腸道缺血再灌注損傷時淋巴干結扎及谷氨酰胺營養干預的作用_《中國普外基礎與臨床雜志》

作者：

何桂珍 , 董良廣 , 周開國 , 陳雪峰

中國醫學科學院北京協和醫學院北京協和醫院腸外腸內營養科（北京 100730）;

關鍵詞：

腸道缺血再灌注腸淋巴干結扎谷氨酰胺腸內營養

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目的研究腸道缺血再灌注損傷時腸淋巴干結扎和含谷氨酰胺的腸內營養對腸道及遠隔組織的影響。
方法 40只SD大鼠胃造瘺后隨機分為：假手術組、普通腸內營養組、普通腸內營養+腸淋巴干結扎組、谷氨酰胺組及谷氨酰胺＋腸淋巴干結扎組，每組8只。除假手術組外，其余4組大鼠行7 d腸內營養干預后開腹夾閉腸系膜上動脈60 min，2個結扎組同時進行淋巴干結扎；假手術組行普通飲食7 d后開腹60 min后關腹。所有大鼠術后繼續原營養3 d。于再灌注前1 d、再灌注后1 d及3 d測定腸道通透性，在再灌注后3 d觀察腸壁形態學改變，檢測血清中內毒素、D-乳酸、二胺氧化酶水平及肺組織細胞凋亡指數。
結果再灌注后1 d時，各組腸道通透性均比再灌注前明顯增加(P lt;0.05)；再灌注后3 d時與再灌注后1 d比較，2個結扎組的腸道通透性均明顯降低(P lt;0.05)。谷氨酰胺＋腸淋巴干結扎組回腸和空腸的黏膜厚度及回腸的絨毛高度明顯高于其余4組(P lt;0.05)，谷氨酰胺組回腸的絨毛高度明顯高于普通腸內營養組(P lt;0.05)；普通腸內營養+腸淋巴干結扎組腸壁各形態學指標均高于普通腸內營養組，但差異無統計學意義(P gt;0.05)。腸淋巴干結扎組的肺組織細胞凋亡指數明顯低于未結扎組(P lt;0.05)，內毒素、D-乳酸及二胺氧化酶水平較未結扎組有下降趨勢，但差異無統計學意義(P gt;0.05)。
結論大鼠腸道缺血再灌注損傷引起腸道通透性增加、細菌內毒素移位和系統炎癥反應，腸淋巴管結扎和谷氨酰胺腸內營養干預可以弱化肺組織損傷，增加腸黏膜的厚度，維護腸屏障功能，減少內毒素移位，降低血中內毒素水平，減輕系統炎癥反應。含谷氨酰胺的腸內營養效果優于普通腸內營養。

引用本文： 何桂珍,董良廣,周開國,陳雪峰. 腸道缺血再灌注損傷時淋巴干結扎及谷氨酰胺營養干預的作用. 中國普外基礎與臨床雜志, 2010, 17(5): 443-448. doi: 復制

