添加果胶膳食纤维的肠内营养对重症患者免疫功能及胃肠道功能的影响

doi:10.3877/cma.j.issn.1674-6880.2021.06.004

中华危重症医学杂志(电子版) ›› 2021, Vol. 14 ›› Issue (06) : 460 -465. doi: 10.3877/cma.j.issn.1674-6880.2021.06.004

论著

添加果胶膳食纤维的肠内营养对重症患者免疫功能及胃肠道功能的影响

缪小莉¹, 叶纪录¹, 濮雪华¹^,^†(

), 侯斌¹, 石志祥², 朱进³, 顾志林⁴

^1. 225399　江苏泰州，泰州市人民医院重症医学科
^2. 225511　江苏泰州，泰州市第二人民医院重症医学科
^3. 225399　江苏泰州，泰州市第四人民医院重症医学科
^4. 225599　江苏泰州，泰州市姜堰中医院重症医学科

收稿日期:2021-04-01 出版日期:2021-12-31
通信作者: 濮雪华
基金资助:
真实世界研究专项基金临床科研资助项目(ZC-2019-ICU-057)

Effect of enteral nutrition with pectin dietary fiber on immune and gastrointestinal functions in severe patients

Xiaoli Miao¹, Jilu Ye¹, Xuehua Pu¹^,^†(), Bin Hou¹, Zhixiang Shi², Jin Zhu³, Zhilin Gu⁴

^1. Department of Critical Care Medicine, Taizhou People's Hospital, Taizhou 225399, China
^2. Department of Critical Care Medicine, Taizhou Second People's Hospital, Taizhou 225511, China
^3. Department of Critical Care Medicine, Taizhou Fourth People's Hospital, Taizhou 225399, China
^4. Department of Critical Care Medicine, Jiangyan Hospital of Traditional Chinese Medicine in Taizhou City, Taizhou 225599, China

Received:2021-04-01 Published:2021-12-31
Corresponding author: Xuehua Pu

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引用本文：

缪小莉, 叶纪录, 濮雪华, 侯斌, 石志祥, 朱进, 顾志林. 添加果胶膳食纤维的肠内营养对重症患者免疫功能及胃肠道功能的影响[J]. 中华危重症医学杂志(电子版), 2021, 14(06): 460-465.

Xiaoli Miao, Jilu Ye, Xuehua Pu, Bin Hou, Zhixiang Shi, Jin Zhu, Zhilin Gu. Effect of enteral nutrition with pectin dietary fiber on immune and gastrointestinal functions in severe patients[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2021, 14(06): 460-465.

目的

探究添加果胶膳食纤维的肠内营养对重症患者免疫功能和肠道功能的影响。

方法

将4家医院2019年9月至2020年8月收治的140例重症患者分为对照组和观察组，每组各70例。对照组患者在基础治疗上予以常规肠内营养治疗，观察组在基础治疗上予以添加果胶膳食纤维的肠内营养治疗。对比两组患者治疗前后血清总蛋白、白蛋白、前白蛋白及血红蛋白的水平，CD3⁺、CD4⁺及CD8⁺的比率及肠道菌群菌落数，并统计治疗期间胃肠道并发症发生情况。

结果

治疗前，两组患者血清总蛋白、白蛋白、前白蛋白、血红蛋白水平，外周血T淋巴细胞亚群CD3⁺、CD4⁺、CD8⁺比率，粪便中双歧杆菌、乳酸杆菌、肠球菌及肠杆菌数目的比较，差异均无统计学意义（P均> 0.05）。与同组治疗前相比，治疗后对照组及观察组患者血清总蛋白、白蛋白、前白蛋白、血红蛋白水平，外周血T淋巴细胞亚群CD3⁺、CD4⁺比率，粪便中双歧杆菌、乳酸杆菌数目均显著升高；CD8⁺比率，粪便中肠球菌、肠杆菌数目均显著降低（P均< 0.05）。且治疗后观察组血清总蛋白[（64 ± 6）g / L vs. （60 ± 6）g / L，t = 4.065，P < 0.001]、白蛋白[（36 ± 5）g / L vs. （33 ± 5）g / L，t = 3.255，P = 0.001]、前白蛋白[（144 ± 27）g / L vs. （120 ± 23）g / L，t = 5.661，P < 0.001]和血红蛋白[（106 ± 18）g / L vs. （99 ± 16）g / L，t = 2.372，P = 0.019]水平，外周血T淋巴细胞亚群CD4⁺比率[（43 ± 6）% vs. （37 ± 6）%，t = 5.709，P < 0.001]，粪便中双歧杆菌[（6.6 ± 0.8）lgCFU / g vs. （4.8 ± 0.6）lgCFU / g，t = 14.503，P < 0.001]、乳酸杆菌[（7.8 ± 0.9）lgCFU / g vs. （6.1 ± 0.8）lgCFU / g，t = 11.689，P < 0.001]数目均显著高于对照组；CD3⁺[（64 ± 7）% vs. （69 ± 8）%，t = 6.045，P < 0.001]、CD8⁺[（21 ± 4）% vs. （25 ± 4）%，t = 6.765，P < 0.001]比率，粪便中肠球菌[（3.2 ± 0.5）lgCFU / g vs. （4.7 ± 0.6）lgCFU / g，t = 15.021，P < 0.001]、肠杆菌[（4.3 ± 0.6）lgCFU / g vs. （6.9 ± 0.8）lgCFU / g，t = 22.190，P < 0.001]数目均显著低于对照组。同时，观察组患者治疗期间腹胀、腹泻、呕吐、便秘、反流及吸入性肺炎的发生率均明显低于对照组（ χ² = 37.428、19.606、15.035、10.570、9.115、6.269，P均< 0.05）。

