重症胰腺炎患者早期肠内营养后炎性介质IL-8及TNF-α改变与预后关系

Early enteral nutrition improved the changes of inflammatory mediators(IL-8 and TNF-α) and its relationship with the prognosis in the patients with severe acute pancreatitis

目的探讨早期肠内营养对血清炎症介质(IL-8及TNF-α)的影响以及重症胰腺炎患者预后的关系。方法 52例患者随机均分为肠内营养组(EEN组,n=25)和肠外营养组(TPN组,n=27),两组患者入院确诊后除营养支持不同外,给予同样的抗生素、抑酸及抑制胰腺外分泌等处理。治疗前1天、治疗后7天和14天检测血清IL-8和TNF-α水平,同时,观察血淀粉酶、血白细胞及预后变化。结果 EEN组治疗后第7天及第14天血清IL-8和TNF-α水平较对照组显著降低(P<0.01)。同时,血淀粉酶及白细胞总数EEN组较TPN组降低明显(P<0.01),患者感染并发症及上消化道出血以EEN组为低,但两组死亡率差异无显著性。结论重症胰腺炎患者早期进行肠内营养可明显降低血中炎性介质的量,改善患者的临床预后,其机制可能与肠内营养维护肠道屏障功能、减少细菌移位、增强肠道及机体免疫功能有关。

Objective To observe the changes in serum interleukin-8 （IL-8） and tumor necrosis factor-α （TNF-α） in the patients with severe acute pancreatitis followed early enteral Nutrition（EEN） compared with total pareneteral nutrition（TPN） and its effect on prognosis. Methods Fifty-two patients with severe pancreatitis were randomized equally into two groups （EEN group and TPN group） which received standard therapeutic procedures except nutrition. Serum IL-8 and TNF-α were measured pretherapy, 7^th day, and 14^th day by ELISA. The blood amylase and WBC account were also monitored at the same time. Patients＇ prognoses with SAP were observed. Results At 7^th and 14^th day after EEN and TPN, all the inflananatory mediators decreased, but the EEN group offered significant differences compared with PN groups （P 〈 0.05 ）. And the Amylase level and WBC account showed the similar results between two groups. For EEN group, the infection peripancreas and upper GI bleeding seemed lower than that of TPN group. Conclusion Early enteral nutrition in the patients with SAP could significantly decrease the level of inflammatory mediators and improved the patients＇ prognoses. Early enteral nutrition might maintain the GI barrier, inhibit the bacteria translocation and improve the GI tract ＆ host defense ability which plays an important role in SAP patients＇ recovery.