免疫微生态营养对重症急性胰腺炎患者炎症反应、免疫功能及肠黏膜屏障功能影响研究

Effects of immune microecological nutrition on inflammatory response,immune function and intestinal mucosal barrier function in patients with severe acute pancreatitis

目的探讨免疫微生态营养对重症急性胰腺炎(SAP)患者炎症反应、免疫功能及肠黏膜屏障功能的影响。方法选取自2017年7月至2020年8月深圳市宝安人民医院(集团)第二人民医院收治的212例SAP患者为研究对象。按随机数字表法分为常规组与观察组,每组106例。常规组采用常规肠内营养,观察组采用免疫微生态营养。比较两组患者恢复情况,检测并比较治疗前、后炎症因子[白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)、C反应蛋白(CRP)]、肠黏膜屏障功能[D-乳酸、降钙素原(PCT)]及免疫功能[免疫球蛋白A(IgA)、免疫球蛋白G(IgG)、免疫球蛋白M(IgM)]水平,观察并记录两组预后情况。结果观察组腹痛缓解时间、腹胀缓解时间、经口进食恢复时间、血淀粉酶恢复时间、尿淀粉酶恢复时间及住院时间均短于常规组;治疗7 d后,两组血清IL-6、TNF-α、CRP水平均较治疗前降低,且观察组低于常规组;治疗7 d后,两组血清D-乳酸、PCT水平均较治疗前降低,且观察组低于常规组;治疗7 d后,两组血清IgA、IgG、IgM水平均较治疗前增加,且观察组高于常规组,差异均有统计学意义(P<0.05)。观察组患者并发症发生率明显低于常规组,差异有统计学意义(P<0.05)。观察组患者的病死率为1.9%(2/106),常规组患者的病死率为4.7%(5/106),两组比较,差异无统计学意义(P>0.05)。结论免疫微生态营养可促进SAP患者恢复,减轻炎症反应,增强肠黏膜屏障功能及免疫功能,降低并发症发生率。

Objective To explore the effect of immune microecological nutrition on inflammatory response,immune function and intestinal mucosal barrier function in patients with severe acute pancreatitis(SAP).Methods A total of 212 patients with SAP admitted from July 2017 to August 2020 were selected and randomly divided into the conventional group and the observation group,with 106 cases in each group.The conventional group received routine enteral nutrition,and the observation group received immune microecological nutrition.The general recovery was compared between the two groups.The levels of inflammatory factors[interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),C-reactive protein(CRP)],intestinal mucosal barrier function[D-lactic acid,procalcitonin(PCT)]and immune function[immunoglobulin A(IgA),immunoglobulin G(IgG),immunoglobulin M(IgM)]were detected and compared before and after treatment.The prognosis of the two groups was observed and recorded.Results The abdominal pain relief time,abdominal distension relief time,oral feeding recovery time,blood amylase recovery time,urine amylase recovery time and hospitalization time in the observation group were shorter than those in the conventional group(P<0.05).After 7 days of treatment,the levels of serum IL-6,TNF-αand CRP in the two groups were decreased,and those in the observation group were lower than those in the conventional group(P<0.05).After 7 days of treatment,the levels of serum D-lactic acid and PCT in the two groups were decreased,and those in the observation group were lower than those in the conventional group(P<0.05).After 7 days of treatment,the levels of serum IgA,IgG and IgM in the two groups were increased,and those in the observation group were higher than those in the conventional group(P<0.05).The incidence of complications in the observation group were lower than those in the conventional group(P<0.05).There was no significant difference in the mortality between the two groups(P>0.05).Conclusion Immune microecological nutrition can promote the recovery of SAP patients,reduce inflammatory response,enhance intestinal mucosal barrier function and immune function,and reduce the incidence of complications.