ω-3多不饱和脂肪酸对严重多发伤患者的炎症反应与免疫功能的调节及预后的影响
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摘要
【目的】探讨ω-3多不饱和脂肪酸对严重多发伤患者伤后的炎症反应与免疫功能的调节作用,以及对患者预后的影响。
【方法】对2008年9月至2009年5月收治于我院创伤外科的损伤严重度评分(injury severity score, ISS)大于等于16分的42例严重多发伤患者,随机分为对照组(n=21)和尤文组(n=21),在治疗中尤文组患者每天加用100 ml的ω-3鱼油脂肪乳注射液,采用静脉输入持续7天,其他治疗与对照组相同。分别于伤后不同时间点监测每日最高体温、白细胞计数、肝功能、肾功能、凝血功能；并检测炎症反应指标TNF-α、IL-6、IL-8、IL-10、C反应蛋白及免疫功能指标CD4＼CD8比值和HLA-DR的表达；并记录患者的SIRS发生率、MOF发生率、ICU停留时间、总住院时间和死亡率,进行组间比较。
【结果】两组患者之间的炎症反应水平和免疫功能差异具有显著性意义(P<0.01,P<0.05),与对照组相比,尤文组的机体炎症反应水平明显降低、免疫功能得到改善,且尤文组患者的预后要优于对照组。
【结论】在严重多发伤患者的治疗中加用ω-3多不饱和脂肪酸,可对机体的炎症反应和免疫功能起到一定的调节作用,并对改善严重多发伤患者的预后具有一定帮助。
Objective:The widespread recognition that severe multiple trauma is characterized as a state of inflammation and immunosuppression. Omega-3 fatty acids can regulate the body's inflammatory response and affect the function of immune cells.
Methods:Patients (n= 42) with severe multiple trauma (injury severity scores, ISS>16) treated at our hospital's Department of Surgical Trauma between September 2008 and May 2009 were randomly divided into a control group (n=21) and Ewing group (n=21). In addition to standard treatment protocols administered to all, the Ewing group received supplementation withω-3 polyunsaturated fatty acids. Maximum temperature, white blood cell count, liver function, renal function, and blood coagulation parameters were monitored at different time points after injury. Levels of inflammatory response indicators TNF-α, IL-6, IL-8, IL-10, and C-reactive protein were obtained; and CD4/CD8 ratios and HLA-DR expression were ascertained to assess immune function. Incidence of systemic inflammatory response syndrome (SIRS) and multiple organ failure (MOF), duration of ICU stay, total length of hospital stay and mortality rates were compared.
Results:Inflammatory response levels and immune function were significantly different for the two groups (P<0.01 and P<0.05, respectively). The inflammatory response in the Ewing group was significantly decreased, and immune function was improved. Better prognosis resulted for the Ewing group than the control group.
Conclusion:Supplementation withω-3 polyunsaturated fatty acids can effectively regulate the inflammatory response and immune function in patients with severe multiple trauma, possibly improving prognosis.
【方法】对2008年9月至2009年5月收治于我院创伤外科的损伤严重度评分(injury severity score, ISS)大于等于16分的42例严重多发伤患者,随机分为对照组(n=21)和尤文组(n=21),在治疗中尤文组患者每天加用100 ml的ω-3鱼油脂肪乳注射液,采用静脉输入持续7天,其他治疗与对照组相同。分别于伤后不同时间点监测每日最高体温、白细胞计数、肝功能、肾功能、凝血功能；并检测炎症反应指标TNF-α、IL-6、IL-8、IL-10、C反应蛋白及免疫功能指标CD4＼CD8比值和HLA-DR的表达；并记录患者的SIRS发生率、MOF发生率、ICU停留时间、总住院时间和死亡率,进行组间比较。
【结果】两组患者之间的炎症反应水平和免疫功能差异具有显著性意义(P<0.01,P<0.05),与对照组相比,尤文组的机体炎症反应水平明显降低、免疫功能得到改善,且尤文组患者的预后要优于对照组。
【结论】在严重多发伤患者的治疗中加用ω-3多不饱和脂肪酸,可对机体的炎症反应和免疫功能起到一定的调节作用,并对改善严重多发伤患者的预后具有一定帮助。
Objective:The widespread recognition that severe multiple trauma is characterized as a state of inflammation and immunosuppression. Omega-3 fatty acids can regulate the body's inflammatory response and affect the function of immune cells.
Methods:Patients (n= 42) with severe multiple trauma (injury severity scores, ISS>16) treated at our hospital's Department of Surgical Trauma between September 2008 and May 2009 were randomly divided into a control group (n=21) and Ewing group (n=21). In addition to standard treatment protocols administered to all, the Ewing group received supplementation withω-3 polyunsaturated fatty acids. Maximum temperature, white blood cell count, liver function, renal function, and blood coagulation parameters were monitored at different time points after injury. Levels of inflammatory response indicators TNF-α, IL-6, IL-8, IL-10, and C-reactive protein were obtained; and CD4/CD8 ratios and HLA-DR expression were ascertained to assess immune function. Incidence of systemic inflammatory response syndrome (SIRS) and multiple organ failure (MOF), duration of ICU stay, total length of hospital stay and mortality rates were compared.
Results:Inflammatory response levels and immune function were significantly different for the two groups (P<0.01 and P<0.05, respectively). The inflammatory response in the Ewing group was significantly decreased, and immune function was improved. Better prognosis resulted for the Ewing group than the control group.
Conclusion:Supplementation withω-3 polyunsaturated fatty acids can effectively regulate the inflammatory response and immune function in patients with severe multiple trauma, possibly improving prognosis.
引文
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