早期肠内营养支持对急性期卒中患者免疫功能的影响

The effect of early enteral nutrition support on immunological function in patients with acute stroke

目的探讨早期肠内营养支持对急性期卒中患者免疫功能的影响。方法选择卒中急性期伴吞咽障碍患者49例,随机分为研究组24例和对照组25例,于入院后72 h内分别给予鼻饲肠内营养支持和普通鼻饲饮食。两组患者分别于入院第1、7及21天测定总淋巴细胞计数(TLC)、免疫球蛋白A(IgA)、G(IgG)、M(IgM)及补体C3、C4含量。并观察营养指标的变化以及感染并发症的发生率。结果21 d后研究组TLC[(2.1±0.4)×109/L]、IgA[(2.7±0.5)g/L]、IgG[(11.1±2.2)g/L]、IgM[(1.7±0.7)g/L]和补体C3[(1.2±0.2)g/L]水平显著高于对照组TLC[(1.7±0.4)×109/L,P<0.05]、IgA[(2.0±0.4)g/L,P<0.01]、IgG[(8.9±2.5)g/L,P<0.01]、IgM[(1.3±0.6)g/L,P<0.05]和补体C3[(1.0±0.3)g/L,P<0.01]。研究组感染并发症发生率(29.2%)显著低于对照组(60.0%,P<0.05)。研究组的营养指标亦显著优于对照组。结论早期肠内营养支持可改善急性期卒中患者机体的免疫功能,降低感染并发症的发生率。

objective To discuss the effect of early enteral nutrition support on immunological function in patients with acute stroke. Methods Forty-nine stroke patients with dysphagia were randomly al- located into study group （ n = 24） and control group （ n = 25 ）. They were received enteral nutrition via nasogassric tube and ordinary nasal feeding of liguid diet, respectively within 72 hours after admission. The levels of total lymphocyte count （TLC）, immune globulin A （IgA） , immune globulin G （IgG） , immune globulin M （ IgM ）, complement 3 （ C3 ）, and complement 4 （C4） in both groups were detected on day 1, 7 and 21 respectively after admission. The changes of nutritional index and the incidence of infective complications were observed. Results The levels of Tl~ [ （2.1±0.4） ×10^9/L], lgA [ （2.7±0.5） g/L], IgG [ （11.1±2.2） g/L], IgM [ （1.7±0.7） g/L], and C3 [ （1.2±0.2） g/L] in the study group were significantly higher than the levels ofTLC （ 1.7 ± 0. 4 × 10^9/L, P 〈0. 05） , IgA[ （2.0 ± 0. 4） g/L, P〈0.01], IgG [ （8.9± 2.5） g/L, P〈0.01], IgM [ （1.3 ±0.6） g/L, P 〈0.05], and C3 [ （ 1.0 ± 0. 3 ） g/L, P 〈 0. 01 ] in the control group after 21 days. The incidence of infective complica- tions in the study group （29. 1% ） was significantly lower than that in the control group （ 60. 0% ; P 〈 0. 05）. The nutritive index of the study group was also significantly better than that in the control group. Conclusion Early enteral nutrition support may improve the immunological function in patients with acute stroke, and decrease the incidence of infective complications.