• 四川大學(xué)華西醫(yī)院胃腸外科中心（成都 610041）;

目的  探討主要免疫營養(yǎng)素的作用和機(jī)理，并介紹其在臨床腸內(nèi)營養(yǎng)應(yīng)用中的進(jìn)展。 方法  采用文獻(xiàn)復(fù)習(xí)的方法，對(duì)腸內(nèi)免疫營養(yǎng)作用及臨床應(yīng)用情況的相關(guān)文獻(xiàn)加以綜述。結(jié)果  合理實(shí)施腸內(nèi)免疫營養(yǎng)可以改善患者營養(yǎng)狀態(tài)、增強(qiáng)免疫力，達(dá)到降低感染率和縮短住院時(shí)間的效果，消化道腫瘤、移植、慢性肝病、急性胰腺炎等患者可從中受益。但作為一種新型的營養(yǎng)支持方法，其在危重患者中的應(yīng)用仍存在爭議。 結(jié)論  腸內(nèi)免疫營養(yǎng)在消化道腫瘤、器官移植等患者的營養(yǎng)支持方面發(fā)揮著重要作用，但仍須不斷進(jìn)行研究。

引用本文： 陳博,伍曉汀. 腸內(nèi)免疫營養(yǎng)及其臨床應(yīng)用. 中國普外基礎(chǔ)與臨床雜志, 2009, 16(12): 978-981. doi: 復(fù)制

1. Bertolini G, Luciani D, Biolo G. Immunonutrition in septic patients: a philosophical view of the current situation [Ｊ]. Clin Nutr, 2007; 26(1): 25-29.
2. Jones NE, Heyland DK. Pharmaconutrition: a new emerging paradigm [Ｊ]. Curr Opin Gastroenterol, 2008; 24(2): 215-222.
3. Gonzales S, Polizio AH, Erario MA, et al. Glutamine is highly effective in preventing in vivo cobalt-induced oxidative stress in rat liver [Ｊ]. World J Gastroenterol, 2005; 11(23): 3533-3538.
4. Wischmeyer PE. Glutamine: role in critical illness and ongoing clinical trials [Ｊ]. Curr Opin Gastroenterol, 2008; 24(2): 190-197.
5. Peranzoni E, Marigo I, Dolcetti L, et al. Role of arginine metabolism in immunity and immunopathology [Ｊ]. Immunobiology, 2007; 212(9-10): 795-812.
6. Quirino IE, Correia MI, Cardoso VN. The impact of arginine on bacterial translocation in an intestinal obstruction model in rats [Ｊ]. Clin Nutr, 2007; 26(3): 335-340.
7. Alvarez W, Mobarhan S. Finding a place for immunonutrition [Ｊ]. Nutr Rev, 2003; 61(6 Pt 1): 214-218.
8. Grimble RF, Howell WM, O’Reilly G, et al. The ability of fish oil to suppress tumor necrosis factor alpha production by peripheral blood mononuclear cells in healthy men is associated with polymorphisms in genes that influence tumor necrosis factor alpha production [Ｊ]. Am J Clin Nutr, 2002; 76(2): 454-459.
9. Novak TE, Babcock TA, Jho DH, et al. NF-kappa B inhibition by omega -3 fatty acids modulates LPS-stimulated macrophage TNF-alpha transcription [Ｊ]. Am J Physiol Lung Cell Mol Physiol, 2003; 284(1): L84-L89.
10. Trickler WJ, Mayhan WG, Miller DW. Brain microvessel endothelial cell responses to tumor necrosis factor-alpha involve a nuclear factor κB (NF-κB) signal transduction pathway [Ｊ]. Brain Res, 2005; 1048(1-2): 24-31.
11. Calder PC. Immunomodulation by omega-3 fatty acids [Ｊ]. Prostaglandins Leukot Essent Fatty Acids, 2007; 77(5-6): 327-335.
12. Hofmanová J, Vaculová A, Kozubík A. Polyunsaturated fatty acids sensitize human colon adenocarcinoma HT-29 cells to death receptor-mediated apoptosis [Ｊ]. Cancer Lett, 2005; 218(1): 33-41.
13. Mayer K, Schaefer MB, Seeger W. Fish oil in the critically ill: from experimental to clinical data [Ｊ]. Curr Opin Clin Nutr Metab Care, 2006; 9(2): 140-148.
