Parks R W, Clements W D, Smye M G, Pope C, Rowlands B J, Diamond T
Department of Surgery, Queen's University of Belfast, UK.
Br J Surg. 1996 Oct;83(10):1345-9. doi: 10.1002/bjs.1800831007.
Intestinal mucosal barrier function in obstructive jaundice was assessed in an animal model and in patients. The effect of internal biliary drainage in patients was also examined. Bile duct ligation for 1 week in the rat resulted in significant bacterial translocation (in seven of 12 animals following ligation versus none of the shamoperated controls, P < 0.01). Intestinal permeability, measured by the urinary recovery of orally administered polyethylene glycol, was also significantly increased (+66.2 per cent for ligation versus -11.6 per cent for sham, P < 0.01). A prospective study was performed on 33 patients with obstructive jaundice undergoing internal biliary drainage, and results were compared with those in six non-jaundiced patients undergoing laparotomy or endoscopic retrograde cholangiopancreatography and in 11 health volunteers. The lactulose: mannitol ratio was used as an intestinal permeability index. Mean(s.e.m.) intestinal permeability assessed before operation was significantly increased in jaundiced patients compared with control patients (0.050(0.010) versus 0.016(0.003), P < 0.005). The mean(s.e.m.) lactulose: mannitol ratio in the healthy volunteers was 0.020(0.003), which was similar to that in control patients. In the jaundiced group of patients the intestinal permeability index fell to within normal levels after 28 days of internal biliary drainage (0.050 before operation versus 0.021 at 28 days, P < 0.02). These data indicate that intestinal barrier function is impaired in obstructive jaundice and that this impairment is reversed by return of bile to the gastrointestinal tract.
在动物模型和患者中评估了梗阻性黄疸时肠黏膜屏障功能。还研究了内胆汁引流对患者的影响。大鼠胆管结扎1周导致显著的细菌移位（结扎后12只动物中有7只出现细菌移位，而假手术对照组无一例出现，P<0.01）。通过口服聚乙二醇的尿回收率测量的肠通透性也显著增加（结扎组增加66.2%，假手术组降低11.6%，P<0.01）。对33例接受内胆汁引流的梗阻性黄疸患者进行了一项前瞻性研究，并将结果与6例接受剖腹手术或内镜逆行胰胆管造影的非黄疸患者以及11名健康志愿者的结果进行了比较。乳果糖：甘露醇比值用作肠通透性指标。与对照组患者相比，黄疸患者术前评估的平均（标准误）肠通透性显著增加（0.050（0.010）对0.016（0.003），P<0.005）。健康志愿者的平均（标准误）乳果糖：甘露醇比值为0.020（0.003），与对照组患者相似。在黄疸患者组中，内胆汁引流28天后肠通透性指数降至正常水平（术前为0.050，28天时为0.021，P<0.02）。这些数据表明梗阻性黄疸时肠屏障功能受损，胆汁回流至胃肠道可逆转这种损害。
