[1]王　瑛,袁鹤立,张　博,等.肠内营养对行肝动脉化学治疗栓塞术原发性肝癌患者血清炎性因子及免疫细胞的影响[J].新乡医学院学报,2019,36(11):1064-1069.[doi:10.7683/xxyxyxb.2019.11.014]
　WANG Ying,YUAN He-li,ZHANG Bo,et al.Effect of enteral nutrition on the levels of serum inflammatory factors and immune cells in patients with primary hepatocellular carcinoma after transcatheter arterial chemoembolization[J].Journal of Xinxiang Medical University,2019,36(11):1064-1069.[doi:10.7683/xxyxyxb.2019.11.014]
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肠内营养对行肝动脉化学治疗栓塞术原发性肝癌患者血清炎性因子及免疫细胞的影响
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
36
期数:
2019年11
页码:
1064-1069
栏目:
临床研究
出版日期:
2019-11-05

文章信息/Info

Title:
Effect of enteral nutrition on the levels of serum inflammatory factors and immune cells in patients with primary hepatocellular carcinoma after transcatheter arterial chemoembolization
作者:
王　瑛1; 袁鹤立2; 张　博1; 袁　楠1; 郭建魁1
（1.开滦总医院肝胆外科，河北　唐山　063000；2.华北理工大学附属医院儿科，河北　唐山　063000）
Author(s):
WANG Ying1; YUAN He-li2; ZHANG Bo1; YUAN Nan1; GUO Jian-kui1
（1. Department of Hepatobiliary Surgery，Kailuan General Hospital,Tangshan 063000,Hebei Province,China; 2.Department of Pediatrics,North China University of Science and Technology Affiliated Hospital,Tangshan 063000,Hebei Province，China）
关键词:
肠内营养; 原发性肝癌; 炎性递质; 免疫细胞; 预后
Keywords:
enteral nutrition;  primary liver cancer;  inflammatory transmitters;  immunocyte;  prognosis
分类号:
R735.7
DOI:
10.7683/xxyxyxb.2019.11.014
文献标志码:
A
摘要:
目的　探讨肠内营养(EN)对原发性肝癌（PLC）患者肝动脉化学治疗栓塞（TACE）术后血清炎性因子、免疫细胞水平及预后的影响。方法　选择2014年6月至2016年6月在开滦总医院肝胆外科接受TACE治疗的90例肝癌患者为观察对象，根据术后营养支持方案分为观察组（n=42）和对照组（n=48）。对照组患者术后给予流食、半流食等，观察组患者在对照组治疗基础上给予EN；分别于术前及术后7、14、21 d检测2组患者血清白细胞介素-1（IL-1）、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、C反应蛋白（CRP）及CD3+、CD4+、CD8+水平；观察2组患者术后3个月并发症发生情况及术后24个月生存状态。结果　2组患者术后7、14 d血清IL-1、IL-6、TNF-α及CRP水平显著高于术前（P<0.05）；对照组患者术后21 d血清IL-6、TNF-α水平与术前比较显著增高（P<0.05）；观察组患者术后21 d血清IL-1水平与术前比较显著增高（P<0.05）。对照组患者术后14、21 d血清IL-6、TNF-α、CRP水平及术后21 d血清IL-1水平均显著低于术后7 d（P<0.05）；对照组患者术后21 d血清IL-1、IL-6水平均显著低于术后14 d（P<0.05）。观察组患者术后14、21 d血清IL-1、IL-6、TNF-α及CRP水平均显著低于术后7 d（P<0.05）；观察组患者术后21 d的血清IL-6、TNF-α及CRP水平显著低于术后14 d（P<0.05）。2组患者术前及术后7 d 血清IL-1、IL-6、TNF-α及CRP水平组间比较差异均无统计学意义（P>0.05）；术后14、21 d，观察组患者血清IL-1、IL-6、TNF-α及CRP水平均低于对照组（P<0.05）。对照组患者术后7 d CD3+、CD4+、CD8+、CD4+/CD8+及术后14 d CD8+、CD4+/CD8+和术后21 d CD3+、CD8+与术前比较显著降低（P<0.05）。观察组患者术后7 d CD3+、CD4+、CD8+、CD4+/CD8与术前比较显著降低（P<0.05），观察组患者术后14 d CD3+、CD4+/CD8+及术后21 d CD4+/CD8+与术前比较显著升高（P<0.05）。对照组患者术后14 d CD3+、CD4+、CD8+、CD4+/CD8+及术后21 d CD4+、CD4+/CD8+显著高于术后7 d，观察组患者术后14 d CD3+、CD4+/CD8+及术后21 d CD3+、CD4+、CD8+、CD4+/CD8+显著高于术后7 d（P<0.05）。与术后14 d比较，对照组患者术后21 d CD3+显著降低（P<0.05）；观察组患者术后21 d CD3+、CD4+、CD8+ CD4+/CD8+与术后14 d比较差异无统计学意义（P>0.05）。2组患者术前及术后7 d CD3+、CD4+、CD8+、CD4+/CD8+水平组间比较差异均无统计学意义（P>0.05）；术后14、21 d观察组患者CD3+、CD4+、CD8+、CD4+/CD8+均高于对照组（P<0.05）。对照组与观察组患者术后3个月内并发症发生率分别为41.67%（20/48）、21.43%（9/42），观察组患者并发症发生率显著低于对照组（χ2=5.347，P<0.05）。对照组患者术后6、12、18、24个月生存率分别为97.92%（47/48）、81.25%（39/48）、56.25%（27/48）、37.50%（18/48），观察组患者术后6、12、18、24个月生存率分别为100.00%（42/42）、88.10%（37/42）、73.81%（31/42）、59.52%（25/42），观察组患者的生存率明显高于对照组（Log-rank χ2=4.964,P<0.05）。结论　EN可以降低TACE治疗术后PLC患者的血清炎性因子水平，提高免疫细胞水平，降低患者术后并发症发生率，提高术后生存率，有助于改善患者的预后。
Abstract:
Objective　To investigate the effect of enteral nutrition (EN) on serum inflammatory factors,immune cells and prognosis in patients with primary liver cancer (PLC) after transcatheter arterial chemoembolization (TACE).Methods　From June 2014 to June 2016,90 patients with liver cancer who received TACE treatment in Department of Hepatobiliary Surgery of Kailuan General Hospital were selected as the observation objects.According to the nutritional support scheme adopted after operation,they were divided into observation group (n=42) and control group (n=48).Patients in the control group were given traditional diet after operation,such as liquid food,semi liquid food,and so on; patients in the observation group were given EN on the basis of traditional diet of the control group.The serum levels of （interleukin,IL）-1,IL-6, tumor necrosis factor-α(TNF-α) and serum hypersensitive C-reactive protein(CRP),CD3,CD4 and CD8 were measured and compared before operation and at 7,14 and 21 days after operation between the two groups. The occurrence of comorbidity within three