限时肠内营养与持续肠内营养对重症卒中患者肠道中短链脂肪酸的影响

Effects of Timed Enteral Nutrition vs. Continuous Enteral Nutrition on Short-Chain Fatty Acids in the Intestine of Critically Ill Stroke Patients

摘要: 目的：本研究通过分析在格拉斯哥昏迷量表(GCS)评分 ≤ 12分或者美国国立卫生研究院卒中量表(NIHSS)评分 ≥ 11分的重症卒中患者肠道菌群代谢产物短链脂肪酸(SCFAs)含量，评价持续肠内营养与限时肠内营养对患者肠道短链脂肪酸的影响，为临床制定重症卒中患者早期肠内营养方案提供参考。方法：入组包头市中心医院神经重症监护室2024.03~2025.05收治的符合纳入标准的重症卒中患者。收集符合纳入标准的患者人口学资料(身高、体重、卒中史、NIHSS评分、GCS评分等)，入组前24 h、入组第7 d时血液样本、新鲜粪便样本，收集入组期间抗生素使用时间。血液样本检测肝肾功能、电解质、空腹血糖、糖化血红蛋白、转铁蛋白、C反应蛋白等。新鲜粪便样本采用气质联用色谱法进行SCFAs (乙酸、丙酸、丁酸、异丁酸、戊酸、异戊酸、己酸)的含量测定。结果：1. 共筛选病例380例，入组30例，限时肠内营养组14例，持续肠内营养组16例；2. 入组前24 h：两组基线资料、血液指标及SCFAs水平无统计学差异(P > 0.05)；3. 入组7 d时：(1) 血液指标：持续肠内营养组天门冬氨酸氨基转移酶、低密度脂蛋白胆固醇、C反应蛋白水平低于限时肠内营养组，差异有统计学意义(P < 0.05)；(2) SCFAs：持续肠内营养组丁酸、异戊酸、戊酸水平高于限时肠内营养组，差异有统计学意义(P < 0.05)，其余短链脂肪酸组间差异无统计学意义(P > 0.05)；4. 抗生素使用相关性分析：限时肠内营养组、持续肠内营养组的抗生素使用时间与各短链脂肪酸变化值均无显著相关性(P > 0.05)。结论：与限时肠内营养相比，持续肠内营养可能更利于维持重症卒中患者肠道菌群代谢产物中丁酸、异戊酸、戊酸的水平，同时可有效改善患者肝功能、调节脂质代谢、减轻机体炎症反应。

Abstract: Objective: This study aimed to evaluate the effects of continuous enteral nutrition versus timed enteral nutrition on the levels of Short-Chain Fatty Acids (SCFAs), metabolites of intestinal flora, in critically ill stroke patients with a Glasgow Coma Scale (GCS) score ≤ 12 or a National Institutes of Health Stroke Scale (NIHSS) score ≥ 11, so as to provide a reference for the clinical formulation of early enteral nutrition regimens for critically ill stroke patients. Methods: Eligible critically ill stroke patients admitted to the Neurological Intensive Care Unit of Baotou Central Hospital from March 2024 to May 2025 were enrolled. Demographic data (height, weight, history of stroke, NIHSS score, GCS score, etc.) were collected. Blood samples and fresh fecal samples were obtained at 24 h before enrollment and on day 7 after enrollment. The duration of antibiotic use during the study period was recorded. Blood samples were tested for liver and renal function, electrolytes, fasting blood glucose, glycosylated hemoglobin, transferrin, C-reactive protein, and other indicators. The concentrations of SCFAs (acetic acid, propionic acid, butyric acid, isobutyric acid, valeric acid, isovaleric acid, caproic acid) in fresh fecal samples were determined by gas chromatography-mass spectrometry. Results: A total of 380 cases were screened, and 30 patients were enrolled, including 14 in the timed enteral nutrition group and 16 in the continuous enteral nutrition group. At 24 h before enrollment, there were no significant differences in baseline data, blood biochemical indicators, or SCFA levels between the two groups (P > 0.05). On day 7 after enrollment: (1) Blood indicators: The levels of aspartate aminotransferase, low-density lipoprotein cholesterol, and C-reactive protein in the continuous enteral nutrition group were significantly lower than those in the timed enteral nutrition group (P < 0.05). (2) SCFAs: The levels of butyric acid, isovaleric acid, and valeric acid in the continuous enteral nutrition group were significantly higher than those in the timed enteral nutrition group (P < 0.05), while no significant differences were observed in other short-chain fatty acids between the two groups (P > 0.05). Correlation analysis of antibiotic use: There was no significant correlation between the duration of antibiotic use and changes in any SCFA levels in either the timed enteral nutrition group or the continuous enteral nutrition group (P > 0.05). Conclusion: Compared with timed enteral nutrition, continuous enteral nutrition may be more conducive to maintaining the levels of butyric acid, isovaleric acid, and valeric acid (intestinal flora metabolites) in critically ill stroke patients, and can effectively improve liver function, regulate lipid metabolism, and alleviate systemic inflammatory response.