结论

添加果胶膳食纤维的肠内营养能够提高重症患者的营养状况，改善患者的免疫功能，减少胃肠道并发症的发生。

关键词: 膳食纤维, 肠道营养, 营养支持, 免疫, 胃肠道

Objective

To explore the effect of enteral nutrition with pectin dietary fiber on immune and gastrointestinal functions in severe patients.

Methods

A total of 140 severe patients admitted to four hospitals from September 2019 to August 2020 were randomly divided into a control group and an observation group, with 70 cases in each group. Patients in the control group were treated with routine enteral nutrition in addition to basic treatment, while patients in the observation group were treated with enteral nutrition with pectin dietary fiber in addition to basic treatment. The levels of serum total protein, albumin, prealbumin and hemoglobin, the ratios of CD3⁺, CD4⁺ and CD8⁺ in peripheral blood T lymphocyte subsets, and the numbers of Bifidobacterium, Lactobacillus, Enterococcus and Enterobacter in feces were compared between the two groups before and after treatment. The incidence of gastrointestinal complications during the treatment was counted.

Results

Before the treatment, the levels of serum total protein, albumin, prealbumin and hemoglobin, the ratios of CD3⁺, CD4⁺ and CD8⁺, and the numbers of Bifidobacterium, Lactobacillus, Enterococcus and Enterobacter in feces all showed no significant differences between the two groups (all P > 0.05). After the treatment, the levels of serum total protein, albumin, prealbumin and hemoglobin, the ratios of CD3⁺ and CD4⁺, and the numbers of Bifidobacterium and Lactobacillus in feces were much higher, and the ratio of CD8⁺ and the numbers of Enterococcus and Enterobacter in feces were much lower than those before the treatment in the control group and observation group (all P < 0.05). In the observation group, the levels of serum total protein [(64 ± 6) g / L vs. (60 ± 6) g / L, t = 4.065, P < 0.001], albumin [(36 ± 5) g / L vs. (33 ± 5) g / L, t = 3.255, P = 0.001], prealbumin [(144 ± 27) g / L vs. (120 ± 23) g / L, t = 5.661, P < 0.001] and hemoglobin [(106 ± 18) g / L vs. (99 ± 16) g / L, t = 2.372, P = 0.019], the ratio of CD4⁺ [(43 ± 6)% vs. (37 ± 6)%, t = 5.709, P < 0.001], and the numbers of Bifidobacteriu [(6.6 ± 0.8) lgCFU / g vs. (4.8 ± 0.6) lgCFU / g, t = 14.503, P < 0.001] and Lactobacillu[(7.8 ± 0.9) lgCFU / g vs. (6.1 ± 0.8) lgCFU / g, t = 11.689, P < 0.001] in feces increased markedly, and the ratios of CD3⁺ [(64 ± 7)% vs. (69 ± 8)%, t = 6.045, P < 0.001] and CD8⁺ [(21 ± 4)% vs. (25 ± 4)%, t = 6.765, P < 0.001] and the numbers of Enterococcus [(3.2 ± 0.5) lgCFU / g vs. (4.7 ± 0.6) lgCFU / g, t = 15.021, P < 0.001] and Enterobacter [(4.3 ± 0.6) lgCFU / g vs. (6.9 ± 0.8) lgCFU / g, t = 22.190, P < 0.001] in feces decreased obviously as compared with the control group after the treatment. Meanwhile, the incidence of abdominal distention, diarrhea, vomiting, constipation, reflux and aspiration pneumonia in the observation group was much lower than that in the control group ( χ² = 37.428, 19.606, 15.035, 10.570, 9.115, 6.269; all P < 0.05).

Conclusion

The enteral nutrition with pectin dietary fiber can improve the nutritional status and immune function, and reduce the occurrence of gastrointestinal complications in severe patients.

