摘要
目的探讨早期肠内营养(EEN)干预对脓毒症休克患者调节性T细胞/辅助性T淋巴细胞17(Treg/Th17)免疫平衡及血清C-反应蛋白(CRP)、白细胞介素-6(IL-6)的影响。方法随机数字表法将2017年1月-2020年1月遵义医科大学附属医院急诊科的75例脓毒症休克患者分为EEN组和延迟肠内营养(DEN)组,EEN组于入院后24 h内启动肠内营养(EN),DEN组于入院72 h后启动EN。比较两组营养状态、不良反应及预后情况,并测定两组干预前后Treg/Th17、CRP、IL-6等指标。结果与入ICU即刻时比较,两组干预7 d后血清总蛋白(TP)、前清蛋白(PA)、清蛋白(ALB)、淋巴细胞计数(LCT)升高,Treg/Th17、CRP、IL-6水平降低,且EEN组干预7 d后TP、PA、ALB、LCT水平高于对照组,Treg/Th17、CRP及IL-6水平低于对照组(P<0.05);EEN组代谢紊乱的发生率低于DEN组(P<0.05);与DEN组比较,EEN组入住ICU时间及机械通气时间较短,干预7 d后急性生理与慢性健康(APACHEⅡ)评分、贯序器官功能衰竭(SOFA)评分较低(P<0.05)。结论与DEN相比,EEN能有效改善脓毒症休克患者营养状况,通过下调Treg/Th17及血清CRP、IL-6水平,改善免疫失衡和炎症反应,减少代谢紊乱的发生率,同时缩短患者入住ICU时间和机械通气时间,减轻病情严重程度,但并未减少患者3个月内病死率。
OBJECTIVE To investigate the effect of early enteral nutrition(EEN)intervention on regulatory T cells/T helper 17 cells(Treg/Th17)balance and serum C-reactive protein(CRP)and interleukin-6(IL-6)levels in patients with septic shock.METHODS Seventy-five patients with septic shock admitted to the Department of Emergency of Affiliated Hospital of Zunyi Medical University from Jan.2017 to Jan.2020 were divided into the EEN group and delayed enteral nutrition(DEN)group by using random number table method.Patients in the EEN group received enteral nutrition(EN)within 24 hours after admission,and those in the DEN group received EN later than 72 hours after admission.The nutritional status,adverse reactions and prognosis between the two groups were compared.Treg/Th17 ratio,CRP and IL-6 levels in the two groups were determined before and after intervention.RESULTS Compared with the condition at the time of ICU admission,serum total protein(TP),prealbumin(PA),albumin(ALB),and lymphocyte count(LCT)in the two groups were significantly elevated,while Treg/Th17,CRP and IL-6 levels were significantly reduced after 7 days of intervention.The levels of TP,PA,ALB,and LCT in the EEN group were significantly higher than those in the control group,while Treg/Th17,CRP and IL-6 levels were significantly lower than those in the control group after 7 days of intervention(P<0.05).The incidence of metabolic disorders in the EEN group was significantly lower than that in the DEN group(P<0.05).Compared with the DEN group,the EEN group had shorter ICU stay and mechanical ventilation time.After 7 days of intervention,the Acute Physiologic and Chronic Health Evaluation(APACHEⅡ)scores and the Sequential Organ Failure Assessment(SOFA)scores in the EEN group were significantly lower than those in the DEN group(P<0.05).CONCLUSION Compared with DEN,EEN can effectively improve the nutritional status of patients with septic shock by lowering Treg/Th17 ratio and serum CRP and IL-6 levels.It can alleviate immune imbalance and inflammatory response and reduce the incidence of metabolic disorders,shortening ICU stay and mechanical ventilation time and improving the patient’s condition.However,it cannot reduce the fatality rate within 3 months.
作者
潘万福
王灿
骆付丽
陈江华
钱民
PAN Wan-fu;WANG Can;LUO Fu-li;CHEN Jiang-hua;QIAN Min(Affiliated Hospital of Zunyi Medical University,Zunyi,Guizhou 563000,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2022年第11期1668-1672,共5页
Chinese Journal of Nosocomiology
基金
贵州省科研基金资助项目(H021021)。
