CAJ | 학술논문

目的：探讨肠内营养液对老年心力衰竭(心衰)患者血清炎性因子及心功能的影响。方法老年心衰患者96例,随机分为治疗A组、治疗B组和对照组共3组,各32例。均给予抗心衰常规治疗,同时治疗A组给予肠内营养500 mL·d-1,治疗1个月；治疗B组给予同剂量肠内营养治疗3个月；对照组给予自由饮食。各组治疗前后均采用NRS2002评估营养状况,同时记录心功能分级,检测左室射血分数( LVEF)、血浆B-型钠尿肽( BNP)、血清炎性因子白细胞介素-6(IL-6)、C-反应蛋白(CRP)、肿瘤坏死因子(TNF-α)等。结果治疗组治疗后体质量指数、上臂肱三头肌皮褶厚度、上臂肌围、AMC、总蛋白、清蛋白、血红蛋白均有升高,LVEF升高,心衰症状缓解比较明显；BNP、IL-6、TNF-α和CRP水平均有不同程度降低( P<0.05),治疗B组改善更为明显( P<0.01)。对照组各营养指标和血清炎性因子水平及心功能治疗前后差异无统计学意义( P>0.05)。结论老年心衰患者在常规治疗心衰的同时补充肠内营养,不仅可以改善患者营养状况和心功能,还可以改善免疫功能,进而降低炎性因子水平,治疗时间越长患者的心功能及炎性因子改善越明显。
목적：탐토장내영양액대노년심력쇠갈(심쇠)환자혈청염성인자급심공능적영향。방법노년심쇠환자96례,수궤분위치료A조、치료B조화대조조공3조,각32례。균급여항심쇠상규치료,동시치료A조급여장내영양500 mL·d-1,치료1개월；치료B조급여동제량장내영양치료3개월；대조조급여자유음식。각조치료전후균채용NRS2002평고영양상황,동시기록심공능분급,검측좌실사혈분수( LVEF)、혈장B-형납뇨태( BNP)、혈청염성인자백세포개소-6(IL-6)、C-반응단백(CRP)、종류배사인자(TNF-α)등。결과치료조치료후체질량지수、상비굉삼두기피습후도、상비기위、AMC、총단백、청단백、혈홍단백균유승고,LVEF승고,심쇠증상완해비교명현；BNP、IL-6、TNF-α화CRP수평균유불동정도강저( P<0.05),치료B조개선경위명현( P<0.01)。대조조각영양지표화혈청염성인자수평급심공능치료전후차이무통계학의의( P>0.05)。결론노년심쇠환자재상규치료심쇠적동시보충장내영양,불부가이개선환자영양상황화심공능,환가이개선면역공능,진이강저염성인자수평,치료시간월장환자적심공능급염성인자개선월명현。
Objective To study the effects of enteral nutrition( EN) on inflammatory factors and cardiac function in elderly patients with heart failure ( HF ) . Methods A total of 96 elderly patients with HF were enrolled in this study and randomly divided into treatment group A,treatment group B and control group( n= 32 in each group) . Patients in group A were provided with 500 mL of EN daily for 1 month, and those in group B were provided with the same dose of EN for 3 months. Control group was treated with normal diet. The nutrition status of each group was assessed by NRS2002. Meanwhile,all patients were evaluated by New York Heart Association(NYHA) class and left ventricle eject fraction(LVEF). The levels of BNP,IL-6, CRP and TNF-α were also measured before and after nutrition treatment. Results In group A and group B,BMI,TSF,AMC, TP,ALB and HGB increased. Symptoms of HF alleviated quickly and LVEF increased compared to the baseline. The levels of BNP,IL-6,CRP and TNF-α were significantly lower after treatment(P<0. 05) in both treatment groups,and the change in group B was more obvious(P<0. 01) than group A. However,in control group,there is neither evident improvement in cardiac function or nutrition status,nor in inflammatory factor levels. Conclusion Adding EN support to the normal treatment of heart failure in elderly malnourished patients with HF not only improves the function of heart and nutrition status, but also helps to support immune system so as to alleviate acute inflammatory response. The benefits from EN depend on the duration of therapy.