脂肪乳剂对食管癌术后细胞因子和免疫功能的影响

目的：本研究探讨脂肪乳剂对食管癌术后炎症反应和免疫功能的影响。方法：采用前瞻性、随机、对照设计，将33例食管癌切除术病人随机分成2组，A组(15例)为对照组接受不含脂肪乳剂的肠外营养，B组(18例)接受含有脂肪乳剂的肠外营养。2组病人的一般临床情况、非蛋白热量分布一致。分别于术前术后不同时段测定血清中IL—6、IL—10浓度、T细胞亚群和NK细胞活性。结果：术后1、3天两组血清IL—6水平均显升高，且B组显高于A组。血清IL—10与IL—6变化相似。术后3天血清IL-6浓度与IL—10浓度显正相关。术后血清IL—6／IL—10比值显升高，术后7天B组显高于A组。术后CD4^ /CD8^ ,NK细胞活性均显降低，术后10天B组CD4^ /CD8^ 比值显低于A组。术后3天CD4^ /CD8^ 比值与术后1天IL—6水平显正相关。结论：高应激病人输注脂肪乳剂能增加细胞因子产生并促进免疫抑制。

Effects of soybean oil emulsion on cytokines and immune function after esophagectomy

Objective:The purpose of this randomized, controlled, clinical study was to investigate the effects of soybean oil emulsion on inflammatory response and immune function after surgery for esophageal cancer. Methods: Patients who underwent esophagectomy were divided into two groups. Group A( n = 15) ,the control group,received fat - free parenteral nutrition(PN). Group B( n = 18)re-ceived PN with soybean oil emulsion. There was no signficant difference between the two groups in regard to clinical backgrounds or non - protein calorie. Results: In both groups, the serum levels of IL - 6 were significantly higher on the first and third postoperative days. IL-6 levels in group B,however, were significantly higher than in group A. The serum concentration of IL- 10 showed a trend similar to that of IL-6.Serum IL-6 showed a significant positive correlation with IL- 10 on the 3rd day after the operation. The ratio of IL-6 to IL - 10 increased after the operation in both groups, and significant differences were observed between the two groups. CD4+ /CD8+ and NK cell activity significantly decreased postoperatively. Also, between group A and B there were statistically significant differences in CD4+ /CL8+ . Suppression of cellular immunity correlated significantly with serum IL- 6,and was preceded by a rise in serum IL- 6. Conclusion : Perioperative PN with excessive levels of soybean oil emulsion after a severely stressful operation has been shown to increase the production of inflammatory cytokines and promote immunosuppression.