不同营养方式对急性胰腺炎患者肠屏障功能和免疫指标的影响研究

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摘要目的探讨全肠外营养和肠内营养对急性胰腺炎患者肠屏障功能和免疫指标的影响。方法选择我院2014年8月～2016年2月收治的急性胰腺炎患者58例，随机分为3组，入院48～72 h患者情况平稳后，A组（20例）接受全肠外营养，B组（19例）接受肠内营养，C组（19例）在接受肠外营养的同时接受阶段性肠内营养，比较三组营养支持前后营养学指标、肠道屏障功能指标和免疫学指标变化。结果治疗14 d后，营养学指标：三组体质指数（BMI）均获改善（P＜0.05）；C 组清蛋白（ALB）最高，而 A 组最低（P＜0.05）；A 组前清蛋白（PAB）显著低于其他两组（P＜0.05）。肠屏障功能指标：三组血液内毒素均显著降低，且均以C组降低程度最高，A组最低（P＜0.01）；L/M比值降低，且以C组降低程度最高（P＜0.05）。免疫学指标：治疗后，IgA水平均显著升高，其中A组升高程度最低（P＜0.05）；IgM水平显著升高，且C组显著高于A组，差异均有统计学意义（P＜0.01）。结论在肠外营养的基础上阶段性实施肠内营养能显著改善患者营养状况，对促进患者肠道屏障功能恢复，改善免疫功能有显著的效果。

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	李国斌
	黄容旺
	魏娣
	陈铭

关键词 ：急性胰腺炎, 肠外营养, 肠内营养, 肠屏障, 免疫功能

Abstract：Objective To investigate the effect of total parenteral nutrition and enteral nutrition on intestinal barrier function and immune parameters in patients with acute pancreatitis.Methods Fifty eight patients with acute pancreatitis who were admitted to our hospital from August 2014 to Ferbruary 2016 were randomly divided into three groups.After admission to hospital for 48-72 h,and patients were at stable status.They were divided into group A(n＝20,totAl parenteral nutrition),group B(n＝19,total enteral nutrition）,and group C(n＝19,total parenteral nutrition with staged enteral nutrition).Nutritional indicators,intestinal barrier function indicators,and immunity were compared before and after nutritional support in the three groups.Results After 14 day treatment,on nutritional indicators,the body mass index(BMI)in the three groups were all improved(P＜0.05).The albumin(ALB)level was highest in group C and lowest in group A (P＜0.05).The prealbumin (PAB)level in group A was significantly lower than that in the other two groups(P＜0.05).With regard to intestinal barrier function index,the blood endotoxins among three groups were all significantly reduced,and the reduction in group C was most obvious,while in group A was least(P＜0.05).The L/M ratio decreased,and the reduction in group C was most obvious(P＜0.05).On immunological in dicators,after treatment IGA level in all group increased in group A (P＜0.05).IgM level in all group increased significantly,and the IgM level was higher in group C than in group A (P＜0.01).Conclusion On the basis of parenteral nutrition staged enteral nutrition can significantly improve the nutritional status of patients,and obtains a significant effect on promoting the recovery of intestinal barrier function and ameliorating immune function.

Key words： Acute pancreatitis Parenteral nutrition Enteral nutrition Intestinal barrier Immune function

引用本文:

李国斌;黄容旺;魏娣;陈铭. 不同营养方式对急性胰腺炎患者肠屏障功能和免疫指标的影响研究[J]. 中国当代医药, 2018, 25(21): 40-42.
LI Guo-bin;HUANG Rong-wang;WEI Di;CHEN Ming. Study of the influence of different nutritional methods on intestinal barrier function and immune index in patients with acute pancreatitis. 中国当代医药, 2018, 25(21): 40-42.

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