不同时机肠内营养对SAP患者早期白细胞过度激活的影响

Impact of enteral nutrition initiated at different time periods on excessive activation of leucocytes occurring in early course of severe acute pancreatitis

目的:观察重症急性胰腺炎(SAP)患者TNF-α,IL-1β,IL-6含量的动态变化,探讨肠内营养(EN)对SAP早期白细胞过度激活的影响及其临床意义。方法:将79例SAP患者分为EN组和肠外营养(PN)组,均按SAP的治疗指南进行基础治疗。PN组(25例)于发病后第3天启动PN支持,直至经口进食;EN组(54例)采用不同时机(发病后第1,4,6天)启动EN支持,持续至经口进食。比较两组TNF-α,IL-1β,IL-6水平的下降程度。结果:治疗后两组患者TNF-α,IL-1β,IL-6水平均逐渐下降,但从第5天开始,各EN组下降的程度均明显大于PN组(P<0.05),且EN启动越早其下降程度越大(P<0.05)。结论:早期EN治疗能明显降低SAP患者TNF-α,IL-1β,IL-6水平,且较PN治疗更利于缩短SAP过程中早期白细胞过度激活的时间,利于患者恢复。

Objective： To monitor the alterations of TNF-α,IL-1β and IL-6 levels in patients with severe acute pancreatitis（SAP）,so as to determine the influence and significance of enteral nutrition（EN） on excessive activation of leucocytes during the early course of SAP. Methods： Seventy-nine SAP patients were divided into EN group and parenteral nutrition（PN） group,and all the patients received the basic treatment according to guidelines for SAP management.In PN group（25 cases）,the PN support was initiated on the third day after onset and continued until oral intake was resumed.In the EN group（54 cases）,the EN support was started at different time periods after onset（the first,fourth or sixth day after onset） and continued until oral intake was resumed.The drop extent in TNF-α,IL-1β and IL-6 levels of the two groups were compared. Results： The TNF-α,IL-1β and IL-6 levels in both groups decreased gradually after treatment.However,from the fifth day after treatment,the drop extents of above parameters in each EN group were significantly evident than those of PN group（P〈0.05）,and the earlier the EN support was initiated,the more evident did the above parameters decrease（P〈0.05）. Conclusion： Early EN support can effectively reduce the TNF-α,IL-1β and IL-6 levels in SAP patients,and it is faster than PN support in reducing the duration of excessive activation of leucocytes during SAP,which is beneficial to the recovery of the patients.