胃肠外营养添加精氨酸对肝癌术后患者细胞免疫功能的影响

目的 探讨胃肠外营养(TPN)添加精氨酸(Arg)对肝癌术后细胞免疫功能的影响.方法 对56例肝癌患者术后进行了TPN支持的前瞻性研究,检测无脂TPN、常规TPN和常规TPN中添加Arg营养支持前后外周血T淋巴细胞亚群(CD4 和CD8 T细胞亚群)、NK细胞以及IL-2、IL-4和IFN-r水平的变化.结果 无脂TPN、常规TPN支持前后外周血CD4 T细胞、CD8 T细胞以及NK细胞无明显变化,IL-2、IL-4以及IFN-r也无明显变化;TPN添加Arg营养支持后外周血CD4 和NK细胞明显增加,CD 4/CD 8比值也较术前升高,外周血中IL-2和IFN-r明显增加,而IL-4减少.结论 常规TPN不能纠正肝癌术后的细胞免疫抑制状态,但TPN添加Arg则可促进CD4 的T淋巴细胞亚群和NK细胞增加,IL-2和IFN-r生成增加,能上调肝癌术后细胞免疫.

Arginine supplementation in total parenteral nutrition improves postoperative cellular immune function of patients with hepatocellular carcinoma after operation

OBJECTIVE: To explore the effect of total parenteral nutrition (TPN) supplemented with arginine on cellular immune function of patients with hepatocellular carcinoma (HCC) after radical tumor resection. METHODS: Fifty-six HCC patients undergoing radical surgery received fat-free TPN support, routine TPN or TPN with arginine supplementation, and their clinical data were analyzed prospectively. The percentages of T lymphocyte subpopulation and national killer (NK) cells in peripheral blood are determined, and the levels of interleukin-2 (IL-2), IL-4 and interferon-gamma (IFN-gamma) were measured. RESULTS: No marked changes were noted in peripheral blood CD4+, CD8+ T cells and NK cells, or in IL-2, IL-4 and IFN-gamma levels after fat-free TPN and routine TPN support. TPN supplemented with arginine resulted in significant increase in CD4+ T cells, NK cells and CD4+/CD8+ T cell ratio in the peripheral blood, as well as in IL-2 and IFN-gamma levels. Peripheral blood IL-4 level was decreased significantly. CONCLUSION: TPN with arginine supplementation can augment the percentages of CD4+ T lymphocytes and NK cells, and increase IL-2 and IFN-gamma levels, suggesting that arginine can enhance cell-mediated immunity in postoperative patients with HCC.