围手术期肠内免疫营养对肝硬化大鼠肝切除术后机能的影响

Effect of Perioperative Enteral Immunonutrition on Physical Functions in Cirrhotic Rats after Partial Hepatectomy

目的探讨肝硬化大鼠行大部分肝切除术时围手术期合理充分的营养支持方案。方法将48只肝硬化大鼠随机分为标准肠内营养组(A组,n=24)和肠内免疫营养组(B组,n=24),根据标本采集时间的不同,各组再分为术前,术后1、4和8天4个亚组,每组6只。两组大鼠分别用等热量的标准肠内营养剂和肠内免疫营养剂喂养8天后行68％肝切除术,术后再喂养至取标本。分别于术前、术后第1、4和8天取相应亚组大鼠血和肝组织标本,检测T淋巴细胞亚群、血清IgG、血清IL-6和增殖细胞核抗原阳性肝细胞计数。结果 B组术后第1天 CD3、CD4、CD4/CD8和IgG的值,术后第4天CD4、CD4/CD8和IgG的值,术后第8天CD4／CD8和IgG的值均显著高于 A组(P<0．05);B组术后第1、4天IL-6值显著低于A组(P<0．05)。两组大鼠术后残肝有一定再生能力,B组增殖细胞核抗原阳性肝细胞计数在术后第4和8天显著高于A组(P<0．05)。结论围手术期肠内免疫营养支持能减轻肝硬化大鼠肝切除术后免疫抑制,增强术后免疫功能,下调术后过度的急性炎症反应,还能增强残肝再生能力, 使肝再生在术后较长时间内保持高水平。

Objective To explore a rational and adequate perioperative scheme of nutrition support for cirrhotic rats undergoing 68% hepatectomy. Methods Forty-eight cirrhotic rats were randomly divided into perioperative standard enteral nutrition group （Group A, n = 24） and perioperative enteral immunonutrition group （Group B, n = 24）. Each group was further divided into four subgroups （n - 6 in each subgroup） based on specimen collection time. The rats in the two groups received equal daily enteral nutrition （690 kJ/kg per day） for 8 days before operation and continuously fed after operation until the day of specimen collection. On the day before hepatectomy and the 1^rt, 4^th, and 8^th postoperative day（POD）, blood T lymphocyte subsets serum levels of IgG and IL-6, and proliferating cell nuclear antigen （PCNA） labeling index of hepatocytes were determined. Results Immunosuppression and acute inflammatory responses were observed in both two groups, but the severity in Group B was lower than that in Group A. The values of CD3, CD4, CD4/CD8, and IgG on the 1^rt POD, the values of CD4, CD4/CDs, and IgG on the 4^th POD, and the values of CD4/CD8 and IgG on the 84 POD were significantly higher in Group B than those in Group A （P 〈 0.05）. The values of IL-6 on the 1^st and 4^th PODs were significantly lower in Group B than those in Group A （P 〈 0.05）. PCNA labeling index increased significantly in both groups on 1^st、 4^th, and 8^th day （P 〈 0.05）, with a maximal value observed on 1^st day after hepatectomy. The values of PCNA labeling index in B3 and B4 subgroups were significantly higher than those in A3 and A4 subgroups （P 〈 0.05）. Conclusions Compared with perioperative standard enteral nutrition, perioperative enteral immunonutrition can alleviate immunosuppression, enhance immune function, and downregulate inflammatory response. Meanwhile, it can improve the regeneration function of the residual liver, and maintain a higher degree of liver regeneration within a longer period.