胃肠外营养添加精氨酸对结直肠癌术后患者细胞免疫功能的影响

The influence of total parenteral nutrition added with arginine on cellular immune function of colonic cancer after operation

目的:探讨胃肠外营养(TPN)添加精氨酸(Arg)对结直肠癌患者术后淋巴细胞免疫功能的影响及临床意义。方法:对56例结直肠癌患者术后进行了TPN支持的前瞻性研究,检测无脂TPN、常规TPN和常规TPN中添加Arg营养支持前后患者外周血的T淋巴细胞亚群(CD4+和CD8+T细胞亚群)和NK细胞百分比的变化以及外周血中IL-2、IL-4以及IFN-r水平的变化。结果:无脂TPN、常规TPN支持前后患者外周血的CD4+T细胞、CD8+T细胞以及NK细胞水平无明显变化,IL-2、IL-4以及IFN-r水平无明显变化;常规TPN中添加Arg营养支持后患者外周血的CD4+和NK细胞百分比明显增加,CD8+T细胞亚群明显减少,CD4+/CD8+比值也较术前明显升高,外周血中IL-2、IL-4以及IFN-r水平明显增加。结论:常规TPN不能纠正结直肠癌患者术后的细胞免疫抑制状态,但TPN添加Arg则可促进CD4+的Th1细胞亚群和NK细胞增加,外周血IL-2和IFN-r生成增加,提示TPN添加Arg对结直肠癌患者术后的细胞免疫有上调作用。

Objective：To explore the influence of total parenteral nutrition（TPN）added with arginine on the cellular immune function of colonic cancer after radical operation.Methods：There were 56 cases of colonic cancer supported with TPN who were divided into 3 groups（TPN without fat,routine TPN and TPN added with arginine）,whose data were designed and analysed prospectively.The percent of T lymphocyte subpopulation and national killer cell（NK）in peripheral blood was detected,and so was the level of IL-2,IL-4 and IFN-r in peripheral blood.Results：There was no marked change about CD4^＋ T cell,CD8^＋ T cell and NK in peripheral blood after TPN without fat and routine TPN,and so was the level of IL-2,IL-4 and IFN-r.After TPN added with arginine,there was significant increase of CD4^＋ T cell,the ratio of CD4^＋ T/CD8^＋T and NK in peripheral blood,and so was the level of IL-2 and IFN-r.On the contrast,the percent of CD8^＋ T cell and the level of IL-4 in peripheral blood decreased significantly after TPN added with arginine.Conclusion：Routine TPN can not correct the cell mediated immunity suppression after radical operation of colonic cancer.But TPN added with arginine can augment the percent of Th1 subpopulation and NK,and increase the level of IL-2 and IFN-r in peripheral blood,which denote that arginine can up-regulate the cell mediated immunity of colonic cancer after operation.