早期肠内营养支持对重症急性胰腺炎患者免疫功能的影响

Effects of early enterai nutrition support on immune function in patients with severe acute pancreatitis

目的观察早期肠内营养（EN）支持对重症急性胰腺炎（SAP）患者免疫功能的影响。方法选择2015年3月11日至2016年12月16日宁波市鄞州人民医院收治的19例SAP患者，按照给予EN的不同时间将患者分为两组，早期给予EN支持的11例患者为研究组，延迟给予EN支持的8例患者为对照组。两组患者人院后均行非手术西医常规治疗，并经鼻放置空肠营养管进行EN。研究组患者于入院后72h即给予早期EN，首日以60mL／h的速率注入250mL糖盐水，次日后改为瑞能200mL；对照组患者于人院后7～10d接受EN，以同样的原则、方法给予相同的EN制剂；两组均给予3周EN。治疗前后取患者静脉血，用免疫比浊法测定血中免疫球蛋白（IgG、IgM、IgA）水平，并观察改良Marshall评分〈1分的时间。结果研究组治疗后免疫球赁白IgG（g/L：11．13±2．56比8．17±1．12）、IgM（g／L：1．71±0．96比0．76±0．71）、IgA（g／L：3．74±1．85比2．13±0．13）均较治疗前明显升高（均Jp〈0．05）；对照组治疗前后上述指标变化不明显[IgG（g／L）：8．32±0．93比8．21±1．04，IgM（g／L）：0．87±0．73比0．81±0．66，IgA（g/L）：2．15±0．37比2．11±0．17]；研究组治疗后IgG、IgM、IgA水平均明显高于对照组（均P〈0．05）。研究组治疗后改良Marshall评分〈1分的时间较对照组明显缩短（d：12．31±1．27比16．18±1．13，P〈0．05）。结论尽早给予免疫营养EN可以有效提高SAP患者机体免疫功能，改善预后。

Objective To observe the effect of early enteral nutrition （EN） on immune function in patients with severe acute pancreatitis （SAP）. Methods Nineteen patients with SAP admitted to Yinzhou People＇s Hospital of Ningbo City from March 11, 2015 to December 16, 2016 were enrolled, they were divided into two groups according to the different times of EN given, 11 patients who were early supported with EN were assigned in the research group and another 8 patients whose EN support was delayed were included in the control group. The patients in two groups were treated with routine non-operative western medicine after admission, and the jejunal nutritional tube was plaeed in the nasal cavity for EN administration. The research group was given early EN beginning at 72 hours after admission, on the first day, 250 mL sugar saline was administered at a rate of 60 mL/h, and on the second clay and afterward, it was changed to 200 mL Ruineng （a commercial kind of EN）; in the control group, the EN began on 7 to 10 days after admission, using the same principle and method as the research group; EN was given for 3 weeks in both groups. Venous blood was collected from each patient before and after the EN support, and immunoglobulin （IgG, IgM and IgA） levels were determined by immunoturbidimetly, the time of improved Marshall score 〈 1 was observed. Results The levels of immunoglobulin IgG （g/L： 11.13 ± 2.56 vs. 8.17 ± 1.12）, IgM （g/L： 1.71 ± 0.96 vs. 0.76±0.71 ） and IgA （g/L： 3.74 ±1.85 vs. 2.13± 0.13） in the research group after treatment were significantly higher than those before treatment （all P 〈 0.05）; the changes in the above indicators before and after treatment in the control group were not obvious [IgG （g/L）： 8.32 ± 0.93 vs. 8.21 ± 1.04, IgM （g/L）： 0.87±0.73 vs. 0.81 ±0.66, IgA （g/L）： 2.15±0.37 vs. 2.11 ±0.17]. The levels of IgG, IgM and IgA in the research group after treatment were significantly higher than those in the control group （all P 〈 0.05）, the time of Marshall score 〈 1 was siginificantly shorter than the research group than that in control group （days： 12.31 ±1.27 vs. 16.18 ± 1.13, P 〈 0.05）. Conclusion Administration of EN as early as possible can effectively enhance the immune function of patients with SAP and improve their prognosis.