medicina51巻13号

2014年12月発行

特集 最新情報をおさえる！—臨床栄養の活用ガイド おさえておこう！　栄養に関する新しい用語や新しい考え方

immunonutrition（免疫栄養法）

著者： 好川謙一¹ 穂苅量太¹ 三浦総一郎¹

所属機関： ¹防衛医科大学校内科学（消化器）

ページ範囲：P.2270 - P.2275

ポイント
◎immunonutrition（免疫栄養法）は従来の経腸栄養の臨床的効果をさらに高める栄養法である．
◎immunonutrients（免疫栄養素）としてグルタミン，アルギニン，ω-3系脂肪酸，核酸などがある．
◎栄養サポートチーム（NST）とも連携し，immunonutritionの適正な使用を心がけることが重要である．

参考文献

1）Heys SD, et al：Enteral nutritional supplementation with key nutrients in patients with critical illness and cancer；A meta-analysis of randomized controlled clinical trials. Ann Surg 229：467-477, 1999

2）Heyland DK, et al：Should immunonutrition become routine in critically ill patients? A systematic review of the evidence. JAMA 286：944-953, 2001

3）Senkal M, et al：Outcome and cost-effectiveness of perioperative enteral immunonutrition in patients undergoing elective upper gastrointestinal tract surgery；A prospective randomized study. Arch of Surg 134：1309-1316, 1999

4）Braga M, et al：Hospital resources consumed for surgical morbidity；Effect of preoperative arginine and omega-3 fatty acid suppkementation on costs. Nutrition 21：1078-1086, 2005

5）土岐　彰：Immunonutritionとは．小児外科40：855-856, 2008

6）村越　智，深柄和彦：Immunonutrientsの種類と作用機序．日臨974：613-616, 2010

7）蛇口達造，他：免疫栄養におけるアルギニン．小児外科40：908-912, 2008

8）荻田桂子，他：Immunonutritionとサイトカイン．小児外科40：879-883, 2008

9）Yoshida H, et al：Fatty acid enhance GRO/CINC-1 and interleukin-6 production in rat intestinal epithelial cells. J Nutr 131：2943-2950, 2001

10）Hara Y, et al：Exposure to fatty acids modulates interferon production by intraepithelial lymphocyte. Immunol Lett 86：139-148, 2005

11）Tsuzuki Y, et al：Enhanced lymphocyte interaction in postcapillary venules of Peyer's patches during fat absorption in rats. Gastroenterology 112：813-825, 1997

12）Matsunaga H, et al：Omega-3 polyunsaturated fatty acids ameliorate the severity of ileitis in the senescence accelerated mice（SAM）Pl/Yit mice model. Clin Exp Immunol 158：325-333, 2009

13）Matsunaga H, et al：Omega-3 fatty acids exacerbate DSS-induced colitis through decreased adiponectin in colonic subepithelial myofibroblasts. Inflamm Bowel Dis 14：1348-1357, 2008

14）Martin FP, et al：Probiotic modulation of symbiotic gut microbial-host metabolic interactions in a humanized microbiome mouse model. Mol Syst Biol, 2008（epub）

15）Di Giacinto C, et al：Probiotics ameliorate recurrent Th1-mediated murine colitis by inducing IL-10 and IL-10-dependent TGF-1β-bearing regulatory cells. J Immunol 174：3237-3246, 2005

16）Okada Y, et al：Propionibacterium freudenreichii component 1,4-dihydroxy-2-naphthoic acid（DHNA）attenuates dextran sodium sulphate induced colitis by modulation of bacterial flora and lymphocyte homing. Gut 55：681-688, 2006

17）Heyland DK, Samis A：Does immunonutrition in patients with sepsis do more harm than god? Intensive Care Medicine 29：669-671, 2003

18）福島亮治，他：栄養管理に置ける位置づけ．日臨974：607-612, 2010

19）Mazaki T, et al：Enteral versus parenteral nutrition after gastrointestinal surgery；A systematic review and meta-analysis of randomized controlled trials in the English literature. J Gastrointest Surg 12：739-755, 2008

20）JASPEN committee：Consensus recommendations from the US summit on immune-enhancing enteral therapy. JPEN 26：S61-63, 2001

21）Martindale RG, et al：Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient. Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition；Executive Summary. Crit Care Med 37：1757-1761, 2009

22）福島亮治，他：臨床への展開．日臨974：617-622, 2010

23）谷口正哲：癌治療と栄養量法─最近の話題から．静脈経腸栄養28：591-595, 2013