肠内免疫营养支持联合CBP对老年重症急性胰腺炎患者症状改善及血清DAO、AMY、LPS水平变化的影响  

Effect of enteral immuno nutritional support combined with CBP on improvement of symptoms and serum levels of DAO,AMY and LPS in elderly patients with severe acute pancreatitis

作　　者：刘伟伟 丁士芳 LIU Wei-Wei;DING Shi-Fang(ICU,Leling People′s Hospital,Leling 253600,China)

机构地区：[1]乐陵市人民医院ICU,乐陵253600 [2]山东大学医学院齐鲁医院,济南250012

出　　处：《中国免疫学杂志》2019年第22期2774-2779,共6页Chinese Journal of Immunology

摘　　要：目的:探讨肠内免疫营养支持联合连续血液净化(CBP)对老年重症急性胰腺炎(SAP)患者症状改善及血清二胺氧化酶(DAO)、淀粉酶(AMY)、脂肪酶(LPS)水平变化的影响。方法:选取我院2015年2月~2017年11月82例老年SAP患者,随机数字表法分组进行对照研究,各41例,两组均给予基础治疗,对照组采用CBP+肠外营养治疗,观察组采用CBP+肠内免疫营养支持。观察统计两组症状改善情况、急性生理与慢性健康评分量表(APACHEⅡ)评分、Ranson评分及预后不良发生率,并对比治疗前后两组血清炎性因子[肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、白细胞介素-6(IL-6)]、肠道屏障功能[血清二胺氧化酶(DAO)、淀粉酶(AMY)、脂肪酶(LPS)]、营养状况[血清白蛋白(ALB)、前白蛋白(PA)、转铁蛋白(TRF)]、细胞免疫功能(CD3+、CD4+、CD8+、CD4+/CD8+)。结果:①观察组住院时间、血清AMS恢复时间短于对照组(P<0.05);治疗2周后观察组APACHEⅡ评分、Ranson评分较治疗前降低,且低于对照组(P<0.05);②治疗2周后观察组血清ALB、PA、TRF水平高于对照组,血清AMY、LPS、DAO水平低于对照组(P<0.05);治疗2周后观察组血清TNF-α、CRP、IL-6低于对照组(P<0.05);③治疗2周后观察组CD3+、CD4+、CD4+/CD8+较治疗前升高,CD8+较治疗前降低,且观察组优于对照组,差异有统计学意义(P<0.05);④观察组感染、MODS(多器官功能综合征)等预后不良总发生率低于对照组(P<0.05)。结论:肠内免疫营养支持联合CBP治疗老年SAP能显著缓解患者症状,改善机体免疫功能及营养状况,促进肠道屏障功能恢复,减轻机体炎性反应,降低预后不良发生率,疗效显著。Objective:To investigate the effects of enteral immuno nutrition support combined with continuous blood purification(CBP)on the improvement of symptoms and the changes of serum levels of two amine oxidase(DAO),amylase(AMY)and lipase(LPS)in elderly patients with severe acute pancreatitis(SAP).Methods:82 aged SAP patients were selected from February 2015 to November 2017 in our hospital and grouped by the randomized digital table,41 cases in each group.The two groups were given basic treatment.The control group was treated with CBP+parenteral nutrition,and the observation group was treated with CBP+enteral immuno nutrition support.The improvement of symptoms,the scores of acute physiology and chronic health scale(APACHEⅡ),Ranson score and the incidence of poor prognosis were observed and statistically analyzed in the two groups.The serum inflammatory factors[tumor necrosis factor-α(TNF-α),C reactive protein(CRP),interleukin-6(IL-6)],intestinal barrier function[serum two amine oxidase(DAO),amylase(AMY),lipase(LPS)],nutritional status[serum white protein(ALB),prealbumin(PA),transferrin(TRF)]and cellular immune function(CD3+,CD4+,CD8+,CD4+/CD8+)of the two groups were compared before and after treatment.Results:①The hospitalization time and the recovery time of serum AMS in the observation group were shorter than those in the control group(P<0.05).After treatment for 2 weeks,the APACHEⅡscore and Ranson score in the observation group were lower than those before treatment,and were lower than those in the control group(P<0.05).②After 2 weeks of treatment,the levels of serum ALB,PA and TRF in the observation group were higher than those in the control group,and the levels of serum AMY,LPS and DAO were lower than those in the control group(P<0.05).After treatment for 2 weeks,the serum levels of TNF-α,CRP and IL-6 in the observation group were lower than those in the control group(P<0.05).③After 2 weeks of treatment,the CD3+,CD4+and CD4+/CD8+were higher in the observation group than before the treatment,and the

关 键 词：CBP 肠内免疫营养支持 重症急性胰腺炎 DAO AMY 营养状况 肠道屏障功能 

分 类 号：R576[医药卫生—消化系统]