生态肠内营养对胃肠术后合并肠瘘患者淋巴细胞亚群和肠黏膜屏障功能的影响

Effect of eco-enteral nutrition on lymphocyte subsets and intestinal mucosal barrier function in patients with gastrointestinal fistula after gastrointestinal surgery

目的探讨在胃肠术后合并肠瘘患者中应用生态肠内营养,对其淋巴细胞亚群功能及肠黏膜屏障功能的影响.方法选择的研究对象为在2010-05/2017-05期间,台州市立医院收治的行胃肠术后并发肠瘘的65例患者,根据营养支持方案的不同分为给予生态肠内营养支持的观察组,共30例患者,和给予普通肠内营养支持的对照组,共35例患者.然后将两组患者的细胞因子CD4^+、细胞因子CD8^+、CD4^+/C D8^+比值等淋巴细胞亚群指标,内毒素、D-乳酸等反映肠黏膜屏障功能指标及一般营养状况进行比较.结果在营养支持治疗前,两组患者的CD4^+、CD8^+、CD4^+/CD8^+比值等淋巴细胞亚群指标及淋巴细胞数、白细胞数上无明显差异,不具有统计学意义.在治疗后1 wk或2 wk,观察组患者CD4、CD4^+/CD8^+比值、淋巴细胞数、白细胞数明显高于对照组的,而CD8^+明显低于对照组的,差异均具有统计学意义.在营养支持治疗前,两组患者的D-乳酸及内毒素水平无明显差异,不具有统计学意义;在治疗后1 wk或2 wk,观察组患者D-乳酸、内毒素水平明显低于对照组的,差异均具有统计学意义.在营养支持治疗前,两组患者的体质量指数(body mass index,BMI)、白蛋白、血红蛋白等一般营养状况指标无明显差异,不具有统计学意义;在治疗后1 wk或2 wk,观察组患者BMI、白蛋白、血红蛋白明显高于对照组的,差异均具有统计学意义.结论在胃肠术后合并肠瘘患者中早期应用生态肠内营养的营养支持方案,能够显著改善患者的淋巴细胞亚群状态,保护肠黏膜屏障功能.

AIM To investigate the effect of eco-enteral nutrition onlymphocyte subsets and intestinal mucosal barrier function in patients with intestinal fistula after gastroin- testinal surgery.METHODS Sixty-five patients with intestinal fistula after gastroin- testinal surgery treated at our hospital from May 2010 to May 2017 were divided into an observation group （n = 30） and a control group （n = 35）. The observation group was given eco-enteral nutrition support, and the control group was given normal enteral nutrition. Indexes including CD4^＋ lymphocytes, CD8^＋ lymphoeytes, CD4^＋/ CD8^＋ ratio, endotoxin, and D-lactate were compared between the two groups to compare the intestinal mucosal barrier function and general nutritional status.RESULTS Before nutritional support treatment, there was no significant difference between the two groups in lymphocyte subsets （CD4^＋ lymphocytes, CD8^＋ lymphocytes, and CD4^＋/CD8^＋ ratio）, lymphocyte count, or white blood cell count. One or two weeks after treatment, CD4^＋ lymphocytes, CD4^＋/CD8^＋ ratio, lymphocyte count, and white blood cell count in the observation group were significantly higher than those of the control group. Before the nutritional support treatment, there was no significant difference between the two groups in the levels of D-lactate and endotoxin. One or two weeks after treatment, the levels of D-lactate and endotoxin in the observation group were significantly lower than those in the control group. Before nutritional support and treatment, body mass index （BMI）, albumin, hemoglobin, and other general nutritional status indicators had no significant difference between the two groups. One or two weeks after treatment, BMI, albumin, and hemoglobin in the observation group were significantly higher than those in the control group.CONCLUSION Early nutritional support in patients with gastrointestinal fistula after gastrointestinal surgery can significantly improve patient＇s lymphocyte subsets and protect the intestinal mucosal barrier function.