大黄联合早期肠内营养对重症急性胰腺炎患者免疫功能的影响

Effects of rhubarb combined with early enteral nutrition on immune function of severe acute pancreatitis patients

目的观察大黄联合早期肠内营养对重症急性胰腺炎(severe acute pancreatitis,SAP)患者免疫功能的影响。方法将2005年3月至2009年3月间我院消化内科收治纳入研究的76例SAP患者随机分为3组。全肠外营养治疗(total parenteral nutrition therapy,TPN)组22例,早期肠内营养治疗(early enteral nutrition therapy,EEN)组28例,大黄联合早期肠内营养治疗(rhubarb combined with early enteral nutrition therapy,REN)组26例。观察3组患者住院费用、住院时间,死亡人数;检测治疗前及治疗1周后CD3、CD4、CD8百分比,CD4/CD8以及免疫球蛋白IgG,IgA,IgM,并进行比较。结果REN组平均住院天数(26.88±4.65)d,平均费用(5.75±0.75)万元,均低于TPN和EEN组(TPN组,P<0.01;EEN组,P<0.05)。3组治疗前CD4%、CD3%和CD4/CD8及IgG、IgM、IgA均有所下降,但差异无统计学意义,REN组治疗后血清免疫球蛋白IgG,IgA,IgM分别为(13.9±2.8)g/L,(3.7±1.6)g/L,(2.1±0.9)g/L,CD4%,CD3%,CD4/CD8分别为(34.41%±2.19%),(53.63%±2.88%),(1.58±0.15),显著高于治疗前(P<0.01),而CD8%与治疗前比较显著下降(P<0.01);治疗后同TPN及EEN组相比,REN组IgG,I-gA,IgM,CD4%,CD3%,CD4/CD8均上升更明显(TPN组,P<0.01;EEN组,P<0.05),而CD8%下降更显著(TPN组,P<0.01;EEN组,P<0.05)。结论REN治疗SAP是有效的,能改善SAP患者免疫状况,缩短住院时间,减少医疗费用,值得临床进一步推广。

Objective To observe the effects of rhubarb combined with early enteral nutrition on immune function of severe acute pancreatitis＇ （SAP） patients. Methods Seventy-six SAP patients were randomly divided into three groups as follows： 22 patients were treated with total parenteral nutrition （TPN）, 28 patients with early enteral nutrition （EEN）, and 26 patients with rhubarb combined with early enteral nutrition（REN）. The hospitalization expenditure, duration of hospitalization, and mortality were observed. The percentages of CD3, CD4, CD8, CD4/CD8 ratio and immunoglobin were detected and compared. Results The mean duration of hospitalization in REN group was （25.09±4.12）days, and the mean hospitalization cost was （57.0±7.0） thousand yuan, both of which were obviously shorter and lower than those in the other groups （TPN group, P〈 0.01; EEN group, P〈0.05）. There was no significant difference among three groups of immunoglobin, CDJCD8 ratio and the percentage of CD3, CD4, CDs before treatment. After one-week treatment in REN group, IgG, IgA, IgM, the percentages of CD3, CD4 and CD4/CD8 were all increased, and the percentage of CD8 was decreased, all of which was significant differences than those before the treatment （P〈0.01）. After treatment, IgG, IgA, IgM, the percentages of CD3, CD4 and CD4/CD8 in REN group were significantly higher than those in EEN and TPN group （TPN, P〈0.01; EEN, P〈O.05）, and the percentage of CDs was lower than those in the other groups （TPN, P〈0.01; EEN, P〈0.05）. Conclusion REN may be effective for SAP. It is worthy of recommendation because it can improve immune function, shorten the length of stay and decrease the hospitalization experditure.