[1]陈文秀,孙加奎,沈 骁,等.早期肠内营养对脓毒症病人Th17/Treg细胞比及IL-23/IL-17轴的调节与临床意义[J].肠外与肠内营养杂志,2019,(01):30-34.[doi:10.16151/j.1007-810x.2019.01.013]
　HEN Wen-xiu,SUN Jia-kui,SHEN Xiao,et al.The effects of early enteral nutrition on Th17/Treg ratio and IL-23/IL-17 axis in patients with sepsis and the clinical significance[J].PARENTERAL & ENTERAL NUTRITION,2019,(01):30-34.[doi:10.16151/j.1007-810x.2019.01.013]
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早期肠内营养对脓毒症病人Th17/Treg细胞比及IL-23/IL-17轴的调节与临床意义
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《肠外与肠内营养》杂志[ISSN:1007-810X/CN:32-1477/R]

卷:
期数:
2019年01期
页码:
30-34
栏目:
论著
出版日期:
2019-01-10

文章信息/Info

Title:
The effects of early enteral nutrition on Th17/Treg ratio and IL-23/IL-17 axis in patients with sepsis and the clinical significance
作者:
陈文秀; 孙加奎; 沈 骁; 章文豪; 袁受涛; 孟 超; 穆心苇; 王 翔
南京市第一医院重症医学科，江苏南京 210006
Author(s):
HEN Wen-xiu;  SUN Jia-kui;  SHEN Xiao;  ZHANG Wen-hao;  YUAN Shou-tao;  MENG Chao;  MU Xin-wei; WANG Xiang
Department of Intensive Care Unit, Nanjing First Hospital, Nanjing 210006, Jiangsu, China
关键词:
早期肠内营养 ; 脓毒症 ; 免疫功能 ; Th17/Treg ; IL-23/IL-17
Keywords:
Early enteral nutrition;  Sepsis;  Immune function;  Th17/Treg ratio;  IL-23/IL-17 axis
分类号:
R631
DOI:
10.16151/j.1007-810x.2019.01.013
文献标志码:
A
摘要:
目的：探讨Th17/Treg细胞比及IL-23/IL-17轴在早期肠内营养（EEN）调节脓毒症病人免疫功能中的作用。 方法：选择2017年10月至2018年06月收入南京医科大学附属南京医院重症医学科的脓毒症病人，随机分入早期肠内营养与延期肠内营养（DEN）组，EEN组在入ICU第一个24小时开始肠内营养，DEN组在入ICU第4天开始肠内营养。在第1、3、7天检测IL-23、IL-17、IL-6、IL-10水平和Th17/Treg细胞比，并记录病人的APACHE II评分、SOFA评分，机械通气时间、住ICU时间、28 d死亡率等预后指标。 结果：与DEN组相比，EEN组在第7天时的IL-23、IL-17、IL-6水平和Th17细胞比、Th17/Treg比值均显著下降；同时，EEN可缩短机械通气时间和住ICU时间，但两组病人28 d死亡率无统计学差异。 结论：EEN可调节脓毒症病人的Th17/Treg细胞比，抑制IL-23/IL-17轴，进而改善免疫失衡，减轻病情严重度，但并未降低28 d死亡率。
Abstract:
Objective: To investigate the roles of Th17 /Treg ratio and IL-23 /IL-17 axis in the effects of early enteral nutrition (EEN) on regulating the immune functions of septic patients. Methods: From October 2017 to June 2018, subjects with sepsis were prospectively enrolled in this observational study, and assigned to EEN and delayed enteral nutrition (DEN) groups randomly. In EEN group, the enteral nutrition (EN) was established within the first 24 hours after admission. In contrast, patients in DEN group received EN on the 4th day after admission. The serum levels of IL-6, IL-10, IL-17, IL-23 and Th17/Treg ratio in septic patients were collected on days 1, 3 and 7 after admission. Furthermore, APACHE II score, SOFA score, mechanical ventilation duration, ICU stay and 28-day mortality of patients in two groups were also recorded. Results: Compared with DEN group, EEN can reduce the serum levels of Th17, IL- 23, IL-17, IL-6 and Th17/Treg ratio; Meanwhile, the mechanical ventilation duration and ICU stay were significantly shorter in EEN group. There were no significant differences in 28-day mortality between two groups. Conclusion: EEN could regulate the Th17 / Treg ratio and inhibit the IL-23 / IL-17 axis, thereby improving immune functions and reducing the disease severity, while failed to reduce the 28-day mortality in patients with sepsis.

