ω-3鱼油脂肪乳剂对脓毒症患者炎症反应和免疫功能的影响

Effect of ω-3 fish oil fat emulsion on the inflammatory response and immunologic function in sepsis patients

目的探讨ω-3鱼油脂肪乳剂对脓毒症患者炎症反应和免疫功能的影响。方法选择70例脓毒症患者并随机分为中长链脂肪乳组和鱼油组,肠外营养支持方案中长链脂肪乳组给予中长链脂肪乳剂1.2 g·kg-1·d-1静脉滴注,每日一次;鱼油组加用ω-3鱼油脂肪乳剂0.24 g·kg-1·d-1静脉滴注,每日一次,余与中长链脂肪乳组肠外营养治疗方案成分相同,共7 d,其他治疗措施相同。检测两组患者治疗第1天和第7天外周血中炎症反应指标[C反应蛋白(CRP)、白介素1β(IL-1β)、白介素6(IL-6)、肿瘤坏死子-α(TNF-α)]和T细胞亚群的变化(CD3+、CD4+、CD8+、CD4+/CD8+)。结果治疗后第7天,鱼油组患者的炎症反应指标中的CRP、IL-1β、IL-6均较第1天有所下降,差异均有统计学意义(t分别=190.78、72.26、115.08,P均<0.05);中长链脂肪乳组与治疗第1天相比,CRP和IL-6明显下降、IL-1β和TNF-α明显上升,差异均有统计学意义(t分别=138.36、64.85、77.13、59.56,P均<0.05)。鱼油组第7天各项炎症反应指标均低于中长链脂肪乳组,差异均有统计学意义(t分别=28.56、134.72、56.85、42.18,P均<0.05)。鱼油组第7天CD3+、CD4+、CD4+/CD8+较第1天明显升高,CD8+较第1天明显降低,差异均有统计学意义(t分别=43.03、71.62、-29.37、35.04,P均<0.05)。中长链脂肪乳组第7天CD3+、CD4+、CD4+/CD8+较第1天明显升高,CD8+较第1天明显降低,差异均有统计学意义(t分别=38.24、65.73、-25.68、30.17,P均<0.05)。且第7天时,两组间CD3+、CD4+、CD8+、CD4+/CD8+比较,差异均有统计学意义(t分别=22.73、10.60、-15.38、7.25,P均<0.05)。结论ω-3鱼油脂肪乳剂可能会减轻脓毒症患者的炎症反应,改善患者的细胞免疫功能。

Objective To investigate the effect of ω-3 fish oil fat emulsion on the inflammatory response and immunologic function in sepsis patients. Methods A total of 70 sepsis patients were included and divided randomly into control group with medium chain triglyceride（MCT） and study group with fish oil（FO）. The MCT group was intravenous infused MCT 1.2 g/kg per day for 7 days. The FO group was intravenous infusedω-3 fish oil fat emulsion 0.24 g/kg per day based on the MCT group treatment for 7 days. The inflammatory index（CRP, IL-1β, IL-6 and TNF-α） and T cell subgroup（CD3^＋、CD4^＋、CD8^＋、CD4^＋/CD8^＋） were detected at first day and 7th day after admission to ICU. Results The CRP,IL-1β,IL-6 of FO group at 7th day after treatment were significantly lower than the first day（t=190.78, 72.26, 115.08,P〈0.05）.The CRP and IL-6 of MCT group at 7th day after treatment were significantly lower than the first day while IL-1β and TNF-α were significantly higher（t=138.36, 64.85, 77.13, 59.56,P〈0.05）. At 7th day after treatment, the inflammatory indexes of FO group were significantly lower than the MCT group（t=28.56, 134.72, 56.85, 42.18,P〈0. 05）. At 7th day after treatment, CD3^＋、CD4^＋、CD4^＋/CD8^＋of FO group were significantly higher than the first day while the CD8＋was significantly lower as well as the MCT group（t=43.03, 71.62,-29.37, 35.04; 38.24, 65.73,-25.68, 30.17,P〈0.05）. And at7 th day after treatment, the differences of CD3^＋,CD4^＋,CD8^＋,CD4^＋/CD8^＋between two groups were statistical significant（t=22.73, 10.60,-15.38, 7.25,P〈0.05）. Conclusion ω-3 fish oil fat emulsion might alleviate the inflammatory response of sepsis and ameliorate T cell immunologic function.