Application and potential mechanism of probiotics combined with high-dose vitamin C in severe acute pancreatitis

Objective To investigate the effects of probiotics combined with high-dose vitamin C on immune function, intestinal mucosal function, and prognosis in patients with severe acute pancreatitis (SAP).

Methods A total of 108 SAP patients were selected as study subjects and divided into control group (treated with high-dose vitamin C as adjuvant therapy, n=53) and observation group (treated with probiotics combined with high-dose vitamin C as adjuvant therapy, n=55) based on different treatment regimens. The efficacy, prognosis, and changes in inflammatory markers tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), interleukin-6 (IL-6), immune function indicators (CD3⁺, CD4⁺, CD4⁺/CD8⁺), intestinal flora, intestinal mucosal function indicators diamine oxidase (DAO), D-lactic acid, endotoxin, and monocyte p38MAPK/nuclear factor-κB (NF-κB) signaling pathway were observed before and after treatment in both groups.

Results The total effective rate in the observation group was 89.09%, which was significantly higher than the 69.81% in the control group (P < 0.05). After 3 and 7 days of treatment, the levels of IL-6, TNF-α, and CRP in the observation group were lower, while the levels of CD3⁺, CD4⁺, and CD4⁺/CD8⁺ were higher than those in the control group(P < 0.05). The levels of Enterococcus and Escherichia coli in the observation group were lower, while the levels of Lactobacillus and Bifidobacterium were higher than those in the control group (P < 0.05). Additionally, the levels of DAO, D-lactic acid, and endotoxin were lower in the observation group, and the relative expression levels of p38MAPK and p-p38MAPK proteins were also lower (P < 0.05). The length of hospital stay and ICU stay in the observation group were shorter compared to the control group (P < 0.05). There was no statistically significant difference in the incidence of voluntary discharge and death between the two groups (P>0.05).

Conclusion The combination of probiotics and high-dose vitamin C has a definite therapeutic effect in SAP patients, effectively reducing inflammatory response, regulating immune function, promoting intestinal mucosal function repair, and facilitating early recovery. The achievement of above efficacy may be related to its inhibition of the p38MAPK/NF-κB signaling pathway.