围手术期应用L-精氨酸联合整蛋白复方制剂对胃癌患者术后抗肿瘤免疫及肿瘤负荷的影响

Effect of perioperative application of L-asrginine combined with intacted protein compound preparations on postoperative antitumor immunity and tumor load in patients with gastric cancer

目的:目的:分析围手术期应用L-精氨酸联合整蛋白复方制剂对胃癌患者术后抗肿瘤免疫及肿瘤负荷的影响。方法:68例胃癌患者均接受根治性手术治疗,根据围术期营养干预不同分为对照组(常规葡萄糖盐水肠内营养)34例、观察组(L-精氨酸联合整蛋白复方制剂肠内营养)34例。检测两组术后近期抗肿瘤免疫细胞水平、血清病情相关指标、营养及炎症指标水平,并随访3年观察患者残胃MRI改变。结果:(1)观察组治疗后3个月,静脉血CD4^+T淋巴细胞水平,CD4^+/CD8^+比值均高于对照组(P<0.05),CD8^+T淋巴细胞、Treg细胞水平低于对照组(P<0.05);血清Pentraxin-3、CYFRA21-1、TTF-1、HE4水平低于对照组(P<0.05);白蛋白(ALB)、前白蛋白(PA)、白介素-2(IL-2)水平高于对照组,白介素-6(IL-6)、白介素-10(IL-10)水平低于对照组(P<0.05)。(2)两组患者术后3年残胃MRI图像存在显著差异。结论:围手术期应用L-精氨酸联合整蛋白复方制剂可优化胃癌患者术后免疫及营养状态,在降低远期残胃癌发生率等方面也有肯定性作用。

Objective： To analyze the effect of perioperative application of L-arginine combined with intacted protein compound preparations on postoperative antitumor immunity and tumor load in patients with gastric cancer. Methods： A total of 68 patients with gastric cancer received radical operation, and according to different perioperative nutrition intervention, they were divided into control group （normal glucose saline enteral nutrition） with 34 cases and observation group （L-arginine com- bined with intacted protein compound preparations enteral nutrition） with 34 cases. Postoperative short-term antitumor immune cell levels and serum levels of illness-related indexes, nutrition and inflammation indexes of two groups were detected, patients were followed up for 3 years and the gastric stump MRI changes were observed. Results： （1） Venous blood CD4＋T lymphocyte level and CD4＋/CD8＋ ratio of observation group 3 months after treatment were significantly higher than those of control group while CDS＋T lymphocyte and Treg cell levels were significantly lower than those of control group （P〈0.05）; serum Pentrax- in-a, CYFRA21-1, TTF-1 and HE4 levels were significantly lower than those of control group （P〈0.05） ; ALB, PA and IL- 2 levels were significantly higher than those of control group while IL-6 and IL-10 levels were significantly lower than those of control group （P〈0.05）. （2） Gastric stump MRI images 3 years after operation were significantly different between twogroups. Conclusions; Perioperative application of L-arginine combined with intacted protein compound preparations can optimizepostoperative immune and nutritional state in patients with gastric cancer, and it also has positive effect on reducing the inci- dence of long-term gastric stump carcinoma and other aspects.