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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:

36

期数:

2019年4

页码:

389-391

栏目:

临床研究

出版日期:

2019-04-05

文章信息/Info

Title:

Effect of early post-operative immune-enhanced enteral nutrition on the immune function and inflammatory reaction in patients with gastric cancer

作者:

张　乐; 刘凯东; 刘　铭; 白月奎

（北京市海淀医院普外科，北京　100081）

Author(s):

ZHANG Le; LIU Kai-dong; LIU Ming; BAI Yue-kui

（Department of General Surgery，Haidian Hospital of Beijing，Beijing 100081，China）

关键词:

胃癌; 肠内营养; 免疫增强型肠内营养液; 炎症反应; 免疫功能

Keywords:

gastric cancer; enteral nutritional; immune-enhanced enteral nutrition solution; inflammatory reaction; immune function

分类号:

R735.2

DOI:

10.7683/xxyxyxb.2019.04.022

文献标志码:

A

摘要:

目的　探讨术后早期免疫增强型肠内营养对胃癌患者免疫功能及炎症反应的影响。方法　选择2015年8月至2017年8月于北京市海淀医院行胃癌根治术的170例胃癌患者为研究对象，根据术后肠内营养支持方案将患者分为观察组与对照组，每组85例。2组患者术后第1天开始经鼻空肠营养管给予肠内营养支持治疗。对照组患者给予常规肠内营养液，观察组患者给予免疫增强型肠内营养合剂，术后第1～3天分别给予患者所需能量的25%、50%和75%，不足部分由周围静脉营养补充；术后第4天起给予全量肠内营养液，疗程均为7 d。分别于术前、术后第7天检测患者血清白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、C反应蛋白（CRP）、免疫球蛋白（Ig）G、IgM、IgA、CD4⁺、CD8⁺水平，并观察2组患者术后感染发生情况。结果　术前2组患者血清IL-6、TNF-α及CRP水平比较差异无统计学意义（P>0.05），2组患者术后第7天血清IL-6、TNF-α及CRP水平显著高于术前（P<0.05）；术后第7天，观察组患者血清IL-6、TNF-α及CRP水平显著低于对照组（P<0.05）。术前2组患者血清IgG、IgM、IgA水平及CD4⁺/CD8⁺比较差异无统计学意义（P>0.05），2组患者术后第7天血清IgG、IgM、IgA水平及CD4⁺/CD8⁺高于术前（P<0.05）；术后第7天，观察组患者血清IgG、IgM、IgA水平及CD4⁺/CD8⁺显著高于对照组（P<0.05）。观察组患者发生切口感染1例，肺部感染1例，泌尿系统感染3例，术后感染率为5.88%（5/85）；对照组患者发生切口感染3例，腹腔感染2例，肺部感染3例，泌尿系统感染5例，术后感染率为15.29%（13/85）；观察组患者术后感染率显著低于对照组（χ²=11.980，P<0.01）。结论　术后早期给予免疫增强型肠内营养可以显著提高胃癌患者的免疫功能，降低炎症反应和术后感染发生率。

Abstract:

Objective　To investigate the effect of early post-operative immune-enhanced enteral nutrition on the immune function and inflammatory reaction in patients with gastric cancer.Methods　A total of 170 patients with gastric cancer who underwent radical operation in Haidian Hospital of Beijing from August 2015 to August 2017 were selected as the study subjects.The patients were divided into observation group and control group according to the enteral nutrition program after operation，85 cases in each group.The patients in the two groups were treated with enteral nutrition support through nasojejunal nutrition tube on the first day after operation.The patients in the control group were treated with routine enteral nutrition solution，while the patients in the observation group were treated with immune-enhanced enteral nutrition mixture.The patients in the two groups were given 25%，50% and 75% of the required energy from the first day to the third day after operation respectively，and the deficiency was supplemented by peripheral venous nutrition.From the fourth day after operation，all patients were given full dose of enteral nutrition solution.All the patients were treated for seven days.The levels of serum interleukin-6 （IL-6），tumor necrosis factor-α（TNF-α），C-reactive protein （CRP），immunoglobulin （Ig） G，IgM，IgA，CD4⁺ and CD8⁺ were detected before operation and the seventh day after operation.The postoperative infection of the patients in the two groups was observed.Results　There was no significant difference in the levels of serum IL-6，TNF-α and CRP between the two groups before operation （P>0.05）.The levels of serum IL-6，TNF-α and CRP on the seventh day after operation were significantly higher than those before operation in the two groups （P<0.05）.The levels of serum IL-6，TNF-α and CRP in the observation group were significantly lower than those in the control group on the seventh day after operation （P<0.05）.There was no significant difference in the levels of serum IgG，IgM，IgA and CD4⁺/CD8⁺ between the two groups before operation （P>0.05）.The levels of serum IgG，IgM，IgA and CD4⁺/CD8⁺ on the seventh day after operation were significantly higher than those before operation in the two groups （P<0.05）.The levels of serum IgG，IgM，IgA and CD4⁺/CD8⁺ in the observation group were significantly higher than those in the control group on the seventh day after operation （P<0.05）.There were one case of incision infection，one case of pulmonary infection and three cases of urinary infection in the observation group；the infection rate was 5.88% （5/85）.There were three cases of incision infection，two cases of abdominal infection，three cases of pulmonary infection and five cases of urinary infection in the control group；the infection rate was 15.29% （13/85）.The infection rate in the observation group was significantly lower than that in the control group （χ²=11.980，P<0.01）.Conclusion　Early post-operative immune-enhanced enteral nutrition can significantly improve the immune function，reduce inflammation and reduce the incidence of postoperative infection in patients with gastric cancer.

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更新日期/Last Update: 2019-04-05