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2.	Kanwar S, Windsor AC, Welsh F, et al. Lack of correlation between failure of gut barrier function and septic complications after major upper gastrointestinal surgery [J]. Ann Surg, 2000; 231(1): 88-95.
3.	Besselink MG, van Santvoort HC, Renooij W, et al. Intestinal barrier dysfunction in a randomized trial of a specific probiotic composition in acute pancreatitis [J]. Ann Surg, 2009; 250(5): 712-719.
4.	王雨，田伏洲. 缺血再灌注損傷與細胞凋亡 [J]. 中國普外基礎與臨床雜志, 2002; 9(1): 61-64.
5.	Lee MA, Yatani A, Sambol JT, et al. Role of gut-lymph factors in the induction of burn-induced and trauma-shock-induced acute heart failure [J]. Int J Clin Exp Med, 2008; 1(2): 171-180.
6.	Sambol JT, Lee MA, Caputo FJ, et al. Mesenteric lymph duct ligation prevents trauma/hemorrhage shock-induced cardiac contractile dysfunction [J]. J Appl Physiol, 2009; 106(1): 57-65.
7.	Badami CD, Senthil M, Caputo FJ, et al. Mesenteric lymph duct ligation improves survival in a lethal shock model [J]. Shock, 2008; 30(6): 680-685.
8.	Noguchi Y, James JH, Fischer JE, et al． Increased glutamine consumption in small intestine epithelial cells during sepsis in rats [J]． Am J Surg, 1997; 173(3): 199-205.
9.	de Oliveira MA, Lemos DS, Diniz SO, et al． Prevention of bacterial translocation using glutamine: a new strategy of investigation [J]. Nutrition, 2006; 22(4): 419-424.
10.	劉曉青, 鐘南山, 江華, 等. 谷氨酰胺是否有雙相免疫調節作用：研究證據分析 [J]．中國臨床營養雜志, 2003, 11(2): 133-135.
11.	秦環龍，高奇，蘇振東. 谷氨酰胺對內毒素血癥大鼠小腸粘膜抗氧化損傷的保護作用 [J]. 中國普外基礎與臨床雜志, 2001； 8(1): 5-7.
12.	Berg RD, Garlington AW. Translocation of certain indigenous bacteria from the gastrointestinal tract to the mesenteric lymph nodes and other organs in a gnotobiotic mouse model [J]. Infect Immun, 1979; 23(2): 403-411.
13.	Alexander JW, Boyce ST, Babcock GF, et al. The process of microbial translocation [J]. Ann Surg, 1990; 212(4): 496-510.
14.	Moore FA, Moore EE, Poggetti R, et al. Gut bacterial translocation via the portal vein: a clinical perspective with major torso trauma [J]. J Trauma, 1991; 31(5): 629-636.
15.	MacFie J, O’Boyle C, Mitchell CJ, et al. Gut origin of sepsis: a prospective study investigating associations between bacterial translocation, gastric microflora, and septic morbidity [J]. Gut, 1999; 45(2): 223-228.
16.	Johnston TD, Fischer R, Chen Y, et al. Lung injury from gut ischemia: insensitivity to portal blood flow diversion [J]. J Trauma, 1993; 35(4): 508-511.
17.	Lemaire LC, van Lanschot JB, Stoutenbeek CP, et al. Thoracic duct in patients with multiple organ failure: no major route of bacterial translocation [J]. Ann Surg, 1999; 229(1): 128-136.
18.	Balzan S, de Almeida Quadros C, de Cleva R, et al. Bacterial translocation: overview of mechanisms and clinical impact [J]. J Gastroenterol Hepatol, 2007; 22(4): 464-471.
19.	Kahlke V, Fndrich F, Brtzmann K, et al. Selective decontamination of the digestive tract: impact on cytokine release and mucosal damage after hemorrhagic shock [J]. Crit Care Med, 2002; 30(6): 1327-1333.
20.	Leone M, Delliaux S, Bourgoin A, et al. Risk factors for late-onset ventilator-associated pneumonia in trauma patients receiving selective digestive decontamination [J]. Intensive Care Med, 2005; 31(1): 64-70.
21.	Bonten MJ, Krueger WA. Selective decontamination of the digestive tract: cumulating evidence, at last? [J]. Semin Respir Crit Care Med, 2006; 27(1): 18-22.
22.	Feinman R, Deitch EA, Aris V, et al. Molecular signatures of trauma-hemorrhagic shock-induced lung injury: hemorrhage- and injury-associated genes [J]. Shock, 2007; 28(3): 360-368.
23.	Deitch EA, Xu D, Kaise VL. Role of the gut in the development of injury- and shock induced SIRS and MODS: the gut-lymph hypothesis, a review [J]. Front Biosci, 2006; 11: 520-528.
24.	Deitch EA, Forsythe R, Anjaria D, et al. The role of lymph factors in lung injury, bone marrow suppression, and endothelial cell dysfunction in a primate model of trauma-hemorrhagic shock [J]. Shock, 2004; 22(3): 221-228.
25.	Magnotti LJ, Upperman JS, Xu DZ, et al. Gut-derived mesenteric lymph but not portal blood increases endothelial cell permeability and promotes lung injury after hemorrhagic shock [J]. Ann Surg, 1998; 228(4): 518-527.
26.	Senthil M, Watkins A, Barlos D, et al. Intravenous injection of trauma-hemorrhagic shock mesenteric lymph causes lung injury that is dependent upon activation of the inducible nitric oxide synthase pathway [J]. Ann Surg, 2007; 246(5): 822-830.
27.	Watkins AC, Caputo FJ, Badami C, et al. Mesenteric lymph duct ligation attenuates lung injury and neutrophil activation after intraperitoneal injection of endotoxin in rats [J]. J Trauma, 2008; 64(1): 126-130.
28.	Kwon WY, Suh GJ, Kim KS, et al. Glutamine attenuates acute lung injury by inhibition of high mobility group box protein-1 expression during sepsis [J]. Br J Nutr, 2010; 103(6): 890-898.
29.	Peng X, Yan H, You Z, et al. Effects of enteral supplementation with glutamine granules on intestinal mucosal barrier function in severe burned patients [J]. Burns, 2004; 30(2): 135-139.
30.	Agostini F, Biolo G. Effect of physical activity on glutamine metabolism [J]. Curr Opin Clin Nutr Metab Care, 2010; 13(1): 58-64.
31.	Larson SD, Li J, Chung DH, et al. Molecular mechanisms contributing to glutamine-mediated intestinal cell survival [J]. Am J Physiol Gastrointest Liver Physiol, 2007; 293(6): G1262-G1271.
32.	崔曉雨, 何桂珍, 董良廣, 等. 大鼠腸道缺血/再灌注損傷后腸淋巴阻斷對肺損傷的保護作用 [J]. 中國臨床營養雜志, 2007; 15(6): 364-367.
33.	何桂珍, 董良廣, 崔曉雨, 等. 腸道缺血再灌注損傷時腸淋巴干結扎對系統炎性反應的影響 [J]. 中華胃腸外科雜志, 2008; 11(5): 469-471.

