强化早期肠内营养对重型颅脑损伤患者细胞免疫功能的影响

目的探讨早期肠内营养对重型颅脑损伤患者细胞免疫功能的影响。方法42例正常健康者作为正常对照组。84例重型颅脑损伤患者按病人的住院号分为两个观察组,单号普通肠内营养组（EN组）42例,双号添加精氨酸强化肠内营养组（EN＋Arg组）42例。对照组于查体时采血,其他两组于伤后10d采血,采用吞噬白念珠菌计数法、链酶亲和素-生物素法及放射免疫法,分别测定白细胞吞噬功能,T细胞表型CD4＋、CD8＋含量和血清白细胞介素-2（IL-2）水平。结果重型颅脑损伤后病人免疫功能显著下降,与对照组比,差异显著（P〈0．05）,而EN＋Arg组病人的血清CD4＋含量、CD4＋／CD8＋比值、IL-2水平以及白细胞吞噬功能均明显高于EN组（P〈0．05）。结论重型颅脑损伤可导致病人细胞免疫功能下降,添加精氨酸的肠内营养能提高细胞免疫功能。

Effect of Early Enteral Nutrition Fortified with Arginlne on Cellular Immunological Function in Patients with Severe Brain Injury

Objectives To investigate the effect of early enteral nutrition (EEN) fortified with Arginine (Arg) on the cellular immunological function in the patients with severe brain injury. Methods Eighty-four patients with severe brain injury (GCS≤8) were randomly divided into two groups, i.e. fortified EEN (FEEN) group (42 patients), where EEN fortified with Arg was performed, and early normal enteral nutriation (NEEN) group (42 patients). Forty-two healthful adults served as normal control. Blood samples were collected in all the groups 10 days after the injury. The phagocytosis of polymorphonclear leucocyte was observed by phagocytic candida albicans count. CD4-positive cells and CD8-positive cells were analyzed by immunohistochemical method. The concentration of serum IL-2 was measured by radioimmunoassay. Results The immunological function of the patient with severe brain injury lowered significantly compared to that of the healthful adults. The CD4-positive cell, ratio of CD4-postitive ceils to CD8-postitive cells, concentration of serum IL-2 and activity of natural killer cell in FEEN group were significantly higher than those in NEEN group (P<0.05). Conclusions The cellular immunological function is decreased in the patients with severe brain injury, in whom EEN fortified with Arg can enhance the cellular immunological function.