• 中國醫(yī)學(xué)科學(xué)院 北京協(xié)和醫(yī)學(xué)院 北京協(xié)和醫(yī)院腸外腸內(nèi)營養(yǎng)科（北京 100730）;

目的 研究腸道缺血再灌注損傷時(shí)腸淋巴干結(jié)扎和含谷氨酰胺的腸內(nèi)營養(yǎng)對(duì)腸道及遠(yuǎn)隔組織的影響。
方法 40只SD大鼠胃造瘺后隨機(jī)分為： 假手術(shù)組、普通腸內(nèi)營養(yǎng)組、普通腸內(nèi)營養(yǎng)+腸淋巴干結(jié)扎組、谷氨酰胺組及谷氨酰胺＋腸淋巴干結(jié)扎組，每組8只。除假手術(shù)組外，其余4組大鼠行7 d腸內(nèi)營養(yǎng)干預(yù)后開腹夾閉腸系膜上動(dòng)脈60 min，2個(gè)結(jié)扎組同時(shí)進(jìn)行淋巴干結(jié)扎； 假手術(shù)組行普通飲食7 d后開腹60 min后關(guān)腹。所有大鼠術(shù)后繼續(xù)原營養(yǎng)3 d。于再灌注前1 d、再灌注后1 d及3 d測(cè)定腸道通透性，在再灌注后3 d觀察腸壁形態(tài)學(xué)改變，檢測(cè)血清中內(nèi)毒素、D-乳酸、二胺氧化酶水平及肺組織細(xì)胞凋亡指數(shù)。
結(jié)果 再灌注后1 d時(shí)，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(shí)與再灌注后1 d比較，2個(gè)結(jié)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(jié)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(nèi)營養(yǎng)組(P lt;0.05)； 普通腸內(nèi)營養(yǎng)+腸淋巴干結(jié)扎組腸壁各形態(tài)學(xué)指標(biāo)均高于普通腸內(nèi)營養(yǎng)組，但差異無統(tǒng)計(jì)學(xué)意義(P gt;0.05)。腸淋巴干結(jié)扎組的肺組織細(xì)胞凋亡指數(shù)明顯低于未結(jié)扎組(P lt;0.05)，內(nèi)毒素、D-乳酸及二胺氧化酶水平較未結(jié)扎組有下降趨勢(shì)，但差異無統(tǒng)計(jì)學(xué)意義(P gt;0.05)。
結(jié)論 大鼠腸道缺血再灌注損傷引起腸道通透性增加、細(xì)菌內(nèi)毒素移位和系統(tǒng)炎癥反應(yīng)，腸淋巴管結(jié)扎和谷氨酰胺腸內(nèi)營養(yǎng)干預(yù)可以弱化肺組織損傷，增加腸黏膜的厚度，維護(hù)腸屏障功能，減少內(nèi)毒素移位，降低血中內(nèi)毒素水平，減輕系統(tǒng)炎癥反應(yīng)。含谷氨酰胺的腸內(nèi)營養(yǎng)效果優(yōu)于普通腸內(nèi)營養(yǎng)。

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(shí)淋巴干結(jié)扎及谷氨酰胺營養(yǎng)干預(yù)的作用. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(5): 443-448. doi: 復(fù)制

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(xì)胞凋亡 [J]. 中國普外基礎(chǔ)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(diào)節(jié)作用： 研究證據(jù)分析 [J]． 中國臨床營養(yǎng)雜志, 2003, 11(2): 133-135.
11. 秦環(huán)龍， 高奇， 蘇振東. 谷氨酰胺對(duì)內(nèi)毒素血癥大鼠小腸粘膜抗氧化損傷的保護(hù)作用 [J]. 中國普外基礎(chǔ)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(duì)肺損傷的保護(hù)作用 [J]. 中國臨床營養(yǎng)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(shí)腸淋巴干結(jié)扎對(duì)系統(tǒng)炎性反應(yīng)的影響 [J]. 中華胃腸外科雜志, 2008; 11(5): 469-471.
  1. 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. 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. 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. 4. 王雨， 田伏洲. 缺血再灌注損傷與細(xì)胞凋亡 [J]. 中國普外基礎(chǔ)與臨床雜志, 2002; 9(1): 61-64.
  5. 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. 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. 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. 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. 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. 10. 劉曉青, 鐘南山, 江華, 等. 谷氨酰胺是否有雙相免疫調(diào)節(jié)作用： 研究證據(jù)分析 [J]． 中國臨床營養(yǎng)雜志, 2003, 11(2): 133-135.
  11. 11. 秦環(huán)龍， 高奇， 蘇振東. 谷氨酰胺對(duì)內(nèi)毒素血癥大鼠小腸粘膜抗氧化損傷的保護(hù)作用 [J]. 中國普外基礎(chǔ)與臨床雜志, 2001； 8(1): 5-7.
  12. 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. 13. Alexander JW, Boyce ST, Babcock GF, et al. The process of microbial translocation [J]. Ann Surg, 1990; 212(4): 496-510.
  14. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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(duì)肺損傷的保護(hù)作用 [J]. 中國臨床營養(yǎng)雜志, 2007; 15(6): 364-367.
  33. 33. 何桂珍, 董良廣, 崔曉雨, 等. 腸道缺血再灌注損傷時(shí)腸淋巴干結(jié)扎對(duì)系統(tǒng)炎性反應(yīng)的影響 [J]. 中華胃腸外科雜志, 2008; 11(5): 469-471.