肠内免疫营养联合重组人生长激素对严重烧伤病人营养状况和细胞免疫的影响  

Effects of Enteral Immune Nutrition Combined with Recombinant Human Growth Hormone on Nutritional Status and Dellular Immunity of Severely Burned Patients

作　　者：付忠华[1] 郭光华[1] 徐成[1] 詹剑华[1] 张红艳[1] 王艳霞[1] 方方[1] 

机构地区：[1]南昌大学第一附属医院烧伤科,南昌330006

出　　处：《南昌大学学报（医学版）》2010年第3期49-52,55,共5页Journal of Nanchang University：Medical Sciences

基　　金：江西省教育厅科技项目

摘　　要：目的研究肠内免疫营养(enteral immune nutrilion,EIN)联合重组人生长激素(recobinant human growthhormone,rhGH)对重度烧伤病人营养状况、细胞免疫及肝肾功能的影响。方法 22例严重烧伤病人按随机数字表法分为2组,即肠内营养(enteral nutrilion,EN)+rhGH组和EIN+rhGH组,每组11例。EN+rhGH组病人给予常规EN液能全力,同时肌内注射生长激素,连续2周;EIN+rhGH组则提供EIN液(强化精氨酸EN液),其余同EN+rhGH组。观察治疗前和治疗2周后营养蛋白、T淋巴细胞亚群及肝肾功能的变化。结果①EN+rhGH组病人治疗2周后有效提高了总蛋白、球蛋白、前白蛋白水平(P<0.05),EIN+rhGH组病人治疗后除提高了以上蛋白水平外,还明显提高了转铁蛋白水平(P<0.05),但2组间比较差异无统计学意义(P>0.05)。②EN+rhGH组病人CD3+、CD8+水平升高,而CD4+、CD4+/CD8+则下降;EIN+rhGH组CD3+水平提高,但CD4+、CD8+、CD4+/CD8+变化不大。2组比较差异无统计学意义(P>0.05)。③EN+rhGH组病人谷丙转氨酶较治疗前有所升高(P<0.05),但仍在正常值范围;EIN+rhGH组治疗前后谷丙转氨酶变化不大(P>0.05)。2组谷草转氨酶、尿素氮、肌酐组内比较或组间比较差异均无统计学意义(均P>0.05)。结论 EN或EIN联合rhGH均可改善严重烧伤病人的营养状态,且未明显加重肝肾功能负担,但EIN联合rhGH相比EN联合rhGH,更有利于维持烧伤病人的免疫平衡。Objective To investigate the effects of enteral immune nutrition（EIN） combined with recombinant human growth hormone（rhGH） on nutritional status and cellular immunity of severely burned patients.Methods Twenty-two patients were divided into two groups by random table method：enteral nutrition（EN）（n=11） and enteral immune nutrition（EIN）（n=11）.The patients of the two groups also injected with rhGH every day.Nutritional support was continued for 14 days.Fasting venous blood was drawn from patients of both groups before receiving treatment and on the morning of 14th day of treatment.Level of serum protein,hepatic function parameters,renal function parameters,and subpopulations of T lymphocytes in peripheral blood were determined.Results ①Compared with pre-treatment,levels of total serum protein,globulin and prealbumin on 14th day of two groups were significantly higher（P0.05）;level of transferring（TRF） of EIN＋rhGH was also higher than before trentment（P0.05）.but there were no significant differences between the two groups（P0.05）.②In EN＋rhGH group,the ratio of CD3＋,CD8＋ after treatment increased,while cell percentage of CD4＋,CD4＋/CD8＋ significantly decreased（P0.05）;In EIN＋rhGH group,the ratio of CD3＋ was also higher than pre-treatment,while the ratio of CD4＋,CD8＋,CD4＋/CD8＋ was close with pre-treatment.There was no significant difference between the two groups（P0.05）.③Level of GPT of EN＋rhGH group was higher compared with pre-treatment（P0.05）,but its mean was still normal,there was no significant difference of GPT in EIN＋rhGH group between pre-trentment and after trentment（P0.05）.Levels of GOT,BUN,Cr were no significant difference between the two groups（P0.05）.Conclusion Without obvious damage on hepatic function and renal function,EN or EIN combined with rhGH also could improve nutritional status of severely burned patients;but compared with EN＋rhGH,EIN＋rhGH seemed to maintain the balance of immune system.

关 键 词：肠内营养 肠内免疫营养 重组人生长激素 血清蛋白 细胞免疫 肝肾功能 

分 类 号：R644[医药卫生—外科学]