胃肠道肿瘤患者术前肠内免疫营养支持

目的　探讨胃肠道肿瘤术前应用免疫肠内营养对提高患者术后营养状况和免疫状态的作用,评价其对术后并发症和感染的影响,以及是否可减少术后平均住院天数。方法　选取 60例行胃肠道肿瘤手术的患者,随机分为 2组,实验组 (EN组 )术前 7天予含精氨酸、RNA和ω 3多不饱和脂肪酸的肠内免疫营养支持,对照组(CONT组)术前常规饮食准备。观察术前和术后营养和免疫指标,以及术后并发症、感染的发生人次和术后平均住院天数。结果　EN组术前营养状况和免疫指标与对照组相比差异无统计学意义。CONT组术后第 3天血清前白蛋白(PALB)和转铁蛋白(TRF)水平明显低于术前(P<0. 01),术后第 7天TRF水平仍明显低于术前。而EN组仅术后第 3天PALB明显低于术前,其余与术前比较差异无统计学意义,且术后第 7天PALB水平明显高于CONT组 (P<0. 05)。CONT组术后补体水平明显低于术前。EN组术后补体水平与术前比较差异无统计学意义,明显高于CONT组 (P<0. 05);术后IgG水平明显高于CONT组 [ ( 13. 35±2. 06 )g/L比 ( 9. 59±2. 23 )g/L,P<0. 05 ],术后CD4 /CD8比值明显高于CONT组(2. 10±0. 51比 1. 62±0. 52)。EN组术后并发症和感染的发生率明显低于CONT组,平均术后住院天数明显下降。结论　胃肠道肿瘤患者术前使用肠内免疫营养可明显提高     

术后早期肠内免疫营养对老年胰腺癌、胃癌患者免疫的影响

目的观察术后早期肠内免疫营养对老年胰腺癌、胃癌患者机体免疫功能的影响.方法采用前瞻性、开放性研究,选择20例胰腺癌、40例胃癌患者分别应用免疫营养制剂(士强,荷兰Nutricia公司产品)(n=30)和对照剂能全力(无锡Nutricia公司产品)(n=30)治疗.均于术后第二天开始等热卡肠内营养支持7 d(30 kcal*kg-1*d-1).检测术前、术后第1天、5天、8天的营养及免疫指标.结果 1.两组病例术后免疫球蛋白(IgG、IgM、IgA)下降(P<0.01),肠内营养支持7 d,两组病例T细胞亚群无显著改变(P>0.05);试验组IgA较术前提高(P<0.05),对照组IgG下降(P<0.05),IgM显著上升(P<0.01).两组病例术后血浆IL-6水平上升(P<0.05),IL-10水平降低(P<0.05).2.术后氮平衡测定肠内营养支持后两组累计氮值为负氮平衡;两组的体重、三角肌皮褶厚度、上臂周径均显著下降(P<0.01);试验组与对照组均出现血清白蛋白、转铁蛋白下降(P<0.05).结论老年胰腺癌、胃癌患者手术后免疫抑制主要表现为血清免疫球蛋白浓度下降;术后早期肠内免疫营养支持可改善患者的体液免疫功能,特别是显著提高血清IgA浓度.     

术后早期肠内免疫营养对老年胰腺癌、胃癌患者免疫的影响

目的 观察术后早期肠内免疫营养对老年胰腺癌、胃癌患者机体免疫功能的影响。方法采用前瞻性、开放性研究,选择20例胰腺癌、40例胃癌患者分别应用免疫营养制剂(士强,荷兰Nutricia公司产品)(n=30)和对照剂能全力(无锡Nutricia公司产品)(n=30)治疗。均于术后第二天开始等热卡肠内营养支持7d(30keal·kg~(-1)·d~(-1))。检测术前、术后第1天、5天、8天的营养及免疫指标。结果 1.两组病例术后免疫球蛋白(IgG、IgM、IgA)下降(P<0.01),肠内营养支持7d,两组病例T细胞亚群无显著改变(P>0.05);试验组IgA较术前提高(P相似文献   

Perioperative artificial nutrition in malnourished gastrointestinal cancer patients

