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目的探讨左旋精氨酸(L-Arg)强化的全肠外营养(TPN)对重症急性胰腺炎(SAP)患者促、抗炎细胞因子的影响。方法将40例SAP患者随机分为2组,每组20例,分别给予L-Arg强化的TPN和常规TPN营养支持,均从中心静脉补充营养液。选取10例健康体检者作为正常对照组。在营养支持的第1、4天用流式细胞小球微阵列术(CBA)检测营养支持组患者的IFN-γ、TNF-α、IL-10、IL-5、IL-4、IL-2水平,并与对照组比较,同时分析强化TPN组及常规TPN组间各细胞因子水平差异。结果营养支持第1天:强化TPN组及常规TPN组IL-2水平均低于正常对照组(P均<0.05),其余5种细胞因子均高于对照组(P均<0.05),但2组之间各细胞因子水平无明显差异(P均>0.05)。营养支持第4天:2组IL-2水平明显高于第1天(P均<0.05);2组IFN-γ、TNF-α、IL-4及IL-10与第1天比较,差异均有统计学意义(P均<0.05);强化TPN组TNF-α、IL-10、IFN-γ、IL-4水平低于常规TPN组(P均<0.05),IL-10/TNF-α、IFN-γ/IL-4比值更接近于正常组水平(P均<0.05)。结论 L-Arg强化的TPN在调节SAP患者促、抗炎平衡方面优于常规TPN,有利于机体免疫平衡的恢复。CBA能够高通量、高灵敏度地检测促、抗炎细胞因子失调状况。
Objective To investigate the effects of L-arginine-enriched total parenteral nutrition (TPN) on pro-and anti-inflammatory cytokines in patients with severe acute pancreatitis (SAP). Methods Forty patients with SAP were randomly divided into two groups (n = 20 each). The L-Arg-enriched TPN and conventional TPN nutrition support were given respectively. Nutrients were supplemented from the central vein. Ten healthy subjects were selected as normal control group. The levels of IFN-γ, TNF-α, IL-10, IL-5, IL-4 and IL-2 in patients in nutrition support group were detected by flow cytometry (CBA) Level, and compared with the control group, at the same time analysis of enhanced TPN group and conventional TPN group differences in cytokine levels. Results The first day of nutrition support: The level of IL-2 in TPN group and conventional TPN group were lower than that in normal control group (P <0.05), and the other five cytokines were higher than those in control group (P <0.05) There was no significant difference in the levels of cytokines between groups (all P> 0.05). On day 4 of nutrition support, the levels of IL-2 in the two groups were significantly higher than those on the first day (all P <0.05). Compared with the first day, the levels of IFN-γ, TNF-α, IL-4 and IL- (P <0.05). The levels of TNF-α, IL-10, IFN-γ and IL-4 in TPN group were lower than those in TPN group (P <0.05) IFN-γ / IL-4 ratio closer to the normal level (P all <0.05). Conclusion L-Arg-enhanced TPN is superior to conventional TPN in regulating the balance of promoting and anti-inflammatory in SAP patients, which is beneficial to the recovery of immune balance. CBA can detect high-throughput, high-sensitivity detection of anti-inflammatory cytokine imbalance.