不同营养支持方式对肠外瘘患者人体组成改善作用之比较

Responses of body composition to dif ferent nutritional supports in patients with enterocutaneous fistula

目的观察不同营养支持方式对肠外瘘患者人体组成的改善作用。方法30例肠外瘘患者分成两组各15例,分别给予全肠外营养支持(TPN)或全肠内营养支持(TEN),观察10d前后患者人体组成及血清胰岛素样生长因子-1(IGF-1)的变化。结果10d后所有患者的体重指数(BMI)与体细胞群(BCM)显著改善,而TEN组患者10d前后BCM增加幅度更明显,分别为(27.5±0.8)kg和(29.0±0.6)kg,Day10与Day0相比,P<0.01。两组患者总体水(TBW)与细胞内水(ICW)均增加,尤其ICW,Day10与Day0相比,TEN组P<0.01;TPN组P<0.05。血清IGF-1在两组患者治疗后均有显著上升,TEN组增加幅度更明显,Day0为(175.0±32.9)ng/ml,Day10为(255.5±34.1)ng/ml,与Day0比较,P<0.01;与TPN组比较,P<0.05。IGF-1的变化与BCM的改善显著正相关(r2=0.16,P<0.05)。结论营养支持治疗能显著改善肠外瘘患者的体细胞群,纠正细胞内、外水的异常分布,而EN作用更明显。

Objective To investigate the responses of body compositions to different nutritio nal supports in patients with enterocut aneous fistula.Methods Thirty patients with enterocutaneo us fistula were divided into two groups and received total parenteral nutrition(TPN)and total enteral nutrition(EN)support respectively.Body compositions were measured by multiple-fre quency bioelectrical impedance analysis and serum insulin-like gro wth factor-1(IGF-1)was measured by enzyme-linked immunosorbent assay(ELISA)before and 10days after nutrition su pport.Results The BMI and body cell mass(BCM)of the patients increased significantly a fter 10days of TPN and TEN support,especially BCM in TEN group.Once the patients received nutrition supplement,intracellular water(ICW)increased significantly by the fift h day in both groups.Plasma IGF-1levels i ncreased significantly in both grou ps,especially in TEN group,and were significantly correlated to the imp rovements in BCM.Conclusions The nutritional intervention rapid ly ameliorates the abnormal distribut ion of body water,prevents the furth er deterioration of cellular composition in patients with enterocutaneous fi stula.There are much more significant impr ove-ments in body cell mass in TEN-fed patients than in TPN-fed patients.[