Braga M, Baccari P, Scaccabarozzi S, Fiacco E, Radaelli G, Gallus G, DiPalo S, DiCarlo V, Cristallo M
Scientific Institute San Raffaele Hospital, Cattedra di Patologia Chirurgica, Milan, Italy.
JPEN J Parenter Enteral Nutr. 1988 Mar-Apr;12(2):138-42. doi: 10.1177/0148607188012002138.
The utilization of delayed hypersensitivity response (DHR) for the identification of high-risk patients with regard to postoperative septic complications is still discussed. The aim of this study was to clarify how much DHR may improve the prognostic capacity of nutritional assessment (NA). Nutritional and immunological evaluations were performed at admission on 405 patients undergoing elective general surgical procedures. Subjects with serum albumin less than or equal to 3.0 g/dl or total iron-binding capacity less than or equal to 220 micrograms/dl or weight loss greater than or equal to 10% with respect to usual body weight were classified as malnourished. DHR was assessed by performing skin tests with four recall antigens: PPD, candida, trichophyton, sk-sd. The incidence of postoperative complications resulted higher among the 187 malnourished patients (31.0%) than in the 218 well-nourished ones (14.2%) (p less than 0.001), and among the 213 anergic patients (29.6%) than in the 192 normal responders (13.5%) (p less than 0.001). To determine how much skin tests may improve the prognostic ability of NA, the relationship between DHR and postoperative complications was also studied in the malnourished and in the well-nourished patients, separately. In the malnourished group, the patients with an impairment of DHR had a higher incidence of postoperative infections than normal responders (p less than 0.05). In the well-nourished group, no significant differences were found between anergic patients and normal responders. In our study, DHR slightly improved the prognostic capacity of NA. Therefore, the first approach to identify the high-risk patients seems to be the unexpensive, quick and available determination of nutritional status.
关于利用迟发型超敏反应（DHR）来识别术后发生脓毒症并发症的高危患者，目前仍存在争议。本研究的目的是阐明DHR能在多大程度上提高营养评估（NA）的预后判断能力。对405例行择期普通外科手术的患者在入院时进行了营养和免疫评估。血清白蛋白小于或等于3.0 g/dl、总铁结合力小于或等于220微克/dl或相对于正常体重体重减轻大于或等于10%的患者被归类为营养不良。通过用四种回忆抗原（结核菌素纯蛋白衍生物、白色念珠菌、毛癣菌、SK-SD）进行皮肤试验来评估DHR。187例营养不良患者术后并发症的发生率（31.0%）高于218例营养良好患者（14.2%）（p<0.001），213例无反应患者术后并发症的发生率（29.6%）高于192例正常反应者（13.5%）（p<0.001）。为了确定皮肤试验能在多大程度上提高NA的预后判断能力，还分别在营养不良和营养良好的患者中研究了DHR与术后并发症之间的关系。在营养不良组中，DHR受损的患者术后感染发生率高于正常反应者（p<0.05）。在营养良好组中，无反应患者和正常反应者之间未发现显著差异。在我们的研究中，DHR略微提高了NA的预后判断能力。因此，识别高危患者的首要方法似乎是进行价格低廉、快速且可行的营养状况测定。
