摘要
目的探讨老年高脂血症性急性胰腺炎(HLAP)患者应用免疫增强型肠内营养支持对其免疫功能及营养状况的影响。方法回顾性选取2018年1月至2020年1月上海中医药大学附属曙光医院收治的老年HLAP患者90例为研究对象。按照随机数表法分为两组,每组各45例。对照组给予常规营养支持,观察组给予免疫增强型肠内营养支持。观察比较两组患者治疗14 d后尿淀粉酶恢复时间、血淀粉酶恢复时间、腹胀缓解时间、腹痛缓解时间及不良反应发生率;比较两组患者治疗前及治疗14 d后免疫功能指标[免疫球蛋白A(IgA)、免疫球蛋白G(IgG)、免疫球蛋白M(IgM)、淋巴细胞总数(TLC)]、营养指标[前白蛋白(PAB)、白蛋白(ALB)]、炎症指标[白细胞介素(IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)]水平变化情况。结果治疗14 d后,观察组患者尿淀粉酶恢复时间、血淀粉酶恢复时间、腹胀缓解时间及腹痛缓解时间分别为(12.16±2.57)、(6.26±1.35)、(3.24±0.65)、(2.24±0.26)d,均显著短于对照组[(13.74±3.44)、(7.61±2.41)、(4.68±1.14)、(2.97±0.59)d],差异均有统计学意义(P<0.05)。治疗14 d后,观察组患者IgA、IgG、IgM、TLC水平分别为(2.42±0.64)g/L、(13.54±3.26)g/L、(1.97±0.45)g/L、(2.56±0.73)×10^(9)/L,均显著高于对照组[(1.97±0.46)g/L、(10.43±2.52)g/L、(1.63±0.36)g/L、(2.14±0.45)×10^(9)/L],差异均有统计学意义(P<0.05)。治疗14 d后,观察组前白蛋白、白蛋白水平分别为(426.17±27.43)mg/L、(41.63±6.28)g/L,均显著高于对照组[(384.28±21.16)mg/L、(38.34±4.65)g/L],差异均有统计学意义(P<0.05)。治疗14 d后,观察组患者的IL-6、TNF-α、CRP水平分别为(42.21±4.64)ng/L、(13.24±1.43)ng/L、(35.54±1.31)mg/L],均显著低于对照组[(50.45±5.57)ng/L、(15.65±2.57)ng/L、(41.29±2.64)mg/L],差异均有统计学意义(P<0.05)。结论免疫增强型肠内营养支持对老年HLAP患者临床疗效显著,可促进患者免疫功能的提升,改善炎症反应,提升患者营养指标,值得临床推广应用。
Objective To investigate the effect of immune enhanced enteral nutrition support on immune function and nutritional status in elderly patients with hyperlipidemic acute pancreatitis(HLAP).Methods A total of 90 elderly hlap patients admitted to Shuguang Hospital,Shanghai University of Traditional Chinese Medicine from January 2018 to January 2020 were retrospectively selected as the study subjects.According to the method of random number table,they were divided into two groups,45 cases in each group.The control group was given conventional nutrition support,and then the observation group was given immune enhanced enteral nutrition support.The recovery time of urinary amylase,blood amylase,abdominal distension,abdominal pain and the incidence of adverse reactions were observed and compared between the two groups after 14 days of treatment.The immune function indexes of the two groups before treatment and after 14 days of treatment were compared,including immunoglobulin A(IGA),immunoglobulin G(IgG),immunoglobulin M(IgM),total lymphocyte count(TLC),nutritional indexes prealbumin(PAB)and albumin(ALB),Inflammatory indicators interleukin(IL-6),tumor necrosis factor-α(TNF-α),C-reactive protein(CRP)level.Results After 14 days of treatment,the urinary amylase recovery time,blood amylase recovery time,abdominal distension relief time and abdominal pain relief time in the observation group were(12.16±2.57),(6.26±1.35),(3.24±0.65),and(2.24±0.26)d,respectively,which were significantly shorter than those in the control group[(13.74±3.44),(7.61±2.41),(4.68±1.14),(2.97±0.59)d],and the differences were statistically significant(P<0.05).After 14 days of treatment,the levels of IgA,IgG,IgM and TLC in the observation group were(2.42±0.64)g/L,(13.54±3.26)g/L,(1.97±0.45)g/L,(2.56±0.73)×10^(9)/L,respectively,which were significantly higher than the control group[(1.97±0.46)g/L,(10.43±2.52)g/L,(1.63±0.36)g/L,(2.14±0.45)×10^(9)/L],and the differences were statistically significant(P<0.05).After 14 days of treatment,the levels of PAB and ALB in the observation group were(426.17±27.43)mg/L,(41.63±6.28)g/L,which were significantly higher than those in the control group[(384.28±21.16)mg/L,(38.34±4.65)g/L],the differences were statistically significant(P<0.05).After 14 days of treatment,the levels of IL-6,TNF-α,and CRP in the observation group were(42.21±4.64)ng/L,(13.24±1.43)ng/L,(35.54±1.31)mg/L,respectively,which were significantly lower than those in the control group[(50.45±5.57)ng/L,(15.65±2.57)ng/L,(41.29±2.64)mg/L],the differences were statistically significant(P<0.05).Conclusion Immune-enhanced enteral nutrition support has significant clinical effect on elderly patients with hyperlipidemia and acute pancreatitis,which can promote the improvement of patients'immune function,improve the inflammatory response,and improve the nutritional indicators of patients,which is worthy of clinical promotion and application.
作者
蒋雪瑾
张晓燕
潘碧筠
JIANG Xue-jin;ZHANG Xiao-yan;PAN Bi-jun(Department of Emergency,Shuguang Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai 200000,China.)
出处
《临床和实验医学杂志》
2022年第20期2177-2180,共4页
Journal of Clinical and Experimental Medicine
基金
上海市卫生健康委员会政策研究课题项目(编号:2020HP23)。
关键词
免疫增强型肠内营养支持
老年高脂血症性急性胰腺炎
免疫功能
营养状况
炎症反应
Immune-enhanced enteral nutrition support
Elderly hyperlipidemic acute pancreatitis
Immune function
Nutritional status
Inflammatory response
