术后早期肠内免疫营养对老年胰腺癌、胃癌患者免疫的影响

Clinical study of early enteral immunonutrition in senile patients with postoperative pancreatic cancer and gastric cancer

目的 观察术后早期肠内免疫营养对老年胰腺癌、胃癌患者机体免疫功能的影响。方法采用前瞻性、开放性研究,选择20例胰腺癌、40例胃癌患者分别应用免疫营养制剂(士强,荷兰Nutricia公司产品)(n=30)和对照剂能全力(无锡Nutricia公司产品)(n=30)治疗。均于术后第二天开始等热卡肠内营养支持7d(30keal·kg^(-1)·d^(-1))。检测术前、术后第1天、5天、8天的营养及免疫指标。结果 1.两组病例术后免疫球蛋白(IgG、IgM、IgA)下降(P<0.01),肠内营养支持7d,两组病例T细胞亚群无显著改变(P>0.05);试验组IgA较术前提高(P<O.05),对照组IgG下降(P<O.05),IgM显著上升(P<0.01)。两组病例术后血浆IL-6水平上升(P<O.05),1L-10水平降低(P<O.05)。2.术后氮平衡测定肠内营养支持后两组累计氮值为负氮平衡;两组的体重、三角肌皮褶厚度、上臂周径均显著下降(P<0.01);试验组与对照组均出现血清白蛋白、转铁蛋白下降(P<O.05)。结论 老年胰腺癌、胃癌患者手术后免疫抑制主要表现为血清免疫球蛋白浓度下降;术后早期肠内免疫营养支持可改善患者的体液免疫功能,特别是显著提高血清IgA浓度。

Objective To explore the effect of early enteral immunonutrition on immunologic function of senile patients with postoperative pancreatic cancer and gastric cancer. Methods Prospective and randomized clinical trials were conducted in 20 patients with pancreatic cancer and 40 patients with gastric cancer. All the patients were fed enterally (30 kcal · kg-1· d-1) through a nasojejunum tube in the early postoperative period, randomly receiving either the immune-enhancing tonic (Stresson, group Ⅰ , n = 30) or a control formula (Nutrison, group Ⅱ , n=30) for 7 days. Serum total protein (TP), albumin ( Alb), prealbumin (PA), transferrin (TRF), immunoglubolin and CD4, CD8, CD4/CD8 and cytokines (TNF-α, IL-1α, IL-2, IL-6, IL-10) were measured. Results After operation both groups presented lower concentration of immunoglobulin (P<0. 01). During nutritional support, there was no significant difference in CD4, CD8,CD4/CD8 between two groups. Higher concentration of IgA was present in group Ⅰ (P<0. 05), and IgG decreased and IgM increased in group I (P<0. 05). The plasma level of IL-6 increased and that of IL-10 decreased after operation in both groups (P<0. 05). The negative nitrogen balance revealed after EN in both groups. Body weight, triceps skinfold thickness and arm circumference decreased significantly in both groups (P < 0. 01). Serum Alb in both groups and TRF in group Ⅱ decreased (P<0. 05), and TP, TRF in group Ⅰ decreased significantly (P<0. 01). Conclusions Immunosuppression after operation for pancreatic cancer and gastric cancer in elderly patients is represented by lower level of immunoglobulin; early postoperative enteral immunonutrition support could help modify the deficiency, by increasing the concentration of serum IgA in particular.