生态免疫营养对消化道恶性肿瘤患者术后营养状况、炎症反应和预后的影响

Effect of Ecoimmuno Nutritient on Nutrition Status,Inflammatory Response and Prognosis of Postoperative Patients with Gastrointestinal Malignant Tumors

目的研究生态免疫营养剂对消化道恶性肿瘤患者术后机体营养状况、炎症反应及预后的影响。方法将2003年6月～2006年6月在我院接受消化道恶性肿瘤手术的40例患者随机分为生态免疫营养组(A组)和常规肠内营养组(B组)。术后第2～8天给予等氮、等热能[125.52kJ/(kg.d)]的营养支持。分别于术前1天、术后9天测量体重、上臂围、肱三头肌皮褶厚度;术前1天、术后5、9天取外周血测血清总蛋白、白蛋白、前白蛋白、转铁蛋白;术前1天,术后1、9天测血清IgG、IgM、IgA、IL-6、CRP、淋巴细胞总数等营养、免疫指标。并记录营养治疗期间术后并发症的发生率、肠功能恢复时间及住院天数。结果术后两组患者均出现各种血清蛋白和免疫球蛋白的下降及炎症因子的升高。经过一段时间的营养支持,两组患者的血清白蛋白都有升高,A组患者术后第5天和第9天显著高于B组(P<0.05);A组患者术后第9天的转铁蛋白也显著高于B组(P<0.05)。两组患者的血清IgG、IgA均逐渐上升,A组患者术后第9天的水平显著高于B组(P<0.05)。A组患者的IL-6、CRP水平术后第9天显著低于B组(P<0.05)。A组患者的肠功能恢复时间和住院天数均少于B组,但差异无显著性。结论生态免疫营养制剂较普通肠内营养能明显减轻消化道恶性肿瘤患者术后的炎症反应,可能有提高血清白蛋白合成速度、改善营养状况的功效,还可较好地保护肠黏膜屏障功能,促进肠功能恢复,提高机体免疫力。

Objective To study the effect of enteral ecoimmuno nutrition on the nutritional status, inflammatory response and prognosis of postoperative patients with gastrointestinal malignant tumors. Methods Forty patients with gastrointestinal malignant tumors were randomly divided into ecoimmuno nutrient group （group A ） and regular enteral nutrient group （group B）. Enteral feeding was performed from the second postoperative day to the 8^th postoperative day with a daily nutritional goal of 125.52 kJ/ （kg ·d）. Body weight, midarm circumference, skinfold thickness, total albumin, albumin, prealbumin, and transferrin were determined as nutritional indicators before operation and on the 1^st, 5^th, and 9^th postoperative day. IgG , IgM, and IgA were measured to determine host immunological status, and IL-6 and C-creative protein （CRP） were measured to determine lymphocytes and inflammatory response. Complications, intestinal function recovery time, and hospital stay were record. Results The levels of serum proteins and immunoglobulins decreased and the inflammation cytokines increased in both two groups after operation. After a period of nutritional support, the serum proteins increased in both group A and group B, although the levels were significantly higher in group A than in group B on the 5^th and 9^th postoperative day （ P 〈 0.05 ） , The transferring, IgG, and IgA were significantly higher in group A than in group B on the 9^th postoperative day （ P 〈 0. 05 ）. However, IL-6 and CRP level on the 9^th postoperative day was significantly lower in group A than in group B （ P 〈 0.05 ）. The intestines function recovery time and hospital stay were shorter in group A than in group B with no statistical significance. Conclusions Compared with the regular enteral nutrition, enteral ecoimmuno nutrition can remarkably alleviate inflammatory responses in postoperative patients with gastrointestinal malignant tumors. It can promote the synthesis of serum albumin, improve nutrition status, protect the intestinal mucosa barrier, accelerate the recovery of intestine function, and enhance the body immunity.