肝细胞癌合并肝硬化患者术后应用重组人生长激素联合肠外营养对生长激素/胰岛素样生长因子-1轴的影响

目的：探讨肝细胞癌合并肝硬化患者术后应用重组人生长激素（rhGH）联合肠外营养（PN）对生长激素（GH）／胰岛素样生长因子-1（IGF-1）轴的影响。方法：24例行根治性切除的肝癌患者随机分为PN组（n=12）和rhGH＋PN组（n=12）。术前、术后1d和6d测血清GH、IGF-1、IGFBP-3，用RT-PCR法检测肝组织（包括癌组织，癌旁组织和术后6d肝穿刺组织）IGF-1 mR-NA、IGFBP-3 mRNA的表达，肝组织行Ki67免疫组织化学染色。同时选12例因胆石症或肝血管瘤行手术的患者作为正常对照。结果肝细胞癌合并肝硬化患者血清GH水平高于正常对照组，而血清IGF-1、IGFBP-3水平低于正常对照组；术后6d，血清GH、IGF-1、IGFBP-3水平、肝组织IGF-1 mRNA、IGFBP-3m RNA表达水平、肝Ki67指数，rhGH＋PN组均高于PN组。PN组中位无瘤生存期是11．2个月，rhGH＋PN组中位无瘤生存期是11．4个月；PN组6个月、12个月无瘤生存率分别是71．1％、46.2％，rhGH＋PN组6个月、12个月无瘤生存率分别是72．2％、59、0％，差异均无统计学意义（P〉0.05）。结论：rhGH＋PN有利于改善肝细胞癌合并肝硬化患者术后GH／IGF-1轴。     

肝硬化大鼠肝部分切除术后肠外营养时氨基酸溶液的选择及评估

目的探讨肝硬化大鼠肝部分切除术后肠外营养时氨基酸溶液的选择及评估。方法6只正常大鼠作为正常对照组熏24只肝硬化大鼠随机分为肝硬化术前组、肝硬化肝部分切除术后1天组、肝部分切除术后行复方18种氨基酸溶液的肠外营养5天组、肝部分切除术后行富含支链氨基酸穴BCAA雪的氨基酸溶液的肠外营养5天组,每组6只。检测大鼠肝功能、血糖及血清生长激素穴GH雪、胰岛素样生长因子-1穴IGF-1雪、胰岛素样生长因子结合蛋白-3穴IGFBP-3雪,肝组织行Ki67免疫组化染色,结果判断计数采用Ki67指数。结果与复方18种氨基酸溶液的肠外营养比较,富含BCAA的氨基酸溶液的肠外营养5天后血清谷丙转氨酶穴ALT雪、碱性磷酸酶穴ALP雪水平降低熏GH水平也降低熏而IGF-1、IGFBP-3水平升高穴P<0.05雪熏但肝Ki67指数无显著性差异穴P>0.05雪。血清GH水平与谷草转氨酶穴AST雪、ALT、ALP呈正相关熏与白蛋白穴ALB雪呈负相关穴P<0.05雪熏而血清IGF-1、IGFBP-3水平与AST、ALT、ALP呈负相关熏与ALB呈正相关穴P<0.05雪。结论肝硬化肝部分切除术后肠外营养应选择富含BCAA的氨基酸溶液,检测血清GH、IGF-1、IGFBP-3有助于对营养素选择的评估。     

肝细胞癌合并肝硬化患者癌组织、癌旁肝组织ALB mRNA、IGF-1 mRNA、IGFBP-3 mRNA的表达

目的探讨肝细胞癌合并肝硬化患者癌组织、癌旁肝组织ALB mRNA、IGF-1mRNA、IGFBP-3mRNA的表达。方法对24例肝细胞癌合并肝硬化行手术的患者和12例因胆石症或肝血管瘤行手术的患者进行研究。用RT-PCR法检测肝组织(包括癌组织、癌旁组织)ALBmRNA、IGF-1mRNA、IGFBP-3mRNA的表达,肝组织行Ki67免疫组织化染色。结果肝细胞癌合并肝硬化患者癌组织、癌旁肝组织ALB mRNA、IGF-1mRNA、IGFBP-3mRNA表达水平明显低于正常肝组织,且癌组织ALB mRNA、IGFBP-3mR-NA表达水平明显低于癌旁肝组织,而IGF-1mRNA表达水平明显高于癌旁肝组织。肝组织Ki67指数,癌组织、癌旁肝组织明显高于正常肝组织,且癌组织明显高于癌旁肝组织。结论IGF-1和IGFBP-3的不平衡可能与肝硬化患者肝癌的发生、发展有关。     

