围手术期肠外营养支持对不同营养状态Crohn病患者免疫球蛋白、体重以及与感染有关并发症的影响

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

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.