早期肠内营养支持对胃肠肿瘤术后患者免疫功能及肠黏膜通透性的影响

Effect of Postoperative Early Enteral Nutrition on Immune Function and Intestinal Permeability of the Patients with Gastrointestinal Carcinoma

目的:比较早期肠内与肠外营养对胃肠道肿瘤患者术后免疫功能和肠黏膜通透性的影响。方法:40例胃肠道肿瘤患者随机分为肠内营养(EN)组和肠外营养(PN)组各20例,分别于术后24 h开始EN或PN,检测术前和术后第9天各免疫指标。术前和术后第9天2组患者均口服甘露醇5 g和乳果糖10 g,收集随后6 h的全部尿液,测量尿中甘露醇与乳果糖排除率之比值(L/M比值)。结果:术后第9天,EN组CD4+、CD4+/CD8+显著高于PN组(P<0.05),但IgGI、gM、IgA、CD3+及CD8+2组间比较差异无显著性意义,L/M比值与术前比较均上升(P<0.01)。结论:术后早期EN可明显改善胃肠道肿瘤患者近期的免疫状况,细胞免疫方面亦明显优于PN,但对肠黏膜通透性的影响与PN支持比较差异无显著性意义。

Objective： To compare the effects of early enteral and parenteral nutrition on immune function and intestinal permeability of the patients after surgery for gastrointestinal carcinoma. Methods： Forty patients were randomly divided into enteral （EN, n=20） and parenteral （PN, n=20） groups. Patients in EN and PN groups were subjected to nutri- tion support from postoperative day 1. Immune parameters were detected on the day before operation and postoperative day 9. Intestinal permeability was evaluated using the lactulose/mannitol test on the day before operation and postoperative day 9. The test solution containing 10 g lactulose and 5 g mannitol was administered with 40 ml of water. Results： The postoperative levels of CD4^＋ , CD4^＋/CD8^＋ in EN group were higher than in PN group （P〈0.05）, but the levels of IgG, IgM, IgA, CD3^＋ and CD8^＋ had no statistical difference between EN and PN groups; The L/M ratio of all the patients on postoperative day 9 had a significant elevation （P〈0.01） as compared with preoperative value, and the L/M ratio in EN group was not statistically different from that in PN group （P〈0.05）. Conclusion： Early enteral nutrition can improve immune statuses of postoperative patients with gastrointestinal carcinoma and is better than parenteral nutrition in cellular immunity. There was no significant difference in altering intestinal permeability between early postoperative enteral nutrition and parenteral nutrition was.