Alverdy J
University of Chicago, IL.
Semin Respir Infect. 1994 Dec;9(4):248-55.
The tightly adherent monolayer of epithelial cells that line the luminal side of the intestine provides a dynamic and highly regulated barrier to the passive transport of macromolecules. The presence of both nutrients and microbes within the gastrointestinal lumen impose a dichotomous task to this epithelial barrier. Several lines of evidence suggest that conditions created in modern intensive care units (ICUs) dysregulate the discriminatory function of the epithelial barrier. Alterations in intestinal barrier function may result in permeation of autotoxic macromolecules of immense size and diversity that normally reside in the gut lumen. It is becoming increasingly recognized that artificial nutritional support of the critically ill patient may result in significant alterations in epithelial barrier function. The causes and consequences of diet-induced alterations in the gastrointestinal barrier will be discussed. Future strategies in the development of more physiological diets for the critically ill will likely involve the addition of neural, hormonal, and growth factors as stimulants for enhancement of barrier function.
肠道腔面紧密附着的单层上皮细胞为大分子的被动转运提供了一个动态且高度调控的屏障。胃肠道腔内营养物质和微生物的存在给这个上皮屏障带来了双重任务。多条证据表明，现代重症监护病房（ICU）所营造的环境会使上皮屏障的辨别功能失调。肠道屏障功能的改变可能导致通常存在于肠腔内的各种大小和种类的自毒性大分子渗透。人们越来越认识到，对重症患者的人工营养支持可能会导致上皮屏障功能发生显著改变。本文将讨论饮食引起的胃肠道屏障改变的原因及后果。为重症患者开发更符合生理需求的饮食的未来策略可能会涉及添加神经、激素和生长因子作为增强屏障功能的刺激物。
