免疫营养制剂临床应用争议与共识

Consensus and argument on the clinical application of immunonutrition

随着临床营养学的不断发展,免疫营养因可以提升病人营养状态和改善免疫功能而受到越来越多的临床关注。含谷氨酰胺、精氨酸、ω-3多不饱和脂肪酸、膳食纤维等中一种或多种的免疫营养制剂可通过刺激免疫细胞,增强免疫应答功能,维持正常、适度的免疫反应,调理机体代谢,减轻有害或过度炎性反应,保护肠屏障功能完整性,减少细菌易位等作用,从而改善病人预后。免疫营养制剂的临床应用逐渐广泛,在部分病人中的临床应用价值也已得到认可,但仍存在较多争议和问题,如各种免疫营养素组合和剂量的个体化选择、免疫营养治疗的最佳时机、生态免疫营养中微生态制剂的选择等。

With the continuous development of clinical nutrition, immunonutrition attracts more and more clinical attention because of the ability to improve the nutritional status and immunologic function of patients. Immunonutrition, such as glutamine, arginine, ω-3 polyunsaturated fatty acids, dietary fiber and so on can improve the clinical outcome by supporting metabolism, enhancing immunologic function, suppressing excessive inflammatory response. With the gradually widespread clinical application of immunonntrition, the clinical value has been confirmed in some specific patients and many controversies and questions also have been presented. The purpose of the review is to describe some known physiological mechanisms of immunonutrition and the consensus and argument on the clinical application of immunonutrition.