早期肠内营养联合锦红汤对急性重症胰腺炎患者免疫功能影响

Effects of Immune Function in Early Enteral Nutrition with Jinhong Decoction in the Patients with SevereAcute Pancreatitis

目的:探讨早期肠内营养联合锦红汤对急性重症胰腺炎(SAP)患者免疫功能的影响。方法:选取2016年3月2018年9月本院收治的60例SAP患者,随机分为肠外营养(PN)组、肠内营养(EN)组、锦红汤+EN组三组,每组20例;分别测定治疗前及治疗后3天和8天的血浆炎症介质肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、D-乳酸和淋巴细胞、CD3^+、CD4^+、CD8^+水平。结果:三组治疗后血浆各炎症介质均较治疗前明显改善(P<0.05),D乳酸水平较治疗前明显升高(P<0.05)。EN组治疗后3天及8天血浆IL-6、TNF-α均较PN组显著降低(P<0.05),锦红汤+EN组治疗后3天和8天血浆IL-6、TNF-α亦均较PN组和EN组显著降低(P<0.05)。治疗后3天三组D-乳酸水平无明显差异(P>0.05),治疗后8天,EN组D-乳酸较PN组明显降低,锦红汤+EN组较EN组明显降低(P<0.05)。治疗后3天三组淋巴细胞、CD3^+、CD4^+、CD8^+、CD4^+/CD8^+无明显差异(P>0.05)。治疗后8天,EN组和锦红汤+EN组淋巴细胞、CD3^+、CD4^+、CD4^+/CD8^+均较PN组显著升高(P<0.05)。CD8^+较PN组降低(P<0.05),锦红汤+EN组的淋巴细胞、CD3^+、CD4^+、CD4^+/CD8^+均较PN组显著升高,CD8^+较PN组降低,差异均有统计学意义(P<0.05)。结论:早期肠内营养联合锦红汤能降低SAP患者血浆中炎性介质的水平,降低肠黏膜通透性,改善患者的免疫功能,快速促进患者康复。

Objective To investigate the effect of immune function in the early enteral nutrition(EN)supplemented with Jinhong Decoction in patients with severe acute pancreatitis(SAP).Methods Sixty patients with SAP admitted to our hospital from March 2016 to September 2018 were randomly assigned into parenteral nutrition(PN)group,EN group and Jinhong decoction added EN(J+EN)group.Twenty cases in each group.In J+EN group,patients were given their nutrition the same as that of EN,but added by Jinhong Decoction.The levels of plasma inflammatory mediators TNF-α,IL-6,D-lactic acid and lymphocyte,CD3^+,CD4^+,CD8^+were measured before treatment and the 3rd and the 8th day after treatment respectively.Results The levels of plasma inflammatory mediators and D-lactate in the three groups were significantly improved after treatment(P<0.05),and the levels of D-lactate were significantly higher than those before treatment(P<0.05).The plasma levels of IL-6,TNF-αand in EN group were significantly lower than those in PN group at the 3rd and the 8th day after treatment(P<0.05).The levels of IL-6,TNF-αand in Jinhong Decoction+EN group were also significantly lower than those in PN group and EN group at the 3rd and the 8th day after treatment(P<0.05).There was no significant difference in the levels of D-lactic acid among the three groups on the 3rd day after treatment(P>0.05).On the 8th day after treatment,the levels of EN group were significantly lower than those of PN group and Jinhong Decoction+EN group were significantly lower than those of EN group(P<0.05).In terms of lymphocyte,CD3^+,CD4^+and CD8^+,there was no significant difference in lymphocyte,CD3^+,CD4^+,CD8^+and CD4^+/CD8^+between the three groups on the 3rd day after treatment(P>0.05).Onthe 8th day after treatment,lymphocyte,CD3^+,CD4^+and CD4^+/CD8^+in EN group and Jinhong Decoction+EN group were significantly higher than those in PN group(P<0.05).CD8^+was lower than PN group(P<0.05),but Jinhong Decoction+EN group improved the level of peripheral lymphocyte significantly compared with ENgroup(P<0.05).Conclusion Early enteral nutrition combined with Jinhong Decoction can reduce the level ofplasma inflammatory mediators as well as intestinal mucosal permeability,improving the immune function for therecovery of patients with SAP quickly.