AIM: To investigate the potential role of perioperative nutrition in reducing complications and mortality in malnourished gastrointestinal cancer patients. METHODS: Four hundred and sixty-eight elective moderately or severely malnourished surgical patients with gastric or colorectal cancers defined by the subjective global assessment (SGA) were randomly assigned to 7 d preoperative and 7 d postoperative parenteral or enteral nutrition vs a simple control group. The nutrition regimen included 24.6±5.2 kcal/kg per d non-protein and 0.23±0.04 g nitrogen /kg per d. Control patients did not receive preoperative nutrition but received 600±100 kcal non-protein plus or not plus 62±16 g crystalline amino acids postoperatively. RESULTS: Complications occurred in 18.3% of the patients receiving nutrition and in 33.5% of the control patients (P=0.012). Fourteen patients died in the control group and 5 in those receiving nutrition. There were significant differences in the mortality between the two groups (2.1% vs 6.0%, P=0.003). The total length of hospitalization and postoperative stay of control patients were significantly longer (29 vs 22 d, P = 0.014) than those of the studied patients (23 vs 12 d. P=0.000). CONCLUSION: Perioperative nutrition support is beneficial for moderately or severely malnourished gastrointestinal cancer patients and can reduce surgical complications and mortality.     

Modulation of postoperative immune and inflammatory response by immune-enhancing enteral diet in gastrointestinal cancer patients

AIM To evaluate if the administration of anenteral diet supplemented with glutamine,arginine and ω-3-fatty acids modulatesinflammatory and immune responses aftersurgery.METHODS A prospective randomized double-blind,clinical trial was performed.Forty-eightpatients with gastrointestinal cancer wererandomized into two groups,one group wasgiven an isocaloric and isonitrogenous standarddiet and the other was fed with the supplementeddiet with glutamine,arginine and ω-3-fattyacids.Feedings were started within 48 hoursafter operation,and continued until day 8.Allvariables were measured before operation andon postoperative day 1 and 8.Immune responseswere determined by phagocytosis ability,respiratory burst of polymorphonuclear cells,total lymphocytes lymphocyte subsets,nitricoxide,cytokines concentration,andinflammatory responses by plasma levels of C-reactive protein,prostaglandin E_2 level.RESULTS Tolerance of both formula diets wasexcellent.There were significant differences inthe immunological and inflammatory responsesbetween the two groups.In supplementedgroup,phagocytosis and respiratory burst aftersurgery was higher and C-reactive protein levelwas lower(P<0.01)than in the standard group.The supplemented group had higher levels ofnitric oxide,total lymphocytes,T lymphocytes,T-helper cells,and NK cells.Postoperativelevels of IL-6 and TNF-α were lower in thesupplemented group(P<0.05). CONCLUSION It was clearly established in thistrial that early postoperative enteral feeding issafe in patients who have undergone majoroperations for gastrointestinal cancer.Supplementation of enteral nutrition withglutamine,arginine,and ω-3 fatty acidspositively modulated postsurgicalimmunosuppressive and inflammatoryresponses.     

Application of bleeding prophylactic criteria (NICE) in patients with acute gastrointestinal bleeding. A Swiss prospective study

Multiple treatment guidelines for nonsteroidal anti-inflammatory drugs (NSAIDs) suggest that patients with one or more risk factors for NSAID-related ulcer complications should be prescribed preventive strategies such as acid-suppressive drugs, misoprostol or COX-2-specific inhibitors to reduce their risk of serious ulcer complications. However data are lacking as to how many patients have been on preventive measures in accordance to the National Institute for Clinical Excellence (NICE) criteria in our population. We therefore evaluated the extent to which patients with acute gastrointestinal bleeding have been under ulcer-preventive strategies at the time of hospital entry. In a one-year-bleeding-study at the Waid city hospital, Zürich, ulcer preventive treatment was practiced in only 25% of 214 patients with acute gastrointestinal bleeding. We conclude that ulcer prevention in everyday medical practice is still being seldom applied.     

Post-colectomy assessment of gastrointestinal function: a prospective study on colorectal cancer patients

Background

Anatomical changes after intestinal resection and the effects of adjuvant treatment for colorectal cancer may lead to gastrointestinal disturbances. The aim of our study was to assess gastrointestinal function using validated health-related quality of life (HRQoL) questionnaires that are able to reliably quantify patients’ symptoms.

