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目的探讨ω-3多不饱和脂肪酸对儿童急性胰腺炎(AP)细胞因子和免疫功能的影响,为临床诊疗提供参考。方法 50例AP患儿随机分为早期肠内营养(EEN)对照组(25例)和EEN联合ω-3多不饱和脂肪酸治疗组(25例)。两组给予抑制胰酶的分泌、制酸、抗感染的同时,胃镜引导下置入鼻饲管至Treitz韧带远端,连续泵入糖盐水、米汤、小百肽等营养物质。治疗组加用ω-3多不饱和脂肪酸,疗程为2周。检测第1、7、14天白介素-1(IL-1)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α),NK细胞相对活性及外周血CD4+/CD8+比值。结果两组患儿均耐受EEN。两组入院第1天血清IL-1、IL-6和TNF-α水平显著增加,同时NK细胞相对活性及外周血CD4+/CD8+比值显著下降;两组治疗第7天血清IL-1、IL-6和TNF-α水平与第1天比较均显著降低,ω-3治疗组降低更明显(P<0.05);ω-3治疗组NK细胞活性及外周血CD4+/CD8+比值明显升高(P<0.05);治疗组血淀粉酶、脂肪酶及APACHEⅡ评分明显下降(P<0.05)。结论儿童急性胰腺炎应用EEN安全可行,EEN联合ω-3多不饱和脂肪酸早期可控制急性胰腺炎炎症反应和平衡T细胞的作用,降低细胞因子水平及调节细胞免疫功能。
Objective To investigate the effects of ω-3 polyunsaturated fatty acids on cytokines and immune function in children with acute pancreatitis (AP) and provide references for clinical diagnosis and treatment. Methods 50 cases of AP children were randomly divided into early enteral nutrition (EEN) control group (25 cases) and EEN combined omega-3 polyunsaturated fatty acid treatment group (25 cases). Two groups were given to inhibit the secretion of pancreatic enzymes, acid, anti-infection at the same time, under the guidance of gastroscope placed nasogastric tube to the distal Treitz ligament, continuous infusion of sugar and salt water, rice soup, small peptides and other nutrients. The treatment group plus omega-3 polyunsaturated fatty acids, treatment for 2 weeks. The levels of interleukin-1, interleukin-6, tumor necrosis factor-α (TNF-α), NK cells and CD4 + / CD8 + ratio in peripheral blood were detected on the 1st, 7th and 14th days. Results Both groups were resistant to EEN. Serum levels of IL-1, IL-6 and TNF-α were significantly increased on the first day after admission, meanwhile the relative activity of NK cells and the ratio of CD4 + / CD8 + in peripheral blood were significantly decreased. Serum IL-1, IL- (P <0.05). The activity of NK cells and the ratio of CD4 + / CD8 + in peripheral blood were significantly increased in the omega-3 treated group (P < 0.05). The levels of amylase, lipase and APACHEⅡ in the treatment group decreased significantly (P <0.05). Conclusion The application of EEN in children with acute pancreatitis is safe and feasible. EEN combined with ω-3 polyunsaturated fatty acid can control the inflammatory response of acute pancreatitis and balance T cells in early stage, reduce the level of cytokines and regulate the cellular immune function.