早期免疫营养支持辅助治疗老年急性胆源性胰腺炎对炎症反应及免疫功能的影响

摘要

Objective To investigate the effect of early immune nutrition adjuvant treatment on the inflammatory response and immune function in elderly patients with acute biliary pancreatitis (ABP).Methods Eighty patients with ABP undergoing row duodenal endoscopic treatment were selected and randomly divided into observation group and control group,with 40 cases in each group.The control group was given routine nutritional support during perioperative period,and the observation group was given immune nutrition support.The serum levels of tumor necrosis factor (TNF-α),interleukin 6 (IL-6),high-sensitivity C-reactiveprotein (hs-CRP),immunoglobulin and complement,and the incidence rate of complication were observed and compared before and 3 d,7 d after nutritional support.Results (1) The APACHE Ⅱ score was significantly decreased in observation group and control group after nutritional support (P≤0.05),and the difference between the two groups was statistically significant(P≤0.05).(2) The serum levels of TNF-α,IL-6,hs-CRP in observation group were significantly lower than those in control group (all P≤0.05).(3) After nutritional support,the levels of IgG,IgA,C3,C4 in observation group were significantly lower and the level of IgM was significantly higher than those in control group (all P≤0.05).Conclusions Early immune nutrition adjuvant treatment will help elderly patients with acute ABP to improve the therapeutic effect,control the inflammatory response and protect the body's immune function.%目的 探讨早期免疫营养支持辅助治疗老年急性胆源性胰腺炎(ABP)对炎症反应及免疫功能的影响 方法 选择行十二脂肠镜治疗的ABP病人80例,随机分为观察组与对照组各40例,其中对照组围手术期内给予常规营养支持,观察组给予免疫营养支持,比较2组病人营养支持前、支持后3d、支持后7d急性生理与慢性健康评分(APACHE-Ⅱ),肿瘤坏死因子-α(TNF-α)、白细胞介素6(IL-6)、超敏C-反应蛋白(hs-CRP)、血清免疫球蛋白(Ig)及血清补体变化,并比较2组并发症发生率. 结果 (1)营养支持后,2组APACHE-Ⅱ评分均较营养支持前明显降低(P≤0.05),2组间比较,差异亦有统计学意义(P≤0.05).(2)营养支持后各时间点观察组血清TNF-α、IL-6、hs-CRP水平均低于对照组,差异有统计学意义(P均≤0.05).(3)营养支持后,观察组血清IgG、IgA、C3、C4水平高于对照组,IgM低于对照组,2组间比较,差异有统计学意义(P均≤0.05). 结论 早期免疫营养支持辅助治疗老年急性ABP,有助于提高治疗效果,控制炎症反应,保护机体免疫功能.