两种肠内营养方案对重症急性胰腺炎患者肠道菌群及预后的影响

目的 探讨肠内免疫微生态营养和免疫增强型肠内营养方案对重症急性胰腺炎患者肠道菌群及远期预后的影响。方法 选择2014年1月至2017年6月在我院就诊的重症急性胰腺炎患者156例。按照随机数字表法将患者分为A组（肠内免疫微生态营养方案组）、B组（免疫增强型肠内营养方案组）和对照组（常规肠内营养方案组），各52例。检测患者治疗前后T淋巴细胞及其亚群NK细胞、B淋巴细胞，血清免疫球蛋白及ALB、TF、PA等营养指标。同时检测患者肠道菌群，判定3组患者肠道菌失调症发生率。治疗后对患者随访6个月，记录并发症及不良预后。结果 治疗后A组和B组患者患者CD4+细胞、CD8+细胞、CD4+/CD8+、NK细胞、B淋巴细胞水平显著高于治疗前，对照组患者除CD8+细胞和NK细胞外，其余各细胞水平亦显著高于治疗前（P0.05）。发病7~10 d后，A组患者菌群失调发生率为5.77%，低于B组（19.23%）和对照组（36.54%），两两比较差异均有统计学意义（P<0.05）。治疗6个月后，A组患者出现1例胰腺及胰周感染，1例MODS，0例病死；B组出现1例胰腺及胰周感染，2例MODS，3例菌血症，1例腹腔感染，2例病死；对照组出现6例胰周胰腺感染，7例MODS，5例菌血症，3例腹腔感染，3例病死。A组和B组预后显著优于对照组，且A组预后优于B组（P<0.05）。结论 肠内免疫微生态营养与免疫增强型肠内营养均能显著提高重症急性胰腺炎患者营养状况，提高免疫水平，且肠内免疫微生态营养在改善肠道菌群及预后方面具有更好的效果，值得临床推广。

Effects of two enteral nutrition regimens on intestinal flora and prognosis in patients with severe acute pancreatitis

Abstract: Objective To investigate the effects of enteral immune microecological nutrition and immune-enhanced enteral nutrition on intestinal flora and long-term prognosis in patients with severe acute pancreatitis. Methods 156 patients with severe acute pancreatitis in our hospital from January 2014 to June 2017 were selected. According to the random number table method, the patients were divided into group A (enteral immuno microecological nutrition group), group B (immune enhanced enteral nutrition group) and control group (routine enteral nutrition group), with 52 cases in each group. Before and after treatment, T lymphocyte and its subsets NK cells, B lymphocyte, serum immunoglobulin, ALB, TF, PA and other nutritional indicators were detected. At the same time, the intestinal flora was detected and the incidence of intestinal dysbacteriosis was determined in the three groups. After treatment, patients were followed up for 6 months to record complications and adverse prognosis. Results After treatment, the levels of CD4+, CD8+, CD4+/CD8+, NK cells and B lymphocytes in group A and group B were significantly higher than those before treatment, and in addition to CD8+ cells and NK cells, the levels of other cells in the control group were significantly higher than those before treatment (P<0.05), and the levels of cells in group A and group B were higher than those in the control group (P<0.05). After treatment, the levels of IgA, IgG, and IgM in the group A and group B were significantly higher, and those in group A and group B were higher than those in the control group (P<0.05). At the same time, the ALB levels in the three groups were significantly higher than those before treatment, group A and The B group was higher than the control group, but there was no significant difference in the ALB levels between the A group and the B group (P>0.05). After 7-10 days of onset, the incidence of dysbacteriosis in group A was 5.77%, lower than that in group B (19.23%) and control group (36.54%) respectively. The difference between the two groups was statistically significant (P<0.05). After 6 months of treatment, 1 patient had pancreatic and peripancreatic infection, 1 patient had MODS, and 0 patient died. In group B, 1 patient had pancreatic and peripancreatic infection, 2 patients had MODS, 3 patients had bacteremia, and 1 patient had abdominal cavity. Infection, 2 cases died of illness; 6 cases of pancreatic peri-pancreatic infection, 7 cases of MODS, 5 cases of bacteremia, 3 cases of abdominal infection, and 3 cases of death. The prognosis of group A and group B was significantly better than that of the control group, and the prognosis of group A was better than that of group B (P<0.05). Conclusion Intestinal immune micro-ecological nutrition and immune-enhanced enteral nutrition can significantly improve the nutritional status of patients with severe acute pancreatitis, and improve the immune level, and intestinal immune micro-ecological nutrition has a better effect in improving intestinal flora and prognosis. It is worthy of clinical promotion.