肠内营养对长期禁食危重症病人炎性反应和细胞免疫的影响  

Effects of enteral nutrition on inflammation responses and cellular immune function in critically ill patients with long-term fasting

作　　者：习丰产[1] 耿艳霞[1] 虞文魁[1] 李维勤[1] 高涛[1] 张娟娟[1] 李宁[1] 黎介寿[1] 

机构地区：[1]南京大学医学院临床学院(南京军区南京总医院)解放军普通外科研究所,江苏南京210002

出　　处：《肠外与肠内营养》2013年第4期212-215,共4页Parenteral & Enteral Nutrition

摘　　要：目的:前瞻性观察长期禁食的危重症病人对恢复肠内营养(EN)初期免疫炎性反应的影响。方法:将28例禁食14 d以上的危重症病人,分别于实施EN前和EN后第1、第3和第7天检测外周血中内毒素、白细胞(WBC)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素(IL-1、IL-6、IL-4、IL-10)、T淋巴细胞亚群(CD3、CD4、CD4/CD8)和抗组织相容性抗原-DR(HLA-DR)水平。结果:①内毒素、WBC、CRP、TNF-α、IL-6水平在EN实施第1、3天后均较EN前显著提高;IL-1在EN实施第1天显著提高;IL-4和IL-10较EN实施前无明显改变。②CD4和CD4/CD8在EN第7天较EN前显著提高。结论:长期禁食的危重症病人在恢复EN初期全身炎症反应增强,持续EN可减轻增强的炎性反应,并改善病人的细胞免疫功能。Objective： To investigate the effects of enteral nutrition （EN） on inflammatmy responses and cellular immune response in critically ill patients with long-term fasting. Methods： This study was a prospective, observational study. We collected the clinical data of 28 critically ill patients with long-term fasting over 14 days. Their serum levels of endotoxin, inflammation markers （ WBC, CRP, TNF-α, IL-1, IL-6, IL-4, IL-10） and cellular immunity （CD3, CD4, CD4/CDS, HLA-DR） were measured before and 1, 3 and 7 days after EN. Results ： ① Serum concentrations of endotoxin, WBC, CRP, TNF-α and IL-6 at d1 and d3 were significantly higher than that before EN. IL-1 level at dl was significantly higher than that before EN. IL-4 and IL-10 showed no significant difference after EN support. ② CD4 and CD4/CD8 index at d7 were significantly higher than that before EN. Conclu-sion： Systemic inflammatory responses in critically ill patients with long-term fasting were magnified by enteral feeding. Continues enteral feeding could modulate the exaggerated inflammation responses and modify the cellular immune function.

关 键 词：肠内营养 长期禁食 重症病人 炎性反应 细胞免疫功能 

分 类 号：R459.3[医药卫生—治疗学]