L-精氨酸对围手术期胃癌病人炎性反应和免疫功能的影响

Effect of L-arginine on inflammatory reaction and immune function in postoperative patients with gastric cancer

目的:研究L-精氨酸(L-Arg)对围手术期胃癌病人炎性反应和免疫功能的影响。方法:将围手术期胃癌病人随机分为研究组和对照组,研究组(n=33)行营养支持加L-Arg治疗,L-Arg 0.4 g/(kg.d)通过静脉给予;对照组(n=30)行营养支持治疗加等量的等渗盐水。能量供给为125.4 kJ/(kg.d),氮量为0.2 g/(kg.d),治疗10 d。观察胃癌病人术前3 d、术后第3和第7天血清C-反应蛋白(CRP)、白细胞介素-2(IL-2)、IL-6、IL-10、肿瘤坏死因子-α(TNF-α)、T淋巴细胞亚群CD4+、CD8+水平和CD4+/CD8+比值的变化。结果:术后第7天,研究组病人血IL-2、TNF-α水平和CD4+/CD8+比值均明显高于对照组和术前3 d,而血液CRP和IL-10水平明显低于对照组和术前3 d。术后第7天,CRP水平明显低于术后第3天。结论:L-Arg可影响胃癌病人的炎性反应水平,下调具有促进肿瘤生长能力的炎性因子水平,上调胃癌病人细胞免疫应答。

Objective： To study the effect of L-arginine on inflammatory reaction and immune function of perioperative patients with gastric cancer. Methods： Perioperative gastric cancer patients were randomly divided into the study group and the control group. The study group （n=33 cases） were given nutrition support therapy with L-arginine 0.4 g/（ kg · d） via vein, while the control group （n=30 cases） were given nutrition support therapy with isometric normal saline, with the energy supply 125.4 kJ/（kg · d） and nitrogen 0.2g /（kg · d）. On AOD-3, POD ＋ 3 and POD ＋ 7, C-reactive protein （CRP）, interleukin-2 （ IL-2）, interleukin-6（ IL-6）, interleukin-10 （IL-10） , tumor necrosis faetor-α （TNF-α） , T lymphocyte subsets CD4^＋ , CD8^＋ and the ratio of CD4^＋/CD8^＋ of gastric cancer patients were observed. Results ： On POD ＋ 7, the levels of IL-2, TNF-α and CD4^ ＋/CD8^ ＋ ratio in the study group were significantly higher than that in the control group or that on AOD-3, while the levels of CRP and IL-10 were obviously lower than that in the control group or that on AOD-3. On POD ＋ 7,the level of CRP was significantly lower than that on POD ＋ 3. Conclusion： In gastric cancer patients, L-arginine can not only affect the level of the inflammatory reaction, cutting the level of inflammatory factor that could promote tumor growth ability, but also improve the immune response.