免疫微生态肠内营养在合并糖尿病的胃肠道肿瘤患者中的应用

目的探讨由益生菌、谷氨酰氨、深海鱼油和短肽肠内营养组成的免疫微生态肠内营养制剂对合并糖尿病的胃肠道肿瘤患者术后恢复的影响。方法将2007年1月至2010年10月期间山东省聊城市人民医院收治的67例合并糖尿病的胃肠道肿瘤患者,按随机数字表法分为治疗组（33例．添加益生菌、谷氨酰胺和深海鱼油的免疫微生态肠内营养制剂）和对照组（34例,普通肠内营养）。分别于术前、术后3d和术后7d检测空腹血糖、空腹胰岛素（FINS）、胰岛素抵抗指数（InHOMA．IR）、T淋巴细胞亚群水平（CD3＋、CD4＋、CD8＋、CD4／CD8）及自然杀伤（NK）细胞计数,并观察院内感染发生率、肠功能恢复时间和住院时间。结果术后7d,治疗组空腹胰岛素和InHOMA．IR明显低于对照组,分别为（8．4±3．7）mU／L比（13．7±5．4）mU／L（P〈0．05）和1．1±0．2比1．7±0．4（P〈0．05）;治疗组CD4＋（45．2±5．4）％]、CD4／CD8（2．1±0．3）及NK细胞计数（19．5±6．6）％]明显高于对照组（38．1±2．9）％、1．6±0．2及（15．4±5．6）％,均P〈0．05]。两组患者院内感染发生率6．1％（2／33）比17．6％（6／34）,P〉0．05]和肠功能恢复时间（69．3±9．5）h比（70．1±11．6）h,P〉0．05]的差异无统计学意义,但住院时间治疗组明显短于对照组（17±3．8）d比（21±4．2）d,P〈0．05]。结论对合并糖尿病的胃肠道肿瘤患者。应用免疫微生态肠内营养能降低胰岛素抵抗,改善免疫状态,促进患者术后恢复。

Application of microbiological and immunological enteral nutrition in patients with gastrointestinal cancer complicated with diabetes mellitus

Objective To investigate the effects of microbiological and immunological enteral nutrition using composition of probiotics, glutamine, fish oil, and peptisorb on patients with gastrointestinal cancer complicated with diabetes mellitus. Methods From January 2007 to October 2010, 67 patients with gastrointestinal cancer complicated with diabetes mellitus were admitted to the Liaocheng People＇s Hospital of Shandong Province and were randomized into the treatment group （n=33, enteral nutrition with probiotics, glutamine, and fish oil） and the routine group （n=34, regular enteral nutrition）. Fasting blood glucose（FBG）, insulin （FINS）, number of lymphocytes （including CD3＋T cell, CD4＋T cell, CD8＋T cell, CD4＋/CD8＋） and natural killer （NK） cells of the two groups were detected on the day before surgery and postoperative day 3 and 7. Insulin resistance index （InHOMA-IR） was calculated by using the homeostasis model assessment （HOMA）. The incidence of nosocomial infections and intestinal function recovery time, and length of hospital stay were collected. Results On postoperative day 7, FINS （8.4±3.7） mU/L vs. （13.7±5.4） mU/L, P〈0.05] and InHOMA-IR （1.11±0.23 vs. 1.68±0.39, P〈0.05） were lower in the treatment group than that in the routine group. The number of CD4＋ （45.2＋5.4）% vs. （38.1±2.9）%, P〈 0.05], CD4/CD8 （2.05±0.27 vs. 1.58±0.16, P〈0.05）, and NK cells （19.5±6.6）% vs. （15.4±5.6）%, P〈0.05 ] were higher in the treatment group. There were no significant differences in nosocomial infection 6.1%（2/33） vs. 17.6%（6/34）, P〉0.05] and intestinal function recovery time （69.3±9.5） h vs. （70.1±11.6） h, P〉0.05] between the two groups. However, the length of hospital stay （17±3.8） d vs. （21± 4.2） d, P〈0.05] was significantly shorter in the treatment group. Conclusion For patients with gastrointestinal cancer complicated with diabetes mellitus, microbiota enteral nutrition can reduce insulin resistance, improve the immune status, and promote postoperative recovery.