支链氨基酸强化的肠内肠外营养对肝硬化大鼠术后肝功能及血浆氨基酸谱的影响

目的探讨支链氨基酸（BCAA）强化的早期肠内肠外营养支持对肝硬化大鼠肝部分切除术后肝功能及血浆氨基酸谱的影响,为临床合理应用提供实验依据。方法将24只雄性SD肝硬化大鼠按编号法随机分为肠内营养组、肠内营养＋BCAA组和肠外营养＋BCAA组3组,3组大鼠行肝部分切除术后1d分别进行等热量等氮量营养支持,共5d。术后6d测定大鼠体重、肝功能、前白蛋白、转铁蛋白、肝组织白蛋白mRNA的表达、Ki67蛋白表达指数及进行血浆氨基酸谱分析。结果与术前比较,术后肠内营养、肠内营养＋BCAA、肠外营养＋BCAA组大鼠体重均减轻（P〈0．05）。术后肠外营养＋BCAA组较肠内营养组碱性磷酸酶水平升高（P〈0．05）;肠外营养＋BCAA组较肠内营养＋BCAA组血清天冬氨酸氨基转移酶、丙氨酸氨基转移酶、碱性磷酸酶水平升高（P〈0．05）。术后肠外营养＋BCAA组较肠内营养、肠内营养＋BCAA组血清前白蛋白水平降低（P〈0．05）,转铁蛋白差异无统计学意义（P〉0．05）。肠外营养＋BCAA、肠内营养＋BCAA组较肠内营养组血浆中亮氨酸、异亮氨酸明显升高,酪氨酸、苯丙氨酸、精氨酸、色氨酸明显降低（P〈0．05）;肠外营养＋BCAA组与肠内营养＋BCAA组比较,各氨基酸浓度差异均无统计学意义（P〉0．05）。肠外营养＋BCAA、肠内营养＋BCAA组较肠内营养组总氨基酸及芳香族氨基酸均降低,BCAA及BCAA／芳香族氨基酸比值升高（P〈0．05）。肠外营养＋BCAA组较肠内营养、肠内营养＋BCAA组肝组织白蛋白mRNA表达水平及Ki67蛋白表达指数均降低（P〈0．05）。结论BCAA强化的肠内肠外营养支持能改善肝硬化大鼠血浆氨基酸失衡,恢复血浆中BCAA／芳香族氨基酸比值;肠内营养在改善肝功能、促进肝脏蛋白质合成和肝硬化大鼠肝切除术后残肝肝再生方面优于肠外营养,但仍不能提高血浆白蛋白水平。     

添加rhGH与Gln的肠外营养对短肠大鼠代谢效应的影响

目的研究添加人重组生长激素(rhGH)及谷氨酰胺(Gln)的肠外营养(PN)对短肠大鼠机体合成代谢的作用及作用机制. 方法将SD大鼠按2×2析因设计方案随机分成STD、Gln、rhGH及GG 4组,建立PN短肠大鼠动物模型.测定各组大鼠体重及氮平衡变化,测定PN后大鼠各组织器官重量及机体总体水、脂肪及蛋白含量变化,测定血GH及IGF-1浓度. 结果 rhGH组及GG组大鼠体重显著增加,氮平衡改善;腓肠肌重量增加;机体总体蛋白明显升高,体脂下降;血GH及IGF-1显著升高,P值均<0.05;单位长度小肠重量在Gln与rhGH组显著增加,GG组增加最为明显,P<0.05. 结论 rhGH具有显著的促机体合成代谢作用,Gln作用不明显,但二者对残余小肠代偿具有协同促进作用.IGF-1在rhGH的促合成代谢机制中起重要介导作用.     