1. Vega D, Badami CD, Caputo FJ, et al. The influence of the type of resuscitation fluid on gut injury and distant organ injury in a rat model of trauma/hemorrhagic shock [J]. J Trauma, 2008; 65(2): 409-414.
2. Kanwar S, Windsor AC, Welsh F, et al. Lack of correlation between failure of gut barrier function and septic complications after major upper gastrointestinal surgery [J]. Ann Surg, 2000; 231(1): 88-95.
3. Besselink MG, van Santvoort HC, Renooij W, et al. Intestinal barrier dysfunction in a randomized trial of a specific probiotic composition in acute pancreatitis [J]. Ann Surg, 2009; 250(5): 712-719.
4. 王雨，田伏洲. 缺血再灌注損傷與細胞凋亡 [J]. 中國普外基礎與臨床雜志, 2002; 9(1): 61-64.
5. Lee MA, Yatani A, Sambol JT, et al. Role of gut-lymph factors in the induction of burn-induced and trauma-shock-induced acute heart failure [J]. Int J Clin Exp Med, 2008; 1(2): 171-180.
6. Sambol JT, Lee MA, Caputo FJ, et al. Mesenteric lymph duct ligation prevents trauma/hemorrhage shock-induced cardiac contractile dysfunction [J]. J Appl Physiol, 2009; 106(1): 57-65.
7. Badami CD, Senthil M, Caputo FJ, et al. Mesenteric lymph duct ligation improves survival in a lethal shock model [J]. Shock, 2008; 30(6): 680-685.
8. Noguchi Y, James JH, Fischer JE, et al． Increased glutamine consumption in small intestine epithelial cells during sepsis in rats [J]． Am J Surg, 1997; 173(3): 199-205.
9. de Oliveira MA, Lemos DS, Diniz SO, et al． Prevention of bacterial translocation using glutamine: a new strategy of investigation [J]. Nutrition, 2006; 22(4): 419-424.
10. 劉曉青, 鐘南山, 江華, 等. 谷氨酰胺是否有雙相免疫調節作用：研究證據分析 [J]．中國臨床營養雜志, 2003, 11(2): 133-135.
11. 秦環龍，高奇，蘇振東. 谷氨酰胺對內毒素血癥大鼠小腸粘膜抗氧化損傷的保護作用 [J]. 中國普外基礎與臨床雜志, 2001； 8(1): 5-7.
12. Berg RD, Garlington AW. Translocation of certain indigenous bacteria from the gastrointestinal tract to the mesenteric lymph nodes and other organs in a gnotobiotic mouse model [J]. Infect Immun, 1979; 23(2): 403-411.
13. Alexander JW, Boyce ST, Babcock GF, et al. The process of microbial translocation [J]. Ann Surg, 1990; 212(4): 496-510.
14. Moore FA, Moore EE, Poggetti R, et al. Gut bacterial translocation via the portal vein: a clinical perspective with major torso trauma [J]. J Trauma, 1991; 31(5): 629-636.
15. MacFie J, O’Boyle C, Mitchell CJ, et al. Gut origin of sepsis: a prospective study investigating associations between bacterial translocation, gastric microflora, and septic morbidity [J]. Gut, 1999; 45(2): 223-228.
16. Johnston TD, Fischer R, Chen Y, et al. Lung injury from gut ischemia: insensitivity to portal blood flow diversion [J]. J Trauma, 1993; 35(4): 508-511.
17. Lemaire LC, van Lanschot JB, Stoutenbeek CP, et al. Thoracic duct in patients with multiple organ failure: no major route of bacterial translocation [J]. Ann Surg, 1999; 229(1): 128-136.
18. Balzan S, de Almeida Quadros C, de Cleva R, et al. Bacterial translocation: overview of mechanisms and clinical impact [J]. J Gastroenterol Hepatol, 2007; 22(4): 464-471.
