早期免疫肠内营养对胃癌患者术后免疫状态和预后的影响

Effect of Early Immune Enteral Nutrition on Postoperative Immune Status and Prognosis in Patients with Gastric Cancer

目的:探讨早期免疫肠内营养对胃癌患者术后免疫状态和预后的影响。方法:选取2015年1月至2017年5月呼和浩特市第一医院收治的拟行胃癌根治术的患者76例,以随机数字表法分为观察组和对照组,每组38例。观察组患者行早期免疫肠内营养,对照组患者行全肠外营养。观察两组患者术前1 d、术后8 d的免疫细胞亚群、免疫球蛋白、营养状态指标[血清总蛋白(TP)、血清前白蛋白(PA)及白蛋白(ALB)]和炎性因子[白细胞介素10(IL-10)、肿瘤坏死因子α(TNF-α)、γ干扰素(IFN-γ)及白细胞介素2(IL-2)]水平,并发症发生情况及1年无进展生存情况。结果:术后8 d,观察组患者CD4^+、CD4^+/CD8^+、自然杀伤细胞及自然杀伤T细胞水平明显高于治疗前及对照组治疗后;免疫球蛋白A、免疫球蛋白M及免疫球蛋白G水平明显高于对照组;TP、PA及ALB水平明显高于对照组;IL-10、TNF-α水平明显低于对照组,IFN-γ、IL-2水平明显高于对照组,上述差异均有统计学意义(P<0.05)。观察组患者术后并发症发生率明显低于对照组,术后1年无进展生存率明显高于对照组,差异均有统计学意义(P<0.05)。结论:早期免疫肠内营养能改善胃癌患者术后的免疫功能和营养状态,减少并发症的发生,提高1年无进展生存率。

OBJECTIVE: To probe into the effect of early immune enteral nutrition on postoperative immune status and prognosis in patients with gastric cancer. METHODS: 76 patients undergoing radical operation for gastric cancer admitted into the First Hospital of Hohhot from Jan. 2015 to May 2017 were selected and divided into obervation group and control group via random number table, with 38 cases in each group. The observation group was given early immune enteral nutrition, while the control group was given total parenteral nutrition. At 1 day before operation and 8 days after, levels of immune cell subset and immune globulin(Ig), indices of nutritional status [serum total protein(TP), pre-albumin(PA) and albumin(ALB)], inflammatory factor levels [interleukin 10(IL-10), tumor necrosis factor α(TNF-α), interferon-γ(IFN-γ) and interleukin 2(IL-2)], incidences of complications and 1-year progression-free survival of both groups were observed. RESULTS: At 8 days after operation, the CD4^+, CD4^+/CD8^+, natural killer cell and natural killer T-cell levels of observation group were significantly higher than those of before treatment and the control group;the IgA, IgM and IgG levels of observation group were significantly higher than those of the control group;the TP, PA and ALB levels of observation group were significantly higher than those of the control group;the IL-10 and TNF-α levels of observation group were significantly lower than those of the control group, the IFN-γ and IL-2 levels were significantly higher than the control group, with statistically significant differences(P<0.05). The incidence of postoperative complications of observation group was significantly lower than that of the control group, and the 1-year progression-free survival was significantly higher than the control group, with statistically significant differences(P<0.05). CONCLUSIONS: Early immune enteral nutrition can improve postoperative immunologic function and nutritional status for patients with gastric cancer, reduce the incidence of complications and improve 1-year progression-free survival rate.