精氨酸强化的肠外营养在肝癌合并肝硬化术后的应用

目的探讨精氨酸(L-Arginine)强化的肠外营养(parenteralnutrition熏PN)在原发性肝癌(hepatocellularcarcinoma,HCC)合并肝硬化患者术后的应用价值。方法70例行肝段或肝叶切除手术的患者,随机分为2组:对照组(给予PN)35例,实验组(给予精氨酸强化的PN,Arg-PN)35例。观察患者术前、术后1d及7d肝功能、营养指标、免疫功能及血清一氧化氮(nitricoxide熏NO)浓度变化。结果两组患者平均住院时间、并发症发生率的差异无显著意义(P>0.05);与术前比较,实验组术后第7天肝天冬氨酸转氨酶(AST)、总胆红素(TBIL)已接近术前水平,血清白蛋白(ALB)明显降低(P<0.05);实验组术后胰岛素样生长因子(IGF-1)和NO浓度与术前及对照组比较,均明显上升(P<0.05);实验组术后CD4升高、CD8下降、CD4/CD8比值升高,与术前比较差异均有显著性(P<0.05)。结论精氨酸强化的肠外营养有可能通过Arg-NO代谢途径增加NO浓度,促进IGF-1产生,有利于肝癌肝硬化患者术后肝功能恢复和改善营养状况,增强细胞免疫功能。     

Low dosages of exogenous growth hormone and its effect on growth in an animal model of suboptimal nutrition

In a previous study, weight gain, insulin growth factor-1 (IGF-1) and insulin growth factor binding protein-3 (IGFBP-3) were increased in rats fed suboptimal levels of energy and administered 0.1 mg/100 g of body weight of recombinant human growth hormone (rhGH). Our objective was to determine whether these anabolic effects were still obtained with lower dosages of rhGH in similarly fed rats. Three groups of male, prepubertal Sprague-Dawley rats were administered rhGH and three groups of similar rats were given normal saline solution daily (0.05 mg/100 g of body weight subcutaneously). All rats were fed a balanced 1:1 carbohydrate:fat ratio diet for 4 wk. Restricted rats within each treatment were pair fed 80% and 60% ad libitum. Daily body weight, food intake, and efficiency were recorded. After 4 wk, serum IGF-1 and IGFBP-3, body fat, fat-free mass, and total body water were determined. Total weight gain and serum IGFBP-3 were significantly higher, with a tendency for increased body fat, in rats treated with rhGH and fed at 60% ad libitum. However, within each treatment, energy restriction caused decreased body fat and total body water. These results suggest that lower dosages of rhGH provide anabolic effects during suboptimal energy intake.     

Effects of growth hormone and insulin-like growth factor 1 (IGF-1 ) on hepatic IGF-1-mRNA, plasma IGF-1 and nitrogen excretion in gastrectomized rats with liver cirrhosis

The growth hormone (GH)-insulin-like growth factor 1 (IGF-1) axis is impaired in liver cirrhosis. We determined the effects of GH and IGF-1 treatments in gastrectomized rats with thioacetamide-induced cirrhosis. GH did not increase hepatic IGF-1-mRNA, plasma IGF-1 or the tissue, i.e. gastrocnemius muscle IGF-1 level. IGF-1 administration increased plasma IGF-1 without increasing hepatic IGF-1-mRNA. GH and IGF-1 independently decreased postoperative urinary nitrogen excretion. We conclude that both GH and IGF-1 improve postoperative nitrogen metabolism. Furthermore, GH may exert its anabolic effects directly and/or via actions mediated by IGF-1 production, other than in the liver and in the skeletal muscle, in the setting of cirrhosis.     

肝细胞癌合并肝硬化患者癌组织、癌旁肝组织ALB

目的探讨肝细胞癌合并肝硬化患者癌组织、癌旁肝组织ALBmRNA、IGF-1mRNA、IGFBP-3mRNA的表达。方法对24例肝细胞癌合并肝硬化行手术的患者和12例因胆石症或肝血管瘤行手术的患者进行研究。用RT—PCR法检测肝组织（包括癌组织、癌旁组织）ALBmRNA、IGF-1mRNA、IGFBP-3mRNA的表达,肝组织行Ki67免疫组织化染色。结果肝细胞癌合并肝硬化患者癌组织、癌旁肝组织ALBmRNA、IGF-1mRNA、IGFBP-3mRNA表达水平明显低于正常肝组织,且癌组织ALBmRNA、IGFBP-3mR．NA表达水平明显低于癌旁肝组织,而IGF-1mRNA表达水平明显高于癌旁肝组织。肝组织Ki67指数,癌组织、癌旁肝组织明显高于正常肝组织,且癌组织明显高于癌旁肝组织。结论IGF—1和IGFBP-3的不平衡可能与肝硬化患者肝癌的发生、发展有关。     