19. Kahlke V, Fndrich F, Brtzmann K, et al. Selective decontamination of the digestive tract: impact on cytokine release and mucosal damage after hemorrhagic shock [J]. Crit Care Med, 2002; 30(6): 1327-1333.
20. Leone M, Delliaux S, Bourgoin A, et al. Risk factors for late-onset ventilator-associated pneumonia in trauma patients receiving selective digestive decontamination [J]. Intensive Care Med, 2005; 31(1): 64-70.
21. Bonten MJ, Krueger WA. Selective decontamination of the digestive tract: cumulating evidence, at last? [J]. Semin Respir Crit Care Med, 2006; 27(1): 18-22.
22. Feinman R, Deitch EA, Aris V, et al. Molecular signatures of trauma-hemorrhagic shock-induced lung injury: hemorrhage- and injury-associated genes [J]. Shock, 2007; 28(3): 360-368.
23. Deitch EA, Xu D, Kaise VL. Role of the gut in the development of injury- and shock induced SIRS and MODS: the gut-lymph hypothesis, a review [J]. Front Biosci, 2006; 11: 520-528.
24. Deitch EA, Forsythe R, Anjaria D, et al. The role of lymph factors in lung injury, bone marrow suppression, and endothelial cell dysfunction in a primate model of trauma-hemorrhagic shock [J]. Shock, 2004; 22(3): 221-228.
25. Magnotti LJ, Upperman JS, Xu DZ, et al. Gut-derived mesenteric lymph but not portal blood increases endothelial cell permeability and promotes lung injury after hemorrhagic shock [J]. Ann Surg, 1998; 228(4): 518-527.
26. Senthil M, Watkins A, Barlos D, et al. Intravenous injection of trauma-hemorrhagic shock mesenteric lymph causes lung injury that is dependent upon activation of the inducible nitric oxide synthase pathway [J]. Ann Surg, 2007; 246(5): 822-830.
27. Watkins AC, Caputo FJ, Badami C, et al. Mesenteric lymph duct ligation attenuates lung injury and neutrophil activation after intraperitoneal injection of endotoxin in rats [J]. J Trauma, 2008; 64(1): 126-130.
28. Kwon WY, Suh GJ, Kim KS, et al. Glutamine attenuates acute lung injury by inhibition of high mobility group box protein-1 expression during sepsis [J]. Br J Nutr, 2010; 103(6): 890-898.
29. Peng X, Yan H, You Z, et al. Effects of enteral supplementation with glutamine granules on intestinal mucosal barrier function in severe burned patients [J]. Burns, 2004; 30(2): 135-139.
30. Agostini F, Biolo G. Effect of physical activity on glutamine metabolism [J]. Curr Opin Clin Nutr Metab Care, 2010; 13(1): 58-64.
31. Larson SD, Li J, Chung DH, et al. Molecular mechanisms contributing to glutamine-mediated intestinal cell survival [J]. Am J Physiol Gastrointest Liver Physiol, 2007; 293(6): G1262-G1271.
32. 崔曉雨, 何桂珍, 董良廣, 等. 大鼠腸道缺血/再灌注損傷后腸淋巴阻斷對肺損傷的保護作用 [J]. 中國臨床營養雜志, 2007; 15(6): 364-367.
33. 何桂珍, 董良廣, 崔曉雨, 等. 腸道缺血再灌注損傷時腸淋巴干結扎對系統炎性反應的影響 [J]. 中華胃腸外科雜志, 2008; 11(5): 469-471.

《中國普外基礎與臨床雜志》

腸道缺血再灌注損傷時淋巴干結扎及谷氨酰胺營養干預的作用

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《中國普外基礎與臨床雜志》

腸道缺血再灌注損傷時淋巴干結扎及谷氨酰胺營養干預的作用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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Content

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