中国组织工程研究

中国组织工程研究 ›› 2011, Vol. 15 ›› Issue (31): 5873-5878.doi: 10.3969/j.issn.1673-8225.2011.31.042

• 肝移植 liver transplantation • 上一篇    下一篇

肝移植患者肠内免疫营养的临床观察

赵德芳1，张  珂2，郎  韧3，赵利军4   

  1. 1内蒙古医学院附属医院肝胆胰脾外科，内蒙古自治区呼和浩特市  010059
    2北京地坛医院普通外科，北京市  100011
    3北京朝阳医院肝胆胰脾外科，北京市  100021
    4河北联合大学医学院普通外科，河北省唐山市  063000
  • 收稿日期:2011-03-06 修回日期:2011-06-11 出版日期:2011-07-30 发布日期:2011-07-30
  • 通讯作者: 张珂，男，1970年生，汉族，副主任医师，北京地坛医院普通外科，北京市 100011
  • 作者简介:赵德芳☆，男，1974年生，博士，2008年首都医科大学毕业，内蒙古自治区科左中旗人，蒙古族，副主任医师；主要从事肝胆外科及肝移植。

Clinical observation of enteral immunonutrition in patients undergoing liver transplantation

Zhao De-fang1, Zhang Ke2, Lang Ren3, Zhao Li-jun4   

  1. 1Department of Hepatobiliary Surgery, Affiliated Hospital of Inner Mongolia Medical College, Hohhot  010059, Inner Mongolia Autonomous Region, China
    2Department of General Surgery, Beijing Ditan Hospital, Beijing  100011, China
    3Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital, Beijing  100021, China
    4Department of General Surgery, Hebei United University Medical School, Tangshan  063000, Hebei Province, China
  • Received:2011-03-06 Revised:2011-06-11 Online:2011-07-30 Published:2011-07-30
  • Contact: Zhang Ke, Associate chief physician, Department of General Surgery, Beijing Ditan Hospital, Beijing 100011, China zhangke302@sina.com
  • About author:Zhao De-fang☆, Doctor, Associate chief physician, Department of Hepatobiliary Surgery, Affiliated Hospital of Inner Mongolia Medical College, Hohhot 010059, Inner Mongolia Autonomous Region, China hostmanabc@hotmail.com

PDF

736

被引次数

5

摘要：

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。

关键词: 肠内营养, 免疫营养, 围手术期, 肝脏移植, 器官移植

Abstract:

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.

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