TPN和EN对急性胰腺炎患者肠屏障和免疫功能的影响  

Effects of TPN and EN on intestinal barrier and immune function in patients with acute pancreatitis

作　　者：杨绪兰[1] 罗莉[1] 余友敏[1] 赵小晶[1] 

机构地区：[1]成都军区昆明总医院营养科,昆明650032

出　　处：《西南国防医药》2016年第6期584-586,共3页Medical Journal of National Defending Forces in Southwest China

基　　金：成都军区昆明总医院青年基金项目(2012YG37)

摘　　要：目的探讨全肠外营养和肠内营养对急性胰腺炎患者肠屏障功能和免疫指标的影响。方法选择本院2013年2月-2014年2月收治的急性胰腺炎患者84例,随机分为3组,患者入院48-72 h情况平稳后,A组接受全肠外营养（TPN）,B组接受肠内营养（EN）,C组同时接受TPN＋EN治疗,观察比较3组营养支持前后营养学、肠道屏障功能和免疫学指标变化。结果治疗14 d后,营养学指标：3组体质指数（BMI）均获改善（P〈0.05）;C组白蛋白（ALB）最高,而A组最低（P〈0.05）;A组前白蛋白（PAB）显著低于其他两组（P〈0.05）。肠屏障功能指标：3组血液内毒素和肠脂肪酸结合蛋白均显著降低,且均以C组降低程度最高,A组最低（P〈0.01）;L/M比值降低,且以C组降低程度最高（P〈0.05）。免疫学指标：治疗后,Ig A水平均显著升高,其中A组升高程度最低（P〈0.05）;Ig M水平显著升高,且C组显著高于A组（P〈0.01）。结论在TPN的基础上阶段性实施EN能够显著改善患者营养状况,对促进患者肠道屏障功能恢复、改善免疫功能具有显著的效果。Objective To explore the effects of TPN and EN on the intestinal barrier and immune function in patients with acute pancreatitis.Methods A total of 84 patients with acute pancreatitis to receive treatment in our hospital from February 2013 to February 2014 were selected and randomly divided into three groups.When the patients got stable 48-72 h after the admission,group A received TPN,group B EN and group C TPN ＋EN,and the changes of nutriologic index,functions of intestinal barrier,and immunologic index of the three groups before and after the nutritional support were compared and analyzed.Results The nutritional index 14 d upon the treatment： the BMI of the three groups were improved（P〈0.05）; ALB of group C was the highest,and that of group A the lowest（P〈0.05）; the PAB of group A was significantly lower than that of the other two groups（P〈0.05）.Intestinal barrier function： the serum endotoxin and i FABP of the three groups significantly decreased,those of group C decreased the most and those of group A decreased the least（P〈0.01）; L/M ratio decreased,especially that of group C（P〈0.05）.Immunologic indexes： after treatment,Ig A of the three groups significantly increased,and that of group A increased the least（P〈0.05）; Ig M also increased,with the Ig M of group C much higher than that of group A（P〈0.01）.Conclusion Periodical application of EN on the basis of TPN can significantly improve the nutritional status in patients and has remarkable effects on the recovery of intestinal barrier function and improvement of immunologic function.

关 键 词：胰腺炎 肠外营养 肠内营养 肠屏障 免疫功能 

分 类 号：R657.51[医药卫生—外科学]