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Objective To summarize the recent progress in pathogenetic,diagnostic and therapeutic researches on the intestinal barrier dysfunction(IBD) of severe acute pancreatitis(SAP).Methods The advancement of IBD in SAP,which was published recently at home and abroad,was collected and reviewed.Results The pathogenesis of IBD in patients with SAP was complex.Ischemia-reperfusion injury,endotoxin,inflammatory mediators and gastrointestinal hormone played an important role in the process of IBD.There were many ways to detect IBD,and the ratio of lactulose and mannitol,plasma diamine oxidase were relatively ideal markers.Medical therapies,such as treatment of SAP and maintaining the perfusion of intestines,were essential to cure IBD.On this basis,the propulsives,nutritional support and traditional Chinese drugs should be administered reasonably.Conclusions IBD is a sophisticated process of pathophysiology.In recent years,abundant of animal experiments and clinical researches have provided new clue for prevention and cure of IBD,but further researches are still needed on the mechanism of the cells and molecules implicated.
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Objective There are two main functions of gastrointestinal tract,digestion and absorption,and barrier function.The latter has an important defensive effect,which keeps the body away from the invading and damaging of bacteria and endotoxin.It maintains the systemic homeostasis.Intestinal dysfunction would happen when body suffers from diseases or harmful stimulations.The more serious intestinal disorders would harm the intestinal protective mechanism,or intestinal barrier function,and bacterial/endotoxin translocation,of intestinal failure(IF) would ensue.This article provides a critical review of the evidence indicating that an increase in bacterial translocation is associated with sepsis,and even the multiple organ failure syndrome in critically ill patients.The in-transit microorganisms play an essential role in the homeostasis of local and systemic immunity.Methods All studies published from 2000 to June 2005 about intestinal permeability,bacterial translocation,and systemic inflammatory response syndrome were located by search of PubMed.Results Clinical and experimental studies investigating the correlation between bacterial translocation and systemic inflammatory response syndrome,associated with the damage of the gut barrier function.To keep the mucosal barrier function intact is one of the main issues in the prevention of bacterial translocation.This could be achieved by the adequate delivery of oxygen and nutrient supplementation to the gut.Enteral nutrition,probiotic can be a good choice.Conclusion With a better understanding of the bacteria-host interactions in health and the alterations induced by critical illness,new therapies that improve the environment of both may lead to better recovery rates in intensive care unit patients.
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Objective To investigate the relationship between the plasma cytokines and the translocation of intestinal bacteria and endotoxin after gut barrier injury in severe acute pancreatitis (SAP) rats. Methods SD rats were divided randomly into sham operation group(n=36) and SAP group (n=36). The rat model of SAP was set up by retrograde injection of 4% sodium taurocholate in biliopancreatic duct. Morphological changes of pancreas and ileum were observed. The plasma levels of TNF-a,IL-6 and IL-10 were determined by ELISA. The plasma levels of DAO activities and LPS were measured at various time points. The rates of bacterial translocation to abdominal organs were also calculated. Results The plasma levels of TNF-a and IL-6 obviously elevated immediately after SAP induction and reached peak value at 48 hours, and the plasma IL-10 level significantly increased only 6 hours after SAP induction. Plasma DAO activities increased at the early stage of SAP and obviously decreased at 24 hours. Plasma LPS levels also increased significantly at the early stage of SAP and reached peak value at 48 hours. The rates of bacterial translocation to organs sharply increased 24 hours after SAP induction and reached 58.3% at 72 hours. Conclusion The levels of cytokines increased and gut barrier function was injured in the early stage of SAP. Cytokines may impair the intestinal microcirculation and gut barrier function, which could promote the intestinal bacteria and endotoxin translocation. Simultaneously, intestinal bacteria-endotoxin translocation could also induce excessive release of cytokines and aggravate the gut barrier damage, which might cause systemic inflammatory response syndrome and multiple organ disfunction syndrome. There was a close relationship beween cytokines and the translocation of intestinal bacteria and endotoxin in SAP.
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Objective To observe the changes in gut mucosal barrier and gut-origin bacteria-endotoxin translocation in acute necrotizing pancreatitis (ANP) rats. Methods Wistar rats were divided randomly into normal group (n=6), sham operation group (n=30) and ANP group (n=39). ANP was introduced by infusion of artificial bile into biliopancreatic duct. Morphology of pancreas and intestine were observed and tight junction on ileum epithelia were assessed by cryofracture replicas electroscopy. Plasma levels of D-lactic acid and endotoxin were examined at various time points. The rates of bacterial translocation to abdominal organs were also calculated. Results Mucosal and tight junction damages of the gut were found during early stage of ANP. Simultaneously, plasma D-lactate levels increased and endotoxemia occurred. The rate of bacterial translocation to organs was 59.5% 72h after ANP occurred. Conclusions Gut barrier function can be injured in the early stage of ANP, and resulting in gut origin bacteria-endotoxin translocation, which may be the originator of systemic inflammatory reaction and secondary infection of the pancreas.
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Objective:To evaluate the clinical therapeutic effect of L-glutamine granules on intestinal damage of severe burn patients and the safety of the drug.Methods:Twenty-two severe burn patients were randomly divided into control group(C group, n =11) and L-glutamine treatment group ( n =11).GLN treatment group were given L-glutamine in a dose of 30g per day for 7 days and C group were given equal amount of placebo.The plasma L-glutamine concentration,the severity of intestinal mucosa damage, the level of plasma protein and parameters of immunological function were observed and the length of hospital stay was recorded.Results:After 7 days of taking L-glutamine orally,plasma L-glutamine concentration was significantly higher and the severity of intestinal mucosal damage were slighter in GLN treatment group than those in C group.The level of plasma protein and parameters of immunological function were higher in GLN treatment group than those in C group.In addition,the length of hospital stay was shorter in GLN treatment group than those in C group.Conclusion:Administration of L-glutamine can raise the plasma GLN level,abate the severity of intestinal damage obviously, maintain the barrier function of intestinal mucosa, enhance the immunological function, correct the negative nitrogen balance and promote the wound healing with no complications.
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Objective To investigate the effect of Intestinal Function-recovering Decoction on the bacteria and endotoxin translocation and the content of malondialdehyde(MDA)and superoxide dismutase(SOD)in serum of rats with multiple organ dysfunction syndrome(MODS).Methods Fifty-seven SD rats were divided into four groups randomly:control group,MODS group,decoction group and ampicillin group.We detected the content of endotoxin in the peripheral vein,portal vein and ileum.Bacterial translocation,change of ileum mucous membrane in pathomorphology and the contents of MDA,SOD,ALT,AST,Cr and BUN in serum in each group were also examined.Results The hepatic and renal function and ileum mucous membranes were significantly damaged in MODS group,decoction group and ampicillin group.Compared with those in MODS group,serum MDA,ALT,AST,Cr,BUN and endotoxin in the peripheral vein,portal vein and ileum in decoction group were significantly lower(P0.01).It exhibited a negative correlation between serum MDA and SOD in MODS group and ampicillin group(P