同种异体肾移植病人早期肠内免疫营养的临床疗效研究  

Effect of enteral immunonutriton on patients undergoing renal transplantation.

作　　者：石林惠 董绉绉 叶龙强 

机构地区：[1]宁波市医疗中心李惠利东部医院重症医学科,浙江宁波315040

出　　处：《肠外与肠内营养》2017年第5期267-270,276,共5页Parenteral & Enteral Nutrition

基　　金：宁波市自然科学基金资助项目(NO.2012A610231;NO.2013A610235)

摘　　要：目的 :研究对肾移植病人术后早期进行肠内免疫营养的有效性和安全性。方法 :将46例肾移植术后病人按营养方式随机分为肠内免疫营养组(实验组)和肠内普通营养组(对照组),分别进行免疫营养和普通营养,分别监测病人术前、术后第1天、第7天、第28天的免疫学指标:Ig G、Ig M、Ig A、CD3+淋巴细胞、CD4+淋巴细胞、CD8+淋巴细胞、CD4+/CD8+,同时监测相同时间点的营养学指标:白蛋白、前白蛋白、血红蛋白、胆固醇,比较两组的差异性。结果 :术后第1天,两组的免疫学指标无显著差异(P>0.05);术后第7天,实验组的Ig M和Ig A均显著高于对照组(P<0.05),两组的Ig G无明显差异(P>0.05);实验组CD3+淋巴细胞较对照组有显著升高(P<0.05),CD4+淋巴细胞、CD4+/CD8+两组间无显著性差异(P>0.05);术后第28天,实验组Ig G、Ig M、Ig A、CD3+淋巴细胞、CD4+淋巴细胞、CD4+/CD 8+均显著高于对照组(P<0.05)。两组的营养学指标,各个时间点均无显著性差异,但两组第28天的营养学指标除胆固醇外,均优于术后第1天,有显著性差异(P<0.05)。术后30 d内,两组均未发生排异反应。结论 :肾移植病人术后早期应用肠内免疫营养在促进病人免疫功能恢复方面明显优于普通肠内营养,且不会增加排异反应发生。Objective： To evaluate the safety and effectiveness of early enteral immunonutrition on the patients undergoing renal transplantation. Methods： Forty-six patients undergoing renal transplantation were randomly divided into two groups, named enteral immunonutrition （E1N） group and regular enteral nutrition （EN） group （given EIN and EN respetively）. The humoral immunity, cellular immunity, serum albumin, prealbumin, hemoglobin, cholesterin and the incidence of rejection were observed in order to compare the therapeutic efficacy of two kinds of nutrition therapy. Results： At the 1st day, humoral immunity and cellular immunity were no significant differences between two groups. At the 7th day, the serum levels oflgM and IgA were significant higher in EIN group than those in EN group （P 〈 0.05） except IgG （P 〉 0.05）. The serum level of CD3^＋ was also significant higher in EIN group than in EN group at the 7th day after operation. The humoral immunity and cellular immunity were significant higher in EIN group than in EN group （P 〈 0.05） at the 28th day after operation. The serum albumin, prealbumin, hemoglobin, cholesterin level had no significant differences between two groups before operation or at the 1st, 7th, 28th day after operation （P 〉 0.05）, although they were higher on the 28th day than 1st day both in two groups （P 〈 0.05）. But cholesterin level had no significant differences between two groups at the 28th day and 1st day （P 〉 0.05）. The incidence of rejection was similar in two groups within 30 days after operation. Conclusion： The E1N can improve the humoral immunity and cellular immunity with a better effect than EN. The early postoperative EIN can improve the clinical outcomes of the patients undergoing renal transplantation.

关 键 词：肠内营养 免疫营养 肾移植 免疫 

分 类 号：R459.3[医药卫生—治疗学] R692.5[医药卫生—临床医学]