免疫增强型肠内营养支持在胃癌术后早期的应用

Postoperatively early application of immune-enhanced enteral nutrition in the patients with gastric carcinoma

目的 研究术后早期免疫增强型肠内营养支持对胃癌患者的机体营养状况和细胞免疫功能的影响。方法 3 6例胃癌患者随机分为两组 ,免疫增强型肠内营养 (IEN )组和肠内营养(EN)组。两组患者均从术后第 1天起等热量、等氮量经空肠造口管匀速输注肠内营养制剂。IEN组使用Stresson○R,EN组使用Nutrison○R,共 7d。分别于术前及术后第 2、4、8天采外周血测定T细胞亚群、NK细胞、血清IL 2与TNF α浓度、血清PA浓度、血清RBP浓度。结果 ①术后患者血清PA、RBP浓度较术前有明显下降 (P <0 .0 5 ,P <0 .0 1) ,经一段时期的IEN和EN支持后基本恢复到术前水平。②术后经IEN和EN支持后T细胞亚群及NK细胞基本恢复到术前水平 ,且两组间无差异。③IEN、EN组的IL 2较术前均有明显增高 (P <0 .0 5 ) ,以IEN组的增高更为显著(P <0 .0 5 )。IEN组的TNF α较术前有明显下降 (P <0 .0 5 ) ,且与EN组相比差异有显著性 (P<0 .0 5 )。结论 术后早期免疫增强型肠内营养支持可以改善胃癌患者的营养状况 。

Objective To investigate the effects of postoperatively early immune-enhanced enteral nutrition (IEN) support on nutritional status and cellular immunity function of gastric cancer patients.Methods Thirty-six gastric cancer patients were divided randomly and equally into two groups:IEN group and enteral nutrition (EN) group.The same quantity of calorie and nitrogen was provided through Flocare Jejunocatheter from the first day after surgery for both groups.Stresson was given to IEN group and Nutrison to EN group for 7 days separately.T-cell subtypes,NK cells,serum levels of IL-2,TNF-α,PA,as well as RBP were measured preoperation and on the postoperative day of 2,4,and 8.Results The postoperative levels of PA and RBP were declined obviously compared with that before operation(P<0.05,P<0.01),but returned to preoperative levels after the treatment with IEN and EN.The T-cell subtypes as well as NK cells returned almost to preoperative levels and there were no differences between two groups.The serum levels of IL-2 from both IEN and EN groups were increased significantly compared with that before operation(P<0.05),especially in the IEN group(P<0.05).Incontrast,the level of TNF-αwas declined in IEN group after surgery compared with that before operation,and there was significant difference between IEN group and EN group(P<0.05).Conclusion The nutritional status of gastric patients were improved by the early application of immune-enhanced enteral nutrition support,and more,it works better than EN in reinforcing the immune functions on some aspects.