免疫調節配方對急性呼吸窘迫症候群病患之營養及抗氧化狀況的影響

Effects of an Immunomodulatory Formula on the Nutritional and Antioxidative Status of Patients with Acute Respiratory Distress Syndrome

急性呼吸窘迫症候群（Acute respiratory distress syndrome, ARDS）患者處於過度發炎反應伴隨高異化代謝及體內氧化物與抗氧化物失衡的狀況。本研究為前瞻性觀察試驗，欲探討免疫調節配方對ARDS 病患，是否可改善其營養狀況、抗氧化狀態。受試者經由腸胃道供應添加魚油、γ-亞麻油酸和抗氧化維生素的免疫調節配方，共灌食7天。分析和比較受試者在使用特殊配方前後之營養狀況（白蛋白、前白蛋白和氮平衡）、氧化傷害指標、抗氧化能力和抗氧化維生素濃度等之差異性。結果顯示，研究期間16 位受試者平均熱量攝取為1450.5±237.8kcal/day（達需求量的106.3±18.3%），蛋白質為88.0±22.0 g/day（達需求量的101.8±20.5%）；觀察試驗期間，C-反應蛋白明顯降低（<0.05）；前白蛋白值及抗氧化維生素C、E和β-胡蘿蔔素濃度均顯著增加（<0.05）。然而，氧化傷害指標及總抗氧化能力於研究前後無顯著差異。根據本研究結果，供應ARDS患者使用免疫調節配方，可改善其營養狀況與發炎反應，且對體內抗氧化狀態具正面影響。

Patients with acute respiratory distress syndrome (ARDS) are in a state of excessive inflammation complicated with hypercatabolism and an oxidant-antioxidant imbalance. In this prospective observational study, we investigated whether an immunomodulatory formulas can improve the nutritional indicators and the antioxidative status in ARDS patients. Subjects received enteral feeding enriched with eicosapentaenoic acid, γ-linolenic acid, and antioxidant vitamins for 7 days. The effects of the immunomodulatory formulas on the nutritional status (albumin, prealbumin, and nitrogen balance), oxidative stress index, antioxidant capacity, and antioxidant vitamins levels were examined. Results showed that 16 subjects received adequate caloric intake of 1450.5 ± 237.8 kcal/day (about 106.3% ± 18.3 % of the estimated requirement) and adequate protein intake 88.0 ± 22.0 g/day (about 101.8% ± 20.5% of the estimated requirement)during the study period. After the study, the level of C-reactive protein (CRP) was significantly reduced (p ＜ 0.05), while the prealbumin level and concentrations of the antioxidant vitamins C and E, and β-carotene had all significantly increased (P ＜ 0.05). However, there were no significant differences in the oxidative stress index or the antioxidant capacity after the intervention. Results of this study indicate that enteral feeding with an immunomodulatory formulas can significantly improve the nutritional status (prealbumin) and inflammatory markers (CRP), and has a positive effect on the antioxidative status (vitamins C and E and β-carotene)in ARDS patients.