CAJ | 학술논문

背景:免疫营养可通过提高机体细胞免疫功能,促进短半衰期蛋白质合成,调节局部及全身细胞因子的产生,维护肠道黏膜结构及功能的完整性,对术后的免疫抑制起正向调节作用.营养治疗能够明显加强肝移植围手术期机体免疫功能,但对肠内免疫营养在肝移植的应用效果至今少有报道.目的:观察肝移植围手术期进行免疫肠内营养治疗的安全性和应用效果.方法:将84例肝移植患者按营养治疗方式不同随机分为免疫肠内营养组和普通肠内营养组,监测移植前、移植后对肝功能、细胞免疫、体液免疫及排斥发生率,并比较两组患者的治疗效果.结果与结论:免疫肠内营养组移植前1 d的血清前白蛋白和胆碱酯酶水平均显著高于营养治疗前.移植前1 d免疫肠内营养组CD3+CD4+显著高于普通肠内营养组 (P < 0.05),普通肠内营养组的细胞免疫功能恢复状态比免疫肠内营养组推迟1周,移植后1～ 28 d免疫肠内营养组IgA均高于普通肠内营养组(P < 0.05),两组均未增加排斥反应发生率.结果证实,疫肠内营养治疗的患者肝细胞合成功能及免疫功能均显著优于普通肠内营养治疗,免疫肠内营养对肝移植围手术期患者的康复起重要作用.
배경:면역영양가통과제고궤체세포면역공능,촉진단반쇠기단백질합성,조절국부급전신세포인자적산생,유호장도점막결구급공능적완정성,대술후적면역억제기정향조절작용.영양치료능구명현가강간이식위수술기궤체면역공능,단대장내면역영양재간이식적응용효과지금소유보도.목적:관찰간이식위수술기진행면역장내영양치료적안전성화응용효과.방법:장84례간이식환자안영양치료방식불동수궤분위면역장내영양조화보통장내영양조,감측이식전、이식후대간공능、세포면역、체액면역급배척발생솔,병비교량조환자적치료효과.결과여결론:면역장내영양조이식전1 d적혈청전백단백화담감지매수평균현저고우영양치료전.이식전1 d면역장내영양조CD3+CD4+현저고우보통장내영양조 (P < 0.05),보통장내영양조적세포면역공능회복상태비면역장내영양조추지1주,이식후1～ 28 d면역장내영양조IgA균고우보통장내영양조(P < 0.05),량조균미증가배척반응발생솔.결과증실,역장내영양치료적환자간세포합성공능급면역공능균현저우우보통장내영양치료,면역장내영양대간이식위수술기환자적강복기중요작용.
BACKGROUND: Immunonutrition therapy can increase the synthesis of proteins with shorten half-life, regulate the local and whole body cytokines production, make the intestinal structure and functional integrity, up-regulate the immunity-inhibiting after operation through the improvement of cellular immune function. It has been proved that the appropriate nutritional therapy during perioperative period can improve the patients' immune function; however, enteral immunonutrition (EIN) in patients undergoing liver transplantation is rarely reported. OBJECTIVE: To evaluate the safety and effectiveness of EIN therapy during liver transplantation.METHODS: Eighty-four patients undertaking liver transplantation were randomly divided into two groups, namely EIN group and regular enteral nutrition (EN) group (given EIN and common EN respectively). The liver function, cellular immunity, humoral immunity, infection and the incidence of rejection were monitored in order to compare the therapeutic efficacy of two kinds of nutrition therapies. RESULTS AND CONCLUSION: The serum prealbumin and cholinesterase levels were impressively higher in the EIN group at 1 day before operation than before nutritional therapy. The expressions of CD3+ and CD4+ were significantly higher in the EIN group than the EN group at 1 day before operation (P < 0.05). The recovery of cell immunity was delayed 1 week in the EN group as compared with the EIN group; at 1-28 days after operation, IgA level was higher in the EIN group than in the EN group (P < 0.05). No increase in the incidence of infections occurred in the two groups. The results suggest that the EIN can improve the cell immunity and humoral immunity with a better effect than the EN. The EIN therapy is necessary for the rehabilitation of patients undergoing liver transplantation at the perioperative stage.