免疫型肠内营养对于慢性阻塞性肺疾病合并呼吸衰竭患者血浆低氧诱导因子-1α的影响

Effects of immunomodulating enteral nutrition on hypoxia inducible factor-1α in COPD patients with type Ⅱrespiratory failure

目的观察免疫型肠内营养支持对慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭患者低氧诱导因子-1α(HIF-1α)的影响,并探讨其机制。方法将68例COPD并Ⅱ型呼吸衰竭患者随机分为2组,标准饮食组(对照组)和免疫型肠内营养组(治疗组),每组各观察34例,均于治疗前及治疗后14d分别测HIF-1α水平、营养指标、外周血T细胞亚群及血气指标。结果对照组及治疗组治疗14d后,对照组患者的血浆HIF-1α水平较治疗前没有明显变化(P>0.05),治疗组血浆HIF-1α水平较治疗前有显著下降,较标准饮食对照组相比有明显下降(P<0.05);治疗组和对照组患者14d的营养指标比较治疗前均有显著增高(P<0.05),治疗组较对照组有明显提高(P<0.05);治疗组和对照组患者14d的CD4+、CD8+数目及CD4+/CD8+较治疗前有显著增高(P<0.05),治疗组CD4+、CD4+/CD8+较对照组有明显提高(P<0.05);治疗组和对照组患者14d的PaO2比治疗前有显著增高(P<0.05),PaCO2有显著下降(P<0.05),治疗组上述指标较对照组相比有明显改善(P<0.05)。结论给予免疫型肠内营养制剂可以降低患者HIF-1α的水平,其机制与营养的改善、感染的控制、缺氧的纠正有关。

Objective To investigate the effects and mechanism of immunomodulating enteral nutrition on hypoxia inducible factor-1α（HIF-1α） in COPD patients with type Ⅱ respiratory failure.Methods Sixty-eight COPD patients with with type Ⅱ respiratory failure were randomized into two groups to receive routine nutrition（control group） and immunomodulating enteral nutrition（treatment group）,with 34 cases in each group.The plasma level of HIF-1α,peripheral blood T cell subsets,nutritional indicators,blood gas analysis were detected before and at 14 days after treatment in the two groups.Results At 14 days after treatment,the control group showed no change in level of HIF-1α from baseline（P0.05）,while the treatment group showed a lowered level of HIF-1α compared with baseline and the control group（P0.05）.The both groups showed higher values of nutritional indicators compared with baseline（P0.05） at 14 days after treatment,with greater increase in these indicators in the treatment group（P0.05）.The counts of CD4＋,CD8＋ and CD4＋/CD8＋ T cell subsets were significantly elevated in both groups on day 14,with statistically greater numbers of CD4＋ and CD4＋/CD8＋ in the treatment group compared with the control group（P0.05）.On day 14,the both groups also showed higher level of PaO2 and lower level of PaCO2 compared with baseline（both P0.05）,with more remarkable improvement in the treatment group compared with control group（P0.05）.Conclusion Immunomodulating enteral nutrition may reduce the plasma level of HIF-1α among COPD patients with type Ⅱ respiratory failure,which is probably associated with improvements in nutrition,infection and hypoxia.