Pierre Joseph F
Section of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Chicago, Chicago, Illinois
Am J Physiol Gastrointest Liver Physiol. 2017 Mar 1;312(3):G246-G256. doi: 10.1152/ajpgi.00321.2016. Epub 2017 Feb 2.
Parenteral nutrition (PN) is a lifesaving therapy that provides intravenous nutrition support to patients who cannot, or should not, feed via the gastrointestinal (GI) tract. Unfortunately, PN also carries certain risks related to infection and metabolic complications compared with enteral nutrition. In this review, an overview of PN and GI immune and microbiome changes is provided. PN impacts the gut-associated lymphoid tissue functions, especially adaptive immune cells, changes the intestinal epithelium and chemical secretions, and significantly alters the intestinal microbiome. Collectively, these changes functionally result in increased susceptibility to infectious and injurious challenge. Since PN remains necessary in large numbers of patients, the search to improve outcomes by stimulating GI immune function during PN remains of interest. This review closes by describing recent advances in using enteric nervous system neuropeptides or microbially derived products during PN, which may improve GI parameters by maintaining immunity and physiology.
肠外营养（PN）是一种挽救生命的治疗方法，为不能或不应通过胃肠道（GI）进食的患者提供静脉营养支持。不幸的是，与肠内营养相比，PN也存在某些与感染和代谢并发症相关的风险。在本综述中，提供了PN以及胃肠道免疫和微生物群变化的概述。PN会影响肠道相关淋巴组织的功能，尤其是适应性免疫细胞，改变肠道上皮和化学分泌物，并显著改变肠道微生物群。总体而言，这些变化在功能上导致对感染性和损伤性挑战的易感性增加。由于大量患者仍需要PN，因此在PN期间通过刺激胃肠道免疫功能来改善治疗效果的研究仍然很有意义。本综述最后描述了在PN期间使用肠神经系统神经肽或微生物衍生产品的最新进展，这些进展可能通过维持免疫力和生理功能来改善胃肠道参数。
