肺结核合并营养不良患者肠外营养支持的应用研究

Research of parenteral nutrition support on pulmonary tuberculosis patients complicated with malnutrition

目的探讨肺结核合并营养不良患者进行肠外营养支持的临床应用价值。方法采取随机对照试验方法,将43例肺结核合并营养不良患者分为肠外营养组(n=22)和对照组(n=21),疗程21 d。比较两组患者治疗前后体重指数(BMI)、肱三头肌皮褶厚度(TSF)、上臂肌围(MAMC)、血红蛋白浓度(Hb)、血淋巴细胞总数(TLC)、血清白蛋白浓度(ALB)及T细胞亚群等指标的变化。结果①治疗21 d后,肠外营养组患者BMI、MAMC较治疗前均有明显升高[BMI:(20.4±3.8)比(16.3±2.5)kg/m2,P﹤0.01;MAMC:(19.5±2.9)比(17.2±3.7)cm,P﹤0.05],亦显著高于对照组[BMI:(20.4±3.8)比(17.5±4.4)kg/m2,P﹤0.05;MAMC:(19.5±2.9)比(17.1±2.6)cm,P﹤0.05];肠外营养组患者TSF较治疗前也有显著升高[(8.8±3.2)比(6.9±2.5)cm,P﹤0.05]。②治疗后肠外营养组患者的Hb、ALB浓度显著高于对照组[(120.1±16.3)比(105.2±17.4)g/L,P﹤0.01;(34.5±3.9)比(30.7±3.3)g/L,P﹤0.01]。③治疗后两组患者血清CD4+、CD4+/CD8+均较治疗前显著升高;肠外营养组患者血清CD3+较治疗前显著升高;治疗后肠外营养组患者血清CD4+/CD8+显著高于对照组(P﹤0.01)。结论对肺结核并营养不良的患者,及时合理的肠外营养支持有助于改善患者的营养状况及细胞免疫功能,促进患者早日康复,值得在临床推广应用。

Objective To study the effect of parenteral nutrition support on pulmonary tuberculosis patients complicat ed with malnutrition.Methods Forty-three pulmonary tuberculosis patients complicated with malnutrition were ran domly divided into two groups： parenteral nutrition support group（n = 22） and control group（n = 21）.Body mass index（BMI）,skinfold thickness of triceps（TSF）,mean arm muscle circumference（MAMC）,hemoglobin（Hb）,total lym phocyte count（TLC）,albumin（ALB） and T-cell subpopulations were detected and compared before and after treat ment of 21 days.Results ①After 21 days treatment,BMI and MAMC of parenteral nutrition support group were sig nificantly higher than those of control group [BMI：（20.4±3.8） vs（17.5±4.4） kg/m2,P﹤0.05;MAMC：（19.5±2.9） vs（17.1±2.6） cm,P﹤0.05].②Hb and ALB of parenteral nutrition support group were significantly higher than those of control group after therapy[（120.1 ±16.3） vs（105.2±17.4） g/L,P﹤0.01;（34.5±3.9） vs（30.7±3.3） g/L,P﹤ 0.01].③21 days later,secrum percentage of CD4＋ and the ratio of CD4＋/CD8＋ increased significantly in both two groups.Percentage of CD3＋ also increased significantly in parenteral nutrition support group.The ratio of CD4＋/CD8＋ was significantly higher in parenteral nutrition support group than that of control group after therapy（P ﹤ 0.01）.Conclusion For pulmonary tuberculosis patients complicated with malnutrition,parenteral nutrition support is helpful to improve nutrition al status and immune function.Therefore,it is worth to apply in clinic.