14. American Heart Association Nutrition Committee, Lichtenstein AH, Appel LJ, et al. Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee [Ｊ]. Circulation, 2006; 114(1): 82-96.
15. Sturtzel B, Mikulits C, Gisinger C, et al. Use of fiber instead of laxative treatment in a geriatric hospital to improve the wellbeing of seniors [Ｊ]. J Nutr Health Aging, 2009; 13(2): 136-139.
16. Salvatore S, Hauser B, Vandenplas Y. Chronic enteropathy and feeding [Ｊ]. Nestle Nutr Workshop Ser Pediatr Program, 2007; 59（1）: 115-126.
17. Bengmark S. Ecoimmunonutrition: a challenge for the third millennium [Ｊ]. Nutrition, 1998; 14(7-8): 563-572.
18. Alvarez-Olmos MI, Oberhelman RA. Probiotic agents and infectious diseases: a modern perspective on a traditional therapy [Ｊ]． Clin Infect Dis, 2001; 32(11): 1567-1576.
19. Gupta V, Garg R. Probiotics [Ｊ]. Indian J Med Microbiol, 2009; 27(3): 202-209.
20. 于江濤, 陳利生. 腸內(nèi)微生態(tài)營養(yǎng)支持與結(jié)直腸癌的治療 [Ｊ]. 結(jié)直腸肛門外科, 2008; 14(3): 216-219.
21. Peng S, Lin JY, Lin MY. Antiallergic effect of milk fermented with lactic acid bacteria in a murine animal model [Ｊ]. J Agric Food Chem, 2007; 55(13): 5092-5096.
22. Callaway TR, Edrington TS, Anderson RC, et al. Probiotics, prebiotics and competitive exclusion for prophylaxis against bacterial disease [Ｊ]. Anim Health Res Rev, 2008; 9(2): 217-225.
23. Qin HL, Zheng JJ, Tong DN, et al. Effect of Lactobacillus plantarum enteral feeding on the gut permeability and septic complications in the patients with acute pancreatitis [Ｊ]. Eur J Clin Nutr, 2008; 62(7): 923-930.
24. 朱翠鳳, 劉曉平, 白植軍, 等. 生態(tài)免疫營養(yǎng)對(duì)消化道惡性腫瘤患者術(shù)后營養(yǎng)狀況、炎癥反應(yīng)和預(yù)后的影響 [Ｊ]. 中國臨床營養(yǎng)雜志, 2007; 15(2): 90-94.
25. 唐朝暉, 余彥, 白祥軍, 等. 生態(tài)免疫腸內(nèi)營養(yǎng)對(duì)嚴(yán)重多發(fā)傷患者調(diào)節(jié)性T細(xì)胞的影響 [Ｊ]. 中國急救醫(yī)學(xué), 2008; 28(7): 583-585.
26. 胡建昆． 外科手術(shù)后早期腸內(nèi)營養(yǎng) [Ｊ]． 中國普外基礎(chǔ)與臨床雜志， 2003； 10(4)： 407-409.
27. 李江， 劉斌， 侯宇， 等． 腹部外科術(shù)后早期腸內(nèi)營養(yǎng)的臨床研究與應(yīng)用 [Ｊ]． 中國普外基礎(chǔ)與臨床雜志， 2006; 13(3): 355-357.
28. Takeuchi H, Ikeuchi S, Kawaguchi Y, et al. Clinical significance of perioperative immunonutrition for patients with esophageal cancer [Ｊ]. World J Surg, 2007; 31(11): 2160-2167.
29. Moskovitz DN, Kim YI. Does perioperative immunonutrition reduce postoperative complications in patients with gastrointestinal cancer undergoing operations? [Ｊ]. Nutr Rev, 2004; 62(11): 443-447.
30. Braga M, Gianotti L. Preoperative immunonutrition: cost-benefit analysis [Ｊ]. JPEN J Parenter Enteral Nutr, 2005; 29(1 Suppl): S57-S61.
31. Braga M, Gianotti L, Vignali A, et al. Preoperative oral arginine and ω-3 fatty acid supplementation improves the immunometabolic host response and outcome after colorectal resection for cancer [Ｊ]. Surgery, 2002; 132(5): 805-814.
