CAJ | 학술논문

目的探讨ω-3鱼油脂肪乳剂对脓毒症患者炎症反应和免疫功能的影响。方法选择70例脓毒症患者并随机分为中长链脂肪乳组和鱼油组，肠外营养支持方案中长链脂肪乳组给予中长链脂肪乳剂1.2 g·kg-1·d-1静脉滴注，每日一次；鱼油组加用ω-3鱼油脂肪乳剂0.24 g·kg-1·d-1静脉滴注，每日一次，余与中长链脂肪乳组肠外营养治疗方案成分相同，共7 d，其他治疗措施相同。检测两组患者治疗第1天和第7天外周血中炎症反应指标[C反应蛋白（CRP）、白介素1β（IL-1β）、白介素6（IL-6）、肿瘤坏死子-α（TNF-α）]和T 细胞亚群的变化（CD3+、CD4+、CD8+、CD4+/CD8+）。结果治疗后第7天，鱼油组患者的炎症反应指标中的CRP、IL-1β、IL-6均较第1天有所下降，差异均有统计学意义（t分别=190.78、72.26、115.08，P均＜0.05）；中长链脂肪乳组与治疗第1天相比，CRP和IL-6明显下降、IL-1β和TNF-α明显上升，差异均有统计学意义（t分别=138.36、64.85、77.13、59.56， P均＜0.05）。鱼油组第7天各项炎症反应指标均低于中长链脂肪乳组，差异均有统计学意义（t分别=28.56、134.72、56.85、42.18， P均＜0.05）。鱼油组第7天CD3+、CD4+、CD4+/CD8+较第1天明显升高，CD8+较第1天明显降低，差异均有统计学意义（t分别=43.03、71.62、-29.37、35.04， P均＜0.05）。中长链脂肪乳组第7天CD3+、CD4+、CD4+/CD8+较第1天明显升高，CD8+较第1天明显降低，差异均有统计学意义（t分别=38.24、65.73、-25.68、30.17， P均＜0.05）。且第7天时，两组间CD3+、CD4+、CD8+、CD4+/CD8+比较，差异均有统计学意义（t分别=22.73、10.60、-15.38、7.25， P均＜0.05）。结论ω-3鱼油脂肪乳剂可能会减轻脓毒症患者的炎症反应，改善患者的细胞免疫功能。
목적탐토ω-3어유지방유제대농독증환자염증반응화면역공능적영향。방법선택70례농독증환자병수궤분위중장련지방유조화어유조，장외영양지지방안중장련지방유조급여중장련지방유제1.2 g·kg-1·d-1정맥적주，매일일차；어유조가용ω-3어유지방유제0.24 g·kg-1·d-1정맥적주，매일일차，여여중장련지방유조장외영양치료방안성분상동，공7 d，기타치료조시상동。검측량조환자치료제1천화제7천외주혈중염증반응지표[C반응단백（CRP）、백개소1β（IL-1β）、백개소6（IL-6）、종류배사자-α（TNF-α）]화T 세포아군적변화（CD3+、CD4+、CD8+、CD4+/CD8+）。결과치료후제7천，어유조환자적염증반응지표중적CRP、IL-1β、IL-6균교제1천유소하강，차이균유통계학의의（t분별=190.78、72.26、115.08，P균＜0.05）；중장련지방유조여치료제1천상비，CRP화IL-6명현하강、IL-1β화TNF-α명현상승，차이균유통계학의의（t분별=138.36、64.85、77.13、59.56， P균＜0.05）。어유조제7천각항염증반응지표균저우중장련지방유조，차이균유통계학의의（t분별=28.56、134.72、56.85、42.18， P균＜0.05）。어유조제7천CD3+、CD4+、CD4+/CD8+교제1천명현승고，CD8+교제1천명현강저，차이균유통계학의의（t분별=43.03、71.62、-29.37、35.04， P균＜0.05）。중장련지방유조제7천CD3+、CD4+、CD4+/CD8+교제1천명현승고，CD8+교제1천명현강저，차이균유통계학의의（t분별=38.24、65.73、-25.68、30.17， P균＜0.05）。차제7천시，량조간CD3+、CD4+、CD8+、CD4+/CD8+비교，차이균유통계학의의（t분별=22.73、10.60、-15.38、7.25， P균＜0.05）。결론ω-3어유지방유제가능회감경농독증환자적염증반응，개선환자적세포면역공능。
Objective To investigate the effect of ω-3 fish oil fat emulsion on the inflammatory response and immuno-logic function in sepsis patients. Methods A total of 70 sepsis patients were included and divided randomly into control group with medium chain triglyceride (MCT) and study group with fish oil (FO). The MCT group was intravenous infused MCT 1.2 g/kg per day for 7 days. The FO group was intravenous infusedω-3 fish oil fat emulsion 0.24 g/kg per day based on the MCT group treatment for 7 days. The inflammatory index (CRP, IL-1β, IL-6 and TNF-α) and T cell subgroup (CD3+、CD4+、CD8+、CD4+/CD8+) were detected at first day and 7th day after admission to ICU. Results The CRP,IL-1β,IL-6 of FO group at 7th day after treatment were significantly lower than the first day (t=190.78, 72.26, 115.08,P<0.05). The CRP and IL-6 of MCT group at 7th day after treatment were significantly lower than the first day while IL-1β and TNF-αwere significantly higher (t=138.36, 64.85, 77.13, 59.56,P<0.05). At 7th day after treatment, the inflammatory indexes of FO group were significantly lower than the MCT group (t=28.56, 134.72, 56.85, 42.18,P<0. 05). At 7th day after treatment, CD3+、CD4+、CD4+/CD8+of FO group were significantly higher than the first day while the CD8+ was signifi-cantly lower as well as the MCT group (t=43.03, 71.62,-29.37, 35.04; 38.24, 65.73, -25.68, 30.17,P<0.05). And at 7th day after treatment, the differences of CD3+,CD4+,CD8+,CD4+/CD8+ between two groups were statistical significant (t=22.73, 10.60, -15.38, 7.25,P<0.05). Conclusion ω-3 fish oil fat emulsion might alleviate the inflammatory response of sepsis and ameliorate T cell immunologic function.