摘要
目的 评价免疫肠内营养（EN）对重症结核患者细胞免疫水平及临床疗效的影响.方法 选择浙江省杭州市红十字会医院2015年6月至2017年6月收治的60例重症结核患者,分为常规EN组和免疫EN组,每组30例.常规EN组根据患者胃肠耐受情况给予普通EN制剂（能全力）、抗结核、抗感染等综合治疗;免疫EN组给予免疫EN制剂（瑞能）,维持目标热卡104.6 kJ·d-1·kg-1,同时根据病情给予抗结核、抗感染.两组疗程均为14 d.观察两组患者治疗前后白细胞介素（IL-6、IL-10）、γ-干扰素（IFN-γ）、白细胞计数（WBC）、C-反应蛋白（CRP）、降钙素原（PCT）,以及细胞免疫水平（CD4＋、CD8＋）、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、28 d病死率的变化.结果 两组治疗后WBC、CRP、PCT均较治疗前明显降低,IL-6、IFN-γ、CD4＋均较治疗前明显升高,且免疫EN组治疗后的变化较常规EN组更显著〔WBC（×109/L）：8.0±3.1比10.0±2.4,CRP（mg/L）：30.3±9.1比45.8±6.6,PCT（μg/L）：2.2±1.8比4.3±2.2,IL-6（mg/L）：182.53±8.52比168.42±7.62,IFN-γ（mg/L）：32.52±3.5比25.41±2.6,CD4＋：0.56±0.06比0.45±0.08,均P〈0.05〕;两者治疗后CD8＋较治疗前有所升高（常规EN组：0.28±0.06比0.27比0.07,免疫EN组：0.27±0.08比0.26±0.09）, APACHEⅡ评分较治疗前有所降低〔常规EN组（分）：11±6比18±4,免疫EN组（分）：10±3比17±6〕;免疫EN组28 d病死率低于常规EN组〔13.3%（4/30）比16.7%（5/30）〕,但两组间CD8＋、APACHEⅡ评分、28 d病死率比较差异均无统计学意义（均P〉0.05）.结论 免疫EN可改善重症结核患者的细胞免疫水平,降低炎症反应程度,改善临床疗效.
Objective To evaluate the effects of enteral immunonutrition on cell immunity level and clinical efficacy in patients with severe tuberculosis. Methods Sixty patients with severe tuberculosis were admitted to the department of tuberculosis intensive care unit of Hangzhou Red Cross Hospital from June 2015 to June 2017, and they were randomly divided into a conventional enteral nutrition group （EN group） and a enteral immunonutrition group （EIN group）, each group 30 cases. Based on the patients＇ gastrointestinal tolerance condition, the EN group was treated with therapies of normal nutrition support, anti-tuberculosis, anti-infection, etc.; the EIN group was treated with enteral immunonutrition （TPF-T）, and simultaneously with anti-tuberculosis, anti-infection, etc. therapies according to the disease situation. The target energy maintained at 104.6 kJ·d-1·kg-1and the therapeutic course was 14 days in the two groups. The levels of interleukins （IL-6, IL-10） and interferon-γ （IFN-γ）, white blood cell count （WBC）, C-reactive protein （CRP）, procalcitonin （PCT）, cell immune indexes （T cell subgroup CD4＋, CD8＋） were observed before treatment and on day 14 after treatment in the patients of two groups; the changes of acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） score before treatment and after treatment and 28-day mortality rate were recorded in the two groups. Results After treatment, the levels of WBC, CRP, PCT were obviously lower than those before treatment, while the levels of IL-6, IFN-γ, CD4＋in the two groups were significantly higher than those before treatment, and the changes of the EIN group were more significant than those in the EN group [WBC （×109/L）： 8.0±3.1 vs. 10.0±2.4, CRP （mg/L）： 30.3±9.1 vs. 45.8±6.6, PCT （μg/L）： 2.2±1.8 vs. 4.3±2.2, IL-6 （mg/L）： 182.53±8.52 vs. 168.42±7.62, IFN-γ （mg/L）： 32.52±3.5 vs. 25.41±2.6, CD4＋： 0.56±0.06 vs. 0.45±0.08, all P 〈 0.05]. The level of CD8＋after treatment in the two groups was higher than that before treatment （the EN group： 0.28±0.06 vs. 0.27±0.07, the EIN group： 0.27±0.08 vs. 0.26±0.09）, the APACHE Ⅱ scores in the two groups were lower than those before treatment （the EN group： 11±6 vs. 18±4, the EIN group： 10±3 vs. 17±6）, the 28-day mortality in the EIN group was lower than that in the EN group [13.3% （4/30） vs. 16.7% （5/30）], no statistical significant difference in CD8＋, APACHE Ⅱscore, 28-day mortality between the two groups being found （all P 〉 0.05）. Conclusion Enteral immunonutrition can improve the level of cell immunity and decrease the degree of inflammatory response, and increase the clinical curative effect in patients with severe tuberculosis.
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2018年第1期66-69,共4页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
浙江省医药卫生科技计划项目（KYA182）
关键词
免疫肠内营养
结核免疫
临床疗效
Enteral immunonutrition
Tuberculosis immunity
Clinical effieacy
作者简介
通讯作者：潘晓鸿，Email：pansaide@fnxmail．com
