老年心力衰竭患者肠内营养治疗与炎症因子和心功能的关系

Relationship between enteral nutrition therapy and inflammatory factors and cardiac function in elderly patients with heart failure

目的:探讨肠内营养治疗对老年心力衰竭患者血清炎症因子及心功能的影响。方法:最终纳入符合条件的老年心力衰竭患者105例,随机分为A组,B组和C组,每组35例。A组给予500 mL/d肠内营养乳剂治疗1个月;B组给予A组相同治疗方式,时间为3个月;C组给予日常饮食1个月。评估入院患者的营养状态,并记录治疗前后心功能及相关炎症因子的变化情况及治疗期间主要的心脏不良事件,包括心源性死亡、心肌梗死和脑卒中。结果:A组和B组治疗后营养状态相关指标BMI、三头肌皮脂厚度、上臂肌围、总蛋白、白蛋白及血红蛋白均较治疗前升高,且B组较A组治疗后改善程度更明显(P<0.05);C组治疗前后上述营养状态指标无明显变化(P>0.05)。A组和B组治疗后较治疗前心功能改善,左室射血分数升高,B型钠尿肽下降;A,B组肿瘤坏死因子,白介素6及C反应蛋白表达水平下降,且B组较A组改善更明显(P<0.05);C组治疗前后心功能及炎症因子的表达水平无明显变化(P>0.05);A组和B组治疗期间未发生主要心脏不良事件,C组发生1例心肌梗死。结论:老年心力衰竭患者给予肠内营养治疗不仅能改善患者的营养状态和心功能,还能降低患者的炎症因子表达水平。而且治疗时间越长,其改善心功能,降低炎症因子的效果越明显。

Objective:To investigate the effect of enteral nutrition on serum inflammatory factors and cardiac function in elderly patients with heart failure.Methods:One hundred and five eligible elderly patients with heart failure were randomly divided into Group A,B and C,with 35 cases per group.Group A was treated with 500 mL/d enteral nutrition for 1 month.Group B was given the same treatment of Group A but for 3 months,and Group C was given daily diet.Nutritional status,changes in cardiac function and inflammatory factors were recorded before and after treatment,as well as major adverse cardiac events,including cardiogenic death,myocardial infarction,and stroke during treatment.Results:After the treatment,the nutritional status indicators,including body mass index,triceps skin fold thickness,upper arm muscle circumference,total protein,albumin,and hemoglobin,in Group A and Group B were higher than those before the treatment,and Group B showed more obvious improvement than Group A(P<0.05);there was no significant change in the nutritional status indicators before and after the treatment in group C(P<0.05);after the treatment,the cardiac function of Group A and Group B was better than that before the treatment(P<0.05).The expression of inflammatory factors,including tumor necrosis factor,interleukin 6,and C-reactive protein,decreased,and the improvement of cardiac function and expression of inflammatory factors in Group B was more obvious than that in Group A(P<0.05);there was no significant change in cardiac function and expression of inflammatory factors before and after treatment in Group C(P>0.05).There were no major adverse cardiac events in Group A and Group B during the treatment,and there was one case of myocardial infarction in Group C.Conclusion:Enteral nutrition can not only improve the nutritional status and cardiac function of elderly patients with heart failure,but also reduce the expression of inflammatory factors.And the longer the treatment time is,the more obvious the effect of improving cardiac function and reducing inflammatory factors is.