Planas M, Español T, Farriol M, Máñez R, Schwartz S, Padró J B
Unidad de Cuidados Intensivos, Hospital General Vall d'Hebrón, Barcelona.
Nutr Hosp. 1990 May-Jun;5(3):165-8.
Malnutrition leads to cellular and humoral immunological response disorders. A study protocol on malnourished patients has been designed in order to assess immune response mechanisms that may be altered due to malnutrition and may or may not recover once normal metabolic conditions have been restored prior to starting the patient on parenteral feeding and control. The immune response was assessed especially regarding immunoglobulin, lymphocyte subsets and mitogen response levels. It is important to know the different malnutrition-related immunologic disorders, disorders secondary to diseases that hinder correct oral feeding, and immunologic tests may be used to assess nutritional parameters. The malnourished patients included in this trial has to be free of any other immunologic or neoplastic disease, and not receive immune response suppression therapy. The trial patients showed lower total and relative CD3 and CD4 lymphocyte values at the onset of the study, although the former lymphocyte subset recuperated sooner at the expense of increasing CD8 lymphocytes, while CD4 lymphocytes still remained low after 15 days of parenteral nutrition. Immunoglobulin levels remained within normal limits. The mitogen response capacity, which was sensibly low at the beginning, recuperated in 50% of the cases treated with parenteral nutrition. This parameters may be used as an index to assess the nutritional status of these patients. The cases studies allowed us to conclude that there was a decrease in CD4 cells and mitogen response in malnourished patients. After 15 days of parenteral nutrition, the cells did not recuperate but their function measured in terms of phytohemagglutinin, was normal in 50% of the cases.
营养不良会导致细胞和体液免疫反应紊乱。已设计了一项针对营养不良患者的研究方案，以评估可能因营养不良而改变、且在开始对患者进行肠外营养和对照之前恢复正常代谢状况后可能恢复或可能无法恢复的免疫反应机制。尤其针对免疫球蛋白、淋巴细胞亚群和丝裂原反应水平评估了免疫反应。了解与营养不良相关的不同免疫紊乱、继发于妨碍正确经口喂养疾病的紊乱情况很重要，并且免疫检测可用于评估营养参数。纳入该试验的营养不良患者必须没有任何其他免疫或肿瘤疾病，且未接受免疫反应抑制治疗。试验患者在研究开始时显示总CD3和CD4淋巴细胞值以及相对值较低，尽管前一个淋巴细胞亚群恢复得更快，但以CD8淋巴细胞增加为代价，而在肠外营养15天后CD4淋巴细胞仍保持较低水平。免疫球蛋白水平保持在正常范围内。丝裂原反应能力在开始时明显较低，在50%接受肠外营养治疗的病例中恢复。该参数可作为评估这些患者营养状况的指标。病例研究使我们得出结论，营养不良患者的CD4细胞和丝裂原反应减少。肠外营养15天后，细胞未恢复，但根据植物血凝素测量的其功能在50%的病例中正常。
