四君子汤合肠内营养对胃癌术后患者免疫状况的影响

Effect of Application of Si-Jun-Zi Decoction and Enteral Nutrition on Immune Status in Patients with Gastric Cancer

目的：观察使用中药四君子汤联合肠内营养对胃癌患者围手术期免疫状况的影响。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20例、研究A组21例和研究B组18例。研究B组术后第2~9天经鼻饲管给予中药四君子汤100mL,两研究组患者术后第2天开始给予等热量、等氮肠内营养支持8天,对照组术后给予等热量、等氮肠外营养支持9天。结果：3组患者IgG,IgA,IgM和CD3^＋,CD4^＋,CD4^＋/CD8^＋水平术后均较术前有显著的降低。术后第10天T细胞亚群及IgG、IgM水平,应用肠内营养的A,B两研究组均较使用肠外营养支持的对照组有不同程度提高,且四君子汤辅助肠内营养的研究B组在IgG和T细胞亚群水平均较单纯肠内营养的研究A组有显著提高（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胃癌术后机体的细胞免疫功能及部分体液免疫功能。

Objective ： To observe the effect of perioperative application of Si - Jun - Zi decoction and enteral nutrition on immune status in patients with gastric cancer. 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）. The study group B was fed with Si -Jun -Zi decoction 100mL on postoperation day 1 -9. Two study groups were given isocaloric and isonitrogonous enteral nutrition ,which was started 36 h after operation continuing 8 days. Control group were given isocaloric and isonltrogonous parenteral nutrition 9 days. All variables of IgG, IgA, IgM and subgroups of T cell were measured before operation day 1 and on postoperation day 1 and 10. Results： IgG, IgA, IgM and subgroups of T cell level decreased significantly after operation. On postoperation day 10, IgG, IgM and subgroups of T cell of two study groups were increased compare with control group, subgroups of T cell and IgG of study group B which use Si - Jun - Zi decoction and enteral nutrition was increased significantly comparing with study group A which use enteral nutrition single （ P 〈 0.05 ）. Conclusion： Enteral nutrition assisted with Si -Jun -Zi decoction can positively improve and optimize cellular immune function and part humoral immunity for postoperation of gastric cancer.