肠内营养对脑外伤患者免疫功能及骨质、骨矿含量的影响分析
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摘要
目的探讨肠内营养对脑外伤患者免疫功能及骨质、骨矿含量的影响。方法选取本院2015年5月至2017年5月接诊的脑外伤患者192例为研究对象,根据排除标准除外12例患者,将余符合标准的180例患者采用随机数表法分为试验组和对照组,每组各90例。对照组患者接受常规治疗,试验组患者在对照组治疗基础上给予肠内营养治疗。比较两组患者治疗前后淋巴细胞比值(LY%)、CD4、CD8水平、CD4/CD8比值、人类白细胞抗原DR(human leukocyte antigen DR,HLA-DR)水平、髂骨及L_2、L_3、L_4腰椎的骨密度和骨矿含量。结果治疗后第30天,试验组患者骨密度和骨矿含量均显著高于对照组(P_均<0.05)。治疗后第7天,试验组患者LY%、CD4、HLA-DR水平均显著高于对照组(P_均<0.05),CD8水平显著低于对照组(P <0.05),CD4/CD8比值组间比较无显著差异(P> 0.05)。试验组患者治疗期间泌尿系统感染、肺部感染及腹泻的发生率均显著低于对照组(P_均<0.05)。结论肠内营养能显著提升脑外伤患者机体免疫功能,避免患者骨密度及骨质含量下降,适于在临床推广应用。
Objective To investigate the effect of enteral nutrition on immune function,bone mass and bone mineral content in patients with traumatic brain injury.Method 192 patients with traumatic brain injury in our hospital from May 2015 to May 2017 were selected as the study subjects.According to the exclusion criteria,the remaining 180 patients who met the criteria were divided into experimental group and control group by random number table method,90 cases in each group.Patients in control group received routine treatment,and patients in experimental group were treated with enteral nutrition on the basis of control group.The levels of lymphocyte ratio(LY%),CD4,CD8 levels,CD4/CD8 ratio,human leukocyte antigen DR(HLA-DR),bone mineral density and bone mineral content of iliac bone and L_2,L_3 and L_4 lumbar vertebrae were compared between the two groups before and after treatment.Result 30 th days after treatment,the bone mineral density and bone mineral content in experimental group were significantly higher than those in control group(P_(all)<0.05).On the 7 th day of treatment,the LY%,levels of CD4,HLA-DR in experimental group were significantly higher than those in control group(P_(all)<0.05),and the level of CD8 was significantly lower than that in control group(P<0.05).There was no significant difference in the ratio of CD4/CD8 between two groups(P>0.05).In the course of treatment,the incidence of urinary tract infection,pulmonary infection and diarrhea in experimental group were significantly lower than that in control group(P_(all)<0.05).Conclusion Enteral nutrition can significantly improve the immune function of patients with traumatic brain injury and avoid the decrease of bone mineral density and bone mineral content,it is suitable for clinical application.
Objective To investigate the effect of enteral nutrition on immune function,bone mass and bone mineral content in patients with traumatic brain injury.Method 192 patients with traumatic brain injury in our hospital from May 2015 to May 2017 were selected as the study subjects.According to the exclusion criteria,the remaining 180 patients who met the criteria were divided into experimental group and control group by random number table method,90 cases in each group.Patients in control group received routine treatment,and patients in experimental group were treated with enteral nutrition on the basis of control group.The levels of lymphocyte ratio(LY%),CD4,CD8 levels,CD4/CD8 ratio,human leukocyte antigen DR(HLA-DR),bone mineral density and bone mineral content of iliac bone and L_2,L_3 and L_4 lumbar vertebrae were compared between the two groups before and after treatment.Result 30 th days after treatment,the bone mineral density and bone mineral content in experimental group were significantly higher than those in control group(P_(all)<0.05).On the 7 th day of treatment,the LY%,levels of CD4,HLA-DR in experimental group were significantly higher than those in control group(P_(all)<0.05),and the level of CD8 was significantly lower than that in control group(P<0.05).There was no significant difference in the ratio of CD4/CD8 between two groups(P>0.05).In the course of treatment,the incidence of urinary tract infection,pulmonary infection and diarrhea in experimental group were significantly lower than that in control group(P_(all)<0.05).Conclusion Enteral nutrition can significantly improve the immune function of patients with traumatic brain injury and avoid the decrease of bone mineral density and bone mineral content,it is suitable for clinical application.