生长激素对荷瘤小鼠化疗效果影响的实验研究

目的:探讨重组人生长激素(rhGH)及其联合化疗对荷瘤小鼠的影响。方法:建立小鼠前胃癌细胞经脾接种肝转移小鼠模型,随机分为两大组。第一大组分为六组:对照组(NS组),rhGH常规剂量组(GH1组),rhGH大剂量组(GH2组),单纯化疗组(5-FU组),联合组1(常规剂量rhGH 5-FU),联合组2(大剂量rhGH 5-FU)。连续用药7 d。术后28 d将第一大组小鼠处死,观察肝转移情况,记录体重、肝重,用流式细胞仪进行DNA细胞周期分析;第二大组分组及治疗方法同前,待其自然死亡或观察满70 d后处死,记录荷瘤小鼠生存期。结果:与对照组相比较,两联合组体重增加(P<0.05),5-FU组及两联合组的小鼠肝重和肝指数均明显下降(P<0.05),生存时间延长(P<0.05);两联合组小鼠肝重和肝指数较5-FU组有所下降(P(0.05),但生存时间明显延长(P<0.05);与对照组相比,两GH组S期细胞百分比及细胞增殖指数(PI)增加(P<0.05),两联合组S期细胞百分比及PI均降低(P<0.05);与5-FU组相比较,两联合组的G2/M期细胞百分比和PI均降低(P<0.05)。两联合组之间、两GH组之间两两比较,各指标无显著性差异。结论:rhGH联合化疗可明显延长小鼠的生存期。rhGH上调增殖状态的细胞数量,增加肿瘤对化疗的敏感性,联合化疗明显降低肿瘤细胞的增殖活性,抑制肿瘤生长。     

生长激素加肠外营养对肝硬化病人蛋白质代谢的影响

目的 :了解生长激素 (GH )加肠外营养 (PN)对肝硬化病人蛋白质代谢的影响。　方法 :对 12例肝硬化病人进行 GH加 PN治疗 (试验组 ) ,并以单纯 PN治疗作为对照 (对照组 )。检测治疗前后各时相点血清白蛋白 (Alb)、转铁蛋白 (TFN)及前白蛋白 (PA)水平 ,并进行组内及组间比较。　结果 :与治疗前相比 ,两组治疗后各时相点的血清蛋白水平均逐渐升高 ,但试验组升高幅度更大。与对照组相比 ,试验组 Alb在治疗后 7天显著增高 (P <0 .0 5 ) ,而TFN和 PA在治疗后 5天及 7天均非常显著增高 (P <0 .0 1)。　结论 :GH联合应用 PN在肝硬化病人促进蛋白质合成作用明显优于单纯 PN治疗。     

The potential role of insulin-like growth factor 1, insulin-like growth factor binding protein 3 and bone mineral density in patients with chronic hepatitis C virus in Cairo, Egypt

Insulin-like growth factor 1 (IGF-1) levels have been found to correlate with measurements of bone mineral density (BMD) in liver diseases. This study investigated the relationship between IGF-1, insulin-like growth factor binding protein 3 (IGFBP-3) and BMD in patients with chronic hepatitis C virus. This study was conducted for 30 patients with chronic hepatitis C virus infection (16 patients without and 14 patients with cirrhosis) and 11 healthy controls. Serum levels of IGF-1 and IGFBP-3 and BMD of the proximal femur and lumbar spine were measured in all subjects. Osteoporosis of the proximal femur and lumbar spine was found in 42.9% and 21.4%, respectively, of the patients with cirrhosis. Patients with liver cirrhosis and osteoporosis of the proximal femur and lumbar spine had lower IGF-1 (P < 0.001, P = 0.04, P = 0.04 respectively). BMD of the proximal femur was lower in cirrhotic patients compared with controls (P < 0.01). Patients with liver cirrhosis had lower IGFBP-3 than patients without cirrhosis and controls (P < 0.001). Patients with osteoporosis of the proximal femur had lower IGFBP-3 than those without osteoporosis (P < 0.01). IGF-1 and IGFBP-3 levels were lower in patients with liver cirrhosis. IGF-1 and IGFBP-3 may play a role in hepatic osteoporosis.     

