精氨酸联合谷氨酰胺胃肠外营养对胃癌患者术后免疫功能的影响

目的评价联合应用精氨酸(Arg)和谷氨酰胺(Glu)的胃肠外营养(PN)对胃癌患者根治术后免疫功能的影响。方法将60例胃癌患者随机平分4组:Arg组、Glu组、Arg+Glu组及常规PN组(Rou组)。术后第1天起各组均连续给予PN支持7 d,均为等氮等热量。另取15例同期行择期手术的普外科腹部手术患者(胃溃疡患者)作为空白对照组。术前、术后第8天分别检测各组的细胞免疫和体液免疫指标。结果术前60例胃癌患者的CD3+、CD4+、CD4+/CD8+、IgA、IgM及IgG均低于空白对照组(P<0.05),CD8+则高于空白对照组(P<0.05)。术后第8天,IgA、IgM、IgG在Arg组、Glu组和Arg+Glu组三组之间差异无统计学意义(P>0.05),三组均高于Rou组(P<0.05);CD3+、CD4+的百分比及CD4+/CD8+比值在Arg组和Glu组组间差异性无统计学意义(P>0.05),两组均高于Rou组(P<0.05),均低于Arg+Glu组(P<0.05);而CD8+的百分比和CRP、C3、C4的浓度与上述相反,CD3+、CD4+及CD4+/CD8+在Arg+Glu组和Rou组组间差异有显著性(P<0.01)。结论Arg和Glu联合应用比单用Arg或Glu更能增强胃癌患者根治术后细胞免疫功能。

Effects of Arginine and Glutamine Enriched Parenteral Nutrition on Immune Function of Patients with Gastric Cancer after Rradical Treatment

Objective To evaluate effects of arginine and glutamine enriched PN on immune function of patients with gastric cancer after radical treatment. Methods Sixty patients with gastric cancer were randomly and equally divided into 4 groups ： Arg group （ Arginine enriched PN, n = 15 ）, Glu group （ Glutarnine supplemented PN, n = 15 ） , Arg ＋ Glu group （ Arginine and Glutamine enriched PN, n = 15 ） and routine PN group （ routing group, n = 15 ）. And 15 patients were taken as control group, who underwent operations due to stomach ulcer. The levels of CD3^＋ CD4^＋ , CD8^＋ , ratio of CD4^＋/CD8^＋ , IgA, IgM and IgG were detected before operation, and on the eighth day after operation. Results Before operation, the levels of CD3^＋ , CD4^＋ , IgA, IgM,IgG and the ratio of CD4^＋/CD3^＋ in 60 patients with gastric cancer were significantly less than those in control group （ P 〈 0.05 ） , while the levels of CD8^＋ were significantly higher than those in control group （ P 〈 0.05 ）. On the eighth day after operation （ POD ＋ 8 ） , the levels of IgA, IgM, IgG were significantly higher in Arg group, Glu group and Arg ＋ Glu group than those in routine PN group （ P 〈 0.05 ）, however between each group,there was no significant difference in concentration. On POD ＋ 8, in Arg group and Glu group wrcentages of CD3^＋ ,CD4^＋ and ratio of CD4^＋/CD8^＋ were significantly higher than those in routine PN group （ P 〈 0.05 ）, which were significantly lower than those in Arg ＋ Glu group （ P 〈 0.05 ）, However, there was no significant difference in percentage between Arg group and Glu group; There were reversed results in percentage of CD8^＋, On POD ＋ 8 percentage of CD3^＋ , CD4^＋ and ratio of CD4^＋/CD8^＋ , in Arg ＋ Glu group were extremely different from those in routine PN group （ P 〈 0.01 ）. Condusion Arg and Glu was more effective than only Arg or Glu enriched one in enhancing cellular immune function for patients after radical treatment of g