结构脂肪乳对消化道肿瘤术后患者炎性细胞因子和免疫功能的影响

Effect of structured lipid emulsion on inflammatory cell factors and immunologic function ingastrointestinal cancer patients after operation

目的探讨结构脂肪乳对消化道肿瘤术后患者炎性细胞因子和免疫功能的影响。方法选取2010年7月至2012年2月收治消化道肿瘤术后患者80例，按分层抽样法随机分为结构脂肪乳组（观察组）和物理混合的中，长链脂肪乳组（对照组），每组40例，于术后1—6d接受等氮、等热量的肠外营养。对比观察两组患者术后一般情况，分别于术前，术后1、7d检测血清炎性细胞因子和免疫功能指标。结果在进行6d的肠外营养以后，两组患者生命体征、血常规、肝肾功能、血脂等均在正常范围，观察组术后感染相关并发症发生率[12．5％（5／40）]较对照组[25．O％（10／40）]低，术后住院时间[（12．9±0．7d）]较对照组[（13．1±0．9）d]短，但差异无统计学意义（P〉0．05）。两组术后1d血清白细胞介素（IL）-1、IL-2、IL-6及肿瘤坏死因子（TNF）-a浓度均有不同程度下降，随后逐渐回升，观察组术后7d血清IL-2、IL-6和TNF-a浓度[（987±203）、（277±107）、（197±98）ng／L]明显低于对照组[（1347±195）、（752±187）、（342±106）ng／L3（P〈0．05）；两组术后1d外周血IgC、IgA、IgM、CD3＋,CD4＋、CD5＋水平均有不同程度下降，随后逐渐回升，观察组术后7d外周血IgG、CD3＋、CD4＋水平[（14．2±1．8）巩、0．746±0．111、0．580±0．067]较对照组[（12．1±2．8）g/L、0．606±0．101、0．404±0．072]明显升高（P〈0．05）。结论结构脂肪乳能减轻消化道肿瘤术后患者免疫抑制，减轻炎性反应，调控炎性细胞因子的产生和释放，改善机体免疫功能。

Objective To explore the influence of structured lipid emulsion on inflammatory cell factors and immunologic function in gastrointestinal cancer patients after operation. Methods From July 2010 to February 2012,80 postoperative patients with gastrointestinal cancer were randomly divided into 2 groups with 40 cases each by stratified sampling method： structured lipid emulsion group （observation group）, physical mixture of medium-chain/long-chain triglyeerides group （control group）. Both groups received isonitrogenous and isocaloric parenteral nutrition for 6 days after operation. The general conditions after operation were compared between two groups. Inflammatory cell factors and immunologic function were measured before operation,the 1st day and 7th day after operation. Results After 6 days parenteral nutrition, the vital sign data, blood routine, liver and renal function, blood fat ere was normal in two groups. There was no significant difference in the incidence of postoperative infection complication and hospitalization duration between observation group and control group [ 12.5 % （ 5/40 ） vs. 25.0% （10/40）, [ （ 12.9 ± 0.7 d ） vs. （13.1 ±0.9） d] （P 〉0.05）. The serum levels of interleukin （IL）-l,IL-2,IL-6,tumor necrosis factor （TNF）- a on the 1 st day after operation in two groups decreased, then gradually increasing. The serum levelsof IL-2, IL-6, TNF-ct on the 7th day after operation in observation group [ （987 ± 203 ）, （277 ± 107 ）, （197 ± 98） ng/L] were lower than those in control group [（1347 ± 195）, （752 ± 187）, （342 ± 106） ng/L] （P 〈 0.05）. The serum levels of IgG, IgA,IgM,CD3＋,CD4＋ and CDs＋ on the 1st day after operation in two groups decreased, then gradually increasing. The serum .levels of IgG, CD3＋, CD4＋ were higher in observation group C （ 14.2 ± 1.8 ） g/L, 0.746 ± 0.111,0.580 ± 0.067 ] than those in control group [ （ 12.1 ± 2.8） g/L, 0.606 ± 0.101, 0.404 ± 0.072 ] （P 〈 0.05）. Conclusion Structured lipid emulsion can reduce immunological suppression and inflammation in gastrointestinal cancer patients after operation, regulate the inflammatory cell factors producing and releasing, improve the immunologic function.