生长激素对门静脉高压症病人肝蛋白质合成的影响

目的:了解生长激素(GH)对经颈静脉肝内门体分流术(TIPS)后门脉性肝硬化病人肝蛋白质代谢的影响. 方法:对10例门静脉高压症病人,在TIPS术后第2天开始皮下注射重组人生长激素(rhGH)8 U×7天.检测治疗前及治疗后3、7天血清清蛋白(Alb)、前清蛋白(PA)、纤维连接蛋白(FN)水平,同时测定血清胰岛素样生长因子(IGF-1)水平,进行治疗前后的比较. 结果:血清IGF-1水平TIPS术前与术后比较无显著差异,GH治疗后3天明显升高(P<0.01);Alb水平TIPS术前与GH治疗后3天比较无显著差异,7天后明显升高(P<0.05);PA和FN水平在GH治疗后第3天开始升高,第7天明显升高 (P<0.01). 结论:GH可以促进肝硬化门静脉高压症病人肝蛋白质合成.     

Enterotrophic effect of insulin-like growth factor-I but not growth hormone and localized expression of insulin-like growth factor-I, insulin-like growth factor binding protein-3 and -5 mRNAs in jejunum of parenterally fed rats

BACKGROUND: Administration of insulin-like growth factor (IGF)-I, but not growth hormone (GH), stimulates mucosal hyperplasia in surgically stressed rats with intestinal atrophy induced by hypocaloric total parenteral nutrition (TPN). Our aim was to characterize the basis for this disparity in enterotrophic action by assessing the relationships between stimulation of intestinal growth, nutritional adequacy, and localization of expression of IGF-I, insulin-like growth factor binding protein (IGFBP)-3 and IGFBP-5 mRNAs in jejunum. METHODS: Rats were maintained with TPN for 8 days and treated with IGF-I or GH and adequate nutrition for 5 days after recovery from surgery. Jejunal mass, morphology, and sucrase activity were assessed. Localization of expression of IGF-I, IGFBP-3, and IGFBP-5 mRNAs in jejunum was accomplished by in situ hybridization. RESULTS: Serum IGF-I and body weight gain were significantly increased by IGF-I or GH. Jejunal mucosal dry mass, morphology, and sucrase activity were improved with IGF-I but not GH. There were no differences in IGF-I mRNA. IGFBP-3 mRNA was localized in the lamina propria of the villi. IGF-I or GH stimulated IGFBP-3 expression. IGF-I strongly stimulated IGFBP-5 expression in the lamina propria and the muscularis and induced a twofold increase in IGFBP-5 mRNA based on RNase protection assay of intact jejunum total RNA. GH induced a modest increase in IGFBP-5 expression in the muscularis with no effect on intact jejunum total RNA. CONCLUSIONS: The GH resistance observed in the jejunal mucosa of TPN rats cannot be fully explained by inadequate nutrition. The expression of IGFBP-5 in the lamina propria suggests it may modulate the enterotrophic action of exogeneous IGF-I.     

重组人生长激素对消化道术后病人氮平衡作用的研究

目的了解重组人生长激素(rhGH)对手术后病人氮平衡的影响。方法在肠全外营养(TIN)的基础上，加用rhGH治疗消化道大中型手术后10例病人，并与同期仅用TPN治疗的10例病人做对照研究。结果1．2组病人均未获得正氮平衡，但GH组氮平衡明显改善；术后5天累积氮平衡GH组显高于对照组。2．术后3天、5天，累积尿氮的排出，对照组较GH组高，二差别有显统计学意义。3．术后1天引流氮的排出、术后3天累积引流氮的排出及平均每天引流氮的排出，GH组均较对照组低，但无显的统计学意义。结论在低氮和低热的基础上，rhGH能减轻术后病人的负氮平衡。主要是通过减少尿氮的排出而达到节氮效果，rhGH对引流氮影响不大。     

Recombinant human growth hormone improves muscle amino acid uptake and whole-body protein metabolism in chronic hemodialysis patients

BACKGROUND: Intradialytic parenteral nutrition (IDPN), with or without exercise, has been shown to reverse the net negative whole-body and forearm muscle protein balances observed during hemodialysis. Pharmacologic doses of recombinant human growth hormone (rhGH) constitute another potential anabolic therapy in chronic hemodialysis patients. OBJECTIVE: Our goal was to examine the potential additive anabolic effects of rhGH compared with IDPN and exercise on protein and energy homeostasis. DESIGN: We studied 7 chronic hemodialysis patients in a crossover design study in which each subject participated in 2 protocols: GH (rhGH + IDPN + exercise) and no GH (IDPN + exercise). During the GH protocol, the subjects were studied after 3 daily doses of rhGH. Each subject was studied 2 h before, 4 h during, and 2 h after a hemodialysis session with the use of a primed, constant infusion of l-[1-(13)C]leucine. RESULTS: Whole-body net protein balance was -0.50 +/- 0.07 mg x kg fat-free mass(-1) x min(-1) when the patients did not receive rhGH and -0.39 +/- 0.04 mg x kg fat-free mass(-1) x min(-1) when the patients received rhGH, a 22% improvement in prehemodialysis whole-body protein homeostasis (P < 0.05). Essential amino acid muscle loss was also significantly less during the prehemodialysis period when rhGH was administered (-18 +/- 23 compared with -71 +/- 20 mmol/L; P < 0.05). The whole-body anabolic effects of rhGH observed during the prehemodialysis period persisted throughout the entire study, as evidenced by a lack of significant interaction or main effect of treatment during hemodialysis and in the posthemodialysis period. CONCLUSION: rhGH improves whole-body protein homeostasis in chronic hemodialysis patients.     

