消化道癌患者术前肠外营养和化疗的价值

Preoperative parenteral nutrition and chemotherapy in patients with gastroenteral carcinoma

目的评价胃、大肠癌患者术前肠外营养和化疗的作用．方法胃、大肠癌患者９２例，随机分成４组，术前分别给７ｄ肠外营养（组Ⅰ）、化疗（组Ⅱ）、肠外营养加化疗（组Ⅲ）及口服普食（组Ⅳ）．治疗前后分别测体重、氮平衡（９Ｎ／２４ｈ），血淋巴细胞计数（Ｌ计数，×１０９／Ｌ），白蛋白（ｇ／Ｌ）、前白蛋白（ｍｇ／Ｌ）、转铁蛋白（ｇ／Ｌ）、补体Ｃ３（ｇ／Ｌ），ＩｇＡ，ＩｇＧ，ＩｇＭ（ｇ／Ｌ）及癌细胞ＤＮＡ含量（ｐｇ／Ｌ）、ＤＮＡ指数和细胞周期时相．结果与治疗前相比，治疗后组Ⅰ（ｎ＝２３）氮平衡（－１０±０５ｖｓ３８±０２，Ｐ＜００１）、Ｌ计数（１８５±０２３ｖｓ２１０±０２４，Ｐ＜００１）、前白蛋白（２５２±７５ｖｓ２９０±３３，Ｐ＜００１）、转铁蛋白（２６±０２ｖｓ３３±０１，Ｐ＜００１）、ＩｇＡ（２１１±０２１ｖｓ２５２±０２０，Ｐ＜００１）、ＩｇＭ（１８５±０１９ｖｓ２３８±０１９，Ｐ＜００１）及癌细胞ＤＮＡ含量（７４７±０４５ｖｓ９９６±０１７，Ｐ＜００５，８６０±１７８ｖｓ１７１０±２６４，Ｐ＜００５）和指数（１６４±０１５ｖｓ２２９±０?

AIM To evaluate the effect of preoperative parenteral nutrition and chemotherapy in patients with gastric or colorectal cancer. METHODS Ninety two cases of gastric or colorectal cancer were randomly divided into four groups: parenteral nutrition (group Ⅰ), chemotherapy (group Ⅱ),parenteral nutrition plus chemotherapy (group Ⅲ) and normal oral intake(group Ⅳ) for 7 days before operation. Body weight, nitrogen balance (NB), blood lymphocyte count (BLC), serum albumin, prealbumin (PA), transfferin (TFN), complement C 3, IgA, IgG, and IgM levels, DNA contents, DNA index and cell cycle phase of the cancer were detected pre and post treatment. RESULTS After 7 days treatment, all the indexes were markedly decreased: NB (-1 0g/24h±0 5g/24h vs 3 8g/24h±0 2g/24h , P <0 01 ), BLC (1 85×10 9/L±0 23×10 9/L vs 2 10×10 9/L±0 24×10 9/L, P <0 01 ), serum PA(252mg/L±7 5mg/L vs 290mg/L±3 3mg/L, P <0 01 ), TFN (2 6g/L±0 2g/L vs 3 3g/L±0 1g/L, P <0 01 ), IgA (2 11g/L±0 21g/L vs 2 52g/L±0 20g/L, P <0 01 ), IgM (1 85g/L±0 19g/L vs 2 38g/L±0 19g/L, P <0 01 )levels, DNA contents (7 47pg/L±0 45pg/L vs 9 96pg/L±0 17pg/L, P <0 05 ,8 60pg/L±1 78pg/L vs 17 10pg/L±2 64pg/L, P <0 05 ), DNA index (1 64±0 15 vs 2 29±0 22, P <0 05 ,1 05±0 22 vs 2 34±0 42, P <0 05 ), S%(36 1±2 1 vs 44 8±2 6, P <0 01 ) and G 2M% (5 8±0 8 vs 10 1±1 3, P <0 05 ) of cancer cell were elevated significantly in group Ⅰ( n =23), NB (-0 6g/24h±0 4g/24h vs -5 8g/24h±0 4g/24h, P <0 01 ), BLC (1 71×10 9/L±0 22×10 9/L vs 0 77×10 9/L±0 09×10 9/L, P <0 01 ), serum albumin (30 8g/L±1 6g/L vs 27 7g/L±1 0g/L, P <0 05 ), PA (259mg/L±7 1mg/L vs 218mg/L±6 2mg/L, P <0 01 ), TNF(2 6g/L±0 1g/L vs 1 9g/L±0 1g/L, P <0 01 ), IgA (1 88g/L±0 20g/L vs 1 64g/L±0 21g/L, P <0 05 ), IgM (1 78g/L±0 23g/L vs 1 28g/L±0 18g/L, P <0 01 )levels were decreased markedly, DNA contents, DNA index and cell cycle phase of the cancer had no significant changes in group Ⅱ ( n =23),NB (-1 0g/24h±0 5g/24h vs 1 0g/24h±0 4g/24h, P <0 01 ), serum PA (256mg/L±8 0mg/L vs 280mg/L±6 4mg/L, P <0 01 ), IgA(1 81g/L±0 21g/L vs 1 99g/L±0 21g/L, P <0 05 ), DNA index 2 (1 25±0 23 vs 2 13±0 29, P <0 05 ), G 2M%(7 1±1 1 vs 12 2±1 1, P <0 05 ) were increased obviously, and G 0G 1%(58 3±2 6 vs 48 9±2 9, P <0 01 ) was decreased evidently in group Ⅲ( n =23 ). CONCLUSION Parenteral nutrition plus chemotherapy can improve the nutritional status and immune function of the patients with gastric or colorectal cancer, and inhibit the proliferation of cancer cells simultaneously