四君子汤联合肠内营养对胃癌手术患者T细胞亚群及营养状况影响的随机对照研究

Effect of Sijunzi Decoction and enteral nutrition on T-cell subsets and nutritional status in patients with gastric cancer after operation:A randomized controlled trial

目的:观察胃癌患者围手术期使用中药四君子汤联合肠内营养对T细胞亚群及营养状况的影响。方法:采用前瞻性、随机、单盲、对照研究,将59例胃癌手术患者随机分为对照组(n=20)、研究A组(n=21)和研究B组(n=18)。研究B组术后2～9d经鼻饲管给予中药四君子汤100ml,研究A、B组患者手术后第2天开始给予等热量、等氮肠内营养支持8d,对照组术后给予等热量、等氮肠外营养支持9d。术前1d,术后第1天和第10天分别检测T细胞亚群及血清白蛋白、前白蛋白、转铁蛋白等营养指标。结果:3组患者血清白蛋白、前白蛋白、转铁蛋白和CD3+、CD4+、CD4+/CD8+水平术后均较术前显著降低。术后第10天,应用肠内营养的A、B两研究组T细胞亚群及营养指标水平较使用肠外营养支持的对照组有不同程度的提高,且四君子汤辅助肠内营养的研究B组血清白蛋白、转铁蛋白和T细胞亚群水平均较单纯肠内营养的研究A组显著提高(P<0.05)。结论:健脾益气中药四君子汤辅助的肠内营养能进一步改善和优化胃癌术后机体的细胞免疫功能及营养状况。

Objective： To observe the effect of perioperative application of Sijunzi Decoction and enteral nutrition on T-cell subsets and nutritional status in patients with gastric cancer after operation. Methods： In this prospective, single-blinded, controlled clinical trial, fifty-nine patients with gastric cancer were randomly divided into three groups： control group （n=20） and two study groups （group A, n=21; group B, n=18）. Sjunzi Decoction （100 ml） was administered via nasogastric tube to the patients in the study group B from the second postoperation day to the 9th postoperation day. Patients in the two study groups were given an isocaloric and isonitrogonous enteral diet, which was started on the second day after operation, and continued for eight days. Patients in the control group were given an isocaloric and isonitrogonous parenteral diet for 9 days. All variables of nutritional status such as serum albumin （ALB）, prealbumin （PA）, transferrin （TRF） and T-cell subsets were measured one day before operation, and one day and 10 days after operation. Results： All the nutritional variables and the levels of CD3^＋, CD4^＋, CD4^＋/CD8^＋ were decreased significantly after operation. Ten days after operation, T-cell subsets and nutritional variables in the two study groups were increased as compare with the control group. The levels of ALB, TRF and T-cell subsets in the study group B were increased significantly as compared with the study group A （P〈0.05）. Conclusion： Enteral nutrition assisted with Sijunzi Decoction can positively improve and optimize cellular immune function and nutritional status in the patients with gastric cancer after operation.