食管癌术后肠外营养支持早期机体免疫功能的变化(附30例临床分析)

目的观察食管癌术后肠外营养支持早期机体免疫功能的变化。方法对３０例食管癌病人根治术后，随机分为ＰＮ组和非ＰＮ组进行对比观察，分别在手术前、术后１天及术后８天检测ＩｇＧ、ＩｇＡ、ＩｇＭ、Ｃ３、Ｔ细胞亚群、ＮＫ细胞活性和ＩＬ－２等的改变。结果食管癌病人术前均有不同程度的免疫功能低下，术后第１天，ＩｇＧ、ＩｇＡ、ＩｇＭ、Ｃ３较术前显著下降，术后１周ＰＮ组ＩｇＧ、ＩｇＡ、Ｃ３恢复较快，达到或超过术前水平，与非ＰＮ组比较差异有显著意义（Ｐ＜００１）。ＣＤ＋３、ＣＤ＋４、ＣＤ＋４／ＣＤ＋８比值术后第１天下降明显，而ＰＮ组术后１周迅速恢复并明显超过术前水平，与非ＰＮ组相比差异有显著意义（Ｐ＜００１）。ＮＫ细胞活性术后第１天也明显降低，ＩＬ－２显著减少。术后１周ＮＫ细胞活性ＩＬ－２ＰＮ组较非ＰＮ组恢复较快，差异有显著意义（Ｐ＜００１）。结论食管癌病人术后早期免疫功能低下，应用ＰＮ包括脂肪乳剂可以有效地改善机体的免疫功能，并相应降低术后并发症和病死率。

Early changs of immunity after postoperative parenteral nutrition in patients with esophageal carcinoma(a report of 30 cases).

Objective In order to observe the early changes of postoperative nutrition on immune functions in patients with esophageal carcinoma.Methods 30 patients after radical esophagectomy were enrolled.They were randomized into PN group( n =15)and non-PN group( n =15)and were compared.At day 1 before operation,day 1 after operation and day 8 after operation,IgG,IgA,IgM,C 3,T-Cell subgroups,NK cell activity and IL-2 were detected.Results The immune function of patients with esophageal carcinoma was deficent at different levels.At day 1 after operation,IgG,IgM,IgA,C 3 decreased more significantly than those before opreation.At week 1 post operation,IgG,IgA,C 3 of PN group recovered rapidly and might reach or exceed the level of preoperation.Compared with non-PN group,the difference was significant( P <0 01).CD 3,CD 4,CD 4/CD 8 ratio decreased significantly at day 1 post operation,but in PN group,they recovered rapidly and exceeded the preoperative level.Compared with non-PN group,the difference was significant( P <0 01).At day 1 post operation,NK cell activity and the level of IL-2 decreaced significantly.At week 1 post operation,NK cell activity and IL-2 recovered more rapidly in PN group than in non-PN group,the difference between them was significant( P <0 01).Conclusion The early immune function of patients with esophageal carcinoma was deficient after operation,the use of PN including fat emusion could improve the patient' immune function and decrease the complication and mortality after oepration accordingly.