生态免疫肠内营养对严重多发伤患者调节性T细胞的影响

Effect of CD4^+,CD25^+,regulatory T cells on the patients with severe multiple injury after treatment by ecological immune enteral nutrition

目的观察伤后早期应用生态免疫肠内营养(EIEN)对严重多发性创伤患者调节性T细胞的影响。方法将60例严重多发伤患者随机分为三组,即生态免疫营养组(EIEN组,20例)、免疫肠内营养组(IEN组,20例)和常规肠内营养组(EN组,20例),营养支持治疗8d,于伤后1、3、5、8d流式细胞仪检测各组患者外周血T细胞亚群和CD4+、CD25+、Treg细胞的比率变化及ELASA法检测血清中IL-10、IFN-γ水平。结果EIEN、IEN及EN支持8 d后各组患者Treg细胞比率与伤后1d比较显著增高,且EIEN组Treg细胞比率显著低于IEN组和EN组(P<0.05,P<0.01)。伤后8d各组血清IFN-γ水平与伤后1d比较显著降低,且EIEN组IFN-γ水平显著高于IEN组和EN组(P<0.05,P<0.01)。伤后8d各组血清IL-10水平与伤后1d比较显著增高,且EIEN组IL-10水平显著低于IEN组和EN组(P<0.05)。结论EIEN虽无法逆转伤后Treg细胞比率的升高,但可减缓其增高的趋势,且在改善严重多发伤患者免疫抑制的作用方面要优于IEN和EN。

Objective To observe the effect of regulatory T（Treg） cells on the patients with severe multiple injury after the treatment by ecological immune enteral nutrition. Methods Sixty patients with severe multiple injuries were randomly divided into 3 groups： ecological immune enteral nutrition group （ EIEN group, 20 cases） ; immune enteral nutrition group （ IEN group, 20 cases） ; enteral nutrition group（ EN group, 20 cases）. On the 1st day after the injury, all the patients were treated with nutritional support. The proportion of T - cell subgroup and Treg cell in peripheral blood were detected by FCM and the level of IL - 10 and IFN -γ in serum were detected by ELISA on the lst,3rd, 5th, 8th day after the injury. Result After the treatment of EIEN, IEN and EN,the proportion of Treg cell subgroup were significantly increased in each group on 8th day after the injury and were significantly lower in EIEN group than in IEN group and EN group （ P 〈 0. 05, P 〈 0.01 ） . The level of IFN - γ were significantly decreased and the level of IL- 10 were significantly increased in each group on 8th day after the injury, at the same time, the level of IFN - γ were significantly higher in EIEN group than in IEN group and EN group（ P 〈0. 05, P 〈 0.01） and the level of IL- 10 were significantly lower in EIEN group than in IEN group and EN group（P 〈 0.05）. Conclusion Although EIEN didnt reverse the increase of the proportion of Treg cell subgroup after injury,it can decrease the ascending tendency. EIEN help to ameliorate the immunosuppressive effect better than IEN and EN on the paitents with severe multiple injury.