Hise Mary E, Compher Charlene, Harlan Lisa, Kohlmeier Jacob E, Benedict Stephen H, Gajewski Byron, Brown John C
Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, Kansas, USA.
Nutrition. 2006 Feb;22(2):97-103. doi: 10.1016/j.nut.2005.05.011.
Patients who used home parenteral nutrition (HPN) and healthy, volunteer control subjects were examined to assess relative immune potential and inflammatory marker expression and to investigate the association between HPN and immune parameters.
Subjective Global Assessments were performed on all subjects. The peripheral blood concentration of C-reactive protein was determined by enzyme-linked immunosorbent assay. The peripheral blood concentration of systemic inflammatory mediators that included tumor necrosis factor-alpha (TNF-alpha), soluble TNF-alpha receptors p55 and p75, and interleukin-6 were similarly determined. Peripheral blood lymphocytes were isolated and the percentage of circulating CD4+ and CD8+ lymphocytes was determined by flow cytometry. In addition, peripheral blood lymphocytes were cultured in the presence of the T-cell mitogen, phytohemagglutinin, and the proliferative response of the CD3+ population was assessed by flow cytometry. Results of these experiments were obtained for 10 clinically stable patients who had used HPN longer than 2 y and these results were compared by Student's t test with data obtained for 12 normal, volunteer control subjects.
Of the 10 patients who used HPN and were examined, seven had short bowel syndrome, two had dysmotility, and one required HPN due to radiation enteritis. Based on Subjective Global Assessments, all patients were well nourished. No difference was observed in TNF-alpha level between groups and C-reactive protein levels were within normal limits (1.2 mg/L in patients, 0.99 mg/L in controls). Soluble TNF-alpha receptors p55 and p75 were significantly increased (P < 0.001), but serum interleukin-6 was not (P = 0.07). The percentage of CD8+ cells and the CD4+/CD8+ ratio were not statistically different between groups. In contrast to this result, the percentage of CD4+ cells and the proliferative T-cell response to phytohemagglutinin were significantly depressed in patients who used HPN versus control subjects.
These data suggest the presence of an underlying inflammatory process and subsequent abnormal T-lymphocyte function in patients who use HPN.
对接受家庭肠外营养（HPN）的患者以及健康志愿者对照进行检查，以评估相对免疫潜能和炎症标志物表达，并研究HPN与免疫参数之间的关联。
对所有受试者进行主观全面评定。采用酶联免疫吸附测定法测定外周血中C反应蛋白的浓度。同样测定外周血中包括肿瘤坏死因子-α（TNF-α）、可溶性TNF-α受体p55和p75以及白细胞介素-6在内的全身炎症介质的浓度。分离外周血淋巴细胞，通过流式细胞术测定循环CD4⁺和CD8⁺淋巴细胞的百分比。此外，将外周血淋巴细胞在T细胞有丝分裂原植物血凝素存在的情况下进行培养，并通过流式细胞术评估CD3⁺群体的增殖反应。对10例使用HPN超过2年的临床稳定患者进行了这些实验，并将结果与12名正常志愿者对照的数据进行了Student t检验比较。
在接受检查的10例使用HPN的患者中，7例患有短肠综合征，2例有胃肠动力障碍，1例因放射性肠炎需要HPN。根据主观全面评定，所有患者营养状况良好。两组之间TNF-α水平无差异，C反应蛋白水平在正常范围内（患者为1.2 mg/L，对照为0.99 mg/L）。可溶性TNF-α受体p55和p75显著升高（P<0.001），但血清白细胞介素-6未升高（P = 0.07）。两组之间CD8⁺细胞百分比和CD4⁺/CD8⁺比值无统计学差异。与该结果相反，使用HPN的患者与对照相比，CD4⁺细胞百分比和T细胞对植物血凝素的增殖反应显著降低。
这些数据表明，使用HPN的患者存在潜在的炎症过程以及随后的异常T淋巴细胞功能。
