肠内营养和肠外营养对全身炎性反应综合征患者炎性因子及免疫功能影响的比较

目的 比较肠内营养（EN）和肠外营养（PN）对全身炎性反应综合征（SIRS）患者炎性因子和免疫功能的影响.方法 以2006年4月至2010年4月在山西医科大学第一医院、山西省人民医院和太原市中心医院收治的85例SIRS患者为研究对象,根据营养支持方式分为EN组（n=49）和PN组（n=36）,比较两组患者营养支持前后炎性和免疫指标的变化情况.结果 全热量营养支持后第7、14天,两组患者的体重、上臂周径、三头肌皮褶厚度及血清总蛋白和白蛋白水平均明显高于支持前（P均＜0.05）;全热量营养支持后第14天,EN组患者的血清总蛋白和白蛋白水平明显高于PN组患者（P均＜0.05）.全热量营养支持后第7、14天,EN组患者的血清肿瘤坏死因子α、白细胞介素（IL）-8、IL-l β水平均明显低于支持前和PN组患者（P均＜0.05）;血CD4/CD8及IgG水平均明显高于支持前和PN组患者（P均＜0.05）.结论 PN和EN均可有效改善SIRS患者的营养状态.EN在改善患者营养状况、提高免疫功能和降低炎性介质释放方面的效果优于PN.

Comparison of the influences of enteral nutrition and parenteral nutrition on the inflammatory factors and immune functions in patients with systemic inflammatory response syndrome

Objective To compare influences of enteral nutrition (EN) and parenteral nutrition (PN) on the inflammatory factors and immune functions in patients with systemic inflammatory response syndrome. Methods Totally 85 patients who were treated in the First Hospital of Shanxi Medical University, Shanxi Province People's Hospital, and Taiyuan Central Hospital from April, 2006 to April, 2010 were enrolled in this study and divided into EN group (n = 49) and PN group (n = 36) according to nutrition support modes. The changes of inflammatory factors and immune functions after nutritional supports were recorded and compared between these two groups. Results The weight, arm circumference, skin fold thickness of brachial triceps, total protein, and serum albumin were significantly improved on the 7th and 14th day after nutrition supports in both two groups compared with the baseline levels (all P ＜ 0.05). On the 14th day after nutritional support, the levels of total protein and serum albumin were significantly higher in EN group than in PN group. On the 7th and 14th day, the levels of tumor necrosis factor-α, Interleukin (IL)-8, and IL-1β in EN group were significantly lower than those in PN group and baseline levels (all P ＜ 0. 05). The blood CD4/CD8 and IgG in EN group were significantly increased compared with the baseline levels and those in PN group (both P ＜0. 05). Conclusions Both PN and EN can effectively improve the nutritional status of patients with SIRS. EN has superior effectiveness in EN group than in PN group in terms of improving nutritional status, ameliorating immune function, and reducing the release of inflammatory factors.