添加精氨酸和谷氨酰胺的肠外营养对食管癌术后应激和免疫状态的影响

Effect of arginine and glutamine-enhanced parenteral nutrition on post-operative stress status and immune function in esophageal cancer patients

目的探讨添加精氨酸和谷氨酰胺的肠外营养对食管癌患者术后应激及免疫状态的影响。方法36例手术治疗的食管癌患者,随机分为实验组和常规组,每组18例。12例同期行择期胸部手术患者作为对照组。术后第1日开始采用全营养混合液通过周围静脉输注,均为等氮等热量,营养支持疗程为7 d。观察实验组与常规组患者在术前1日及术后第1日、第8日的应激状态(C3、C4、CRP)和免疫功能(CD4+,CD8+,CD4+/CD8+,IgG,IgM)的变化。结果术前1日食管癌患者的C3、C4及CRP高于对照组(P<0.05),实验组上述指标在术后第8日低于常规组(P<0.05)。食管癌患者入院时均有明显的免疫抑制,实验组(CD4+、CD4+/CD8+)在术后第8日与常规组相比有改善(P<0.05)。结论添加精氨酸和谷氨酰胺的肠外营养能有效地改善食管癌术后患者的应激和免疫状态。

Objective To investigate the effect of arginine（Arg） and glutamine（Glu）-enriched parenteral nutrition（PN） on stress status and immune function of esophageal cancer patients after operation.Methods Thirty-six patients with esophageal cancer after operation were randomly divided into experimental group and routine group（standard PN group）.Twelve patients receiving thoracic operation were chosen as controls.From the first day after operation,total PN with equal calorie and equal nitrogen was infused to the patients by peripheral vein for 7 days. Tests for the stress status（ C3, CA and CRP） and immune function （CIM ~ , CD8 ~ , CIM ~/CD8 ＊, IgG, IgM） were performed preoperatively and on the day before operation, the 1st day and the 8th day after operation respectively. Results The C3, CA and CRP of esophageal cancer patients on the day before operation were higher than those of the control group（P 〈0. 05 ）. The above indexes of experiment group were ameliorated compared with routine group on the the 8th day after operation（ P 〈 0. 05 ）. Experimental group and routine group had immune suppression before operation. Experimental group had improved immune function with increased CD4^＋ and CD4^＋/CD8^＋ as compared with routine group on the 8th day after operation （ P 〈 0. 05 ）. Conchsion Arg and Glu enriched PN can effectively ameliorate the stress status and immune function after operation of esophageal cancer patients.