Stallmach A, Zeitz M
Medizinische Klinik und Poliklinik, Universitätskliniken des Saarlandes, Homburg, Bundesrepublik Deutschland.
Wien Klin Wochenschr. 1998 Feb 13;110(3):72-8.
The intestinal mucosa is in close contact with a large number of foreign antigens and mitogenic substances in the gut lumen. To protect the host against invasion of potential pathogens or an inappropriate immune response to the enormous number of antigens, a highly specialized immune system in the intestinal mucosa has developed, the so-called gut-associated lymphoid tissue (GALT). The passage of viable bacteria from the gastrointestinal tract through the epithelial mucosa is called bacterial translocation. Bacterial translocation in critically ill patients may lead to a significant incidence of systemic sepsis. This has attracted much clinical interest, as it has been shown that disturbances of the GALT and malnutrition itself, impair various aspects of barrier function. Enteral nutrition seems to be superior to parenteral nutrition in maintaining the functional barrier of the gut. Defined dietary variable (fibre, glutamine) influence bacterial translocation. Future therapeutic strategies should therefore concentrate on early enteral feeding in traumatised patients to reduce the incidence of bacterial translocation and septic complications.
肠黏膜与肠腔内大量的外来抗原和促有丝分裂物质密切接触。为保护宿主免受潜在病原体的侵袭或对大量抗原产生不适当的免疫反应，肠黏膜中已形成了一种高度专业化的免疫系统，即所谓的肠道相关淋巴组织（GALT）。活细菌从胃肠道穿过上皮黏膜的过程称为细菌移位。重症患者的细菌移位可能导致全身性脓毒症的发生率显著升高。这已引起了临床的广泛关注，因为研究表明，GALT紊乱和营养不良本身会损害屏障功能的各个方面。在维持肠道功能屏障方面，肠内营养似乎优于肠外营养。特定的饮食变量（纤维、谷氨酰胺）会影响细菌移位。因此，未来的治疗策略应集中于对创伤患者尽早进行肠内喂养，以降低细菌移位和脓毒症并发症的发生率。
