Chuntrasakul C, Siltharm S, Sarasombath S, Sittapairochana C, Leowattana W, Chockvivatanavanit S, Bunnak A
Research Center for Nutritional Support, Siriraj Hospital.
J Med Assoc Thai. 1998 May;81(5):334-43.
To evaluate the nutritional, metabolic and immune effects of dietary arginine, glutamine and omega-3 fatty acids (fish oil) supplementation in immunocompromised patients, we performed a prospective study on the effect of immune formula administered to 11 severe trauma patients (average ISS = 24), 10 burn patients (average % TBSA = 48) and 5 cancer patients. Daily calorie and protein administration were based on the patient's severity (Stress factor with the range of 35-50 kcal/kg/day and 1.5-2.5 g/kg/day, respectively) Starting with half concentration liquid immune formula through nasogastric tube by continuous drip at 30 ml/h and increasing to maximum level within 4 days. The additional energy and protein requirement will be given either by parenteral or oral nutritional support. Various nutritional, metabolic, immunologic and clinical parameters were observed on day 0 (baseline), day 3, 7, and 14. Analysis was performed by paired student-t test. Initial mean serum albumin and transferrin showed mild (trauma) to moderate (burn and cancer) degree of malnutrition. Significant improvement of nutritional parameters was seen at day 7 and 14 in trauma and burn patients. Significant increase of total lymphocyte count (day 7, P < 0.01), CD4 + count (day 7, p < 0.01), CD8 + count (day 7, p < 0.0005 & day 14, p < 0.05), complement C3 (day 7, p < 0.005 day 14, p < 0.01), IgG (day 7, and 14, p < 0.0005), IgA (day 7, p < 0.0005 & day 14, p < 0.05), in all patients. C-reactive protein decreased significantly on day 7 (p < 0.0005) and day 14 (p < 0.005). 3 cases of burn wound infection, one case of UTI and one case of sepsis were observed. Two cases of hyperglycemia in burn, 3 cases of hyperbilirubinemia in trauma, 10 cases of elevated LFT (5 trauma/5 burn), and one case of hyponatremia in cancer patients were observed. Two cases of nausea, 4 cases of vomiting, 5 cases of diarrhea (< 3 times/day), 2 cases of abdominal cramp, 1 case of distension were observed. The feeding of IMMUNE FORMULA was well tolerated and significant improvement was observed in nutritional and immunologic parameters as in other immunoenhancing diets. Further clinical trials of prospective double-blind randomized design are necessary to address the so that the necessity of using immunonutrition in critically ill patients will be clarified.
为评估补充膳食精氨酸、谷氨酰胺和ω-3脂肪酸（鱼油）对免疫功能低下患者的营养、代谢及免疫影响，我们对11例严重创伤患者（平均损伤严重度评分[ISS]=24）、10例烧伤患者（平均烧伤总面积[％TBSA]=48）和5例癌症患者进行了一项关于免疫配方制剂效果的前瞻性研究。每日热量和蛋白质供给基于患者的病情严重程度（应激系数范围分别为35 - 50千卡/千克/天和1.5 - 2.5克/千克/天），起始通过鼻胃管以30毫升/小时的速度持续滴注半浓度液体免疫配方制剂，并在4天内增加至最大剂量。额外的能量和蛋白质需求将通过肠外或口服营养支持来提供。在第0天（基线）、第3天、第7天和第14天观察了各种营养、代谢、免疫和临床参数。采用配对学生t检验进行分析。初始平均血清白蛋白和转铁蛋白显示出轻度（创伤）至中度（烧伤和癌症）程度的营养不良。创伤和烧伤患者在第7天和第14天营养参数有显著改善。所有患者的总淋巴细胞计数（第7天，P<0.01）、CD4 +计数（第7天，p<0.01）、CD8 +计数（第7天，p<0.0005和第14天，p<0.05）、补体C3（第7天，p<0.005，第14天，p<0.01）、IgG（第7天和第14天，p<0.0005）、IgA（第7天，p<0.0005和第14天，p<0.05）均显著增加。C反应蛋白在第7天（p<0.0005）和第14天（p<0.005）显著下降。观察到3例烧伤创面感染、1例尿路感染和1例脓毒症。观察到2例烧伤患者出现高血糖、3例创伤患者出现高胆红素血症、10例患者肝功能检查结果升高（5例创伤/5例烧伤）以及1例癌症患者出现低钠血症。观察到2例恶心、4例呕吐、5例腹泻（<3次/天）、2例腹部绞痛、1例腹胀。免疫配方制剂的喂养耐受性良好，并且在营养和免疫参数方面观察到了与其他免疫增强饮食一样的显著改善。有必要进行进一步的前瞻性双盲随机设计临床试验，以便明确在重症患者中使用免疫营养的必要性。
