营养支持对慢性阻塞性肺病急性加重期患者免疫和肺功能的影响

Effect of nutritional support therapy on immune and pulmonary function in patients with chronic obstructive pulmonary disease

目的 探讨营养支持对慢性阻塞性肺病 (COPD)急性加重期患者合并营养不良的疗效及其对免疫和肺功能的影响。方法 COPD急性加重期合并营养不良患者 6 0例 ,随机分为胃肠外营养 (PN)组及对照组 ,给予为期 2周的PN支持。结果 (1)临床疗效 :PN组有效率 93 3% ,对照组 70 0 % ,χ2 =4 0 1,P <0 0 5。 (2 )人体测量及生化检查 :PN组IBW %、TSF、MAMC及血清白蛋白明显增加。 (P <0 0 5 ) ,对照组无显著变化 (P >0 0 5 )。 (3)免疫功能检查 :PN组血TLC、CD3、CD4 、CD4 /CD8以及IgA显著性增加(P <0 0 5 ) ,对照组除血TLC显著性增加 (P <0 0 5 )外 ,其它指标无显著性变化 (P >0 0 5 )。 (4 )肺功能和血气检查 :PN组的FVC、FEV1 /FVC及PaO2 有明显改善 (P <0 0 5 ) ,对照组上述指标无显著性改变(P >0 0 5 )。结论 PN支持可以改善COPD急性加重期患者的免疫功能和肺功能 ,提高临床疗效。

Objective To explore the effect of nutritional support in treatment of patients with chonic obstructive pulmonary disease(COPD).Methods 60 patients with COPD(acute aggravating episode with malnutridtion)were randomly divided into two groups:parenteral nutrition(PN) group and control group.They were observed two weeks after PN support.Results (1)Clinical effects:valid rate of PN group was 93.3%,control group 70.0%,χ 2=4.01(P<0.05).(2)Anthropometric measurement and biochemical test:IBW%,TSF,MAMC and blood serum albumin in PN group were significantly increased(P<0.05),but did not significantly change in control group(P>0.05).(3)Measurements of immune function:the volume of blood TLC,CD 3,CD 4,ratio of CD 4/CD 8 and IgA in PN group were significantly increased(P<0.05).In the control group,no significant difference was found,except blood TLC.(4)Measurements of pulmonary function and arterial blood gas:FVC,FEV 1/FVC,P aO 2 and P aO 2 in PN group were significantly improved(P<0.05),but weren't in control group(P<0.05).Conclusion Nutritional support can improve immune and pulmonary function,and enhance clinical effect in patients during acute exacerbation of COPD.