肠内免疫营养对肝移植患者术后早期营养状态和免疫功能的影响

Influence of enteral immunonutrition on early postoperative nutritional state and immune function of patients after liver transplantation

目的:观察肝移植患者术后早期进行肠内免疫营养支持的有效性及临床意义。方法:采用前瞻、随机、单盲、对照的临床研究方法,将30例行原位肝移植术患者随机分为两组,每组15例。两组患者术中于空肠上段留置鼻肠管,术后12 h开始肠内营养支持,热量摄取均为105 kJ.kg-1.d-1。免疫营养组用富含免疫营养物ω-3脂肪酸、谷氨酰胺、膳食纤维的等渗高浓缩营养配方瑞先;普通营养组用仅含热量的普通营养制剂百普力。两组患者于麻醉前及术后3 d和10 d取静脉血,检测血清转铁蛋白、前白蛋白、T细胞亚群(CD3、CD4、CD8、CD4/CD8)、免疫球蛋白(IgA、IgM和IgG)水平。结果:与术前比较,两组患者术后3 d均有营养状态和免疫功能进一步下降(P<0.05或P<0.01),10 d免疫营养组血清前白蛋白水平较术前显著增加,且显著高于普通营养组(P均<0.05),术后3 d和10 d免疫营养组CD4/CD8及血清IgG较普通营养组显著增加(P<0.05或P<0.01)。结论:肠内免疫营养可减轻肝移植术后免疫功能低下,阻止营养不良的进一步加重,对提高肝移植围手术期存活率具有重要意义。

Objective： To investigate the influence of supplementation of enteral immune nutrition supplementation on nutritional and immunological index in patients in early period after liver transplantation. Methods： This was a prospective randomized single -blind clinical study. Thirty patients who undergone orthotopic liver transplantation were randomly divided into two groups, each n=15 ： immune nutrition group （with iso - osmia condensed nutritional prescription fresubin composed of ω - 3 fat acid, glutamine, dietary fiber）, conventional nutrition group （peptison composed of heat only）. Nasointestinal tube was placed in the proximal segment of jejunum before the liver transplantation. Twelve hours after the operation enteral nutrition supplementation was began in patients of both groups. The caloric intake was 105 kJ· kg^-1 · d^-1 in both groups. Serum transferrin, prealbumin, T cell subgroups （CD4, CD3, CD8 and CD4/CD8） and immunoglobulins （IgA, IgM and IgG） in venous blood were determined before operation （before anesthesia）, 3 days and 10 days after operation. Results ： In both groups, nutritional state and immune function 3 days after liver transplantation were decreased compared with that before transplantation （P〈0. 05 or P〈0. 01）. Serum content of prealbumin in immune nutrition group was increased significantly compared with those before operation and that in conventional nutrition group 10 days after operation （both P〈0.05）, and CD4/CD8, serum IgG also increased significantly 3 days and 10 days after operation in the immune nutrition group （P〈0.05 or P〈0. 01）. Conclusion： Enteral immunonutrition can lessen aggravation of immune hypofunction and malnutrition after liver transplantation, and it is important in raising survival rate after liver transplantation.