糖尿病专用型肠内营养混悬液对重型脑损伤病人营养指标以及免疫功能的影响  

Effects of TPF-DM on Nutrient Indexes and Immune Function in Severe Traumatic Brain Injury Patients

作　　者：闫凯旋[1] 曹铖 杨磊[1] 王沪旭 吴伟[1] 高恒[1] YAN Kai-xuan, CAO Cheng, YANG Lei, WANG Hu-xu, WU Wei, GAO Heng(Department of NICU, Jiangyin hospital affiliated to Southeast University, Jiangyin 272100, Jiangsu, Chin)

机构地区：[1]东南大学医学院附属江阴医院,江苏江阴214400

出　　处：《肠外与肠内营养》2018年第2期76-80,共5页Parenteral & Enteral Nutrition

基　　金：黎介寿院士肠道屏障专项研究基金

摘　　要：目的 :探讨糖尿病专用肠内营养混悬液(TPF-DM)在重型颅脑损伤(STBI)病人的血糖和免疫调节过程中的作用。方法 :本中心连续纳入60例STBI病人并随机分为实验组和对照组,两组病人分别应用TPFDM和TPF作为主要能量供应。在第1、7和14天分别监测所有病人总蛋白、白蛋白、前白蛋白、降钙素原(PCT)、免疫球蛋白M(IgM)、免疫球蛋白G(IgG)、免疫球蛋白A(IgA)及血糖水平。对组间免疫相关指标、血清蛋白以及血糖水平进行统计学分析。结果两组病人第一周平均血糖及低血糖发生率无显著差异(P>0.05),但血糖变异(BGV)差异显著(P<0.05),在第二周上述血糖指标均在正常范围且无显著差异(P>0.05)。所有病人第一天所监测的IgG、IgA、IgM、白蛋白、前白蛋白以及总白蛋白均低于正常范围,而PCT均高于正常水平,组间差异不显著(P>0.05);在第七天,对照组与实验组PCT均较第一天下降,其余上述指标均呈上升趋势,但实验组上述指标上升较对照组显著(P<0.05)。两组病人上述数据在第14天均恢复至正常水平且组间差异无统计学意义(P>0.05)。结论 :TPF-DM对血糖影响显著优于TPF,可能对早期过度炎症及感染的控制产生积极影响,益于免疫功能的改善,但内在病理生理机制尚需进一步研究。Objective： To investigate the effect of TPF-DM on blood glucose levels and immune function in severe traumatic brain injury（STBI） patients. Methods： We consecutively included 60 STBI patients who were randomly divided into control and experimental groups. The two groups of patients were treated with TPF and TPF-DM as the main energy supply, respectively. Total protein, albumin, prealbumin, procalcitonin（PCT）, immunoglobulin M（IgM）, immunoglobulin G（IgG）, immunoglobulin A（IgA） and blood glucose of all patients were detected on day 1, 7 and 14. Immune function related indicators, serum protein and blood glucose were statistically analyzed. Results In the first week, the mean blood glucose level and incidence of hypoglycemia were not significantly different between the two groups（P 〉 0.05）. However, the blood glucose variability（BGV） was significantly different（P 〈 0.05）. In the second week, both the blood glucose level and BGV were in normal range with no significant difference between two groups（P 〉 0.05）. At day1, the total protein, albumin, prealbumin, IgM, IgG and IgA of all the patients were below the normal level, while the PCT was exact opposite, but with no significant difference between the two groups（P 〉 0.05）. At day7, PCT decreased compared to day1 in both the control and experimental groups, while the total protein, albumin, prealbumin, IgM, IgG and IgA increased, but the experimental group increased much more compare to the control group（P〈 0.05）. At day14, all these indexes returned to normal levels with no significant difference between the two groups（P 〉0.05）. Conclusion： TPF-DM is significantly better than TPF to control the blood glucose level. TPF-DM may have a positive effect on the control of early excessive inflammation and infection, and then improve the immune function. Yet the potential physiopathologic mechanism needs further study.

关 键 词：肠内营养 免疫功能 血糖 重症颅脑损伤 

分 类 号：R651.1[医药卫生—外科学]