Immunonutrition
Immunonutrition
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DOI：
10.1097/01.mog.0000153360.90653.82
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发表时间：
2005-03-01
影响因子：
2.5
通讯作者：
Grimble, RF
中科院分区：
文献类型：
--
作者：
Grimble, RF
综述目的概述免疫营养素在手术、感染和癌症引起的炎症应激患者中的作用的最新发现。最近发现肠外营养比肠外营养更有效，风险更低。它降低了感染率，缩短了重症患者的ICU和住院时间。免疫营养的有益作用在营养不良患者中最为明显。围手术期肠内营养比术后营养更有效。在克罗恩病中，肠内营养与类固醇治疗的缓解率相似。谷氨酰胺、omega-3脂肪酸和抗氧化剂对不同的患者群体都有有益的影响。l -精氨酸是一种重要的免疫营养素，既有有益的作用，也有不利的作用。前者发生在坏死性坏死；小肠结肠炎;后一种影响见于败血症患者。肠道在全身氨基酸代谢，尤其是精氨酸稳态中起着重要作用。精氨酸酶和一氧化氮合成酶在免疫细胞内竞争精氨酸，在感染期间的临床结果中起关键作用。在癌症中，一系列抗氧化剂能够改善免疫抑制。由于-6脂肪酸的促炎作用，静脉注射脂质可能是有害的。Omega-3脂肪酸具有抗炎作用，与中链甘油三酯（MCT）和橄榄油结合使用可以提供更有效的静脉注射脂质。免疫营养在肠内应用时可有效改善大量患者的预后，特别是营养不良患者。肠外免疫营养具有较高的风险，但在肠内营养有问题的特定患者群体中可能有效。
Purpose of reviewTo outline recent findings on the efficacy of immunonutrients in patients undergoing inflammatory stress due to surgery, infection and cancer.Recent findingsEnteral nutrition is more efficacious and poses lower risks than parenteral nutrition. It reduces infection rates and shortens ICU and hospital length of stay of critically ill patients. Beneficial effects of immunonutrition most apparent in malnourished patients. Perioperative enteral nutrition is more effective than postoperative nutrition. In Crohn disease similar remission rates are achieved with enteral nutrition as with steroids. Glutamine, omega-3 fatty acids and antioxidants exert beneficial influences in diverse patient populations. L-arginine is an important immunonutrient having both beneficial and adverse effects. The former effect occurs in necrotizing; enterocolitis; the latter influence is seen in septic patients. The gut plays a major role in whole body amino acid metabolism, particularly arginine homeostasis. Arginase and nitric oxide synthetase compete for arginine within immune cells and play a pivotal role in clinical outcome during infection. In cancer a range of antioxidants are able to ameliorate immunosuppression. Intravenous lipids may be deleterious due to the pro-inflammatory effects of omega-6 fatty acids. Omega-3 fatty acids are anti-inflammatory and combined with medium chain triglyceride (MCT) and olive oil may provide a more efficacious form of intravenous lipid.SummaryImmunonutrition is effective in improving outcome in a wide range of patients when applied enterally, particularly in malnourished individuals. Parenteral immunonutrition carries a higher risk but can be efficacious in selected patient groups for whom enteral nutrition is problematic.