胃癌术后辅助化疗期间肠内营养对患者免疫及营养状况的影响

目的观察胃癌全胃根治性切除术后辅助化疗期问肠内营养支持对患者免疫及营养状况的影响。方法将2009年1月至2010年6月行全胃根治性切除加空肠造口术后给予辅助静脉化疗的86例胃癌患者按住院号尾号单双数分成肠内营养支持组（EN组）和对照组，每组各43例。EN组延期留置空肠造口管至6个化疗疗程结束，每个疗程经空肠造口管给予肠内营养支持7d。对照组于化疗前拔除空肠造口管，每个化疗疗程自由饮食，不予营养支持。检测两组第1次化疗前1d和第6次化疗结束后1d的营养及免疫指标。结果EN组3例因导管堵塞或导管脱落、对照组2例因化疗副反应或经济原因未能完成研究，81例进入统计分析。第6次化疗结束后两组体重均有所下降，EN组体重下降百分比显著低于对照组（6．9％±0．95％比11．2％±1．32％，P=0．0000）。与第1次化疗前比较，第6次化疗结束后两组预后营养指数（PNI）均下降，但EN组化疗前后差异无统计学意义（P=0．1534），对照组化疗后PNI显著低于化疗前（P=0．0000），且EN组化疗后PNI显著高于对照组（P=0．0040）。第6次化疗结束后，EN组IgG、自然杀伤细胞、CD4^＋和CD4^＋／CD8^＋水平显著高于对照组（P=0．0083、P=0．0143、P=0．0000、P：0．0000）。结论术后辅助化疗期间给予肠内营养支持可改善全胃根治性切除胃癌患者的营养及免疫状况。由于病例数少，两组入量控制存在不可控制因素，需要更严格的进一步研究。

Impact of enteral nutrition through jejunal feeding tube during chemotherapy on the nutritional status and immunologic function of patients after total gastrectomy

[ Abstract ] Objective To investigate the impact of enteral nutrition （EN） through jejunal feeding tube on the nutritional status and immunologic function of patients during chemotherapy after total gastrectomy. Methods Totally 86 patients with gastric cancer who had undergone total gastrectomy with radical resection and jejunostomy received adjuvant venous chemotherapy in our department from January 2009 to June 2010. They were divided into EN group （ n = 43 ） and control group （ n = 43 ） according to the hospitalization number. The EN group maintained the jejunostomy tube until the end of 6 courses of chemotherapy, and was given EN support for 7 days through jejunal tube during each course of chemotherapy; the control group removed the tube before chemotherapy without further dietary restriction or nutrition support. The nutritional and immunologic indicators on the 1 st day before chemotherapy and the 1 st day after 6 chemotherapy courses were measured. Results Three patients in the EN group withdrew from the study because of catheter blockage or catheter loss and 2 patients in the control group failed to complete the trial because of chemotherapy side effects or economic reasons; 81 patients entered the final analysis. After 6 courses of chemotherapy, both groups experienced body weight loss, but the percentage is significantly lower in EN group than in control group （6. 9% ＋ 0. 95% vs. 11.2% ＋ 1.32%, P =0. 0000）. Compared with the nutritional status before the first chemotherapy, the prognosis nutritional index （PNI） in both groups declined after the 6th chemotherapy. Such decline was not statistically significant in EN group （P = 0. 1534 ） but was significant in control group （P = 0. 0000）. The PNI in EN group after chemotherapy was significantly higher than that in control group （ P = 0. 0040）. The levels of IgG, NK, CD4^＋ , and CD4^＋/CD8^＋ were significantly higher in EN group than in control group （ P = 0. 0083, 0. 0143, 0. 0000, and 0. 0000, respectively） after chemotherapy. Conclusion EN during postoperative chemotherapy may improve the nutritional status and immunologic function in gastric cancer patients after total gastreetomy.