Peng Lu, Kun Wang, Lihua Zheng, Dongliang Li, Jie Zhang, Ziqin Su
The First Hospital of Hebei Medical University, Department of Intensive Care Unit I, Shijiazhuang, China.
J Med Biochem. 2025 Aug 21;44(5):1074-1082. doi: 10.5937/jomb0-56222.
This study aims to evaluate the effects of high-protein nutritional support (HPNS) combined with probiotics (Bifid Triple Viable Capsule) on the nutritional status, biochemical markers, and immune function in critically ill patients (CIPs) requiring mechanical ventilation, with a focus on preventing ventilator-associated pneumonia (VAP). The study explores how this intervention impacts serum albumin, prealbumin, and inflammatory cytokines (TNF-a, IL-1, IL-6), key nutritional and immune function indicators.
This study included 86 critically ill patients requiring mechanical ventilation in the ICU. Participants were randomly assigned to either a research group (n=46) receiving HPNS combined with probiotics (Bifid Triple Viable Capsule) or a control group (n=40) receiving standard nutritional support. The primary outcomes included changes in serum albumin, prealbumin, and inflammatory cytokines (TNF-a, IL-1, IL-6) and the incidence of VAP The study duration was 3 weeks, and biochemical markers and clinical outcomes were assessed at baseline and post-intervention. The patients' body mass index (BMI) and body weight are calculated and compared. A spectrophotometer measures the content of serum protein. The prevalence of ventilator-associated pneumonia is analysed by sputum gram staining. The clinical symptoms of patients with ventilator-associated pneumonia during ICU are monitored. ELISA detects serum levels of inflammatory cytokines TNF-a, IL-1 and IL-6.
The research group demonstrated significant improvements in serum albumin and prealbumin levels and a lower TNF-a, IL-1, and IL-6 ratio than the control group (P< 0.05). The incidence of ventilator-associated pneumonia (VAP) was significantly lower in the research group (6.52%) compared to the control group (30%, P<0.05). Additionally, the research group showed higher BMI and body weight (P< 0.05), suggesting improved nutritional status following the intervention.
High-protein nutritional support combined with probiotics can significantly raise the nutritional conditions of critically ill patients and effectively prevent ventilator-associated pneumonia. This intervention enhanced key biochemical markers, such as serum albumin, prealbumin, and the albumin/total protein ratio, all of which are important indicators of nutritional status. The improvement in these markers suggests that HPNS supports tissue repair and immune function, which are crucial for recovery in ICU patients. Additionally, the combination of HPNS and probiotics reduced serum levels of inflammatory cytokines (TNF-a, IL-1, IL-6), which are commonly elevated in critically ill patients and contribute to developing infections like VAP By regulating the inflammatory response, this intervention may help reduce the risk of infection and promote faster recovery. The results of this study highlight the potential clinical value of HPNS combined with probiotics for improving the management of critically ill patients in ICU settings.
本研究旨在评估高蛋白营养支持（HPNS）联合益生菌（双歧三联活菌胶囊）对需要机械通气的重症患者（CIPs）营养状况、生化指标及免疫功能的影响，重点关注预防呼吸机相关性肺炎（VAP）。该研究探讨了这种干预措施如何影响血清白蛋白、前白蛋白及炎性细胞因子（TNF-α、IL-1、IL-6），这些是关键的营养和免疫功能指标。
本研究纳入了86例在重症监护病房（ICU）需要机械通气的重症患者。参与者被随机分为研究组（n = 46），接受高蛋白营养支持联合益生菌（双歧三联活菌胶囊），或对照组（n = 40），接受标准营养支持。主要结局包括血清白蛋白、前白蛋白及炎性细胞因子（TNF-α、IL-1、IL-6）的变化以及VAP的发生率。研究持续时间为3周，在基线和干预后评估生化指标和临床结局。计算并比较患者的体重指数（BMI）和体重。用分光光度计测量血清蛋白含量。通过痰革兰氏染色分析呼吸机相关性肺炎的患病率。监测ICU期间呼吸机相关性肺炎患者的临床症状。采用酶联免疫吸附测定法（ELISA）检测血清炎性细胞因子TNF-α、IL-1和IL-6的水平。
研究组血清白蛋白和前白蛋白水平有显著改善，且TNF-α、IL-1和IL-6的比值低于对照组（P < 0.05）。研究组呼吸机相关性肺炎（VAP）的发生率（6.52%）显著低于对照组（30%，P < 0.05）。此外，研究组的BMI和体重更高（P < 0.05），表明干预后营养状况有所改善。
高蛋白营养支持联合益生菌可显著提高重症患者的营养状况，并有效预防呼吸机相关性肺炎。这种干预提高了关键生化指标，如血清白蛋白、前白蛋白及白蛋白/总蛋白比值，这些都是营养状况的重要指标。这些指标的改善表明高蛋白营养支持有助于组织修复和免疫功能，这对ICU患者的康复至关重要。此外，高蛋白营养支持与益生菌的联合降低了炎性细胞因子（TNF-α、IL-1、IL-6）的血清水平，这些因子在重症患者中通常升高，并导致如VAP等感染的发生。通过调节炎症反应，这种干预可能有助于降低感染风险并促进更快康复。本研究结果凸显了高蛋白营养支持联合益生菌在改善ICU重症患者管理方面的潜在临床价值。
