早期肠内营养对老年慢性心力衰竭患者血清炎症介质及瘦素的影响  

Effect of early enteral nutrition on serum inflammatory mediators and leptin in elderly patients with chronic heart failure

作　　者：张悦[1] 王丽君[1] 毕美峰[1] 赵静[1] 吕欣[1] 陈怀红[1] Zhang Yue;Wang Lijun;Bi Meifeng;Zhao Jing;Lv Xin;Chen Huaihong(Zhejiang Hospital,Hangzhou 310013,China)

机构地区：[1]浙江医院,杭州310013

出　　处：《心脑血管病防治》2021年第2期146-148,178,共4页CARDIO-CEREBROVASCULAR DISEASE PREVENTION AND TREATMENT

基　　金：浙江省医药卫生科技项目(2013KYA009)。

摘　　要：目的探讨早期肠内营养对老年慢性心力衰竭(CHF)患者心功能及血清炎症介质和瘦素等的影响。方法选取2017年6月至2019年1月在浙江医院住院的老年CHF患者80例,随机分为对照组38例和治疗组42例,两组患者在常规抗心力衰竭治疗下,对照组予自由饮食,治疗组予日常膳食联合肠内营养制剂治疗2~4 w,检测治疗前后两组患者的营养指标、心功能指标、血清炎症介质及瘦素水平。结果治疗2 w后,治疗组体质量指数(BMI)、上臂肱三头肌皮褶厚度(TSF)、血清前白蛋白、血红蛋白水平、6分钟步行距离均高于同组治疗前(t=-5.468、-5.842、-3.978、-4.810、-2.974,P<0.05),血浆B型脑钠肽(BNP)、肿瘤坏死因子α(TNF-α)、白细胞介素-6(IL-6)及瘦素水平均低于同组治疗前(t=3.796、3.417、2.499、7.121,P<0.05);治疗4 w后,除了BNP及TNF-α外,治疗组各项指标较治疗2 w后改善更为明显(P<0.05)。且治疗4 w后,治疗组BMI、TSF、血清白蛋白、前白蛋白、血红蛋白水平、左室射血分数(LVEF)、TNF-α、IL-6及瘦素水平,较均对照组有改善(t=-4.150、-3.844、-2.085、-3.144、-2.256、-2.064、3.758、2.130、2.083,P<0.05)。结论早期肠内营养治疗可改善老年CHF患者营养状态,提高心功能,降低TNF-α、IL-6及瘦素水平,治疗时间越长患者的心功能及炎症介质改善越明显。Objective To investigate the effect of early enteral nutrition(EN)on cardiac function,serum levels of inflammatory mediators and leptin in elderly patients with chronic heart failure(CHF).Methods 80 elderly patients with CHF hospitalized in Zhejiang Hospital from June 2017 to January 2019 were selected,who were randomly divided into two groups:control group(n=38)and treatment group(n=42).Based on the routine treatment of CHF,the control group was given free diet,and the treatment group was given daily diet combined with EN preparations for 2 to 4 weeks.Nutritional status,the cardiac function index,serum inflammatory mediators and leptin levels of the two groups were tested before and after treatment.Results After 2 weeks of EN treatment,the body mass index(BMI),triceps skin fold thickness(TSF),serum prealbumin(PA),hemoglobin(hgb)concertration,6 min walking distance in treatment group were higher than those before treatment(t=-5.468,-5.842,-3.978,-4.810,-2.974;P<0.05).The serum levels of brain natriuretic peptide(BNP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and leptin in treatment group were lower than those before treatment(t=3.796,3.417,2.499,7.121;P<0.05).After 4 weeks of treatment,the indicators in treatment group were more obviously improved than those after 2 weeks except BNP and TNF-α(P<0.05).And after 4 weeks of treatment,BMI,TSF,serum albumin(ALB),PA,hgb,left ventricular ejection fraction(LVEF),TNF-α,IL-6 and leptin were obviously improved than those in the control group(t=-4.150,-3.844,-2.085,-3.144,-2.256,-2.064,3.758,2.130,2.083;P<0.05).Conclusion Early EN treatment can improve the nutritional status and the cardiac function of elderly patients with CHF,reduce the levels of TNF-α,IL-6 and leptin.The longer the treatment goes on,the more obvious the improvement of cardiac function and inflammatory mediators improve.

关 键 词：肠内营养 老年 慢性心力衰竭 炎症介质 瘦素 

分 类 号：R541.6[医药卫生—心血管疾病]