添加rhGH与Gln的肠外营养对短肠大鼠小肠代偿作用的研究

目的研究添加生长激素(rhGH)及谷氨酰胺(Gln)的肠外营养(PN),对短肠大鼠残存小肠代偿的作用及作用机制。     

胰岛素样生长因子-1对脓毒症大鼠血浆应激激素和胰岛素样生长因子-1受体表达的影响

目的探讨胰岛素样生长因子-1（IGF-1）对脓毒症大鼠血浆应激激素及骨骼肌IGF-1受体（IGF-1R）蛋白质和mRNA表达的影响。方法选择71只SD大鼠采用盲肠结扎穿孔法建立腹腔感染及颈静脉置管肠外营养（PN）模型后，将存活的30只大鼠随机分为脓毒症组（n=10）、PN组（n=10）及IGF-1组（n=10），另设正常组（n=10）。正常组和脓毒症组给予生理盐水，PN组给予营养支持，IGF-1组为PN＋IGF-1静脉注射，连续5天。第6天行颈动脉置管，开腹取门静脉血测定胰岛素、胰高血糖素、肾上腺素、皮质醇和IGF-1水平；免疫组织化学法及实时定量PCR法测定肝脏和骨骼肌IGF-1R蛋白质和mRNA的表达。结果与对照组相比，脓毒症组大鼠血浆胰岛素、胰高血糖素、肾上腺素、皮质醇水平显著升高，IGF-1显著下降（P〈0．01）；IGF-1组前5项指标较脓毒症组和PN组显著降低，IGF-1则显著升高（P〈0．05，P〈0．01）。脓毒症组肝脏和骨骼肌IGF-1R蛋白质及mRNA表达较对照组显著增强（P〈0．05，P〈0．01）；IGF-1组的IGF-1R蛋白质及mRNA表达较脓毒症组和PN组显著降低（P〈0．01）。结论IGF-1可改善应激激素之间的平衡，降低脓毒血症大鼠IGF-1R在蛋白质和mRNA水平的表达，从而有利于血糖的控制。     

老年患者胰十二指肠切除术后不同营养支持方法对肝功能和临床结局的影响

目的比较胰十二指肠切除术后老年患者肠外营养（PN）联合肠内营养（EN）与单纯PN对术后内毒素血症、肝功能与临床结局的影响。方法回顾性总结我院不同时段接受胰十二指肠切除术老年患者共48例,其中术后接受PN联合EN营养支持的患者25例为研究组（PN＋EN组）,单纯给予PN营养支持的患者23例为对照组（PN组）。记录其一般资料、比较术后内毒素水平和肝功能变化,以及临床结局（死亡率、并发症、术后住院日和总住院费用等）。结果两组内毒素水平术后1d较术前均有升高趋势,但组间比较差异无统计学意义（P〉0．05）,后随时间逐渐下降,其中术后7和14d分别与术后1d的差值比较,PN＋EN组的下降幅度显著大于PN组（P〈0．01）;两组谷丙转氨酶、谷草转氨酶、总胆红素和直接胆红素值术后1d较术前均有升高趋势,但组间比较差异无统计学意义（P〉0．05）,术后逐渐下降,术后14d与术后1d的差值PN＋EN组下降幅度显著高于PN组（P〈0．05）;PN＋EN组感染并发症（2／25,8．0％）显著低于PN组（6／23,26．0％,P〈0．05）;总并发症发生率、术后住院日、总住院费用两组差异无统计学意义（P〉0．05）。结论老年患者胰十二指肠切除术后PN联合EN可降低内毒素血症、改善肝功能、减少术后感染并发症。