免疫增强型肠内营养辅助治疗老年重症肺炎的疗效及HMGB1/IL-17/IL-23变化

Effect of immune-enhancing enteral nutrition on treatment of elderly patients with severe pneumonia and changes of HMGB1/IL-17/IL-23

目的 探讨免疫增强型肠内营养制剂辅助治疗对老年重症肺炎患者高迁移率族蛋白B1(HMGB1)、白细胞介素-17(IL-17)、IL-23水平的影响。方法 选择四川省医学科学院·四川省人民医院呼吸与内科危重症科2020年2月-2020年8月收治的重症肺炎患者100例为研究对象,根据患者治疗方案分为研究组45例和对照组55例,入院后常规抗感染治疗的基础上,对照组采用常规肠内营养制剂,研究组采用免疫增强型肠内营养制剂给予肠内营养支持。治疗7 d后,分析两组临床疗效及HMGB1、IL-17、IL-23水平变化。结果 治疗7 d后,研究组肺炎症状消退时间(4.71±0.64)d、总住院时间(6.34±1.20)d较对照组缩短(P<0.05),肺炎严重程度评分(PSI)、急性生理与慢性健康评分(APACHEⅡ)和营养风险筛查(NRS)评分均低于对照组(P<0.05),研究组HMGB1(48.86±16.75)、IL-17(35.60±13.77)和IL-23(24.38±13.02)ng/ml均低于对照组(P<0.05)。结论 免疫增强型肠内营养制剂可通过纠正HMGB1/IL-17/IL-23炎症失衡来调节胃肠功能稳态,明显改善患者临床结局。

OBJECTIVE To explore the effect of immune-enhancing enteral nutrition preparations on the levels of high mobility group protein B1(HMGB1), interleukin-17(IL-17) and interleukin-23(IL-23) of the elderly patients with severe pneumonia. METHODS A total of 100 patients with severe pneumonia who were treated in respiratory and critical care medicine department of Sichuan Academy of Medical Sciences, Sichuan Provincial People′s Hospital from Feb 2020 to Aug 2020 were recruited as the study sujects and divided into the study group with 45 cases and the control group with 55 cases according to treatment plans. On basis of the conventional anti-infection therapy, the control group was treated with conventional enteral nutrition preparations, while the study group was treated with immune-enhancing enteral nutrition preparations. The clinical effects and levels of HMGB1, IL-17 and IL-23 were observed and compared between the two groups after the treatment for 7 days. RESULTS After the treatment for 7 days, the time for pneumonia symptoms to subside and total length of hospital stay of the treatment group were respectively(4.71±0.64)days and(6.34±1.20)days, significantly shorter than those of the control group(P<0.05). The pneumonia severity score(PSI), Acute Physiology and Chronic Health Evaluation(APACHE II)score and nutritional risk screening(NRS) score of the study group were significantly lower thanthose of the control group(P<0.05). The levels of HMGB1, IL-17 and IL-23 of the study group were respectively(48.86±16.75),(35.60±13.77) and( 24.38±13.02)ng/ml, significantly lower thanthose of the control group(P<0.05). CONCLUSION The immune-enhancing enteral nutrition preparations can adjust gastrointestinal function homeostasis by correcting the inflammatory imbalance of HMGB1/IL-17/IL-23 and remarkably improve the clinical outcome of the patients.