免疫增强型肠内营养对胃肠癌根治术后患者免疫功能的影响

Effect of postoperative immune-enhanced enteral nutrition on immune function in gastrointestinal cancer patients with radical resection

目的评价术后免疫增强型肠内营养对胃肠癌根治患者术后免疫功能的影响。方法将58例胃肠癌根治患者随机分为免疫增强型肠内营养组（IEDs组）和常规肠内营养组（EN组）各29例，IEDs组使用含谷氨酰胺、精氨酸、ω－3多不饱和脂肪酸的免疫增强型肠内营养制剂，EN组使用常规的制剂能全力。分别检测术前1d、术后l，9d2组患者的免疫指标：T淋巴细胞亚群（CD3＋、CD4＋、CD8＋、CD4＋／CD8＋）、自然杀伤（NK）细胞和免疫球蛋白（IgA、IgM、IgG）。结果2组患者均无严重并发症，术后恢复顺利。术前、术后1d2组各项免疫指标比较差异有统计学意义。术后1d2组的各项免疫指标均降低，术后9d均回升。术后9d IEDs组CD3＋、CD4＋、CD4＋／CD8＋、NK细胞、IgA、IgG与IgM较术后1d均显著增加。术后9d IEDs组CD3＋、CD4＋、CD4＋／CD8＋、NK细胞、IgA、IgM较EN组分别增加了6．57％、27．97％、26．47％、36．05％、22．75％、25．62％，差异有统计学意义。结论胃肠癌根治患者术后给予免疫增强型肠内营养在改善免疫功能方面优于常规的肠内营养。

Objective To evaluate the effect of postoperative immune-enhanced enteral nutrition on host immune function in gastrointestinal cancer patients with radical resection. Methods 58 patients of radical resection of gastrointestinal carcinoma were randomly divided into the immuneenhanced enteral nutrition group（IEDs group）and the regular enteral nutrition group（EN group）with 29 cases in each group. Patients in the IEDs group received immune enhanced nutrition, containing glutamine, arginine ω-3 polyunsaturated fatty acids, while Nutrison Fibre was given to the EN group. T-lymphocyte subsets （ CD3＋, CD4＋, CD8＋, CD4＋/CD8＋）, NK cells, immunoglobulin （IgA, IgM, IgG）were measured respectively on preoperative day 1, and postoperative day 1 and day 9. Results No severe adverse effects of those two formulas were recorded. Postoperative procedures went smoothly in two groups. There were no significant differences in immune parameters between two groups on preoperative day 1 and postoperative day 1. The immune indicators were decreased on postoperative day 1 while increased on postoperative day 9 in both two groups. The level of CD3＋, CD4＋, CD4＋/CD8＋, NK, IgA, IgM in the IEDs group on postoperative day 9 were higher than those on postoperative day 1 while all relevant parameters of the EN group showed no significant difference except CD3＋ and immunoglobulin. The level of CD3＋, CD4＋, CD4＋/CD8＋, NK, IgA, IgM in the IEDs group on postoperative day 9 had increased significantly in comparison with those of the EN group. Conclusions The postoperative immuneenhanced enteral nutrition in gastrointestinal cancer patients with radical resection is superior to regular enteral nutrition in improving immune function.