精氨酸强化免疫肠内营养制剂对消化道肿瘤术后免疫功能的影响

Modulation of Postoperative Immune and Inflammatory Response by Arginine-enhancing Enteral Diet in Gastric Cancer Patients

目的:探讨精氨酸(Arg)强化免疫肠内营养制剂对消化道肿瘤术后病人免疫功能及炎性反应的影响。方法:将消化道肿瘤患者96例双盲、随机分为研究组和对照组。手术后第2天开始给予等热量、等氮量肠内营养制剂1周。研究组使用含精氨酸强化的肠内营养剂Impact,对照组使用普通的肠内营养剂Nutrison。对比观察术前、术后第1天和第8天两组血浆蛋白质水平、氮平衡、免疫功能状况、炎性反应、感染有关并发症、住院时间。结果:在进行7 d的肠内营养以后,两组患者生命体征、血常规、肝肾功能、蛋白质水平、氮平衡、血脂和全身副反应均无显著性差异;两组患者术后均有急性炎性反应的发生和免疫功能的降低。但研究组较对照组的术后第8天,IgGI、gAI、gM和CD3、CD4明显升高(均为P<0.05);血清IL-6、TNFα、CRP、PGE2显著下降;术后住院时间,研究组显著低于对照组(P<0.05)。结论:消化道肿瘤术后添加Arg的免疫肠内营养,能改善患者手术后免疫功能低下,缓解急性相炎性反应。

Objective： To evaluate the effect of the enteral diet supplemented with arginine on host immune and inflammatory responses in gastric cancer surgical patients. Methods： Ninety-six gastric cancer patients were randomized equally to receive either an arginine enriched enteral diet （Arg group）, or an isocaloric standard enteral diet （control group）. The patients received enteral nutrition by continuous pump infusion via a nasogastric tube. Jejunal infusion was started 48 hours after surgery and continued for seven days. All variables were measure before operation and on postoperative day 1 and 8. The level of protein, immune function, nitrogen balance, infection related complication, inflammatory responses and in-hospital days were compared between the two groups. Results： There were significant postoperative changes in inflammatory response and immunological variables in both groups. CD3, CD4, IgG, IgA and IgM levels in Arg group were higher （all P〈0.05） than in the standard group at 1 or 8 d after operation. CRP, IL-6, TNFα and PGE2 levels were lower （all P〈0.05）, and in-hospital days were less in the Arg group compared with those in control group. The level of protein and nitrogen balance were not different between the two groups. Conclusion： Supplementation of enteral nutrition with arginine can ameliorate the host immunosuppressive and control inflammatory response.