Methods

Two hundred and eighty-nine colorectal cancer patients underwent HRQoL assessment preoperatively and at 3,6 and 12 months postoperatively. They were evaluated with the Gastrointestinal Quality of Life Index (GIQLI) [“global” and “symptoms” scales and questions 3 (“bloating”), 4 (“excessive gas”), 6 (“gurgling noises”), 7 (“frequent bowel movements (BMs)”), 30 (“urgent BMs”), 31 (“diarrhea”), 32 (“constipation”), 36 (“uncontrolled stools”)] and the European Organization for Research and Treatment of Cancer (EORTC) modules QLQ-C30 (symptom scales: “constipation” and “diarrhea”) and QLQ-CR29 (symptom scales: “defecation problems,” “incontinence,” and “bloating”).

Results

GIQLI “global” and “symptom” indices and the majority of single-item scores and the EORTC QLQ-C30 “constipation” and “diarrhea” subscales showed significant postoperative improvement (p < 0.05). Females and younger age (<70 years) patients appeared to have worse postoperative gastrointestinal function. Rectal cancer patients had more “urgent BMs,” “uncontrolled stools” and worse “global” and “symptom” scores at 3 months and more “diarrhea” at 3 and 6 months than colon cancer patients (p < 0.03). Right colectomy patients had less “excessive passage of gas,” “constipation,” and “uncontrolled stools” than left colectomy patients (3 months, p < 0.01). Anterior resection patients faced more gastrointestinal difficulties, especially in the first 6 months after surgery. Adverse effects related to stage and adjuvant treatment were predominant only at baseline (p < 0.05). GIQLI “diarrhea” and “constipation” scores were correlated with the respective EORTC QLQ-C30 domains (p = 0.0001).

Conclusions

Overall, gastrointestinal function is improved after colorectal cancer surgery. However, women and younger patients are at higher risk of postoperative gastrointestinal dysfunction.     

The prognostic role of fatigue,depression and anxiety on postoperative outcomes after pancreatectomy for pancreatic cancer. A prospective observational study (FAT-PRO study)

ObjectivesThis study aims to assess the prevalence of preoperative fatigue, depression and anxiety among patients undergoing pancreatic surgery for pancreatic cancer (PC), and possible relationship with postoperative outcomes.MethodsProspective data from 162 consecutive patients undergoing pancreatectomy for PC at a third-level referral centers for pancreatic surgery were collected. All patients preoperatively completed four questionnaires assessing depression (PHQ-9), anxiety (STAI-Y2), chronic illness fatigue (FACIT-F) and cancer therapy fatigue (FACT-G).ResultsForty patients (25%) where in the first quartile for chronic illness (FACIT-F ≤34) and/or cancer therapy (FACT-G ≤78) fatigue, 26 patients (16%) met the criteria for major depression (PHQ-9 ≥10) and 34 patients (21%) had anxiety symptoms (STAI-Y2 ≥40). Cancer therapy fatigue was significantly associated with higher rates of morbidity (70% vs 49%), major morbidity (Clavien-Dindo ≥3) (28% vs 11%), post-pancreatectomy hemorrhage (18% vs 4%), pulmonary complications (20% vs 9%) and mortality (8% vs null) (all P ≤ 0.01). Major depression was associated with higher rates of post-pancreatectomy hemorrhage and readmission (23% vs 5%). Multivariable logistic regression analysis of preoperative factors confirmed diabetes (OR 2.71, 95%CI 1.01–7.20; P = 0.04), ASA score ≥3 (OR 4.12, 95%CI 1.52–11.21; P < 0.01) and cancer therapy fatigue (OR 2.95, 95%CI 1.01–8.74; P = 0.04) to be independent predictors of major morbidity.ConclusionsHigher levels of fatigue (in particular cancer therapy fatigue) strongly correlates with worse postoperative outcomes.     

A prospective study of upper gastrointestinal hemorrhage in patients with hepatocellular carcinoma

Our purpose was to determine, in a prospective study, the causes of gastrointestinal hemorrhage in patients with hepatocellular carcinoma, and the relationship of portal vein invasion with variceal hemorrhage in these patients. During an 11-month period, 55 patients presented with hepatocellular carcinoma presented with signs and/or symptoms of upper gastrointestinal hemorrhage. Forty-seven percent had bleeding from varices, whereas the majority, 53%, had a nonvariceal bleeding source. Among those with nonvariceal bleeding, duodenal ulceration was the commonest cause. Direct tumor invasion into the gastrointestinal tract was found in three patients. Tumor invasion of the portal venous system was detected by ultrasound examination in 76% of the variceal bleeders, compared to only 45% of the nonvariceal bleeders. Despite the very high frequency of cirrhosis among patients with hepatocellular carcinoma, the source of bleeding was variceal in less than half of the patients. Portal vein invasion is a risk factor for subsequent variceal bleed.     

