肠内免疫营养对脓毒症患者急性肾损伤发生的影响  

The effect of enteral immune nutrition on occurrence of acute kidney injury in patients with sepsis

作　　者：方红龙[1] 陈娟[2] 陈梅琴 吴华勇[1] 罗建[1] 胡建华[1] 张伟文[1] 

机构地区：[1]衢州市人民医院重症医学科,浙江衢州324000 [2]衢州市人民医院检验科,浙江衢州324000

出　　处：《中国中西医结合急救杂志》2018年第1期62-65,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：浙江省衢州市科技计划指导性项目（20172025）

摘　　要：目的 探讨肠内免疫营养对脓毒症患者急性肾损伤（AKI）发生的影响.方法 采用回顾性研究方法,选择2015年1月至2016年12月衢州市人民医院重症医学科（ICU）住院的脓毒症患者80例,按治疗方法不同分为免疫营养组和标准营养组,每组40例.两组均使用等热量、等氮量肠内营养（EN）.观察两组治疗后血清总蛋白（TP）、白蛋白（Alb）、前白蛋白（PA）、血红蛋白（Hb）、C-反应蛋白（CRP）、肿瘤坏死因子-α （TNF-α）、白细胞介素（IL-6、IL-10）、感染部位、ICU住院时间、ICU病死率、AKI发生率、AKI分期等变化.结果 ① 两组治疗后营养指标TP、Alb、PA、Hb水平均较治疗前明显升高,血清炎症因子CRP、TNF-α、IL-6均较治疗前显著降低,IL-10较治疗前明显升高（均P〈0.05）,且以免疫营养组治疗后的变化较标准营养组更明显〔TP（g/L）：60.84±5.90比58.32±6.11,Alb（g/L）：33.95±3.83比31.79±3.44,PA（g/L）：0.24±0.04比0.21±0.03,Hb（g/L）：117.47±16.15比112.50±15.71,CRP（mg/L）：53.04±23.76比82.33±37.09,TNF-α （ng/L）：20.29±17.74比29.63±18.43,IL-6（ng/L）：50.74±28.55比80.32±31.67,IL-10（ng/L）：41.09±24.65比40.86±24.73〕; ② 免疫营养组ICU住院时间（d：10.54±4.33比14.80±5.19）和ICU病死率〔15.00%（6/40）比32.50%（13/40）〕以及AKI发生率〔22.50%（9/40）比47.50%（19/40）〕均明显低于标准营养组（均P〈0.05）;免疫营养组9例患者发生AKI,以Ⅰ、Ⅱ期为主（共8例）,而标准营养组19例发生AKI,以Ⅲ期为主（11例）.结论 肠内免疫营养制剂能有效减少脓毒症患者AKI的发生,其机制可能与肠内免疫营养制剂可以抑制TGF-α、IL-6等促炎因子的表达有关.Objective To evaluate the effect of enteral immune nutrition on the occurrence of acute kidney injury（AKI） in sepsis patients. Methods A retrospective study was conducted, 80 patients with sepsis admitted and treated in the intensive care unit （ICU） of Quzhou People＇s Hospital from January 2015 to December 2016 were enrolled, and according to different treatment programs, they were divided into an immune nutrition group and a standard nutrition group, each group 40 cases. The two groups received an equal amount of calories and nitrogen in enteral nutrition （EN）. After treatment, the changes of serum total protein （TP）, albumin （Alb）, prealbumin （PA）, hemoglobin （Hb）, C-reactive protein （CRP）, tumor necrosis factor-α （TNF-α）, interleukin （IL-6, IL-10）, infection site, length of stay in ICU, mortality in ICU, AKI incidence, AKI staging, etc in the two groups were observed. Results ① After treatment, the nutritional indicators TP, Alb, PA, Hb levels were significantly increased, the serum inflammatory factors CRP, TNF-α, IL-6 were obviously decreased and IL-10 was markedly increased in the two groups compared with those before treatment （all P 〈 0.05）, the changes in the immune nutrition group were more obvious than those in the standard nutrition group [TP （g/L）： 60.84±5.90 vs. 58.32±6.11, Alb （g/L）： 33.95±3.83 vs. 31.79±3.44, PA （g/L）： 0.24±0.04 vs. 0.21±0.03, Hb （g/L）： 117.47±16.15 vs. 112.50±15.71, CRP （mg/L）： 53.04±23.76 vs. 82.33±37.09, TNF-α （ng/L）： 20.29±17.74 vs. 29.63±18.43, IL-6 （ng/L）： 50.74±28.55 vs. 80.32±31.67, IL-10 （ng/L）： 41.09±24.65 vs. 40.86±24.73]; ② The length of stay in ICU （days： 10.54±4.33 vs. 14.80±5.19）, ICU mortality [15.00% （6/40） vs. 32.50% （13/40）] and the incidence of AKI [22.50% （9/40） vs. 47.50% （19/40）] of immune nutrition group were significantly lower than those of standard nutrition group （all P 〈 0.05）; There were 9 cases of AKI m

关 键 词：肠内免疫营养 脓毒症 肾损伤 急性 

分 类 号：R734.2[医药卫生—肿瘤]