Key words: Dietary fiber, Enteral nutrition, Nutritional support, Immunity, Gastrointestinal tract

表1 两组重症患者治疗前后营养状况相关指标的比较（± s）

组别		例数	总蛋白（g / L）	白蛋白（g / L）	前白蛋白（mg / L）	血红蛋白（g / L）
对照组
	治疗前	70	49 ± 5	25 ± 4	87 ± 14	90 ± 15
	治疗后	70	60 ± 6^a	33 ± 5^a	120 ± 23^a	99 ± 16^a
观察组
	治疗前	70	50 ± 5	26 ± 4	87 ± 13	90 ± 15
	治疗后	70	64 ± 6^ab	36 ± 5^ab	144 ± 27^ab	106 ± 18^ab

表1 两组重症患者治疗前后营养状况相关指标的比较（± s）

组别		例数	总蛋白（g / L）	白蛋白（g / L）	前白蛋白（mg / L）	血红蛋白（g / L）
对照组
	治疗前	70	49 ± 5	25 ± 4	87 ± 14	90 ± 15
	治疗后	70	60 ± 6^a	33 ± 5^a	120 ± 23^a	99 ± 16^a
观察组
	治疗前	70	50 ± 5	26 ± 4	87 ± 13	90 ± 15
	治疗后	70	64 ± 6^ab	36 ± 5^ab	144 ± 27^ab	106 ± 18^ab

表2 两组重症患者治疗前后免疫功能相关指标的比较（%，± s）

组别		例数	CD3⁺	CD4⁺	CD8⁺
对照组
	治疗前	70	59 ± 7	34 ± 5	30 ± 5
	治疗后	70	69 ± 8^a	37 ± 6^a	25 ± 4^a
观察组
	治疗前	70	60 ± 7	34 ± 5	30 ± 4
	治疗后	70	64 ± 7^ab	43 ± 6^ab	21 ± 4^ab

表2 两组重症患者治疗前后免疫功能相关指标的比较（%，± s）

组别		例数	CD3⁺	CD4⁺	CD8⁺
对照组
	治疗前	70	59 ± 7	34 ± 5	30 ± 5
	治疗后	70	69 ± 8^a	37 ± 6^a	25 ± 4^a
观察组
	治疗前	70	60 ± 7	34 ± 5	30 ± 4
	治疗后	70	64 ± 7^ab	43 ± 6^ab	21 ± 4^ab

表3 两组重症患者治疗前后肠道菌群菌落数的比较（lgCFU / g，± s）

组别		例数	双歧杆菌	乳酸杆菌	肠球菌	肠杆菌
对照组
	治疗前	70	3.2 ± 0.5	4.2 ± 0.6	7.0 ± 0.9	11.0 ± 1.2
	治疗后	70	4.8 ± 0.6^a	6.1 ± 0.8^a	4.7 ± 0.6^a	6.9 ± 0.8^a
观察组
	治疗前	70	3.2 ± 0.5	4.3 ± 0.7	7.0 ± 0.9	11.1 ± 1.3
	治疗后	70	6.6 ± 0.8^ab	7.8 ± 0.9^ab	3.2 ± 0.5^ab	4.3 ± 0.6^ab

表3 两组重症患者治疗前后肠道菌群菌落数的比较（lgCFU / g，± s）

组别		例数	双歧杆菌	乳酸杆菌	肠球菌	肠杆菌
对照组
	治疗前	70	3.2 ± 0.5	4.2 ± 0.6	7.0 ± 0.9	11.0 ± 1.2
	治疗后	70	4.8 ± 0.6^a	6.1 ± 0.8^a	4.7 ± 0.6^a	6.9 ± 0.8^a
观察组
	治疗前	70	3.2 ± 0.5	4.3 ± 0.7	7.0 ± 0.9	11.1 ± 1.3
	治疗后	70	6.6 ± 0.8^ab	7.8 ± 0.9^ab	3.2 ± 0.5^ab	4.3 ± 0.6^ab

表4 两组重症患者治疗期间胃肠道并发症发生情况的比较[例（%）]

组别	例数	腹胀	腹泻	呕吐	便秘	导管阻塞	反流	吸入性肺炎
对照组	70	40（57.14）	27（38.57）	20（28.57）	18（25.71）	3（4.29）	11（15.71）	6（8.57）
观察组	70	6（8.57）	5（7.14）	3（4.29）	4（5.71）	8（11.43）	1（1.43）	0（0.00）
χ²值		37.428	19.606	15.035	10.570	2.467	9.115	6.269
P值		< 0.001	< 0.001	< 0.001	0.001	0.116	0.003	0.012

表4 两组重症患者治疗期间胃肠道并发症发生情况的比较[例（%）]

组别	例数	腹胀	腹泻	呕吐	便秘	导管阻塞	反流	吸入性肺炎
对照组	70	40（57.14）	27（38.57）	20（28.57）	18（25.71）	3（4.29）	11（15.71）	6（8.57）
观察组	70	6（8.57）	5（7.14）	3（4.29）	4（5.71）	8（11.43）	1（1.43）	0（0.00）
χ²值		37.428	19.606	15.035	10.570	2.467	9.115	6.269
P值		< 0.001	< 0.001	< 0.001	0.001	0.116	0.003	0.012

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Effect of enteral nutrition with pectin dietary fiber on immune and gastrointestinal functions in severe patients

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Effect of enteral nutrition with pectin dietary fiber on immune and gastrointestinal functions in severe patients