短期营养支持对COPD呼吸衰竭合并严重营养不良患者免疫功能的作用

Short-term nutritional support improved the immune function of COPD and respiratory insufficiency with severely malnutrition

目的 评价COPD呼吸衰竭合并严重营养不良患者的营养状态及短期营养支持的疗效。方法 研究 2 1例住院患者的营养状态 ,患者随机分为胃肠外营养 (PN)及非胃肠外营养 (NPN)组 ,观察期为两周。结果 ①人体测量 :入院时两组患者体重明显低于IBW值 (P <0 0 5 ) ;营养支持两周后 ,PN组的体重由 42 4± 6 6kg增加至 45 6± 5 4kg(P <0 0 5 ) ,体重增加1 6～ 3 2kg ,而NPN组无显著性变化。入院时 ,PN、NPN组的TSF严重降低 ,MAMC降低较TSF不明显 ,只有中度降低 ,显著低于预计值 (P <0 0 5 )。②免疫功能 :入院时两组血TLC、PPD阳性率、T淋巴细胞亚群CD4 及CD4 /CD8比均显著降低 (P <0 0 5 ) ;营养支持两周后 ,PN组的血TLC、PPD阳性率及CD4 /CD8显著性增高 (P <0 0 5 ) ,与NPN组有显著性差异 (P <0 0 5 )。

Objective To assess the nutritional status of severe malnourished patients with COPD and respiratory insufficiency.Methods We studied the nutritional status with anthropometric measurements,serume and urinary biochemical testing,immune function.21 severe malnourished patients were randomized to a parenteral nutrition(PN) group or a non-parenteral nutrition(NPN) group,studied again two weeks after two weeks PN support.Results ①Anthropometric measurement:the mean weight of two group was significantly lower than IBW values on admission( P <0 01);two weeks of PN support later,the mean weight of PN group increased from 42 4±6 6 to 45 6±5 4 ( P <0 05),the range of weight gain was 1 6 to 3 2 kg,but the mean weight of NPN group had not significantly altered.②Immune function:blood total lymphocyte count(TLC),percentage of purified protein derivation(PPD)positive,T-lymphocyte subsets CD 4/CD 8 were significantly lower than normal values( P <0 05);two weeks of PN support later,blood TLC,percentage of PPD positive,ratio of CD 4/CD 8 were significantly increased( P <0 05),and significantly higher than those of NPN group ( P <0 05) Conclusions Short-term nutritional support can improve the nutritional status and immune function of severe malnourished patients with COPD and respiratory insufficiency.