在ICU患者及时进行营养干预的障碍:探索预测因素和神经内分泌调节通路
Jiali Liu1,2, Yali Xu1, Yun Xu1,2
1Department of Critical Care Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China.
危急疾病阻碍了早期的营养支持,因为高度炎症和疾病的严重程度. 下丘脑的表观遗传变化可能会调解这些效应,影响营养目标的实现.
科学领域:
- 关键护理医学 关键护理医学
- 营养科学 营养科学
- 分子生物学分子生物学
背景情况:
- 低于最佳的早期营养支持在重症监护病房 (ICU) 中很常见.
- 导致营养支持水平不佳的因素需要阐明.
- 炎症和疾病严重程度是可疑的障碍.
研究的目的:
- 确定危急病患者早期营养支持不足的决定因素.
- 研究系统性炎症和潜在的表观遗传机制的作用.
主要方法:
- 对403名成年ICU患者的营养支持数据 (1-7天) 的回顾性分析.
- 收集患者的人口统计数据,疾病严重程度 (APACHE II),炎症 (CRP,WBC) 和预后指标.
- 使用注射脂聚糖 (LPS) 的老鼠模拟炎症的动物研究,并对甲基化进行下丘脑和骨肌肉组织分析.
主要成果:
- 在第7天未能达到80%目标卡路里的患者的基线APACHE II和CRP得分较高.
- 在热量输送和炎症标志物 (WBC,CRP) 之间观察到逆相关性.
- 在老鼠中,LPS诱导的炎症在下丘脑中显示出依赖时间的甲基化变化,但不是骨肌肉.
结论:
- 系统性炎症和疾病严重程度是严重疾病中实现营养目标的重大障碍.
- 中枢表观遗传调节,特别是下丘脑促进物甲基化,可能是其中的一个关键机制.
- 研究结果表明,在重症患者中改善营养支持的潜在治疗点.
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