胃肠道恶性肿瘤术前肠内免疫营养支持的临床意义

The Clinical Significance of Preoperative Enteral Immune Nutrition in Patients with Malignant Gastrointestinal Tumors

目的探讨胃肠道恶性肿瘤术前肠内免疫营养支持的效果。方法将82例胃癌和大肠癌患者分为常规饮食组(对照组)和肠内营养支持组(EN组),每组41例。对照组入院后常规饮食,EN组术前7d给予肠内营养乳剂(TPF-T)瑞能口服,两组提供的热量和氮量完全相同。定期检测血清白蛋白、转铁蛋白、前白蛋白、视黄醇结合蛋白及T细胞亚群,记录术后并发症、肠蠕动恢复时间、术后住院天数和术前术后营养支持的总费用情况。结果 EN组术前营养状况较入院时普遍提高,转铁蛋白、前白蛋白、视黄醇结合蛋白升高(P<0.05);免疫功能增强,CD3+、CD4+/CD8+提高(P<0.05),与对照组比较,差异有统计学意义(P<0.05)。两组患者术后无死亡、消化道瘘等严重并发症,EN组术前术后营养支持总费用与对照组相仿(P>0.05),但EN组术后肠动力恢复早、术后住院天数减少、术后并发症率低、节约术后营养支持费用(P<0.05)。结论胃肠道恶性肿瘤患者术前应用肠内营养支持能改善患者术前营养状态、增强免疫功能、促进术后恢复。

Objective To study the impact of preoperative enteral immune nutrition on patients with malignant gastrointestinal tumors. Methods 82 patients with malignant gastrointestinal tumors were divided equally into 2 groups：enteral nutrition group （EN） and normal diet group （Control）. Enteral Nutritional Emulsion （TPF- T） served as nasogastically-fed liquid diet for the patients in EN group over a period of 7 days prior to surgery. Normal diet was given to the patients in control group under the same condition as those in EN group in terms of calories and nitrogen contents. Enzyme linked immunosorbent assay （ELISA） was performed to determine the quantity of serum albumin （ALB）, transferrin protein （TRF）, pre-albumin （PA） and retinol binding protein （RBP）. Flow cytometry （FCM） was performed to determine T cell subsets. Postoperative complications, resumption of peristalsis, length of hospital stay, and nutritional costs were also recorded. Results TRF, PA and RBP increased significantly in the patients in EN group compared with those in control group （P（0.05）. The patients in EN group had significantly higher proportions of CD3＋ , CD4＋/CD8＋ higher than those of control （P（ 0.05）. No serious complications （eg. death or gastrointestinal fistula） were found in the patients. The total nutritional cost for the patients in EN group was similar to that of the controls （P〉0.05）. The patients in EN group had less postoperative complications, quicker resumption of peristalsis, shorter hospital stay and lower level of postoperative nutrition cost compared with those of controls （P〈0.05）. Conclusion Enteral nutrition support can improve the nutritional status and immunity of patients with malignant gastrointestinal tumors, which has both pre-operative and post-operative benefits for the patients.