Effects of enteral immunonutrition supplemented with omega-3 polyunsaturated fatty acid on inflammatory response and intestinal mucosal barrier function in patients with severe traumatic brain injury

Q4 Nursing

中华临床营养杂志 Pub Date : 2018-02-28 DOI:10.3760/CMA.J.ISSN.1674-635X.2018.01.003

Xiangrong Chen, Cui'e Wang, Baoyuan Xie, Rongrong Zhu, Jinxia Liu, Tian-zao Huang

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引用次数: 1

Abstract

Objective To investigate the effects of enteral immunonutrition supplemented with omega-3 polyunsaturated fatty acid (ω-3 PUFA) on inflammatory response, intestinal mucosal barrier function and the prognosis in patients with severe traumatic brain injury (sTBI). Methods 122 patients of sTBI hospitalized between January 2015 and December 2016 were randomly divided into experimental group (ω-3 PUFA, n=61) and control group (n=61). The serum levels of tumor necrosis factor-α (TNF-α), interleukin (IL)-6 and neuron specific enolase (NSE) were tested with enzyme linked immunosorbent assay. Meanwhile, D-lactate acid and intestinal fat acid binding protein (I-FABP) were evaluated by enzymology spectrophotometer method. After 14 days of treatment, the Glasgow Coma Scale (GCS) scores, Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ scores and prognoses of both groups were compared. Results The serum levels of inflammatory factors (TNF-α and IL-6), intestinal mucosal barrier function indicators (D-lactate acid and I-FABP) and NSE proteins significantly increased after sTBI (P=0.01). Compared with the control group, the experimental group on day 3 had significantly lower serum levels of inflammatory factors [TNF-α: (107.77±19.79)μg/L vs. (151.76±21.65)μg/L, P=0.01; IL-6: (76.85±7.15)μg/L vs. (105.27±10.12)μg/L, P=0.01] and intestinal mucosal barrier function indicators [D-lactate: (69.81±6.32)μg/L vs. (89.80±8.75)μg/L, P=0.03; I-FABP: (40.81±6.73)μg/L vs. (56.60±8.58)μg/L, P=0.01]. On day 7, the experimental group had significantly lower expression of NSE proteins than the control group [(13.63±2.53)μg/L vs. (19.12±3.00)μg/L, P=0.02]. The experimental group received better prognosis compared to the control group on day 14 [GCS scores: (9.74±0.76)vs. (8.44±0.53), P=0.04; APACHE Ⅱ scores: (14.67±1.37)vs. (17.53±1.47), P=0.03]. The experimental group also had fewer days in hospitalization [(19.37±2.27)d vs. (25.42±2.61)d, P=0.01]. Conclusion Enteral immunonutrition supplemented with ω-3 PUFA can effectively regulate the inflammatory response, and reduce impairment to the intestinal mucosal barrier function and damage to neurons in patients with sTBI. Key words: Craniocerebral trauma; Unsaturated fatty acids; Inflammatory response; Intestinal mucosal barrier

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补充omega-3多不饱和脂肪酸的肠内免疫营养对重型颅脑损伤患者炎症反应及肠黏膜屏障功能的影响

目的探讨添加ω-3多不饱和脂肪酸(ω-3 PUFA)的肠内免疫营养对重型颅脑损伤(sTBI)患者炎症反应、肠黏膜屏障功能及预后的影响。方法选取2015年1月~ 2016年12月住院的sTBI患者122例，随机分为实验组(ω-3 PUFA, n=61)和对照组(n=61)。采用酶联免疫吸附法检测血清肿瘤坏死因子-α (TNF-α)、白细胞介素(IL)-6和神经元特异性烯醇化酶(NSE)水平。同时采用酶学分光光度法测定d -乳酸和肠脂肪酸结合蛋白(I-FABP)含量。治疗14 d后，比较两组患者的格拉斯哥昏迷评分(GCS)、急性生理和慢性健康评估(APACHE)Ⅱ评分及预后。结果sTBI后血清炎症因子(TNF-α、IL-6)、肠黏膜屏障功能指标(d -乳酸、I-FABP)、NSE蛋白水平显著升高(P=0.01)。与对照组相比，试验组第3天血清炎症因子水平显著降低[TNF-α:(107.77±19.79)μg/L vs(151.76±21.65)μg/L, P=0.01;IL-6:(76.85±7.15)μg/L vs(105.27±10.12)μg/L, P=0.01;肠黏膜屏障功能指标[d -乳酸:(69.81±6.32)μg/L vs(89.80±8.75)μg/L, P=0.03;I-FABP:(40.81±6.73)μg / L和(56.60±8.58)μg / L, P = 0.01)。第7天，实验组NSE蛋白表达量显著低于对照组[(13.63±2.53)μg/L vs(19.12±3.00)μg/L, P=0.02]。与对照组相比，实验组在第14天的预后较好[GCS评分:(9.74±0.76)vs。(8.44±0.53),P = 0.04;APACHEⅡ评分:(14.67±1.37)vs。(17.53±1.47),P = 0.03)。实验组患者住院天数更短[(19.37±2.27)d vs(25.42±2.61)d, P=0.01]。结论肠内免疫营养中添加ω-3 PUFA可有效调节sTBI患者的炎症反应，减轻对肠黏膜屏障功能的损害和神经元的损伤。关键词:颅脑损伤;不饱和脂肪酸;炎症反应;肠黏膜屏障

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来源期刊

中华临床营养杂志 Nursing-Nutrition and Dietetics

CiteScore

0.20

自引率

0.00%

发文量

2282

期刊介绍： The Chinese Journal of Clinical Nutrition was founded in 1993. It is the first professional academic journal (bimonthly) in my country co-sponsored by the Chinese Medical Association and the Chinese Academy of Medical Sciences to disseminate information on clinical nutrition support, nutrient metabolism, the impact of nutrition support on outcomes and "cost-effectiveness", as well as translational medicine and nutrition research. It is also a professional journal of the Chinese Medical Association's Parenteral and Enteral Nutrition Branch. The purpose of the Chinese Journal of Clinical Nutrition is to promote the rapid dissemination of knowledge on nutrient metabolism and the rational application of parenteral and enteral nutrition, focusing on the combination of multidisciplinary and multi-regional field investigations and clinical research. It mainly reports on nutritional risk screening related to the indications of parenteral and enteral nutrition support, "cost-effectiveness" research on nutritional drugs, consensus on clinical nutrition, guidelines, expert reviews, randomized controlled studies, cohort studies, glycoprotein and other nutrient metabolism research, systematic evaluation of clinical research, evidence-based case reports, special reviews, case reports and clinical experience exchanges, etc., and has a special column on new technologies related to the field of clinical nutrition and their clinical applications.