免疫調節配方對急性呼吸窘迫症候群病患之營養及抗氧化狀況的影響

Effects of Immune-modulating Formula on Nutritional and Antioxidative Status in Patients with Acute Respiratory Distress Syndrome

蔡淑敏(Shu-Min Tsai)

指導教授 ： 楊淑惠

臺北醫學大學/公共衛生暨營養學院/保健營養學研究所/碩士(2014年)

摘要

急性呼吸窘迫症候群 (Acute respiratory distress syndrome, ARDS) 患者處於過度發炎反應伴隨高異化代謝及體內氧化物與抗氧化物失衡的狀況。本研究為前瞻性觀察試驗，欲探討免疫調節配方對ARDS病患，是否可改善其營養狀況、抗氧化狀態。受試者經由腸胃道供應添加魚油、γ-亞麻油酸和抗氧化維生素的免疫調節配方，共灌食7天。分析和比較受試者在使用特殊配方前後之營養狀況 (白蛋白、前白蛋白和氮平衡)、氧化傷害指標、抗氧化能力和抗氧化維生素濃度等之差異性以及與臨床預後 (加護病房住院天數、呼吸器使用天數) 的相關性。結果顯示，研究期間受試者平均熱量攝取為1450.5 ± 237.8 kcal /day (達需求量的106.3 % ± 18.3) ，蛋白質為88.0 ± 22.0 g/day (達需求量的101.8 % ± 20.5)；觀察試驗期間，C-反應蛋白 (C-reactive protein, CRP) 明顯降低 (p < 0.05)；前白蛋白值 (prealbumin) 及抗氧化維生素C、E和β-胡蘿蔔素濃度均顯著增加 (p < 0.05)。然而，氧化傷害指標及總抗氧化能力於研究前後無顯著差異，營養和抗氧化狀況與臨床預後亦無相關性。根據本研究結果，供應ARDS患者使用免疫調節配方，可改善其營養狀況 (前白蛋白) 及發炎反應 (C-反應蛋白)，且對體內抗氧化狀態具正面影響 (維生素C、E和β-胡蘿蔔素)，但與臨床預後則無顯著相關性。

關鍵字

急性呼吸窘迫症候群 ； 免疫調節配方 ； 營養狀況 ； 抗氧化維生素 ； 氧化傷害指標 ； 臨床預後

並列摘要

Background: Patients with acute respiratory distress syndrome (ARDS) are in a state of excessive inflammation complicated with hypercatabolism and oxidant-antioxidant imbalance.Objective: This prospective observational study was to investigate whether the immune-modulating formulas can improve the nutritional indicator, antioxidative status for ARDS patients.Method: Subjects received enteral feeding enriched with eicosapentaenoic acid, γ-linolenic acid and antioxidant vitamins for 7 days. Analysis was done to examine the effects of immune-modulating formulas on nutritional status (albumin, prealbumin and nitrogen balance), oxidative stress index, antioxidant capacity, antioxidant vitamins level and the association between nutritional and antioxidative status on clinical outcomes (ie. intensive care unit days, ventilator days).Results: The results showed that subjects received mean caloric intake 1450.5 ± 237.8 kcal/day (about 106.3% ± 18.3 of estimated requirement), mean protein intake 88.0 ± 22.0 g/day (about 101.8% ± 20.5 of estimated requirement) during the study period. After the study, C-reactive protein was significantly reduced (p < 0.05); prealbumin level and antioxidant vitamins C, E and ??-carotene concentration were all significantly increased (p < 0.05). However, there were no significant differences on oxidative stress index and antioxidant capacity. Nutritional and antioxidative status were also not associated with clinical outcomes.
Conclusion: This study indicates that enteral feeding with immune-modulating formulas can significantly improve the nutritional status (prealbumin), inflammatory marker (CRP), and antioxidative status (Vitamin C, E, and β-carotene); but nutritional status and antioxidative status do not appear to be associated with clinical outcomes in ARDS patients.

並列關鍵字

Acute respiratory distress syndrome ； nutritional status ； immune-modulating formulas ； antioxidant vitamins ； oxidative stress index ； clinical outcome

參考文獻

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中央健康保險局。(2010) 全民健康保險醫療費用支付標準第二部第一章第五節管灌飲食費。

吳雨杰、黃千芬、胡雪萍、劉珍芳 (2013) 健康成人攝取多樣化蔬果與體內氧化壓力之相關性。台灣營養學會雜誌。38(1):19-28。

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二、英文部份：