.91 ±0.15), (11.1 ±0.61), (6.9 ±0.62);the intestinal TLR4 expressions were 0.7506 ± 0.003, 1.3404 ±0.004, 0.9544 ±0.004;the intestinal NF-κB expressions were 1.33 ±0.50, 6.92 ±1.06,2.93 ±0.89.The values of TPN and EEN group were significantly higher than those of SO group (P<0.05). The values of EEN group were significantly lower than those of TPN group (P<0.05).Conclusions EEN can inhibit TLR4 and NF-κB signal pathway in gut , then reduce IL-6 and TNF-αexpression and relieve inflammatory reaction of ANP , finally decrease the mortality of ANP .