精氨酸强化的肠内营养对胃癌术后患者免疫营养的影响

Modulation of postoperative nutrition and immune response by arginine-enhancing enteral diet in gastric cancer patients

目的探讨精氨酸强化的早期肠内营养支持对胃癌术后患者免疫、营养状况的影响。方法 40例胃癌术后患者随机分为试验组和对照组各20例。两组患者均在术后经鼻空肠管进行等热量等氮、持续14 d的营养治疗。对照组采用常规肠内营养支持,试验组在此基础上添加精氨酸(15～20)g/d,其剂量为0.3 g/(kg.d)。在营养治疗前、营养治疗第8天、第15天清晨抽取患者空腹静脉血,检测血清白蛋白、前白蛋白、总蛋白、转铁蛋白、IgA、IgG、IgM、CD3+、CD4+、CD8+、CD4+/CD8+,并观察住院天数、胃肠道反应等指标。结果在营养治疗15 d后,机体达到了更好的免疫营养反应状态;试验组白蛋白、总蛋白、IgA、CD4+、CD4+/CD8+水平显著高于对照组并且住院天数明显低于对照组(P<0.05)。结论胃癌术后早期给予精氨酸强化的肠内营养,可增强机体免疫功能、提高营养状况、缩短住院天数;干预持续15 d效果更明显。

Objective To evaluate the enteral diet supplemented with arginine on host nutrition and immune response in postoperative gastric cancer patients. Methods Forty cases of postoperative gastric cancer patients were randomly divided into experimental group and control group of 20 cases in each. The patients received enteral nutrition by continuous pump infusion via a nasogastric tube. Jejunal infunal infusion was after surgery and continued for 14 days. The levels of proteins, immune function and hospitalization day were compared between two groups. All indicators were measured before operation and on postoperation day 8 and 15. Results Total protein, albumin, IgA, CD4＋, CD4＋/CD8＋ levels in the experimental group were higher （all P 〈 0.05） than in the control group at 15 days after operation, and hospitalization day was less in the exper- imental group than in the control group （P 〈 0.05）. Conclusion Early supplementation of enteral nutrition with arginine can ameliorate the immune function, nutrition response and reduce hospitalization day for postoperative gastric cancer patients.