肠内营养对长期禁食的肠外瘘患者肠黏膜上皮内淋巴细胞及黏液屏障功能的影响

Effects of enteral nutrition of intraepithelial lymphocytes and mucus barrier function on the intestinal mucosa of patients with long-term fasting intestinal fistula

目的探讨肠内营养(enteral nutrition,EN)对长期禁食的肠外瘘患者肠黏膜上皮内淋巴细胞及黏液屏障功能的影响。方法选择2012年4月~2014年12月接受治疗的肠外瘘患者60例进行肠内营养治疗,对比实施EN前后患者的CD3^+、CD4^+、CD8^+及iIEL水平变化,实施EN前后患者的肠黏液屏障功能情况,以及实施EN前后患者的营养指标。结果 EN支持1周及2周后的CD3^+、CD4^+、CD8^+及iIEL水平均分别显著高于EN支持前,差异有统计学意义(P<0.05)。EN支持2周后的D3^+、CD4^+、CD8^+及iIEL水平又分别显著高于EN支持1周后,差异有统计学意义(P<0.05)。EN支持1周及2周后的小肠黏膜黏液的厚度以及黏蛋白基因2的水平均分别显著高于EN支持前,差异有统计学意义(P<0.05)。EN支持2周后的小肠黏膜黏液的厚度以及黏蛋白基因2的水平均又分别高于EN支持1周后,差异有统计学意义(P<0.05)。EN支持1周2周后的血清总蛋白、清蛋白及血红蛋白水平均分别显著高于EN支持前,差异均有统计学意义(均P<0.05)。结论肠内营养对于长期禁食的肠外瘘患者的机体免疫功能及黏液屏障功能具有较好的改善作用,肠内营养2周效果明显好于1周,可作为临床优先选择方式。

Objective To study effects of enteral nutrition of intraepithelial lymphocytes and mucus barrier function on the intestinal mucosa of patients with long-term fasting intestinal fistula. Methods The study was performed in 60 patients with enterocutaneous fistula from April 2012 to December 2014 in our hospital. All patients were treated with enteral nutrition therapy. CD3^＋ , CD4^＋ , CD8^＋ and iIEL levels, intestinal mucus barrier function in patients, and the implementation of nutrition indexes in patients with before and after EN were observed, Results CD3^＋ , CD4^＋ , CD8^＋ and iIEL levels after 1 week and 2 weeks EN support were significantly higher than those before EN support （P〈0. 05）. CD3^＋ , CD4^＋ , CD8^＋ and iIEL levels 2 weeks after EN supports were significantly higher than 1 week after EN supports （P〈0.05）. The intestinal mucus thickness and mucin gene 2 2 weeks after EN supports were significantly higher than those before EN support and 1 week after EN supports （P〈0.05）. The serum total protein, albumin and hemoglobin 1 week and 2 weeks after EN supports were significantly higher than those before EN support （P〈0.05）. Conclusion Enteral nutrition can improve immune function, which is good for long-term fasting patients with enterocutaneous fistula and mucus barrier.