目的 探讨ω-3多不饱和脂肪酸对儿童急性胰腺炎(AP) 细胞因子和免疫功能的影响,为临床诊疗提供参考。方法 50例AP患儿随机分为早期肠内营养(EEN)对照组(25例)和EEN联合ω-3多不饱和脂肪酸治疗组(25例)。两组给予抑制胰酶的分泌、制酸、抗感染的同时,胃镜引导下置入鼻饲管至Treitz韧带远端,连续泵入糖盐水、米汤、小百肽等营养物质。治疗组加用ω-3多不饱和脂肪酸,疗程为2周。检测第1、7、14天白介素-1(IL-1)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α),NK细胞相对活性及外周血CD4⁺/CD8⁺比值。结果 两组患儿均耐受EEN。两组入院第1天血清IL-1、IL-6和TNF-α水平显著增加,同时NK细胞相对活性及外周血CD4⁺/CD8⁺比值显著下降;两组治疗第7天血清IL-1、IL-6和TNF-α水平与第1天比较均显著降低,ω-3治疗组降低更明显(P＜0.05);ω-3治疗组NK细胞活性及外周血CD4⁺/CD8⁺比值明显升高(P＜0.05);治疗组血淀粉酶、脂肪酶及APACHE Ⅱ评分明显下降(P＜0.05)。结论 儿童急性胰腺炎应用EEN安全可行,EEN联合ω-3多不饱和脂肪酸早期可控制急性胰腺炎炎症反应和平衡T细胞的作用,降低细胞因子水平及调节细胞免疫功能。

Objective To explore the effect ω-3 polyunsaturated fatty acids on inflammatory Cytokine and immune function in children with acute pancreatitis (AP). Methods A total of 50 children with AP were randomly divided into early enteral nutrition(EEN) group (25 cases) and EEN combined with ω-3 polyunsaturated fatty acids group (25 cases).Two group within 48 h of hospitalization in patients with inhibitors of trypsin secretio,antacids,and anti-infective treatment,assisted by endoscopy,the nasojejunal feeding tube was placed in the Treitz ligament distal,continuous pump into the rice soup and pepetmen junior nutrition for 24 h.The treatment group was treated with ω-3 polyunsaturated fatty acids for 2 weeks.Before enteral nutrition treatment and then 7 and 14 days after treatment,blood samples were collected for analysis of interleukin-1 (IL-1),interleukin-6 (IL-6),tumor necrosis factor-α(TNF-α),NK-cells activity and peripheral blood CD4⁺/CD8⁺ ratio. Results Two groups of children were all tolerated EEN.The levels of IL-1,IL-6 and TNF-α were significantly increased in 2 groups,while the activity of NK cells and CD8⁺/CD4⁺ ratio decreased significantly in the first groups.After nutrition treatment in the seventh days,compared with the first day of admission,the serum levels of IL-1,IL-6 and TNF-α in the two group were significantly decreased,ω-3 group was a significant decrease.The ω-3 group in patients with NK-cells activity and CD4⁺/CD8⁺ ratio were significantly increased (P<0.05).In the treatment group,the serum amylase,lipase and APACHE II score decreased obviously (P<0.05). Conclusion EEN is safe and feasible for children with acute pancreatitis,EEN combined with ω-3 polyunsaturated fatty acids can controll early inflammatory response and balance the role of T cells,and reduce the inflammatory cytokine and regulate cellular immune function in children with acute pancreatitis.