添加丙氨酰谷氨酰胺全胃肠外营养对消化道肿瘤术后化疗老年患者的作用

目的研究添加丙氨酰谷氨酰胺（Ala—Gin）的全胃肠外营养（TPN）对消化道肿瘤术后化疗老年患者的作用。方法30例消化道肿瘤老年患者，按序随机分为2组：传统组和二肽组，每组15例，术后给予TPN同时化疗5d。术前术后对人体测量、血浆蛋白、肝肾功能、血脂全套、血淋巴细胞数目等指标进行检测；术后监测每日氮平衡和累积氮平衡。结果二肽组上臂中部肌周长（AMC）、转铁蛋白（TRF）、血淋巴细胞数术后第6天能维持术前水平（P〉0．05），传统组则明显低于术前（P〈0．05）；2组间人体测量、血浆蛋白、肝肾功能、血脂全套、淋巴细胞数差异无显著性（P〉0．05）。术后第6天传统组累积氮平衡为（-32．17±10．16）g，二肽组为（-13．56±5．61）g，2组间差异显著（P〈0．01）。结论老年消化道肿瘤患者术后化疗同时应用添加Ala—Gin的肠外营养是安全有效的，能减轻肿瘤患者术后的分解代谢，有效地改善机体氮平衡，维持血循环中淋巴细胞数目，增强对手术及化疗的耐受性。     

Anxiety and depression in patients with gastrointestinal cancer: does knowledge of cancer diagnosis matter?

Background  

Gastrointestinal cancer is the first leading cause of cancer related deaths in men and the second among women in Iran. An investigation was carried out to examine anxiety and depression in this group of patients and to investigate whether the knowledge of cancer diagnosis affect their psychological distress.     

Lymphokine activated killer (LAK) cells in patients with gastrointestinal cancer.

Lymphokine activated killer (LAK) cells are a recently described cellular immune phenomenon with exciting potential for the treatment of tumours arising from solid organs. A comparison of some aspects of LAK cell precursors and LAK cell function was undertaken in 44 control subjects and 44 preoperative patients suffering from gastrointestinal cancer (20 localised and 24 advanced). Lymphokine activated killer cell precursor (natural killer (NK) cell) activity was significantly diminished in patients with advanced tumours (p less than 0.02) as was fully mature LAK cell activity against an NK resistant target cell (p less than 0.012). T-lymphocyte responses were not significantly different between the three groups. The reduced LAK cell generation was associated with a significantly diminished proliferative response of LAK precursors to stimulation with high dose IL-2 in vitro (p less than 0.012). Impaired LAK cell generation may explain the failure of adoptive cellular immunotherapy with LAK cells in some patients with advanced gastrointestinal cancer and prompts the search for means of augmenting this activity in such patients.     

A new esophageal stent design (Niti-S stent) for the prevention of migration: a prospective study in 42 patients

BACKGROUND: Covered, rather than uncovered, metal stents are used for the palliation of dysphagia from esophageal cancer, but a major drawback is the risk of stent migration, which occurs in up to 20% of patients. To overcome this problem, a double-layered stent, the Niti-S stent (Taewong Medical, Seoul, Korea), has been developed. The Niti-S stent consists of an inner polyurethane layer to prevent tumor ingrowth and an outer uncovered nitinol wire tube to allow the mesh of the stent to embed itself in the esophageal wall. METHODS: Between June 2003 and May 2004, 42 patients with malignant dysphagia caused by inoperable carcinoma of the esophagus or gastric cardia were treated with a Niti-S stent. Patients were prospectively followed and data collection focused on recurrent dysphagia, functional outcome, complications, and survival. RESULTS: At 4 weeks, the dysphagia score had significantly improved from a median of 3 (liquids only) to 0 (ability to eat a normal diet). Five of 42 (12%) patients with a Niti-S stent developed recurrent dysphagia, mainly due to tissue overgrowth (2 of 42; 5%) and stent migration (3 of 42; 7%). Major complications (perforation, 1; aspiration pneumonia, 2; hemorrhage, 2) occurred in 5 of 42 (12%) patients. Pain following stent placement was observed in 5 of 42 (12%) patients, and symptomatic gastroesophageal reflux occurred in 2 of 42 (5%) patients. CONCLUSIONS: The Niti-S stent provides symptomatic relief of malignant dysphagia and effectively reduces recurrent dysphagia. Its double-layered design is probably important in preventing migration. In addition, the complete covering of the Niti-S stent may be a factor in preventing tissue overgrowth at both ends of the stent.     

