不同营养支持对重症急性胰腺炎炎症反应及免疫功能的影响

Effects of different nutritional supports on inflammatory response and immune function in severe acute pancreatitis

目的探讨早期肠内免疫营养(EIN)支持对重症急性胰腺炎(SAP)患者的炎症反应及免疫功能的作用。方法选取2015年1月至2016年12月在中国石油乌鲁木齐石油化工有限公司职工医院外一科住院治疗的SAP患者50例,按照随机数表法将患者分为观察组和对照组,每组25例。两组均在患者肠功能恢复后通过盲插或经胃镜辅助,将鼻肠营养管经胃、幽门插至屈氏韧带以下,经X线确认营养管正确后给予空肠内营养,以短肽型肠内营养剂为肠内营养的主要能量物质。观察组在短肽型营养制剂的基础上加入微生态制剂。比较两组患者的并发症发生情况和免疫指标的变化。结果两组患者治疗后免疫球蛋白G(IgG)、免疫球蛋白M(IgM)、免疫球蛋白A(IgA)等免疫指标均较治疗前升高,白细胞(WBC)降低;治疗后观察组患者的IgG[(19.29±2.13)g/L]、IgM[(2.57±0.71)g/L]、IgA[(3.29±0.71)g/L]明显高于对照组[(18.34±3.17)g/L、(2.44±0.29)g/L、(3.17±0.59)g/L],但观察组WBC[(10.31±2.47)×109/L]明显低于对照组[(13.22±4.31)×109/L],差异均有统计学意义(P<0.05);两组患者治疗后的CD4、CD8、CD4/CD8均较治疗前明显升高,差异均有统计学意义(P<0.05),但组间治疗后的CD4、CD8、CD4/CD8比较差异均无统计学意义(P<0.05);两组患者急性期并发症的发生率差异无统计学意义(P>0.05)。结论早期肠内免疫营养能提高免疫球蛋白的水平,降低继发感染率。

Objective To evaluate the effect of early enteral immunonutrition（EIN） on the inflammatory response and immune function of patients with severe acute pancreatitis（SAP）. Methods Fifty patients with SAP were enrolled in the hospital from January 2015 to December 2016 in China. The patients were divided into observation group and control group according to random number table, with 25 cases in each group. After the recovery of intestinal function, by blind intubation or through endoscopy, the nasal feeding tube was inserted into below the flexor ligament via stomach, pylorus. jejunum nutrition was given after confirming that the nutrition tube was correct by X-ray. Short peptide type nutritional preparations were used as the main energy substance for enteral nutrition. The observation group applied microecological preparations on the basis of short peptide type nutritional preparations. The incidence of complications was compared between the two groups, and the immune indexes of the two groups were detected and compared. Results Immunoglobulin G（IgG）, IgM, immunoglobulin A（IgA） levels in the two groups after treatment were higher than those before treatment, while WBC were decreased. The levels of IgG, IgM, IgA after treatment were（19.29±2.13） g/L,（2.57±0.71） g/L,（3.29±0.71） g/L in the observation group, significantly higher than（18.34±3.17） g/L,（2.44±0.29） g/L,（3.17±0.59） g/L in the control group（P〈0.05）, while white blood cell（WBC） was（10.31±2.47）×109/L, significantly lower than（13.22±4.31）×109/L of the control group（P〈0.05）. CD4, CD8 and CD4/CD8 levels were significantly increased after treatment in the two groups（P〈0.05）, but the levels showed no significant difference between the two groups after treatment（P〉0.05）. There was no significant difference in the incidence of acute complications between the two groups（P〉0.05）. Conclusion Early enteral immunonutrition can increase the level of immunoglobulin and reduce the rate of secondary infection.