Yao Guo-xiang, Wang Xiu-rong, Jiang Zhu-ming, Zhang Si-yuan, Ma En-ling, Ni An-ping
Department of Surgery, PUMC Hospital, CAMS, PUMC, Beijing 100730, China.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2002 Apr;24(2):181-4.
To evaluate the role of nutritional status on serum immunoglobulins, body weight and postoperative infectious-related complications in patients with Crohn's disease receiving perioperative parenteral nutrition (PN).
32 patients with Crohn's disease receiving perioperative parenteral nutrition in our department between 1984 and 1994 were enrolled in this survey. 16 patients with loss of body weight in the range of 15%-30% were assigned to the malnutrition group, the other 16 patients with normal weight or loss of body weight less than 15% to the control group. Serum IgM, IgG and IgA levels were measured before and after PN by enzyme-linked immunosorbent assays. Liver function, body weight changes and postoperative complications were also analyzed.
IgM levels were elevated before PN in both groups [control group: (133 +/- 16) mg/dl, malnutrition group: (139 +/- 41) mg/dl; normal value: (110 +/- 35) mg/dl; P = 0.04], decreased to normal value [(105 +/- 29) mg/dl, P = 0.02] in the malnutrition group while having no obvious changes in the control group [(129 +/- 13) mg/dl, P = 0.34]. No significant changes in concentrations of IgG and IgA were found (P in the range of 0.20-0.57). The average weight gain was 1.862 kg in malnutrition group [before PN: (45.8 +/- 8.9) kg, after PN: (48.0 +/- 8.8) kg; P = 0.005] and no significant changes in the control group [before PN: (55.6 +/- 6.1) kg, after PN: (56.3 +/- 6.0) kg; P = 0.46]. There was an increase in infectious complications in the control group (control group: 4 cases, 25%, malnourished group: 2 cases, 12.5%; P = 0.13).
Perioperative parenteral nutrition ameliorated the humoral immunity, increased the body weight in patients with obvious malnutrition, whereas it had little value for those without or with mild malnutrition.
评估营养状况对接受围手术期肠外营养（PN）的克罗恩病患者血清免疫球蛋白、体重及术后感染相关并发症的作用。
选取1984年至1994年间在我科接受围手术期肠外营养的32例克罗恩病患者进行本研究。将16例体重下降15% - 30%的患者归入营养不良组，另外16例体重正常或体重下降小于15%的患者归入对照组。采用酶联免疫吸附测定法检测PN前后血清IgM、IgG和IgA水平。同时分析肝功能、体重变化及术后并发症情况。
两组患者PN前IgM水平均升高[对照组：(133 ± 16)mg/dl，营养不良组：(139 ± 41)mg/dl；正常值：(110 ± 35)mg/dl；P = 0.04]，营养不良组降至正常水平[(105 ± 29)mg/dl，P = 0.02]，而对照组无明显变化[(129 ± 13)mg/dl，P = 0.34]。IgG和IgA浓度无显著变化（P值在0.20 - 0.57范围内）。营养不良组平均体重增加1.862kg[PN前：(45.8 ± 8.9)kg，PN后：(48.0 ± 8.8)kg；P = 0.005]，对照组无明显变化[PN前：(55.6 ± 6.1)kg，PN后：(56.3 ± 6.0)kg；P = 0.46]。对照组感染并发症有所增加（对照组：4例，25%，营养不良组：2例，12.5%；P = 0.13）。
围手术期肠外营养改善了明显营养不良患者的体液免疫，增加了其体重，而对无营养不良或轻度营养不良患者作用不大。
