ω3鱼油脂肪酸治疗脓毒症并肠功能障碍的疗效及其对患者免疫功能的影响

Efficacy of omega 3 fish oil in the treatment of sepsis patients with intestinal dysfunction and its effect on immunological function

目的探讨ω3鱼油脂肪酸能否通过改善淋巴细胞免疫功能来降低肠功能障碍患者的病死率。方法选择48例存在肠功能障碍的严重脓毒症并多脏器功能障碍患者,随机将其为对照组与观察组,每组24例,对照组采用胸腺肽α1及乌司他丁等常规治疗,观察组在此基础上加用ω3鱼油脂肪酸治疗,比较两组患者的死亡率、ICU住院日、急性生理与慢性健康评分(APACHEⅡ)、Marshall评分、T淋巴细胞亚群(CD3+、CD4+、CD8+及CD4+/CD8+)及超敏C反应蛋白(hs-CRP)水平。结果 28 d随访中,对照组死亡10例,占41.7%,观察组死亡3例,占12.5%,两组患者病死率比较差异有统计学意义(P<0.05);观察组ICU住院日短于对照组(P<0.05);观察组治疗第7 d APACHEⅡ和Marshall评分均低于对照组,差异均有统计学意义(P<0.05);观察组血清CD3+、CD4+、CD4+/CD8+均明显高于对照组,hs-CRP低于对照组,差异均有统计学意义(P<0.05)。结论ω3鱼油脂肪酸可能通过改善淋巴细胞免疫功能从而降低肠功能障碍患者的病死率。

Objective To study the efficacy of omega 3 fish oil in reducing mortality in patients with intesti- nal dysfunction by improving lymphoeytes＇ immunological function. Methods Forty-eight patients with severe sep- sis, multiple organ dysfunction syndrome （MODS） and intestinal dysfunction were recruited and randomly divided in- to the control group and the treatment group, with 24 eases in each group. The control group was treated by thymosin α1, ulinastatin and other conventional treatment, while the treatment group added omega 3 fish oil on the basis of the con- trol group. The mortality, duration of mechanical ventilation, ICU stay days, and APACHE Ⅱ, Marshall score, T lym- phocyte subsets （CD3＋, CD4＋, CD8＋ and CD4＋/CD8＋） and hs-CRP levels were compared. Results During the 28-day fol- low-up, 10 patients died in the control group （41.7%） and 3 patients died in the treatment group （12.5%）, with statisti- cally significant difference in the mortality between the two groups （P〈0.05）. Patients in treatment group had significantly shorter ICU stay time （P〈0.05）. On the 74 day of treatment, APACHE Ⅱ and Marshall Scores in the treatment group were all significantly lower than those in the control group （P〈0.05）. Besides, CD3＋, CD4＋, and the ratio of CD4＋/CD8＋ were all significantly higher in treatment group than in control group, but hs-CRP levels were significantly lower in the treatment group （P〈0.05）. Conclusion Omega 3 fish oil can reduce mortality in patients with intestinal dysfunction by improving immunological function of lymphocytes.