营养支持及手术应激对IL-10、HLA-DR表达的影响

Effects of enteral, parenteral nutrition and major gastrointestinal operation on levels of IL-10, CRP and HLA-DR expression

目的 :测定肠内营养 (EN)、肠外营养 (PN)支持及手术 (OP)应激病人外周血单核细胞人白细胞抗原裂解反应 (HLA DR)的表达以及外周血白细胞介素 1 0 (IL 1 0 )、C反应蛋白 (CRP)水平 ,从而了解不同营养支持条件以及手术应激对外周血单核细胞HLA DR、IL 1 0以及血浆CRP的影响。 方法 :检测 1 0例对照病人、2 1例PN病人或 1 8例EN病人以及 8例手术病人外周血单核细胞HLA DR、IL 1 0以及CRP水平。 结果 :单核细胞HLA DR抗原表达各组差异显著。与对照组 (96 .35± 4 .2 82 ) %比较 ,OP组 (6 0 .2 3± 1 0 .4 1 9) %下降最明显 (P <0 .0 1 ) ,PN组 (78.72±1 3.2 1 ) %次之 (P <0 .0 1 ) ,EN组 (93.1 1± 7.6 4 1 ) %无显著差异 (P >0 .0 5 )。CRP水平从低到高依次为对照组 (4 .5 73± 0 .5 89 6 )mg/L ,EN组 (7.1 4 5± 0 .85 4 6 )mg/L ,PN组 (7.393± 0 .85 4 6 )mg/L ,OP组 (7.4 80± 0 .9389)。IL 1 0以OP组升高明显 (P <0 .0 1 ) ,其余各组间无显著差异。 结论 :EN对免疫功能影响最小 。

Objectives: To evaluate the influences of enteral nutritfion(EN), parenteral nutrition(PN) and major gastrointestinal operation on HLA DR, CRP and IL 10 level. Methods: A prospective, successive and controlled trial was taken. 39 non infection patients with intestinal fistula and severe acute pancreatitis were divided into EN group ( n =18) and PN group ( n =21). 8 patients with major gastrointestinal operation(OP) were taken as OP group.10 patients admitted with the diagnoses of cholecystopolyp and inguinal hernia were taken as control group. The blood levels of HLA DR, CRP and IL 10 were measured and compared between groups. Results: Compared to control group〔(96.35± 4.282)%〕, OP group〔(60.23± 10.419)%〕 and PN group〔(78.72± 13.21)%〕 had significant decreases ( P <0.01) in HLA DR expression, while EN group〔(93.11± 7.641)%〕 had no difference . IL 10 level was decreased significantly only in OP group.CRP level was (4.573± 0.589 6) mg/L in control group, (7.145± 0.854 6)mg/L in EN group,(7.393 ±0.854 6)mg/L in PN group and (7.480± 0.938 9)mg/L in OP group. The differences between the groups were significant ( P <0.01). Conclusions:Compared to control group, EN could properly maintain the immune function and might be an ideal methool of mutritional support.