早期个体化肠内营养支持联合安宫牛黄丸对重型颅脑损伤患者免疫状态和炎症因子及神经功能的影响

The impact of personalized enteral nutrition support administered early alongside the An'gong Niuhuang pill on immune status,levels of inflammation and neurological function in patients suffering from severe traumatic brain injury

目的观察早期个体化肠内营养支持联合安宫牛黄丸治疗对重型颅脑损伤(sTBI)患者免疫状态、炎症因子及神经功能的影响.方法选择保定市第一中心医院2020年7月至2023年6月收治80例sTBI患者作为研究对象.按不同治疗方法将患者分为对照组和观察组,每组40例.对照组进行了早期个体化营养支持治疗,观察组在对照组上述营养支持基础上加用安宫牛黄丸,每日1丸(每丸3g),两组疗程均为7d.收集治疗后1、3及7d两组患者血清免疫球蛋白(IgG、IgM、IgA)和淋巴细胞亚群,以及治疗前和治疗后7d两组血清白细胞介素-6(IL-6)、中性粒细胞计数(NEUT)、淋巴细胞计数(LYM),并计算中性粒细胞/淋巴细胞比值(NLR),同时观察两组神经功能的变化.结果①补体及免疫球蛋白:观察组治疗后3d补体C4水平较对照组明显下降(g/L:0.2±0.1比0.3±0.1,P<0.05),治疗后7d补体C3、IgA、IgG、IgM水平均较对照组明显升高[补体C3(g/L):1.2±0.2比0.9±0.2,IgA(g/L):2.7±0.8比2.0±0.6,IgG(g/L):9.3±1.2比8.0±1.0,IgM(g/L):1.2±0.4比0.7±0.3,均P<0.05].②淋巴细胞亚群水平:观察组治疗后3 d CD8+T及自然杀伤细胞(NK细胞)水平均较对照组明显下降(CD8+T:0.20±0.05比0.25±0.06,NK细胞:0.16±0.10比0.22±0.03,均P<0.05);观察组治疗后7 d CD3+T、CD4+T水平均较对照组明显升高(CD3+T:0.76±0.07比0.71±0.01,CD4+T:0.48±0.05比0.41±0.07,均P<0.05),NK细胞水平较对照组下降(0.12±0.05比0.17±0.02,P<0.05).③炎症指标和血常规指标:两组治疗7d后IL-6及NLR水平均较治疗前明显下降,且以观察组的下降更明显[IL-6(ng/L):26.4(15.3,38.4)比42.9(30.7,58.8),NLR:5.7±2.5比9.1±5.0,均P<0.01].两组治疗后LYM水平均较治疗前降低,但观察组治疗后明显高于对照组(×10^(9)/L:1.6±0.4比1.1±0.5,P<0.05).④GCS评分:两组治疗后7dGCS评分均较治疗前明显升高,但观察组治疗后GCS评分明显高于对照组(分:6.8±2.7比5.6±2.1,P<0.05).结论sTBI患者在早期个体化肠内营养支持基础上加用安宫牛黄丸治疗能有效减轻患者炎症反应,增强肌体体液及细胞免疫功能,并有助于改善神经功能.

Objective To investigate how the immune status,inflammatory factors,and nervous function of coma patients with severe traumatic brain injury(sTBI)were impacted by early personalized enteral nutrition support in combination with An'gong Niuhuang pill.Methods A total of 80 patients with sTBI admitted to the First Central Hospital of Baoding from July 2020 to June 2023 were selected as the study objects.The patients were divided into control group and observation group according to different treatment methods,with 40 cases in each group.The control group received early individualized nutritional support treatment,and the observation group was supplemented with one An'gong Niuhuang pill daily(3 g per pill)based on the above nutritional support.Each group underwent a 7-day treatment regimen.Serum immunoglobulin G(IgG),immunoglobulin A(IgA),immunoglobulin M(IgM)and lymphocyte subsets were collected at 1,3 and 7 days after treatment,as well as serum levels of interleukin-6(IL-6),neutrophil count(NEUT)and lymphocyte count(LYM)before and 7 days after treatment,neutrophil/lmphocyte ratio(NLR)was calculated,and the change of nerve function was observed.Results①Complement and immunoglobulin:the level of complement C4 in the observation group was significantly lower than that in the control group 3 days after treatment(g/L:0.2±0.1 vs.0.3±0.1,P<0.05),and the level of complement C3,IgA,IgG and IgM were significantly higher than that in the control group 7 days after treatment[C3(g/L):1.2±0.2 vs.0.9±0.2,IgA(g/L):2.7±0.8 vs.2.0±0.6,IgG(g/L):9.3±1.2 vs.8.0±1.0,IgM(g/L):1.2±0.4 vs.0.7±0.3,all P<0.05].②Lymphocyte subsets:the levels of CD8+T and natural killer cell(NK cell)in the observation group were significantly lower than those in the control group at 3 days after treatment(CD8+T:0.20±0.05 vs.0.25±0.06,NK cell:0.16±0.10 vs.0.22±0.03,both P<0.05),the levels of CD3+T and CD4+T in the observation group were significantly higher than those in the control group 7 days after treatment(CD3+T:0.76±0.07 vs.0.71±0.01,CD4+T:0.48±0.05 vs.0.41±0.07,both P<0.05),NK cell levels continued to decrease compared with control group(0.12±0.05 vs.0.17±0.02,P<0.05).③Inflammation index and blood routine index:after 7 days of treatment,IL-6 and NLR levels in both groups were significantly decreased compared with those before treatment,and the decrease was more significant in the observation group[IL-6(ng/L):26.4(15.3,38.4)vs.42.9(30.7,58.8),NLR:5.7±2.5 vs.9.1±5.0,both P<0.01],the level of LYM in both groups after treatment was significantly lower than that before treatment,but the level of LYM in the observation group was significantly higher than that in the control group after treatment(×10^(9)/L:1.6±0.4 vs.1.1±0.5,P<0.05).④GCS score:7 days after treatment,the GCS score of both groups was significantly higher than before treatment,but the GCS score of the observation group was significantly higher than that of the control group(6.8±2.7 vs.5.6±2.1,P<0.05).Conclusion Treatment with An'gong Niuhuang pill based on early individualized enteral nutrition support can effectively reduce the inflammatory response of patients with sTBI,enhance the body fluid and cellular immune function,and help to improve the neurological function.