参考文献/References:


［1］ Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock:2016. Intensive Care Med, 2017 , 43(3):304-377.
［2］Leentjens J, Kox M, van der Hoeven JG, et al. Immunotherapy for the adjunctive treatment of sepsis: from immunosuppression to immunostimulation. Time for a paradigm change?Am J Respir Crit Care Med, 2013, 187(12):1287-1293.
［3］Gupta DL, Bhoi S, Mohan T, et al. Coexistence of Th1/Th2 and Th17 / Treg imbalances in patients with post traumatic sepsis. Cytokine, 2016, 214–221.
［4］Li J, Li M, Su L, et al. Alterations of T helper lymphocyte subpopulations in sepsis, severe sepsis, and septic shock: a prospective observational study. Inflammation, 2015, 38(3): 995-1002.
［5］ Cauvi DM, Williams MR, Bermudez JA, et al. Elevated expression of IL-23 / IL-17 pathway-related mediators correlates with exacerbation of pulmonary inflammation during polymicrobial sepsis. Shock, 2014, 42(3):246-255.
［6］ Astry B, Venkatesha SH, Moudqil KD. Venkatesha,Moudgil,et al.Involvement of the IL-23/IL-17 axis and the Th17/Treg balance in the pathogenesis and control of autoimmune arthritis.Cytokine, 2015, 74(1): 54–61.
［7］ Lubbers T, Kox M, de Haan JJ, et al. Continuous administration of enteral lipid- and protein-rich nutrition limits inflammation in a human endotoxemia model. Crit Care Med, 2013, 41(5):1258–1265.
［8］ Bhaumik S, Basu R. Cellular and Molecular Dynamics of Th17 Differentiation and its Developmental Plasticity in the Intestinal Immune Response. Front Immunol, 2017, 8: 254.
［9］ Omenetti S, Pizarro TT. The Treg/Th17 Axis: A Dynamic Balance Regulated by the Gut Microbiome. Front Immunol, 2015 Dec,6:639.
［10］Moore FA, Phillips SM, McClain CJ, et al. Nutrition Support for Persistent Inflammation, Immunosuppression, and Catabolism Syndrome. Nutr Clin Pract. 2017, 32(1_suppl):121S-127S.
［11］ Sun JK, Yuan ST, Mu XW, et al. Effects of early enteral nutrition on T helper lymphocytes of surgical septic patients：A retrospective observational study. Medicine (Baltimore), 2017,96(32):e7702.
［12］Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA, 2016, 315(8):801-810.
［13］Sun JK, Li WQ, Ke L, et al. Early enteral nutrition prevents intra abdominal hypertension and reduces the severity of severe acute pancreatitis compared with delayed enteral nutrition:a prospective pilot study. World J Surg, 2013, 37(9):2053-2060.
［14］ Martindale RG, McClave SA, Vanek VW, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition: Executive Summary. Crit Care Med, 2009, 37(5):1757-1761.
［15］Greenberg JA, Hrusch CL, Jaffery MR, et al. Distinct T-helper cell responses to Staphylococcus aureus bacteremia reflect immunologic comorbidities and correlate with mortality. Crit Care, 2018, 22(1):107.
［16］Chen X, Feng Y, Shen X, et al. Anti-sepsis protection of Xuebijing injection is mediated by differential regulation of pro and anti-inflammatory Th17 and T regulatory cells in a murine model of polymicrobial sepsis. J Ethnopharmacol. 2018, 211:358-365.
［17］Guo J, Tao W, Tang D, et al. Th17/regulatory T cell imbalance in sepsis patients with multiple organ dysfunction syndrome: attenuated by high-volume hemofiltration. Int J Artif Organs,2017, 40(11):607-614.
［18］Gaffen SL, Jain R, Garg AV, et al. The IL-23-IL-17 immune axis: from mechanisms to therapeutic testing. Nat Rev Immunol, 2014,14(9):585–600.
［19］马年斌,万 珍,刘剑飞,等. 早期肠内营养对重症脓毒症病人预后的影响. 肠外与肠内营养, 2015，22(3):174-176.
［20］Tian F, Heighes PT, Allingstrup MJ, et al. Early Enteral Nutrition Provided Within 24 Hours of ICU Admission: A Meta-Analysis of Randomized Controlled Trials. Crit Care Med, 2018, 46(7):1049-1056.

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备注/Memo

备注/Memo:
基金项目 ：国家自然科学基金青年基金项目（81701881），南京市医学科技发展项目（YKK15098，YKK17102） 作者简介 ：陈文秀，医师，医学硕士，从事重症医学专业。E-mail：xevia1993@126.com 通讯作者 ：王 翔，E-mail：njdrwx2016@163.com
更新日期/Last Update: 1900-01-01