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免疫調節配方對加護病房患者淋巴球分佈及白血球黏著分子表現之影響

Effects of immune-modulating Formula on Lymphocyte Distribution and Leukocyte Adhesion Molecule Expression in ICU Patients

Abstracts


本實驗以加護病房之重症患者為對象,比較一般均衡配方與免疫調節配方,對加護病房患者淋巴球分佈及白血球黏著分子表現之影響。實驗將台大醫院一般外科加護病房中APACHⅡ指數8~15的患者12名,隨機分成2組,每組6名,均經由腸道灌食,一組給予兩種免疫調節配方(Impact-glutamine,Nu-Immune)之其中一種,兩產品均為均衡完整配方並添加精胺酸、ω-3脂肪酸及麩醯肢,另一組則給予一般完整均衡配方。兩組分別在灌食前、灌食3天及一星期後,以流式細胞儀分析灌食前後,及不同組別間淋巴球分布及白血球上整合素CDl1a/CD18、CD11b/CD18表現量之差異。結果顯示在灌食第3天,實驗組淋巴球亞群中的CD8高於控制組,CD4/CD8比例則低於控制組。其餘CD4、CD3、CD19、CD11a/CD18、CD11b/CD18在灌食前後或兩組間均無明顯差異。由於CD3為T細胞的標記,而CD19為B細胞的標記,CD11a/CD18、CD11b/CD18為發炎反應的指標之一,本研究結果顯示,加護病房重症患者在給予免疫調節配方後,並不致造成免疫抑制作用,但與一般完整均衡配方相較,免疫調節配方在淋巴球分佈及白血球相關的發炎反應表現上並無差異。

Parallel abstracts


This study compared the effects of immune-modulating and general balanced formulas on lymphocyte distribution and leukocyte adhesion molecule expression in intensive care unit (ICU) patients. Twelve patients with Acute Physiology and Chronic Health Evaluation (APACHE) II score 8~15 were allocated to 2 groups. Control group received general balanced formula whereas test group received either one of the immune-modulating formula (Impact-glutamine or Nu-Immune). The immune-modulating formulas contain arginine ω-3 fatty acid and glutamine in addition to complete balanced nutrition. Blood samples were collected before and 3 and 7 d after enteral feeding in all patients, and were analyzed for lymphocyte distribution and leukocyte adhesion molecule expression by flow cytometry. The results showed that after enteral feeding for 3 days, the CD8 percentage was higher and CD4/CD8 ratio was lower in the test group than those of the control group. There were no differences in CD3, CD4, CD8, CD19 distribution and leukocyte CD11a/CD18, CD11b/CD18 expression before and after enteral feeding in both groups. Also, no differences in these parameters were observed between the 2 groups. Since CD3 is the marker of T cells and CD19 is the marker of B cells, and CD11a/CD18, CD11b/CD18 expression are correlated with inflammatory reaction, these results suggest that immuno-modulating formulas do not result in immunosuppression. Compared with the balanced formula, immuno-modulating formula had no favorable effect on lymphocyte distribution and leukocyte associated inflammation in ICU patients.

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