months and the survival status within 24 months were observed in the two groups. Results　The serum levels of IL-1,IL-6,TNF-α and CRP at 7,14 days after operation were significantly higher than those before operation in the two groups(P<0.05); the serum levels of IL-6 and TNF-α at 21 days after operation in the control group were significantly higher than those before operation(P<0.05); the serum level of IL-1 at 21 days after operation in the observation group was significantly higher than that before operation(P<0.05).The serum levels of IL-6,TNF-α,CRP at 14,21 days after operation and the level of IL-1 at 21 days after operation were significantly lower than those at 7 days after operation in the control group (P<0.05),and the serum levels of IL-1 and IL-6 at 14 days after operation were significantly lower than those at 21 days after operation in the control group (P<0.05). The serum levels of IL-1,IL-6,TNF-α and CRP at 14,21 days after operation were significantly lower than those at 7 days after operation in the observation group(P<0.05); the serum levels of IL-6,TNF-α and CRP at 21 days after operation were significantly lower than those at 14 days after operation in the observation group (P<0.05).There was no significant difference in the level of IL-1,IL-6,TNF-α and CRP between the two groups before operation and at 7 days after operation (P>0.05). The levels of IL-1,IL-6,TNF-α and CRP in the observation group were lower than those in the control group at 14 and 21 days after operation (P<0.05).The levels of CD3+,CD4+,CD8+ and CD4+/CD8+ at 7 days after operation , the levels of CD8+ and CD4+/CD8+ at 14 days after operation and the levels of CD3+ and CD8+ at 21 days after operation were lower than those before operation in the control group（P<0.05）. The levels of CD3+, CD4+, CD8+, CD4+/CD8+ at 7 days after operation were significantly lower than that before operation, while the levels of CD3+, CD4+/CD8+ at 14 days after operation, and the level of CD4+/CD8+ at 21 days after operation were significantly higher than that before surgery in the observation group (P<0.05).The levels of CD3+，CD4+，CD8+，CD4+/CD8+ at 14 days after operation and the level of CD4+、CD4+/CD8+ at 21 days after operation were significantly higher than at 7 days after operation in the control group(P<0.05).The levels of CD3+,CD4+/CD8+ at 14 days after operation and the levels of CD3+,CD4+,CD8+,CD4+/CD8+ at 21 days after operation were significantly higher than at 7 days after operation in the observation group(P<0.05).The level of CD3+ at 21 days after operation was lower than that at 14 days after operation in the control group(P<0.05).There was no significant difference in the level of CD3+,CD4+,CD8+,CD4+/CD8+ between those at 21 days after operation and at 14 days after operation in the observation group(P>0.05). There was no statistically significant difference in the level of CD3+,CD4+,CD8+,CD4+/CD8+ between the two groups before operation and at 7 days after operation(P>0.05).The levels of CD3+,CD4+,CD8+,CD4+/CD8+ in the observation group were all higher than those in the control group at 14 and 21 days after operation (P<0.05).The incidence of complications at three months after operation in the control group and the observation group was 41.67% (20/48) and 21.43% (9/42), respectively, and the incidence of complications in the observation group was significantly lower than that in the control group (χ2=5.347，P<0.05).The survival rates at 6, 12, 18 and 24 months in the control group were 97.92% (47/48), 81.25% (39/48), 56.25% (27/48) and 37.50% (18/48), respectively. The survival rates at 6, 12, 18 and 24 months in the observation group were 100% (42/42), 88.10% (37/42), 73.81% (31/42) and 59.52% (25/42), respectively. The survival rate in the observation group was significantly higher than that in the control group (Log-rank χ2=4.964,P<0.05).Conclusion　EN can reduce the serum inflammatory factor level of PLC patients after TACE treatment, improve the level of immune cells, reduce the incidence of postoperative complications, improve the postoperative survival rate, and help improve the prognosis of PLC patients.

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更新日期/Last Update: 2019-11-05