目的：探讨不同配方肠内营养支持对重症急性胰腺炎（SAP）患者营养状况、肠道屏障功能及全身炎症反应的影响。方法：将120 例SAP 患者随机均分3 组，分别行为肠内免疫营养（IN 组）、肠内要素营养（EN 组）及肠内免疫微生态营养（EIN 组）各40 例，比较3 组患者治疗前与治疗后7、14 d 各项营养指标、外周血内毒素以及氧化应激与炎症反应指标。结果：营养支持治疗前，3 组间各项指标差异均无统计学意义（均P>0.05），治疗后，各组各指标均明显改善，且随时间逐步提高（均P<0.05）。各组间比较显示，EIN 组治疗后7、14 d 血红蛋白、白蛋白、转铁蛋白、前白蛋白水平，以及IL-10、超氧化物歧化酶（SOD）水平明显高于IN 组及EN 组，而血清二胺氧化酶（DAO）、内毒素、丙二醛（MDA）、超敏C 反应蛋白（hs-CRP）、IL-6、TNF-α水平明显低于IN 组和EN 组（均P<0.05）；IN 组和EN 组各项指标在同时间点上差异均无统计学意义（均P>0.05）。结论：肠内免疫微生态营养能有效改善SAP 患者营养状况，保护患者肠道屏障功能，减少氧自由基与血清内毒素水平，有利于改善患者病情转归及预后。
Comparison of efficacy of different formulas of enteral nutrition supports applied in patients with severe acute pancreatitis
Objective: To investigate the influences of enteral nutrition supports of different formulas on nutritional status, intestinal barrier function and systemic inflammatory responses in patients with severe acute pancreatitis (SAP). Methods: One-hundred and twenty SAP patients were equally randomized into 3 groups, and then underwent immune-enhancing enteral nutrition (IN group), elemental enteral nutrition (EN group) and ecological immune enteral nutrition (EIN group), respectively. The nutrition indicators, peripheral blood endotoxin concentrations and parameters of oxidative stress and inflammatory responses before and at 7 and 17 after treatment among the three groups were compared. Results: There was no statistical difference in any of the studied indexes among the three groups before treatment, which were all significantly improved after treatment and progressively with time (all P<0.05). Results of intergroup comparison showed that serum levels of hemoglobin, albumin, transferrin, prealbumin and levels of IL-10 and superoxide dismutase (SOD) were significantly higher, while the serum levels of diamine oxidase (DAO), endotoxins, malondialdehyde (MDA), high-sensitivity C-reactive protein (hs-CRP), IL-6 and TNF-α were significantly lower in EIN group than those in either IN group or EN group at 7 and 14 d after treatment (all P<0.05); all indexes at the same time point showed no statistical difference between IN and EN group (all P>0.05). Conclusion: For SAP patients, ecological immune enteral nutrition can effectively improve the nutritional status, protect intestinal barrier function, lower the levels of oxygen free radicals and serum endotoxins, so it is beneficial to improving the outcome and prognosis of these patients.