胃肠道肿瘤患者围术期营养治疗对甲状腺激素及前清蛋白水平影响

The level of thyroid hormone and albumin after nutrition supportive therapy in perioperative gastrointestinal cancer patients

目的研究肠外营养治疗下胃肠道肿瘤患者围术期甲状腺激素及PA水平变化。方法选取2013年5月至2016年7月,于我院接受根治术治疗的胃肠道肿瘤患者80例为研究对象。根据随机数字表法均分为观察组与对照组,每组各40例。其中观察组术后予以肠外营养治疗,对照组术后不予以肠外营养治疗。分别检测两组患者术前1天、术后1天、术后5天以及术后8天的甲状腺激素与PA水平。其中采用微粒子捕捉酶免疫分析法检测游离三碘甲状腺氨酸以及总三碘甲状腺原氨酸,采用放射免疫分析法检测反三碘甲状腺原氨酸(rT3)以及PA水平。并作相关性分析。结果观察组术前1天、术后1天、术后5天以及术后8天的FT3、TT3、rT3、PA水平比较,采用重复测量数据的方差分析,结果显示:不同时间点的FT3、TT3、rT3、PA水平差异均有统计学意义(均P<0.05)。而对照组术前1天、术后1天、术后5天以及术后8天的FT3、TT3、rT3、PA水平比较,采用重复测量数据的方差分析,结果显示:不同时间点的FT3、TT3、rT3、PA水平差异无统计学意义(均P>0.05)。经Pearson相关分析可得:观察组不同时间段FT3、TT3与PA水平均呈正相关关系(r=0.473,P<0.01;r=0.502,P<0.01),而rT3与PA水平呈负相关(r=-0.424,P<0.05)。结论胃肠道肿瘤患者术前便存在非甲状腺疾病综合征,且在术后短时间内无法完全恢复。此外,肠外营养治疗下胃肠道肿瘤患者围术期甲状腺激素及PA水平均存在明显变化,可作为患者围术期营养状态的评估指标之一。

Objective To study the effects of parenteral nutrition support in patients with gastrointestinal cancer during theperioperative period of thyroid hormone and prealbumin （PA） levels. Methods From May 2013 to July 2016, 80 cases withgastrointestinal cancer treated in our hospital were randomly divided into the observation group and the control group, with 40cases in each group. The observation group was given parenteral nutrition support after operation, and the control group was notgiven parenteral nutrition support. The preoperative 1 day, postoperative 1 day, postoperative 5 days and thyroid hormone and PAlevels in the two groups were detected before and after operation respectively in the patients of the two groups, respectively. Theresults showed that the patients in the control group were not given parenteral nutrition support after operation. The levels of thyroidhormone and 8 days in the two groups were detected before operation, after the operation, after the operation and after the operation.The particle analysis method for detecting free triiodothyronine three capture ELISA （FT3） and total three triiodothyronine （TT3）,detection of reverse triiodothyronine three by radioimmunoassay （rT3） and the level of PA. The correlation analysis was done.Results The observation group preoperative 1D, postoperative 1 day, postoperative 5 days and postoperative 8 days, FT3, TT3, rT3,PA level, using the analysis of variance of repeated measurement data, the results showed that： different time points of FT3, TT3,rT3, PA level differences were statistically significant （P〈0.05）.The control group preoperative 1D, postoperative 1 day, postoperative5 days and postoperative 8 days, FT3, TT3, rT3, PA level, using the analysis of variance of repeated measurement data, the resultsshowed that： different time points of FT3, TT3, rT3, no significant difference in PA levels （P〉0.05）. Pearson correlation analysisshowed that the FT3, TT3 and PA levels in the observation group were positively correlated （r=0.473, P〈0.01; r=0.502, P〈0.01） atdifferent time periods, while the rT3 and PA levels were negatively correlated （r=-0.424, P〈0.05）. Conclusion The gastrointestinalcancer patients before the existence of non thyroid disease syndrome, and in a short period after operation can not be fully restored.In addition, parenteral nutrition support in patients with gastrointestinal cancer during the perioperative period of thyroid hormoneand PA levels have obvious changes, can be used as one of the evaluation indexes of patients with perioperative nutritional status.