Aldazabal P, Eizaguirre I, Barrena M J, Garcia-Arenzana J M, Ariz C, Cuadrado E
Hospital Na Sa de Aranzazu, San Sebastian, Spain.
Eur J Pediatr Surg. 1998 Aug;8(4):247-50. doi: 10.1055/s-2008-1071164.
Bacterial translocation (BT) accounts in part for sepsis in short-bowel syndrome in which total parenteral nutrition (TPN) is routinely necessary. TPN "per se" facilitates BT and it has been suggested that decreased T-lymphocyte populations (TLP) in newborn rabbits and nude mice promote BT as well. We have tested the hypothesis that BT and modifications in TLP are to be expected in rats subjected to TPN and gut resection. Forty-five adult Wistar rats underwent central venous cannulations and were randomly assigned to one of three groups receiving for ten days three treatment regimes: - Group Sham (n = 17) oral intake of rat chow + saline (300 ml/kg/24 h) through a jugular vein catheter. - Group TPN (n = 17) fasting + infusion of all-in-one TPN solution (300 ml/kg/24 h). - Group RES (n = 11) fasting, same TPN regime + 80% gut resection. At the end of the experiment they were sacrified and specimens (peripheral and portal blood, spleen and mesenteric lymph nodes) were recovered, cultured and/or assessed for CD4+ and CD8+. Bacterial translocation was found in 47% of TPN animals, 92% of RES rats, but not in SHAM ones. Lymphocyte populations were not different in BT+ (n = 8) or BT- (n = 9) rats in the TPN group. TPN and resected animals showed a rise in CD4+ and a drop in CD8+ (then a better CD4+/CD8 ratio) when comparing with SHAM group rats. From this data we may conclude that: 1) BT is frequent if TPN is administered, and constant in resected animals. 2) No apparent relationship between the proportions of CD4+ and CD8+ lymphocytes and BT could be shown in TPN group. 3) High CD4+/CD8+ ratio in TPN and RES groups demonstrate that BT is possible even having good TLP.
细菌易位(BT)在短肠综合征所致脓毒症中起部分作用,在此类病症中全胃肠外营养(TPN)通常是必要的。TPN“本身”会促进BT,并且有研究表明新生兔和裸鼠体内T淋巴细胞群(TLP)减少也会促进BT。我们检验了以下假设:接受TPN和肠道切除的大鼠会出现BT以及TLP的改变。45只成年Wistar大鼠接受中心静脉插管,并随机分为三组,接受三种治疗方案,为期十天:-假手术组(n = 17)通过颈静脉导管经口摄入大鼠饲料+生理盐水(300 ml/kg/24 h)。-TPN组(n = 17)禁食+输注全合一TPN溶液(300 ml/kg/24 h)。-RES组(n = 11)禁食,相同的TPN方案+80%肠道切除。实验结束时,将它们处死并采集标本(外周血和门静脉血、脾脏和肠系膜淋巴结),进行培养和/或评估CD4+和CD8+。在TPN组动物中,47%发现有细菌易位,RES组大鼠中为92%,而假手术组未发现。TPN组中细菌易位阳性(n = 8)和阴性(n = 9)的大鼠淋巴细胞群无差异。与假手术组大鼠相比,TPN组和切除组动物的CD4+升高,CD8+降低(CD4+/CD8比值更佳)。根据这些数据我们可以得出以下结论:1)给予TPN时细菌易位很常见,而在切除组动物中则持续存在。2)TPN组中未发现CD4+和CD8+淋巴细胞比例与细菌易位之间存在明显关系。3)TPN组和RES组中较高的CD4+/CD8+比值表明,即使TLP良好,细菌易位也有可能发生。