结构脂肪乳对消化道肿瘤患者术后蛋白质代谢和免疫功能的影响

目的:探讨结构脂肪乳对消化道肿瘤患者术后蛋白质代谢和免疫功能的影响。方法:将消化道肿瘤患者80例双盲、随机分为结构脂肪乳(ST)组和物理混合的中/长链脂肪乳(MCT/LCT)组。于术后第1-6天接受等氮等热量肠外营养。对比观察术后两组患者一般情况、血浆蛋白质水平、氮平衡、免疫功能状况。结果:在进行6 d的肠外营养以后,两组患者生命体征、血常规、肝肾功能、血脂和全身副反应均无显著性差异;术后第5天,ST组蛋白质水平恢复至术前水平,IgG、IgA、IgM和CD3、CD4下降不明显(P>0.05);MCT/LCT组术后第7天蛋白质水平才恢复至术前水平,IgG、IgM、CD3和CD4下降明显(P<0.05);术后第5天、第7天,MCT/LCT组前清蛋白、转铁蛋白、纤维连接蛋白浓度、IgG、IgM、CD3和CD4均显著低于受试组;ST组氮平衡明显优于MCT/LCT组。结论:结构脂肪乳由于具有很好的节氮效果,能有效地改善手术创伤病人的蛋白质代谢,将有利于消化道肿瘤患者术后免疫功能的恢复。

Effect of Structured Lipid Emulsion on Protein Metabolism and Immunologic Function in Gastrointestinal Cancer

Objective: To study the influence of structured lipid emulsion on protein metabolism and immunologic function in gastrointestinal cancer patients.Methods: A prospective,random,and double-blind clinical trial was performed,and 80 patients with gastrointestinal cancer were randomly divided into two groups according to the treatment of structured lipid(ST) emulsion or physical mixture of medium-chain/long-chain triglycerides(MCT/LCT) emulsion.Both groups received isonitrogenous and isocaloric parenteral nutrition(PN) in the six days after operation.The serum levels of proteins,function of immunity,and nitrogen balance were compared between the two groups.Results: The serum level of proteins,IgG,IgA,and IgM,CD_3 and CD_4 T cells in ST group had no changes on day 5 postoperatiion than before operation.All indexes in MCT/LCT group were lower on day 5 postoperation than that before operation.The levels of pre-albumin,transferrin,fibronectin,IgG,IgM,CD_3 and CD_4 T cells,and nitrogen balance in the ST group were significantly higher than those in the MCT/LCT group respectively.Conclusion: Structured lipid emulsion can improve the nutrition and immunologic function of gastrointestinal cancer patients,which is benefit to postoperative recovery of patients.