32. 江志偉, 李寧, 黎介壽. 消化道腫瘤病人術(shù)前腸內(nèi)免疫營養(yǎng)支持 [Ｊ]. 中國實(shí)用外科雜志, 2005; 25(5): 305-306.
33. Warnecke HB, Schirmeier A, Nüssler AK, et al. The combined treatment with L-arginine and methylprednisolone improves graft morphology and mucosal barrier function [Ｊ]. Transplant Proc, 2002; 34(3): 996-998.
34. Alexander JW, Metze TJ, McIntosh MJ, et al. The influence of immunomodulatory diets on transplant success and complications [Ｊ]. Transplantation, 2005; 79(4): 460-465.
35. Nickkholgh A, Schneider H, Encke J, et al. PROUD: Ef-fects of preoperative long-term immunonutrition in patients listed for liver transplantation [Ｊ]. Trials, 2007; 8（1）: 20.
36. 趙德芳, 陳大志, 張珂, 等. 肝移植圍手術(shù)期腸內(nèi)免疫營養(yǎng)治療的觀察 [Ｊ]. 腸外與腸內(nèi)營養(yǎng), 2008; 15(2): 88-91.
37. 次仁桑珠， 王征夏， 張輝， 等. 免疫營養(yǎng)劑對(duì)器官移植的作用 [Ｊ]. 中國普外基礎(chǔ)與臨床雜志, 2007; 14(2): 243-244.
38. 李為蘇, 黎介壽. 肝硬化患者營養(yǎng)不良與圍手術(shù)期營養(yǎng)支持 [Ｊ]. 實(shí)用臨床醫(yī)藥雜志, 2004; 8(5): 26-28.
39. Mssner J, Teich N. Nutrition in acute pancreatitis [Ｊ]. Z Gastroenterol, 2008; 46(8): 784-789.
40. Darvas K, Futó J, Okrs I, et al. Principles of intensive care in severe acute pancreatitis in 2008 [Ｊ]. Orv Hetil, 2008; 149(47): 2211-2220.
41. Montejo JC, Zarazaga A, López-Martínez J, et al. Immunonutrition in the intensive care unit. A systematic review and consensus statement [Ｊ]. Clin Nutr, 2003; 22(3): 221-233.
42. Marik PE, Zaloga GP. Immunonutrition in critically ill patients: a systematic review and analysis of the literature [Ｊ]. Intensive Care Med, 2008; 34(11): 1980-1990.
43. Galbán C, Montejo JC, Mesejo A, et al. An immune-enhancing enteral diet reduces mortality rate and episodes of bacteremia in septic intensive care unit patients [Ｊ]. Crit Care Med, 2000; 28(3): 643-648.
  1. 1. Bertolini G, Luciani D, Biolo G. Immunonutrition in septic patients: a philosophical view of the current situation [Ｊ]. Clin Nutr, 2007; 26(1): 25-29.
  2. 2. Jones NE, Heyland DK. Pharmaconutrition: a new emerging paradigm [Ｊ]. Curr Opin Gastroenterol, 2008; 24(2): 215-222.
  3. 3. Gonzales S, Polizio AH, Erario MA, et al. Glutamine is highly effective in preventing in vivo cobalt-induced oxidative stress in rat liver [Ｊ]. World J Gastroenterol, 2005; 11(23): 3533-3538.
  4. 4. Wischmeyer PE. Glutamine: role in critical illness and ongoing clinical trials [Ｊ]. Curr Opin Gastroenterol, 2008; 24(2): 190-197.
  5. 5. Peranzoni E, Marigo I, Dolcetti L, et al. Role of arginine metabolism in immunity and immunopathology [Ｊ]. Immunobiology, 2007; 212(9-10): 795-812.
  6. 6. Quirino IE, Correia MI, Cardoso VN. The impact of arginine on bacterial translocation in an intestinal obstruction model in rats [Ｊ]. Clin Nutr, 2007; 26(3): 335-340.
  7. 7. Alvarez W, Mobarhan S. Finding a place for immunonutrition [Ｊ]. Nutr Rev, 2003; 61(6 Pt 1): 214-218.
  8. 8. Grimble RF, Howell WM, O’Reilly G, et al. The ability of fish oil to suppress tumor necrosis factor alpha production by peripheral blood mononuclear cells in healthy men is associated with polymorphisms in genes that influence tumor necrosis factor alpha production [Ｊ]. Am J Clin Nutr, 2002; 76(2): 454-459.
