抗發炎免疫調節腸道營養在急性呼吸窘迫症候群病人的應用

急性呼吸窘迫症候群（ARDS）與急性肺損傷（ALI）是一種急性且瀰漫性的肺部發炎反應，臨床表現以快速形成的兩側肺部浸潤合併急性缺氧性呼吸衰竭為主。在2012年發表的柏林定義更新了ARDS的定義而包含原本ALI的範圍，並將它依氧合功能（PaO2/FiO2）分為輕度、中度與重度。二十碳五烯酸（EPA）及二十二碳六烯酸（DHA）等ω-3族脂肪酸與一種稱為γ-次亞麻油酸（GLA）的特殊ω-6族脂肪酸已被顯示可以調節免疫反應，而可被應用於ARDS等發炎性疾病。在本篇綜論裏，我們回顧了幾篇重要的臨床研究並討論其研究設計和結果。早期的研究與一篇統合研究顯示經腸道給予富含抗發炎性脂肪酸（EPA、DHA、GLA）與抗氧化物質的配方可以改善病人的氧合狀態、需要呼吸器支持的程度、死亡率、無使用呼吸器的天數、非於加護病房停留的住院天數及產生新器官衰竭的比率。然而，最近的研究使用了不同的實驗設計、配方與對照組，發現抗發炎性免疫調節腸道營養並無顯著的幫忙。這或許是因為不同的實驗設計所導致的結果，不過我們相信近年內由於重症照護的進步，使急性呼吸窘迫症候群病患有較佳的預後，也是導致這類營養配方無法顯現出效果的原因之一。儘管先前的研究顯示這類抗發炎性免疫調節腸道營養是安全的，但是近期的研究顯示這類的營養補充對於改善臨床預後並沒有明顯效果，而且花費可觀，因此我們期待有更大規模的研究來釐清其可用性。

關鍵字

免疫營養；急性呼吸窘迫症候群；急性肺損傷； ω-3脂肪酸

並列摘要

Acute respiratory distress syndrome (ARDS), as well as acute lung injury (ALI), is an acute and diffuse inflammatory disorder of the lung. Clinically, it is characterized by rapid-developing bilateral pulmonary infiltration with acute hypoxemic respiratory failure. In 2012, the Berlin definition re-defined ARDS to include the whole spectrum of ALI and classified ARDS into mild, moderate and severe diseases by PaO2/FiO2. Omega-3 fatty acids, including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and a special omega-6 fatty acid called γ-linolenic acid (GLA) have been demonstrated to modulate immune responses and may be implicated in inflammatory disorders like ARDS. Herein, we review important clinical studies and discuss their study designs and results. Earlier studies including a meta-analysis have demonstrated that enteral nutrition enriched in anti-inflammatory fatty acids (EPA, DHA, and GLA) and antioxidants improved oxygenation status, required level of ventilator support, mortality, ventilator-free day, intensive care unit-free day, and rate of developing new organ failure. However, recent studies using different study designs, regimens, and control groups failed to show significant benefits. The futility in recent trials may be attributed to different study design. However, the improved ARDS outcomes related to recent advances in critical care may also play a role in blunting the effects of the immuno-modulating enteral nutrition. Although these immuno-modulating regimens are generally safe, recent studies showed these expensive regimens provide no significant benefit in clinical prognosis. Therefore, further large studies are needed to clarify their clinical utility.

並列關鍵字

Immunonutrition ； Acute Respiratory Distress Syndrome(ARDS) ； Acute Lung Injury (ALI) ； ω-3 Fatty Acid

國際替代計量

抗發炎免疫調節腸道營養在急性呼吸窘迫症候群病人的應用

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