肠内免疫营养对胃癌手术病人免疫功能和急性炎性反应的调理作用

目的 :观察胃癌病人围手术期使用肿瘤特异性肠内免疫营养物 Supportan对病人的营养、免疫和急性炎性反应的调理作用。　方法 :本研究是一个前瞻、随机、单盲、对照的临床研究。30例营养不良择期手术的胃癌病人 ,随机分为两组 :1、免疫营养组 (Supportan,n=15 ) ,2、标准营养组 (能全素 Nutrison,n=15 )。两组使用等热量肠内营养 ,12 5 k J(30 kcal) / (kg· d)。术前置鼻胃管 ,使用 7天。术中均行空肠造口 ,术后 12小时开始空肠输注肠内营养 ,连续 7天。术前第 8、1天 ;术后第 1、8天抽取静脉血 ,检测血清白蛋白、前白蛋白、转铁蛋白、T淋巴细胞亚群、血清免疫球蛋白、血清 IL - 6、CRP、PGE2 浓度。　结果 :两组病人术后均有急性炎性反应的发生和免疫功能的降低。但免疫营养组比标准营养组的术后第 1、8天的 CD4/ CD8比值、血清 Ig G水平有显著增加 ;血清 IL- 6、CRP、PGE2 有显著下降 ;术后第 8天血清前白蛋白浓度有显著增加。　结论 :胃癌合并营养不良的病人围手术期使用肠内免疫营养物 Supportan可以改善手术后免疫功能的低下 ,缓解急性相炎性反应和增加内脏蛋白的合成。

The effect of perioperative enteral immunonutrition on host immune and inflammatory responses in malnourished gastric cancer surgical patients

Objectives: To evaluate the effect of perioperative immunonutrition (Supportan) on host immune and inflammatory responses in malnourished gastric cancer surgical patients . Methods : This was a prospective , randomized , single blind , controlled trial . 30 malnourished gastric cancer patients were randomized to receive either an enriched enteral diet ,Supportan( n =15) or a control isocaloric standard enteral diet , Nutrison ( n =15) .For 7 days before surgery , the patients received enteral nutrition by continuous pump infusion via a nasogastric tube . Jejunal infusion was started 12 hours after surgery and continued for 7 days . The daily nutritional goal was 125 kJ(30 kcal)/kg . Postoperative immune and inflammatory responses were investigated by lymphocyte subsets , serum levels of immunoglobulins , C reactive protein ( CRP ) ,interleukin 6 ( IL 6 ) and PGE 2 . Prealbumin , transferrin , and albumin were determined as nutritional indicators. Results : There were significant postoperative changes in inflammatory responses , immunological and nutritional variables in both groups . CD4/CD8 ratio and IgA levels in immunonutrition group were higher ( P < 0.05 ) than in the standard group on postoperative day ( POD ) 1, 8 . CRP , IL 6 and PGE 2 levels were lower ( P < 0.05) in immunonutrition group than in the standard group on POD 1 , 8 . Prealbumin level recovered more ( P < 0.05) in the immunonutrition group than in standard group on POD 8. Conclusions : Perioperative administration of immunonutrition (Supportan) in malnourished cancer patients can ameliorate the host defense, controll inflammatory responses and improve nutritional status.