  9. 9. Novak TE, Babcock TA, Jho DH, et al. NF-kappa B inhibition by omega -3 fatty acids modulates LPS-stimulated macrophage TNF-alpha transcription [Ｊ]. Am J Physiol Lung Cell Mol Physiol, 2003; 284(1): L84-L89.
  10. 10. Trickler WJ, Mayhan WG, Miller DW. Brain microvessel endothelial cell responses to tumor necrosis factor-alpha involve a nuclear factor κB (NF-κB) signal transduction pathway [Ｊ]. Brain Res, 2005; 1048(1-2): 24-31.
  11. 11. Calder PC. Immunomodulation by omega-3 fatty acids [Ｊ]. Prostaglandins Leukot Essent Fatty Acids, 2007; 77(5-6): 327-335.
  12. 12. Hofmanová J, Vaculová A, Kozubík A. Polyunsaturated fatty acids sensitize human colon adenocarcinoma HT-29 cells to death receptor-mediated apoptosis [Ｊ]. Cancer Lett, 2005; 218(1): 33-41.
  13. 13. Mayer K, Schaefer MB, Seeger W. Fish oil in the critically ill: from experimental to clinical data [Ｊ]. Curr Opin Clin Nutr Metab Care, 2006; 9(2): 140-148.
  14. 14. American Heart Association Nutrition Committee, Lichtenstein AH, Appel LJ, et al. Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee [Ｊ]. Circulation, 2006; 114(1): 82-96.
  15. 15. Sturtzel B, Mikulits C, Gisinger C, et al. Use of fiber instead of laxative treatment in a geriatric hospital to improve the wellbeing of seniors [Ｊ]. J Nutr Health Aging, 2009; 13(2): 136-139.
  16. 16. Salvatore S, Hauser B, Vandenplas Y. Chronic enteropathy and feeding [Ｊ]. Nestle Nutr Workshop Ser Pediatr Program, 2007; 59（1）: 115-126.
  17. 17. Bengmark S. Ecoimmunonutrition: a challenge for the third millennium [Ｊ]. Nutrition, 1998; 14(7-8): 563-572.
  18. 18. Alvarez-Olmos MI, Oberhelman RA. Probiotic agents and infectious diseases: a modern perspective on a traditional therapy [Ｊ]． Clin Infect Dis, 2001; 32(11): 1567-1576.
  19. 19. Gupta V, Garg R. Probiotics [Ｊ]. Indian J Med Microbiol, 2009; 27(3): 202-209.
  20. 20. 于江濤, 陳利生. 腸內(nèi)微生態(tài)營養(yǎng)支持與結(jié)直腸癌的治療 [Ｊ]. 結(jié)直腸肛門外科, 2008; 14(3): 216-219.
  21. 21. Peng S, Lin JY, Lin MY. Antiallergic effect of milk fermented with lactic acid bacteria in a murine animal model [Ｊ]. J Agric Food Chem, 2007; 55(13): 5092-5096.
  22. 22. Callaway TR, Edrington TS, Anderson RC, et al. Probiotics, prebiotics and competitive exclusion for prophylaxis against bacterial disease [Ｊ]. Anim Health Res Rev, 2008; 9(2): 217-225.
  23. 23. Qin HL, Zheng JJ, Tong DN, et al. Effect of Lactobacillus plantarum enteral feeding on the gut permeability and septic complications in the patients with acute pancreatitis [Ｊ]. Eur J Clin Nutr, 2008; 62(7): 923-930.
  24. 24. 朱翠鳳, 劉曉平, 白植軍, 等. 生態(tài)免疫營養(yǎng)對(duì)消化道惡性腫瘤患者術(shù)后營養(yǎng)狀況、炎癥反應(yīng)和預(yù)后的影響 [Ｊ]. 中國臨床營養(yǎng)雜志, 2007; 15(2): 90-94.
  25. 25. 唐朝暉, 余彥, 白祥軍, 等. 生態(tài)免疫腸內(nèi)營養(yǎng)對(duì)嚴(yán)重多發(fā)傷患者調(diào)節(jié)性T細(xì)胞的影響 [Ｊ]. 中國急救醫(yī)學(xué), 2008; 28(7): 583-585.
