肠内营养液对营养不良老年心力衰竭患者炎性因子及心功能的影响

Effects of Enteral Nutrition on Inflammatory Factors and Cardiac Function in Elderly Malnourished Patients with Heart Failure

目的探讨肠内营养液对老年心力衰竭(心衰)患者血清炎性因子及心功能的影响。方法老年心衰患者96例,随机分为治疗A组、治疗B组和对照组共3组,各32例。均给予抗心衰常规治疗,同时治疗A组给予肠内营养500 mL·d-1,治疗1个月;治疗B组给予同剂量肠内营养治疗3个月;对照组给予自由饮食。各组治疗前后均采用NRS2002评估营养状况,同时记录心功能分级,检测左室射血分数(LVEF)、血浆B-型钠尿肽(BNP)、血清炎性因子白细胞介素-6(IL-6)、C-反应蛋白(CRP)、肿瘤坏死因子(TNF-α)等。结果治疗组治疗后体质量指数、上臂肱三头肌皮褶厚度、上臂肌围、AMC、总蛋白、清蛋白、血红蛋白均有升高,LVEF升高,心衰症状缓解比较明显;BNP、IL-6、TNF-α和CRP水平均有不同程度降低(P<0.05),治疗B组改善更为明显(P<0.01)。对照组各营养指标和血清炎性因子水平及心功能治疗前后差异无统计学意义(P>0.05)。结论老年心衰患者在常规治疗心衰的同时补充肠内营养,不仅可以改善患者营养状况和心功能,还可以改善免疫功能,进而降低炎性因子水平,治疗时间越长患者的心功能及炎性因子改善越明显。

Objective To study the effects of enteral nutrition（ EN） on inflammatory factors and cardiac function in elderly patients with heart failure （ HF ） . Methods A total of 96 elderly patients with HF were enrolled in this study and randomly divided into treatment group A,treatment group B and control group（ n= 32 in each group） . Patients in group A were provided with 500 mL of EN daily for 1 month, and those in group B were provided with the same dose of EN for 3 months. Control group was treated with normal diet. The nutrition status of each group was assessed by NRS2002. Meanwhile,all patients were evaluated by New York Heart Association（NYHA） class and left ventricle eject fraction（LVEF）. The levels of BNP,IL-6, CRP and TNF-α were also measured before and after nutrition treatment. Results In group A and group B,BMI,TSF,AMC, TP,ALB and HGB increased. Symptoms of HF alleviated quickly and LVEF increased compared to the baseline. The levels of BNP,IL-6,CRP and TNF-α were significantly lower after treatment（P〈0. 05） in both treatment groups,and the change in group B was more obvious（P〈0. 01） than group A. However,in control group,there is neither evident improvement in cardiac function or nutrition status,nor in inflammatory factor levels. Conclusion Adding EN support to the normal treatment of heart failure in elderly malnourished patients with HF not only improves the function of heart and nutrition status, but also helps to support immune system so as to alleviate acute inflammatory response. The benefits from EN depend on the duration of therapy.