肠内营养对食管癌术后免疫功能的影响

Effect of enteral nutrition on immune function after esophagectomy of esophageal carcinoma

目的探讨肠内营养对食管癌术后免疫功能的影响。方法将44例食管癌患者随机分成肠内营养组(20例)和肠外营养组(24例)。均于手术后24h开始给予等热量(125.4kJ·kg-1·d-1)、等氮量(0.2g·kg-1·d-1)营养支持,持续9d,测定手术前1d、术后1d和9d的外周血B淋巴细胞,免疫球蛋白A(IgA),IgG,IgM,淋巴细胞总数,T淋巴细胞亚群(CD3,CD4,CD8,CD4/CD8),自然杀伤细胞(NK细胞)活性等免疫指标。结果43例完成研究。两组术前各免疫指标比较无差别,术后第1d均有一定程度的免疫抑制,术后第9d肠内营养组IgA,IgG,IgM,淋巴细胞总数,CD3,CD4,CD4/CD8,NK细胞活性明显回升,CD8细胞则回落正常水平,而肠外营养组CD8细胞仍处于高水平,其余指标仍处于低水平。结论早期肠内营养可促进食管癌术后免疫功的恢复。

Objective To study the effect of enteral nutrition on immune function in patients after esophagectomy. Methods Forty-four patients who underwent surgery for esophageal cancer were randomized into enteral nutrition（EN） group （n=20） or parenteral nutrition （PN） group （n=24）. From the 1st day after operation, the patients received either enteral nutrition or parenteral nutrition, with an isocalorie and isonitrogen for 9 days. Host immunity was evaluated by IgA, IgG, IgM, B-lymphocytes, total lymphocytes, CD3, CD4, CD8, CD4/CD8, and NK cell activity preoperatively, on the 1st day and 9th day postoperatively. Results 43 cases completed the study. There were no significant differences in the results of all of above parameters in two groups before operation. Patients in two groups had a certain degree of postoperative immunosuppression. On postoperative day 9, there was no significant difference in B-lymphocytes between two groups, but the levels of IgA, IgG, IgM, total lymphocytes, CD3, CD4, CD4/CD8, and NK cell activity were significantly higher and CD8 was significantly lower in the EN group than in the PN group （P 〈 0.05） . Conclusion Compared with the parenteral nutrition, enteral nutrition may have beneficial effects on the immunity function in patients following esophagectomy.