TPF-DM对急性重症胰腺炎伴肠道菌群移位患者免疫功能的影响

Effect of enteral nutrition suspension on immune function in severe acute pancreatitis patients with intestinal bacterial translocation

目的观察分析肠内营养混悬液(enteral nutrition suspension,TPF-DM)对急性重症胰腺炎伴肠道菌群移位患者免疫功能的影响.方法随机选取解放军一一七医院治疗的急性重症胰腺炎伴肠道菌群移位患者110例,采用随机数字表法将其分为两组,对照组55例采用常规治疗,TPF-DM组55例采用TPF-DM联合治疗.统计两组患者入院时、治疗后7 d、治疗后14 d的炎症因子白细胞(white blood cell,WBC)和快速C反应蛋白(C-reactive protein,CRP)水平、生化指标[白蛋白(albumin,ALB);淀粉酶(amylase,AMY);内皮素(endothelin,ET)]水平、免疫指标(Ig G、Ig M、Ig A)水平.统计分析两组患者的腹痛消失时间、住院时间、住院费用、死亡率,分析其应用价值.结果入院时,两组患者WBC、CRP、ALB、AMY、ET、IgG、IgM、IgA水平比较差异无统计学意义(P>0.05).治疗后7 d、14 d,两组患者WBC、CRP水平均呈现出降低趋势(P<0.05),且TPF-DM组治疗后7 d、14 d的WBC、CRP水平均明显低于对照组患者,差异有统计学意义(P<0.05).治疗后7 d、14 d,两组患者ALB呈现出降低趋势,且AMY、ET水平均呈现出升高趋势(P<0.05).TPF-DM组治疗后7 d、14 d的ALB水平明显高于对照组,且AMY、ET水平均明显低于对照组患者,差异有统计学意义(P<0.05).两组患者的腹痛消失时间、住院时间、住院费用、死亡率无明显差异,无统计学意义(P>0.05).治疗后7 d、14 d,两组患者Ig G、Ig M、Ig A水平均呈现出升高趋势(P<0.05),且TPF-DM组治疗后7 d、14 d的IgG、IgM、IgA水平均明显高于对照组患者,差异有统计学意义(P<0.05).结论 TPF-DM可有效治疗急性重症胰腺炎伴肠道菌群移位患者,改善其炎症状态及免疫功能,值得临床推广.

AIM To observe the effect of enteral nutrition suspension（TPF-DM） on the immune function of acute severe pancreatitis patients with intestinal flora translocation.METHODS One hundred and ten acute severe pancreatitis patients with intestinal flora translocation treated at Jiuli Songyuan District People＇s Liberation Army No.117 Hospital were randomly divided into either a control group or a TPF-DM group（n = 55 each）. The control group was treated with conventional therapy, while the TPF-DM group were treated with TPF-DM. The levels of inflammatory indexes [white blood cell（WBC） and C-reactive protein（CRP）], biochemical indicators [albumin（ALB）, amylase（AMY）, and endothelin（ET）], and immune markers（IgG, IgM, and IgA） were recorded at admission, 7 and 14 d after treatment. Time to abdominal pain disappearance, hospitalization time, hospitalization costs, and mortality rate were also compared in the two groups.RESULTS At admission, there was no significant difference in the levels of WBC, CRP, ALB, AMY, ET, Ig G, Ig M, or IgA between the two groups（P 0.05）. At 7 d and 14 d after treatment, the WBC and CRP levels of the two groups showed a decreasing trend（P 0.05）. The WBC and CRP levels at 7 and 14 d after treatment were significantly lower in the TPF-DM group than in the control group（P 0.05）. At 7 d and 14 d after treatment, ALB showed a decreasing trend in both groups, and the AMY and ET levels showed a trend of increasing（P 0.05）. The ALB levels in the TPF-DM group were significantly higher than those in the control group at 7 d and 14 d after treatment, and the levels of AMY and ET were significantly lower than those in the control group（P 0.05）. There was no significant difference in the time to disappearance of abdominal pain, hospital stay, hospitalization costs, or mortality between the twogroups（P 0.05）. At 7 d and 14 d after treatment, the levels of Ig G, Ig M, and Ig A in both groups showed a trend of increase（P 0.05）, and the levels of IgG, IgM, and Ig A at 7 and 14 d after treatment in the TPF-DM group were significantly higher than those in the control group（P 0.05）.CONCLUSION TPF-DM can effectively treat severe acute pancreatitis patients with intestinal bacterial translocation by improving their inflammatory status and immune function.