引文
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[14]张晓强,孙凌云,周辉.重型颅脑损伤术后长期昏迷病人肠内营养乳液治疗的效果观察[J].肠外与肠内营养,2016,23(4):245-246.
[15]蒋铭,万年亮,李博,等.经鼻空肠肠内营养支持对急性颅脑外伤ICU机械通气患者预后的影响[J].现代中西医结合杂志,2016,25(25):2818-2821.
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[17]王锐,尹路路,苏成洋,等.创伤后免疫抑制的研究进展[J].医学综述,2017,23(6):1095-1099.
[18]陈剑平,卢阳珍,朱浩刚.早期肠内营养对重症颅脑外伤病人炎性因子及免疫功能的影响[J].肠外与肠内营养,2015,22(2):94-97.
[19]Wang X,Dong Y,Han X,et al.Nutritional support for patients sustaining traumatic brain injury:a systematic review and meta-analysis of prospective studies[J].PLoS One,2013,8(3):e58838.
[20]Curtis L,Epstein P.Nutritional treatment for acute and chronic traumatic brain injury patients[J].J Neurosurg Sci,2014,58(3):151-160.
[2]Xu G,Su R,Li B,et al.Trace Element Concentrations in Human Tissues of Death Cases Associated With Secondary Infection and MOF After Severe Trauma[J].Biol Trace Elem Res,2015,168(2):335-339.
[3]许慧中,颜庆华,常志英,等.重型脑外伤患者院前评估指标与ICU死亡率的相关性[J].海南医学,2015,26(21):3208-3210.
[4]Eisenstein TK,Meissler JJ.Effects of Cannabinoids on T-cell Function and Resistance to Infection[J].J Neuroimmune Pharmacol,2015,10(2):204-216.
[5]Shen P,Roch T,Lampropoulou V,et al.IL-35-producing Bcells are critical regulators of immunity during autoimmune and infectious diseases[J].Nature,2014,507(7492):366-370.
[6]许云飞,杨文涛,王春凤,等.CD4+CD25+调节性T细胞在蠕虫感染免疫中的作用[J].中国寄生虫学与寄生虫病杂志,2014,32(2):148-151.
[7]Scapini P,Cassatella MA.Social networking of human neutrophils within the immune system[J].Blood,2014,124(5):710-719.
[8]姚珍莹.重型颅脑损伤患者超早期行肠内营养支持的效果分析[J].中国临床新医学,2013,6(9):854-857.
[9]El-Menyar A,Goyal A,Latifi R,et al.Brain-Heart Interactions in Traumatic Brain Injury[J].Cardiol Rev,2017,25(6):279-288.
[10]章小芬,余艳飞,林沙沙,等.重型颅脑外伤患者术后下呼吸道感染相关因素分析[J].中华医院感染学杂志,2017,27(21):4912-4915.
[11]茹妍妮,王燕宏,李新毅.重症脑梗死急性期病人皮质醇与蛋白质代谢的相关性研究[J].中西医结合心脑血管病杂志,2016,14(13):1465-1468.
[12]张然,许勤.外科非糖尿病患者应激性高血糖的研究进展[J].护理学报,2017,24(4):34-38.
[13]赵士利,焦伟.颅脑外伤伴蛋白质营养不良患者营养支持分析[J].徐州医学院学报,2013,33(11):774-775.
[14]张晓强,孙凌云,周辉.重型颅脑损伤术后长期昏迷病人肠内营养乳液治疗的效果观察[J].肠外与肠内营养,2016,23(4):245-246.
[15]蒋铭,万年亮,李博,等.经鼻空肠肠内营养支持对急性颅脑外伤ICU机械通气患者预后的影响[J].现代中西医结合杂志,2016,25(25):2818-2821.
[16]Scrimgeour AG,Condlin ML.Nutritional treatment for traumatic brain injury[J].J Neurotrauma,2014,31(11):989-999.
[17]王锐,尹路路,苏成洋,等.创伤后免疫抑制的研究进展[J].医学综述,2017,23(6):1095-1099.
[18]陈剑平,卢阳珍,朱浩刚.早期肠内营养对重症颅脑外伤病人炎性因子及免疫功能的影响[J].肠外与肠内营养,2015,22(2):94-97.
[19]Wang X,Dong Y,Han X,et al.Nutritional support for patients sustaining traumatic brain injury:a systematic review and meta-analysis of prospective studies[J].PLoS One,2013,8(3):e58838.
[20]Curtis L,Epstein P.Nutritional treatment for acute and chronic traumatic brain injury patients[J].J Neurosurg Sci,2014,58(3):151-160.