肠内免疫微生态营养支持对肝癌切除术后肝损害的影响

Effect of Enteral Immune Micro-ecological Nutrition Support on Liver Damage in Patients with Liver Cancer After Hepatectomy

目的探讨肠内免疫微生态营养支持(EIN)对原发性肝癌(简称肝癌)肝切除术后肝损害的影响。方法选取2010年4月—2015年4月我院收治的肝癌80例,随机分为EIN组和肠内营养(EN)组,每组各40例,排除因病情突发及拒绝治疗而剔除出研究者,最终EIN组纳入37例,EN组纳入36例。两组均予EN,EIN组在此基础上予EIN,营养支持时间均为1周。观察比较两组术后肛门排气时间和营养支持并发症;术前、术后2 d及术后8 d检测两组肝功能指标及血内毒素、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)并进行比较。结果术后不良反应EIN组5例(13.5%),EN组7例(19.4%),两组比较差异无统计学意义(P>0.05)。术后肛门排气时间EIN组较EN组短(P<0.05)。两组术前和术后2 d肝功能指标及血内毒素、IL-6比较差异均无统计学意义(P>0.05);术后8 d EIN组肝功能指标改善情况优于EN组(P<0.001);两组TNF-α在术后2 d均较术前升高,但EIN组升高水平低于EN组(P<0.001);EIN组血内毒素、TNF-α和IL-6在术后8 d明显低于EN组(P<0.001)。结论 EIN可通过保护肠黏膜屏障功能,减少细菌和内毒素易位,调节免疫功能,减轻全身炎性反应,从而减轻肝癌患者肝切除术后的肝损害。

Objective To investigate the effect of enteral Immune micro-ecological nutrition support（ EIN） on liver damage in patients with liver cancer after hepatectomy. Methods 80 patients with liver cancer during April 2010 and April2015 were selected and were randomly divided into EIN group and early enteral nutrition（ EN） group（ n = 40 in each group）.Patients who suffered a seizure or refused the treatment were ruled out of the study. Eventually EIN group had 37 cases and EN group had 36 cases in this study. Both groups were given EN,and on the basis of EN,EIN group was given EIN,nutritional support for 1 week. The anus exhaust time and nutrition complications after operation were observed. Preoperative and postoperative 2 days and postoperative 8 days,liver function detection,endotoxin,tumor necrosis factor alpha（ TNF alpha）,interleukin 6（ IL6） were compared. Results EIN group had 5 cases of postoperative adverse reactions（ 13. 5%） while EN group had 7 cases（ 19. 4%）,and there was no statistically significant difference（ P〈0. 05）. Postoperative exhaust time of EIN was shorter than that of EN group（ P〈0. 05）. Preoperative and postoperative 2 days,liver function and blood endotoxin,IL-6 level had no statistical significance in the two groups（ P〈0. 05）. Postoperative 8 days,liver function of EIN group was superior to that of EN group（ P〈0. 001）. TNF-α 2 days after surgery was higher than that of the two groups. The elevated levels of EIN were lower than that of EN group（ P〈0. 001）. Blood endotoxin and TNF-α and IL-6 of EIN group postoperative8 days were significantly lower than that of EN group（ P〈0. 001）. Conclusion EIN can protect intestinal mucosal barrier function,reduce bacteria and endotoxin translocation,adjust the immune function,reduce systemic inflammatory reaction,and therefore reduce liver damage of hepatocellular carcinoma patients after hepatectomy.