早期肠内营养对重症急性胰腺炎患者免疫功能的影响

Effect of Early Enteral Nutrition on Immune Function in Patients with Severe Acute Pancreatitis

目的观察早期肠内营养(enteral nutrition,EN)对重症急性胰腺炎(severe acute pancreatitis,SAP)患者免疫功能的影响。方法选取泸州医学院临床医学院附属医院消化内科2012年1月至2013年6月收治的SAP患者共56例,随机分为早期EN组和延迟EN组。观察两组患者ICU住院时间、并发症发生情况和院内死亡率;检测患者APACHElI评分、Balthazar CT评分、CD4^+百分率、CD8^+百分率、CD4^+/CD8+比率、C反应蛋白以及HLA-DR。结果早期EN组患者并发MODS和ICU住院时间更优于延迟EN组;相对于延迟EN组,早期EN组在治疗第8天,CD4^+百分率和CD4^+/CD8^+比率明显降低,HLA-DR百分率升高,C-反应蛋白下降;平均住院时间以及并发症发生情况明显优于延迟EN组。结论 SAP患者早期EN治疗可以缓解患者过度免疫反应,改善患者临床症状,但不能降低死亡率。

Objective To investigate the effects of early enteral nutrition（EN）on the immune function of patients with severe acute pancreatitis（SAP）.Methods 56 patients hospitalized from January 2012 to June 2013 in our hospital were randomly divided into early EN group and delayed EN group.Their ICU stay,complication,hospital mortality were observed and their APACHElI scores,Balthazar CT scores,CD4~＋percentage,CD8~＋percentage,CD4~＋/CD8~＋ratio,C-reactive protein and HLA-DR were measured.Results The patients in the early EN group had lower MODS occurred and shorter ICU stay compared to the delayed EN group.Early EN group′s CD4~＋percentage and CD4~＋/CD8~＋ratio decreased significantly,HLA-DR percentage increased,and C-reactive protein decreased significantly on 8th day of treatment.Early EN group has shorter average hospital stay and less complications than delayed EN group.Conclusion Early EN treatment can moderate the excessive immune response during the early stage of SAP,improve clinical outcome,but can not decrease hospital mortality.