肠内营养支持治疗对炎症性肠病患者肠黏膜屏障功能及炎症反应的影响

目的探讨早期肠内营养(EN)支持治疗对炎症性肠病(IBD)患者肠黏膜屏障功能及炎症反应的影响。方法将80例IBD患者按营养支持治疗途径分为EN组(48例)和肠外营养(PN)组(32例),在常规治疗的基础上分别给予早期EN、PN支持治疗。比较治疗前后2组患者营养学相关指标白蛋白(ALB)、前白蛋白(PA)、转铁蛋白(TF)]、肠黏膜屏障功能指标(内毒素、D-乳酸)及炎症相关指标C-反应蛋白(CRP)、降钙素原(PCT)、粪便钙卫蛋白(FCP)]水平。结果治疗前,2组患者各观察指标水平差异无统计学意义(P0.05);治疗后,与治疗前相比,2组患者血清ALB、PA及TF水平均显著升高(P0.05),血清内毒素、D-乳酸、CRP、PCT及FCP水平均显著降低(P0.05);与PN组患者治疗后相比,EN组治疗后血清PA水平显著升高(P0.05),血清内毒素、D-乳酸、CRP、PCT及FCP水平均显著降低(P0.05)。治疗后2组患者的血清ALB及TF水平之间差异无统计学意义(P0.05)。结论在常规治疗的基础上,早期EN支持治疗对IBD患者肠黏膜屏障功能的改善及炎症缓解作用优于PN支持治疗。

Effects of enteral nutrition support on intestinal mucosal barrier function and inflammatory reaction in patients with inflammatory bowel disease

Abstract: Objective To explore the effects of enteral nutrition (EN) support on the intestinal mucosal barrier function and inflammatory reaction in patients with inflammatory bowel disease (IBD). Methods 80 patients with IBD were divided into the EN group (n=48) or the parenteral nutrition (PN) group (n=32), and given early EN support or PN support respectively on the basis of conventional treatment. Before and after the treatment, the levels of nutritional indicators albumin (ALB), prealbumin (PA) and transferrin (TF)], intestinal mucosal barrier function (endotoxin and D-lactic acid) and inflammation C-reaction protein (CRP), procalcitonin (PCT) and fecal calprotectin (FCP)] were compared between the two groups. Results Before treatment, there were no significant differences between the two groups in each of the observed indexes (P>0.05). The levels of serum ALB, PA and TF in both groups significantly increased (P<0.05), while the levels of serum endotoxin, D-lactic acid, CRP, PCT and FCP significantly decreased (P<0.05) after treatment. No significant differences in serum ALB and TF were found between the two groups after treatment (P>0.05); However, the level of serum PA in the EN group was obviously higher than that in the PN group (P<0.05), and the levels of endotoxin, D-lactic acid, CRP, PCT and FCP were lower than those in the PN group (P<0.05). Conclusion On the basis of conventional treatment, early EN support therapy is more effective than PN for improving intestinal mucosal barrier function and inflammatory response in patients with IBD.