| Objective:Early trophic enteral nutrition was used in rats with severe acute pancreatitis.Changes in the levels of inflammatory factors and intestinal immune barriers in rats were examined.To explore the effect of early trophic enteral nutrition with Luzhou-Feier Powder(?)on the inflammatory response and intestinal immune barrier of SAP rats.Methods:SD male rats were randomly divided into sham-operated group receiving normal diet(SO+Normal group),SAP group receiving total parental nutrition(SAP+TPN group),SAP group receiving trophic enteral nutrition with TPF(SAP+TPF group)and SAP group receiving trophic enteral nutrition with Luzhou-Feier Powder(SAP+LZ-FP group).After laparotomy,the pancreases of the SO+Normal group were gently flipped and free to eat 12 hours after surgery.The rat model of SAP was established by retrograde injection of 5%sodium taurocholate into the biliopancreatic duct.After the gastrostomy,place the gastrointestinal tube to establish an enteral nutrition pathway.The parenteral nutrition pathway was established by placing the right external jugular vein catheter.Twelve hours after model establishment,the SAP+TPN group was only pumped into the parenteral nutrient solution through the right external jugular vein for complete parenteral nutrition,and no enteral nutrition was given.The SAP+TPF group and the SAP+LZ-FP group were given the TPF and LZ-FP for early trophic enteral nutrition,At the same time,the parenteral nutrition solution was pumped through the right external jugular vein for supplemental parenteral nutrition.Nutritional support was carried out for 6 days,and the rats were sacrificed on the 7th day and specimens were collected.After HE staining,pathological changes of ileum and pancreas were observed under the light microscope and pathological scores were obtained.Serum levels of TNF-α,IL-1β and IL-6 were detected by enzyme-linked immunosorbent assay(ELISA).RT-PCR was used to detect the relative expression of TNF-α,IL-1βand IL-6 mRNA in pancreas and ileum tissues.immunohistochemistry was used to detect the expression level of sIgA in terminal ileum mucosa and the expression levels of MAdCAM-1,CD4+and CD8+ cells in Peyer’s patches.Plasma endotoxin levels were measured by the test tube chromogenic substrate method.Results:①The survival rate of SAP model rats was significantly lower than that of SO+Normal group.The survival rate of SAP+TPF and SAP+LZ-FP groups was higher than that of SAP+TPN group,but the difference was not statistically significant(P>0.05).There was no significant difference in survival rate between SAP+TPF group and SAP+LZ-FP group(P>0.05).②The pathological damage of pancreas and ileum in SAP+TPF and SAP+LZ-FP groups was less than that in SAP+TPN group,and the pathological score was significantly lower than that in SAP+TPN group(P<0.05).There were no significant differences in the pancreatic or ileal pathological scores between SAP+TPF and SAP+LZ-FP rats(P>0.05).③The serum levels of TNF-α,IL-1β,and IL-6 in SAP model rats increased to varying degrees.The levels of serum TNF-α,IL-1β,and IL-6 in the SAP+TPN group were(384.2±2.87),(57.80±0.36),(155.0±1.72),were significantly higher than the SO+Normal group(P<0.05).The levels of serum TNF-α,IL-1β and IL-6 in SAP+TPF group and SAP+LZ-FP group were significantly lower than those in SAP+TPN group(P<0.05).There was no significant difference between SAP+TPF and SAP+LZ-FP group(P>0.05).The expressions of TNF-α,IL-1β and IL-6 mRNA in pancreas and ileum tissues of each group were consistent with the changes of serum TNF-α,IL-1β,and IL-6 levels.④The plasma endotoxin level in the SAP+TPN group was(3.05±0.49),which was significantly higher than that in the SO+Normal group(P<0.05).The plasma endotoxin levels in the SAP+TPF and SAP+LZ-FP groups were(0.39±0.20)and(0.93±0.50),respectively,which were significantly lower than those in the SAP+TPN group(P<0.05).There was no significant difference between SAP+TPF and SAP+LZ-FP groups(P>0.05).⑤The expression levels of MAdCAM-1,CD4+,CD8+and sIgA in SAP+TPN group were significantly lower than those in SO+Normal group(P<0.05).The expression levels of MAdCAM-1,CD4+,CD8+and sIgA in SAP+TPF group and SAP+LZ-FP group were significantly higher than those in SAP+TPN group(P<0.05).There was no significant difference between SAP+TPF group and SAP+LZ-FP group(P>0.05).Conclusions:①It is safe to adopt trophic enteral nutrition in the early stage of SAP,but it can not improve the survival rate of SAP rats.②Early trophic enteral nutrition can improve the local and systemic inflammatory response in SAP rats and reduce the pathological damage of pancreas and ileum.③Early trophic enteral nutrition can improve the intestinal immune barrier of SAP rats,reduce intestinal permeability and reduce endotoxin translocation.④Compared with TPF,the early trophic enteral nutrition with Luzhou-Feier Powder(?)can also effectively improve the inflammatory response and intestinal immune barrier of SAP rats.⑤This experiment provides a theoretical basis for the application of enteric nutrition in early enteral nutrition support for clinical SAP patients,but further clinical studies are needed to confirm its safety and efficacy. |
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