免疫栄養は,重症患者の場合,日常的に行うべきなのでしょうか? 証拠を体系的に検討する
D K Heyland1, F Novak, J W Drover
1Angada 3, Kingston General Hospital, 76 Stuart St, Kingston, Ontario K7L 2V7, Canada. dkh2@post.queensu.ca
JAMA
|August 31, 2001
まとめ
免疫を強化する栄養素による腸内栄養は,重症患者の感染症合併症を軽減する可能性があるが,全体的な死亡率に大きな影響を与えない. 治療効果は,介入,患者グループ,研究品質によって異なります.
科学分野:
- クリニカル・ニュートリション
- クリティカルケア・メディシン
- 免疫学 免疫学とは
背景:
- 栄養素は免疫反応と炎症反応に影響する.
- 重症患者の免疫強化栄養素の臨床効果は不明である.
研究 の 目的:
- 免疫を強化する腸内栄養と重症患者のアウトカムの関係を調べる.
- 感染症合併症と死亡率への影響を評価する.
主な方法:
- 複数のデータベースからランダム化試験 (1990-2000年) の体系的なレビュー.
- 含まれている研究では,アルギニン,グルタミン,ニュクレオチド,オメガ3脂肪酸による腸内栄養を評価した.
- 感染合併症と死亡率を評価した.
主要な成果:
- 低感染性合併症に関連した免疫栄養 (RR 0.66; 95% CI, 0.54-0.80)
- 全体的な死亡率の有意な利点はない (RR 1.10; 95% CI, 0.93-1.31).
- アルギニンが多く含まれている商業用配方では,合併症が減り,死亡率が低下する傾向を示した.
結論:
- 免疫栄養は感染症の合併症を減少させるかもしれないが,全体的な死亡率は低下しない.
- 治療効果は,介入,患者集団,研究の質に基づいて変動します.
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