心脏永久起搏器安置后抑郁症39例临床分析

目的:探讨起搏器术后抑郁症的发病情况。方法:根据WHO1992年抑郁症诊断标准确诊起搏器术后抑郁症39例,每位患者均进行汉密尔顿量表评分,对患者进行心理干预及药物治疗,四周后再对所有患者行汉密尔顿量表评分。结果:心理干预和药物治疗后患者的汉密尔顿量表评分显著下降(26±3.2分:9±2.1分,P<0.01),临床症状显著改善。结论:心理干预可提高起搏器治疗效果。     

耳穴贴压促进胃癌术后胃肠功能恢复的研究

[目的]探讨耳穴贴压促进胃癌术后胃肠功能恢复及预防术后并发症的作用.[方法]选择60例择期行胃癌根治术的患者,随机分为对照组（30例）和观察组（30例）,对照组行禁食、胃肠减压、营养支持等常规治疗,观察组在常规治疗的基础上行耳穴贴压,通过观察两组患者肠鸣音恢复时间、首次肛门排气/排便时间和术后并发症（如恶心呕吐、腹胀）发生率,来评价耳穴贴压促进胃癌术后胃肠功能恢复及预防术后并发症的作用效果.[结果]观察组患者术后肠鸣音恢复时间、首次肛门排气/排便时间明显少于对照组,差异有统计学意义（P＜0.05）;术后早期观察组恶心呕吐、腹胀发生率低于对照组,差异有统计学意义（P＜0.05）.[结论]耳穴贴压可促进胃癌术后胃肠功能恢复,并有效预防术后并发症.     

Innate and acquired immune system in patients developing interferon-alpha-related autoimmune thyroiditis: a prospective study

OBJECTIVE: In this prospective study, we investigated whether the development of interferon (IFN)-alpha-related autoimmune thyroiditis (IFN-AT) was correlated with the sequential changes of cytokine pattern induced by IFNalpha in the peripheral lymphocytes. PATIENTS AND METHODS: We enrolled 18 hepatitis C virus (HCV)-positive patients who developed IFN-AT, eight patients with euthyroidism [IFN-AT(Eu)] and 10 with thyroid dysfunction [IFN-AT(Dy)]. Twenty HCV-positive patients without IFN-AT acted as control group (Co-HCV+). Intracellular expression of IFNgamma and IL-4 was evaluated by multicolor flow-cytometry analysis in peripheral lymphocytes in vitro stimulated by phorbol-12-myristate-13-acetate (PMA) (25 ng/ml) and ionomycin (1 mug/ml) in presence of monensin (5 microm). RESULTS: At the appearance of thyroid disease, both IFN-AT(Eu) and IFN-AT(Dy) patients showed a significant increase of IFNgamma expression in CD3+CD56+ and CD3-CD56+ cells but not in CD4+ and CD8+ cells. At this time point, IFN-AT(Eu) but not IFN-AT(Dy) patients also showed an increase of IL-4 expression in CD3+CD56+ cells and CD4+ cells. Six months later, IFN-AT(Eu) patients maintained high expression of IL-4 in CD4+ and CD3+CD56+ cells without any further increase in IFNgamma expression. By contrast, IFN-AT(Dy) patients showed an increase of IFNgamma expression in CD4+ and CD8+ cells, with a concomitant decrease of IL-4 expression in CD4+ cells. CONCLUSIONS: Type 2 immune response is activated early and specifically in patients with IFN-AT who remain euthyroid throughout the follow-up. Predominant in patients developing thyroid dysfunction, by contrast, is the type 1 immune response that seems to occur earlier in innate than acquired immune system.     

Anxiety and depression in patients with rheumatoid arthritis: a prospective study of 400 patients

We investigated psychological and clinical factors in patients with rheumatoid arthritis (RA) by studying 400 patients at 6 month intervals over a mean 3.1 (1.2 SD) years utilizing the Arthritis Impact Measurement Scales psychological scales. Entry clinical and demographic variables explained 25% of the variance in psychological scores. Patients with RA had scores similar to those with other rheumatic disorders (n = 441), and scores remained stable over the study period. Development of depression was associated with socioeconomic not clinical factors, and disease activity appeared to have a limited effect on psychological status. Initial psychological scores were associated with subsequent pain levels and number of physician visits.