Meyer J, Yurt R W, Duhaney R, Hesse D G, Tracey K J, Fong Y, Richardson D, Calvano S, Dineen P, Shires G T
Department of Surgery, Cornell University Medical College, New York, New York.
Surg Gynecol Obstet. 1988 Dec;167(6):501-9.
This study was done to determine whether or not increased susceptibility to infection seen in enterally versus parenterally fed patients was caused by altered neutrophil (PMN) responsiveness. To determine the differential effects of route of feeding on human PMN activation, plasma C3a levels, circulating PMN counts, PMN migration to leukotriene B4 (LTB4), the peptide, N-formyl-methionyl-leucyl-phenylalanine (FMLP) and zymosan activated serum (ZAS) and generation of LTB4 were assayed before and after and infusion of endotoxin. Nine normal volunteers were enterally (n=4) or parenterally (n=5) fed a diet sufficient to maintain body weight for seven days prior to a standard challenge of endotoxin. Samples were taken prior to the infusion and hourly thereafter for six hours. Prior to the injection of endotoxin, significant differences were seen in the two feeding groups. Plasma C3a levels, absolute circulating PMN counts and chemotaxis to LTB4 were all significantly (p less than 0.02) elevated in the enterally fed group. Generation of LTB4 was higher in the intravenously fed group at base line than the orally fed group (p less than 0.05). Plasma C3a levels rose in the enterally fed group, but not in the intravenously fed group, at two hours after infusion. Neutrophil counts rose in both feeding groups after endotoxin infusion; but the change in percentage was greater in the enterally fed group than in the intravenously fed group. Chemotaxis to FMLP and ZAS was not different during the study and did not differ between the two feeding can have significant impact on neutrophil function and that parenteral nutrition may impair host responsiveness.
本研究旨在确定肠内喂养与肠外喂养患者相比，感染易感性增加是否由中性粒细胞（PMN）反应性改变所致。为确定喂养途径对人PMN激活的不同影响，在输注内毒素前后检测血浆C3a水平、循环PMN计数、PMN向白三烯B4（LTB4）、肽N-甲酰甲硫氨酰-亮氨酰-苯丙氨酸（FMLP）和酵母聚糖激活血清（ZAS）的迁移以及LTB4的生成。9名正常志愿者在接受内毒素标准激发前7天，分别通过肠内（n = 4）或肠外（n = 5）途径给予足以维持体重的饮食。在输注前及之后每小时采集样本，共采集6小时。在内毒素注射前，两个喂养组之间存在显著差异。肠内喂养组的血浆C3a水平、绝对循环PMN计数和对LTB4的趋化性均显著升高（p < 0.02）。静脉喂养组基线时LTB4的生成高于口服喂养组（p < 0.05）。输注后2小时，肠内喂养组血浆C3a水平升高，而静脉喂养组未升高。内毒素输注后，两个喂养组的中性粒细胞计数均升高；但肠内喂养组的百分比变化大于静脉喂养组。在研究期间，对FMLP和ZAS的趋化性无差异，且两个喂养组之间也无差异。这表明喂养途径可对中性粒细胞功能产生显著影响，肠外营养可能损害宿主反应性。
