不同途径营养支持方式对肝硬化患者康复效果及肠道菌群和免疫功能的影响  

Effects of nutritional support with different ways on rehabilitation efficacy,intestinal flora and immune function of patients with liver cirrhosis

作　　者：孙月[1] 李君杰[1] 邹雪梅 李君杰[1] 王晓宇 SUN Yue;LI Jun-jie;ZOU Xue-mei(Department of Infections,The Affiliated First Hospital of Harbin Medical University,Harbin 150000,China)

机构地区：[1]哈尔滨医科大学附属第一医院感染科,黑龙江哈尔滨150000 [2]海南省第二人民医院外科,海南五指山572299

出　　处：《中国医学装备》2020年第10期113-116,共4页China Medical Equipment

摘　　要：目的:探讨分析不同的营养支持方式对肝硬化患者康复效果、肠道菌群和免疫功能的影响。方法:选取医院收治的75例肝硬化患者,根据随机数表法将其分为常规热量肠外营养(PN)组、低热量肠外营养(HPN)组和低热量肠内营养(HEN)组,每组25例。3组分别给予PN、HPN和HEN支持治疗,比较3组患者治疗后临床功能指标和治疗前后免疫功能,同时对3组患者治疗前后肠道菌群分布情况及治疗期间不良反应发生情况进行比较。结果:HEN组患者胃肠道功能恢复时间、出入院时的体重差和营养支持费用均显著低于PN和HPN组,住院时间显著短于PN组,差异具有统计学意义(F=6.201,F=3.890,F=9.225,F=3.162;P<0.05);治疗后3组患者T淋巴细胞及亚群CD3^+、CD4^+和CD8^+均显著升高,且HEN组显著高于PN和HPN组,差异均具有统计学意义(F=3.221,F=3.257,F=3.420;P<0.05),3组免疫功能敏感指标CD4^+/CD8^+水平比较差异无统计学意义;治疗后HEN组肠杆菌、双歧杆菌和乳酸杆菌数量均显著高于PN和HPN组,酵母样真菌数量显著低于PN和HPN组,差异具有统计学意义(F=3.310,F=4.873,F=3.652,F=3.796;P<0.05);3组不良反应发生率比较差异无统计学意义。结论:肝硬化患者采用HEN支持治疗方式在改善患者胃肠道功能、缩短住院时间、降低经济负担和不良反应等方面显著优于其他支持治疗方式,并可明显改善患者肠道菌群分布,提高其免疫功能,值得在临床进一步应用。Objective:To explore and analyze the effects of nutritional support with different ways on the rehabilitation effect,intestinal flora and immune function of patients with liver cirrhosis.Methods:75 patients with liver cirrhosis admitted to our hospital were selected and they were randomly divided into three groups:conventional caloric parenteral nutrition(PN)group,hypocaloric parenteral nutrition(HPN)group and hypocaloric enteral nutrition(HEN)group,with 25 cases in each group.The three groups were implemented PN,HPN and HEN support treatment respectively.The distribution of intestinal flora pre and post treatment and the occurrence of adverse reaction in duration of therapy among 3 groups were compared.Results:The recovery time of gastrointestinal function,weight difference between hospital discharge and in hospital,and nutritional support cost of HEN group were significantly lower than those of PN and HPN group,respectively,and the hospitalization time of HEN group was significantly shorter than that of PN group(F=6.201,F=3.890,F=9.225,F=3.162,P<0.05).After treatment,T lymphocytes and subpopulation CD3^+,CD4^+and CD8^+of 3 groups were significantly increased,and them of HEN group were significantly higher than those of PN group and HPN group(F=3.221,F=3.257,F=3.420,P<0.05),respectively.But there was no significant difference in the levels of CD4^+/CD8^+of sensitive index of immunity function among the three groups after treatment.After treatment,the number of Enterobacteriaceae,Bifidobacterium and Lactobacillus in HEN group were significantly higher than those in PN group and HPN group,respectively,and the number of yeastlike fungi in HEN group was significantly lower than that in PN group and HPN group(F=3.310,F=4.873,F=3.652,F=3.796,P<0.05).And the difference of the incidence of adverse reactions among the three groups was no significant.Conclusion:For patients with liver cirrhosis,HEN support therapy is superior to other supportive treatment in improving gastrointestinal function,shortening hospitalization t

关 键 词：肝硬化 营养支持 低热量肠内营养 免疫功能 肠道菌群 

分 类 号：R657.3[医药卫生—外科学]