  26. 26. 胡建昆． 外科手術(shù)后早期腸內(nèi)營養(yǎng) [Ｊ]． 中國普外基礎(chǔ)與臨床雜志， 2003； 10(4)： 407-409.
  27. 27. 李江， 劉斌， 侯宇， 等． 腹部外科術(shù)后早期腸內(nèi)營養(yǎng)的臨床研究與應(yīng)用 [Ｊ]． 中國普外基礎(chǔ)與臨床雜志， 2006; 13(3): 355-357.
  28. 28. Takeuchi H, Ikeuchi S, Kawaguchi Y, et al. Clinical significance of perioperative immunonutrition for patients with esophageal cancer [Ｊ]. World J Surg, 2007; 31(11): 2160-2167.
  29. 29. Moskovitz DN, Kim YI. Does perioperative immunonutrition reduce postoperative complications in patients with gastrointestinal cancer undergoing operations? [Ｊ]. Nutr Rev, 2004; 62(11): 443-447.
  30. 30. Braga M, Gianotti L. Preoperative immunonutrition: cost-benefit analysis [Ｊ]. JPEN J Parenter Enteral Nutr, 2005; 29(1 Suppl): S57-S61.
  31. 31. Braga M, Gianotti L, Vignali A, et al. Preoperative oral arginine and ω-3 fatty acid supplementation improves the immunometabolic host response and outcome after colorectal resection for cancer [Ｊ]. Surgery, 2002; 132(5): 805-814.
  32. 32. 江志偉, 李寧, 黎介壽. 消化道腫瘤病人術(shù)前腸內(nèi)免疫營養(yǎng)支持 [Ｊ]. 中國實(shí)用外科雜志, 2005; 25(5): 305-306.
  33. 33. Warnecke HB, Schirmeier A, Nüssler AK, et al. The combined treatment with L-arginine and methylprednisolone improves graft morphology and mucosal barrier function [Ｊ]. Transplant Proc, 2002; 34(3): 996-998.
  34. 34. Alexander JW, Metze TJ, McIntosh MJ, et al. The influence of immunomodulatory diets on transplant success and complications [Ｊ]. Transplantation, 2005; 79(4): 460-465.
  35. 35. Nickkholgh A, Schneider H, Encke J, et al. PROUD: Ef-fects of preoperative long-term immunonutrition in patients listed for liver transplantation [Ｊ]. Trials, 2007; 8（1）: 20.
  36. 36. 趙德芳, 陳大志, 張珂, 等. 肝移植圍手術(shù)期腸內(nèi)免疫營養(yǎng)治療的觀察 [Ｊ]. 腸外與腸內(nèi)營養(yǎng), 2008; 15(2): 88-91.
  37. 37. 次仁桑珠， 王征夏， 張輝， 等. 免疫營養(yǎng)劑對(duì)器官移植的作用 [Ｊ]. 中國普外基礎(chǔ)與臨床雜志, 2007; 14(2): 243-244.
  38. 38. 李為蘇, 黎介壽. 肝硬化患者營養(yǎng)不良與圍手術(shù)期營養(yǎng)支持 [Ｊ]. 實(shí)用臨床醫(yī)藥雜志, 2004; 8(5): 26-28.
  39. 39. Mssner J, Teich N. Nutrition in acute pancreatitis [Ｊ]. Z Gastroenterol, 2008; 46(8): 784-789.
  40. 40. Darvas K, Futó J, Okrs I, et al. Principles of intensive care in severe acute pancreatitis in 2008 [Ｊ]. Orv Hetil, 2008; 149(47): 2211-2220.
  41. 41. Montejo JC, Zarazaga A, López-Martínez J, et al. Immunonutrition in the intensive care unit. A systematic review and consensus statement [Ｊ]. Clin Nutr, 2003; 22(3): 221-233.
  42. 42. Marik PE, Zaloga GP. Immunonutrition in critically ill patients: a systematic review and analysis of the literature [Ｊ]. Intensive Care Med, 2008; 34(11): 1980-1990.
  43. 43. Galbán C, Montejo JC, Mesejo A, et al. An immune-enhancing enteral diet reduces mortality rate and episodes of bacteremia in septic intensive care unit patients [Ｊ]. Crit Care Med, 2000; 28(3): 643-648.