结直肠癌术前联用化疗和肠内免疫营养的临床研究

The effect of combined preoperative chemotherapy and enteral immunonutrition on the prognosis of colorectai cancer

目的探讨结直肠癌术前联合应用肠内免疫营养和化疗对结直肠癌预后的影响,研究术后营养状况和免疫状态,评价其对术后恢复的影响。方法将120例结直肠癌患者随机分成4组：对照组：常规饮食和术前准备;EN组：术前肠内免疫营养治疗;CH组：术前化疗;EN-CH组：术前联合应用肠内免疫营养和化疗。比较各组手术前后的营养情况和免疫指标、并发症的发生率、肿瘤细胞的增殖和凋亡,以及随访术后生存率和复发转移率。结果体重变化：EN组术后第7天体重减轻明显低于对照组和CH组（x^2=3.68和3.25,P＜0.05）,EN组体重减轻与EN-CH组无明显差异。EN组和EN-CH组平均住院天数明显少于对照组（x^2=4.02和3.33,P＜0.05）。术后并发症：EN组及EN-CH组术后感染人次明显少于对照组和CH组（x^2=4.12和3.65,P＜0.05）。对照组和CH组分别有1例发生吻合口瘘,EN组及EN-CH组无吻合口瘘。术后发热、术后肠梗阻及心肺功能异常各组差异无统计学意义。营养状况比较：各组间手术前,术后3 d和术后7 d的血红蛋白、总蛋白及白蛋白均无明显差别。而前白蛋白在术后3 d与术前比较均有明显下降（0.11±0.16 vs.0.16±0.17, x^2=7.32,P＜0.01）,转铁蛋白在术后3 d与术前比较均有明显下降（1.23±0.3 vs.2.12±0.66, x^2=4.33,P＜0.05）。术后7 d EN组和EN-CH组恢复明显,PALB,TRF均升高,与对照组、CH组相比,差异有统计学意义（分别为0.26±0.14 vs.0.15±0.15,x^2=5.53,P＜0.05及1.82±0.59 vs.1.37±0.53,x^2=3.88,P＜0.05）。免疫方面：EN组和EN-CH组的CD3/CD4比值升高,IgG升高,补体升高;术前单纯应用化疗或肠内营养对肿瘤细胞增殖和凋亡没有影响,而联合应用肠内免疫营养和化疗后,G0-G1期细胞增加。异倍体比例升高,增殖抗原Ki67减少,凋亡增加。CH组与对照组以及EN-CH组与EN组相比,术后生存率提高,复发率及转移率下降。结论术前化疗联合应用肠内免疫营养能够改善结直肠癌患者的营养状况,减少术后并发症和感染的发生,提高机体免疫力,促进肿瘤细胞凋亡,改善患者预后。

Objective To study the effect of combined preoperative chemotherapy and enteral immunonutrition on the prognosis of coloreetal cancer, the patients＇ postoperative nutrition and immune state. Method In this study, 120 colorectal cancer patients were randomly divided into 4 groups： control group with routine preoperative preperation; EN group with preoperative enteral immunonutrition; CH group with preoperative chemotherapy and EN-CH group with combination preoperative enteral immunonutrition and chemotherapy. Result The patients in EN group and EN-CH group lost less body weight with shorter postoperative hospital stay and significantly faster recovery of nutritional state. The patients in EN and EN-CH group were with significantly higher ratio of CD3/CD4, IgG and complements. Combination EN and chemotherapy significantly increased the ratio of G0-G1 cell and heteroploid, decreased Ki67 antigen, and significantly increased cell apoptosis. Patients in EN-CH group had a longer survival and lower recurrence and metastases rate. Conclusion A combination preoperative chemotherapy and enteral immunonutrition improves the nutrition state of colorectal cancer patients, reduces the postoperative complication and infection rate, promotes tumor cell apoptosis, improves the prognoses of colorectal cancer patients.