联合Gln的早期肠内营养对SAP患者全身炎症反应和免疫功能的影响

摘要] 目的 探讨联合谷氨酰胺（glutamine，Gln）的早期肠内营养（early enteral nutrition，EEN）对重症急性胰腺炎（severe acute pancreatitis，SAP）患者全身炎症反应和免疫功能的影响。方法 将安徽医科大学附属安庆医院普外科2015年10月至2017年5月收治的SAP患者49例随机分为试验组（24例）及对照组（25例）：试验组采用联合Gln的早期肠内营养，对照组采用单纯早期肠内营养。在入院后第1、6、11天分别检测两组患者的炎症指标C-反应蛋白（CRP）、降钙素原（PCT）、白细胞介素6 （IL-6）、白细胞介素8 （IL-8）、肿瘤坏死因子-α（TNF-α）]及免疫指标（CD 3⁺ 、CD 4⁺ 、CD 4⁺ /CD 8⁺ ）等值。比较两组间的差异，进行统计学分析。结果 （1）两组患者炎症指标及免疫指标在第1天的差异无统计学意义（P＞0.05）；（2）第6天，炎症指标CRP （56.31±18.04）mg/L vs （98.12±11.54）mg/L，P=0.037]、IL-6 （45.87±10.99）pg/mL vs （54.72±4.77）pg/mL，P=0.026]、IL-8 （45.15±9.27）ng/mL vs （59.03±4.87）ng/mL，P=0.013]、TNF-α （24.35±7.15）pg/mL vs （32.41±4.22）pg/mL，P=0.010]以及PCT （1.11±0.49）ng/mL vs （1.50±0.30）ng/mL，P=0.024]，试验组均低于对照组（P＜0.05），而免疫指标CD 3⁺ （63.42±2.86）% vs （54.67±1.76）%，P=0.035]、CD 4⁺ （43.69±1.83）% vs （40.08±1.08）%，P=0.014]以及CD 4⁺ /CD 8⁺ （2.25±0.39） vs （1.87±0.22），P=0.006]，试验组均高于对照组（P＜0.05）；（3）第11天，炎症指标CRP （16.81±7.56）mg/L vs （43.01± 2.74）mg/L，P=0.009]、IL-6 （29.39±7.92）pg/mL vs （38.29±5.33）pg/mL，P=0.020]、IL-8 （30.73±9.26）ng/mL vs （39.69±5.26）ng/mL，P=0.018]、TNF-α （13.87±5.67）pg/mL vs （20.35±3.82）pg/mL，P=0.019]以及PCT （0.34±0.11）ng/mL vs （0.95±0.29）ng/mL，P=0.035]，试验组均低于对照组（P＜0.05），而免疫指标CD 3⁺ （69.68±1.87）% vs （61.14±1.21）%，P=0.017]、CD 4⁺ （54.27±3.23）% vs （45.30±1.59）%，P=0.007]以及 CD 4⁺ /CD 8⁺ （2.98±0.51） vs （2.01±0.28），P=0.012]，试验组均高于对照组（P＜0.05）。结论 联合Gln的早期肠内营养比单纯的早期肠内营养能更好地降低SAP患者的全身炎症反应，提高免疫功能。

Effect of early enteral nutrition supplemented with glutamine for patients with severe acute pancreatitis on systemic inflammatory response and immune function

Abstract objective To evaluate the effect of early enteral nutrition (EEN) supplemented with glutamine (Gln) for patients with severe acute pancreatitis (SAP) on systemic inflammatory response and immune function. Methods Forty-nine SAP patients admitted to the General Surgery of Anqing Hospital Affiliated to Anhui Medical University from Oct. 2015 to May. 2017 were randomly divided into the experimental group (24 cases) and the control group (25 cases). EEN combined with Gln was used in the experimental group and only EEN was used in the control group. Blood samples from all the patients were collected for analysis of inflammatory markers C-Reactive protein (CRP), procalcitonin (PCT), Interleukin-6 (IL-6), Interleukin-8 (IL-8), tumor necrosis factor-α (TNF-α)] and immune indices (CD 3⁺ , CD 4⁺ , CD 4⁺ /CD 8⁺ ) on the day l, 6 and 11 after admission, and their differences were compared between the two groups. Results (1) On the first day after admission,compared with the control group, there was no significant difference of systemic inflammation markers (including CRP, PCT, IL-6, IL-8, TNF-α) and immune parameters (CD 3⁺ , CD 4⁺ , CD 4⁺ /CD 8⁺ ) in the experimental group. (2) On day 6, the levels of inflammatory markers CRP (56.31±18.04) mg/L vs (98.12±11.54) mg/L, P=0.037], IL-6 (45.87±10.99) pg/mL vs (54.72±4.77) mg/L, P=0.026), IL-8 (45.15±9.27) ng/mL vs (59.03±4.87) ng/mL, P=0.013], TNF-α (24.35±7.15) pg/mL vs (32.41±4.22) pg/mL, P=0.010] and PCT (1.11±0.49) ng/mL vs (1.50±0.30) mg/L, P=0.024] in the experimental group were significantly lower than those in the control group. In addition, levels of immune indices CD 3⁺ (63.42±2.86)% vs (54.67±1.76)%, P=0.035], CD 4⁺ (43.69±1.83)% vs (40.08±1.08)%, P=0.014] and CD 4⁺ /CD 8⁺ (2.25±0.39) vs (1.87±0.22), P=0.006] were significantly higher in the experimental group. (3) On day 11, the levels of CRP (16.81±7.56) mg/L vs (43.01±2.74) mg/L, P=0.009], IL-6 (29.39±7.92) pg/mL vs (38.29±5.33) pg/mL, P=0.020], IL-8 (30.73±9.26) ng/mL vs (39.69±5.26) ng/mL, P=0.018], TNF-α (13.87±5.67) pg/mL vs (20.35±3.82) pg/mL, P=0.019] and PCT (0.34±0.11) ng/mL vs (0.95± 0.29) ng/mL, P=0.035] in the experimental group were also significantly lower than those in the control group. And the levels of CD 3⁺ (69.68±1.87)% vs (61.14±1.21)%, P=0.017], CD 4⁺ (54.27±3.23)% vs (45.30±1.59)%, P=0.007] and CD 4⁺ /CD 8⁺ (2.98±0.51) vs (2.01±0.28), P=0.012] in the experimental group were also significantly higher.Conclusion For patients with severe acute pancreatitis, EEN combined with Gln is superior to EEN alone in reducing systemic inflammatory response and improving immune function.