早期内镜肠内营养支持对重症脑出血患者免疫球蛋白及T淋巴细胞亚群的影响  

Effects of early endoscopic enteral nutrition support on immunoglobulins and T lymphocyte subsets in patients with severe intracerebral hemorrhage

作　　者：陈景霞 廖晓斌[1] 康承湘 CHEN Jingxia;LIAO Xiaobin;KANG Chengxiang(The First People's Hospital of Chenzhou,Department of Neurosurgery,Chenzhou 423400,China)

机构地区：[1]郴州市第一人民医院神经外科,郴州423400

出　　处：《中国免疫学杂志》2025年第3期686-689,共4页Chinese Journal of Immunology

摘　　要：目的:探讨早期内镜肠内营养支持对重症脑出血患者免疫球蛋白及T淋巴细胞亚群的影响。方法:选取2019年8月至2022年6月郴州市第一人民医院收治的120例重症脑出血患者,按随机数字表法分为胃管组和肠管组,每组60例。入院后12~24 h,胃管组给予鼻胃管进行早期营养支持,肠管组胃镜辅助下置鼻空肠管进行早期营养支持。比较两组患者入院次日和第14天NIHSS、GCS评分、营养指标[白蛋白(Alb)、前白蛋白(PAB)、血红蛋白(Hb)]、IgG、IgA、IgM、T淋巴细胞亚群(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+))水平及并发症情况。结果:入院后第14天,相较于胃管组,肠管组NIHSS评分明显降低,GCS评分、外周血Alb、PAB、Hb、IgG、IgA、IgM、CD3^(+)T、CD4^(+)T、CD4^(+)T/CD8^(+)T水平明显升高(P<0.05)。肠管组治疗后消化道出血、反流性食管炎、胃潴留、呕吐的发生率低于胃管组(P<0.05)。结论:早期内镜肠内营养支持可有效改善重症脑出血患者营养状态,提高患者免疫功能,改善患者预后。Objective:To explore effects of early endoscopic enteral nutrition support on immunoglobulin and T lymphocyte subsets in patients with severe intracerebral hemorrhage.Methods:A total of 120 patients with severe intracerebral hemorrhage admitted to The First People's Hospital of Chenzhou were enrolled between August 2019 and June 2022,who were divided into gastric tube group and intestinal tube group according to random number table method,with 60 cases in each group.Gastric tube group was given nasogastric tube 12~24 h after admission,while intestinal tube group was given gastroscope-assisted nasojejunal tube for early nutrition support.NIHSS and GCS scores,nutritional indexes[albumin(Alb),prealbumin(PAB),hemoglobin(Hb)],IgG,IgA,IgM and T lymphocyte subsets(CD3^(+),CD4^(+),CD4^(+)/CD8^(+))levels on the following day and 14 d after admission,and complications were compared between two groups.Results:At 14 d after admission,NIHSS score in intestinal tube group were significantly lower than gastric tube group,while GCS score,peripheral blood Alb,PAB,Hb,IgG,IgA,IgM,CD3^(+)T,CD4^(+)T and CD4^(+)T/CD8^(+)T levels were significantly higher than gastric tube group(P<0.05).After treatment,incidences of gastrointestinal bleeding,reflux esophagitis,gastric retention and vomiting in intestinal tube group were lower than gastric tube group(P<0.05).Conclusion:Early endoscopic enteral nutrition support can effectively improve nutritional status and enhance immune function in patients with severe intracerebral hemorrhage,which is beneficial to improve prognosis.

关 键 词：重症脑出血 肠内营养支持 内镜 免疫球蛋白 T淋巴细胞亚群 

分 类 号：R743.34[医药卫生—神经病学与精神病学] R472.91[医药卫生—临床医学]