摘要
目的探讨围手术期肠外营养支持对不同营养状态Crohn病患者的免疫球蛋白、体重和并发症的影响。方法将在本院确诊、计划手术治疗的32例Crohn病患者按术前有无营养不良分组,体重下降在15%~30%者为营养不良组,共16例;体重下降<15%者为对照组,共16例。两组患者均在手术前1周和手术后3周应用肠外营养穴PN雪支持穴共4周雪;于PN前后测定血清中IgM、IgG和IgA水平、肝功及体重变化。监测术后并发症。结果两组患者的IgM水平于PN前均高于正常值眼对照组:穴133±16雪mg/dl,营养不良组:穴139±41雪mg/dl;正常值:穴110±35雪mg/dl;P=0.04演;PN治疗后营养不良组患者明显下降眼穴105±29)mg/dl,P=0.02雪演,达到正常水平,对照组无明显变化眼穴129±13雪mg/dl熏P=0.34演。两组患者的IgA和IgG水平于PN前在正常范围,PN后无明显变化穴P值在0.20~0.57之间雪。体重:对照组PN前后无明显变化眼PN前:穴55.6±6.1雪kg,PN后:穴56.3±6.0雪kg;P=0.46演,营养不良组较PN前升高眼穴PN前:穴45.8±8.9雪kg,PN后穴48.0±8.8雪kg;P=0.005雪演。对照组患者与感染有关性并发症较营养不良组多穴对照组4例,25%;营养不良组2例,12.5%鸦P=0.13雪,但无统计学差别。结论围手术期应用肠外营养支持,能改善有明显营养不良Crohn病患者的体液免疫状态,增?
Objective To evaluate the role of nutritional status on serum immunoglobulins,body weight and postoperative infectious-related complications in patients with Crohn' s disease receiving perioperative parenteral nutrition(PN).Methods32patients with Crohn' s disease receiving perioperative parenteral nutrition in our department between1984and1994were enrolled in this survey.16patients with loss of body weight in the range of15%~30%were assigned to the malnutrition group,the other16patients with normal weight or loss of body weight less than15%to the control group.Serum IgM,IgG and IgA levels were measured before and after PN by enzyme-linked immunosorbent assays.Liver function,body weight changes and postoperative complications were also analyzed.Results IgM levels were elevated before PN in both groups control group:(133±16)mg/dl,malnutrition group:(139±41)mg/dl;normal value:(110±35)mg/dl;P =0.04 ,decreased to normal value (105±29)mg/dl,P =0.02 in the malnutrition group while having no obvious changes in the control group (129±13)mg/dl, P =0.34 .No significant changes in concentrations of IgG and IgA were found( P in the range of0.20~0.57).The average weight gain was1.862kg in malnutrition groupbefore PN:(45.8±8.9)kg,after PN (48.0±8.8)kg;P =0.005 and no significant changes in the control group before PN:(55.6±6.1)kg,after PN (56.3±6.0)kg;P =0.46.There was an increase in infectious complications in the control group(control group 4cases,25%,malnourished group 2cases,12.5%; P =0.13). Conclusions Perioperative parenteral nutrition ameliorated the humoral immunity,increased the body weight in patients with obvious malnutrition,whereas it had little value for those without or with mild malnutrition.
出处
《中国医学科学院学报》
CAS
CSCD
北大核心
2002年第2期181-184,共4页
Acta Academiae Medicinae Sinicae
关键词
CROHN病
肠外营养
体液免疫
术后并发症
Crohn's disease
parenteral nutrition
immunoglobulins
infectious-related complication