早期含ω-3多不饱和脂肪酸肠内营养联合静脉补充丙氨酰谷氨酰胺对胃癌根治术后患者炎症反应及免疫功能的作用

Effects of early enteral nutrition containing ω-3 polyunsaturated fatty acids combined with intravenous infusion of alanyl-glutamine on inflammatory response and immune function of postoperative gastric cancer patients

目的探究早期含ω-3多不饱和脂肪酸肠内营养支持治疗联合静脉补充丙氨酰谷氨酰胺对胃癌根治术后患者炎症反应及免疫功能的作用。方法前瞻性纳入2017年10月至2018年12月期间在四川大学华西医院胃肠外科行胃癌根治术的患者110例,随机均分为2组。对照组在术后24 h内开始连续6 d行含ω-3多不饱和脂肪酸肠内营养制剂营养支持,试验组在对照组方案基础上每日静脉补充丙氨酰谷氨酰胺20 g。分别于术前(3 d内),术后第1、3及7天采集清晨外周静脉血,检测炎症指标、免疫指标及营养指标,同时监测记录并发症发生情况、住院时间和住院费用。结果试验组及对照组均有52例患者完成研究,2组各有3例因未能行根治术退出研究。术后第3天2组患者的中性粒细胞百分比(NEUT%)、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)比较,术后第7天2组患者的C反应蛋白(CRP)、降钙素原(PCT)、IL-6和TNF-α比较,差异均有统计学意义,试验组均较低(P<0.05);术后第7天,2组患者的免疫球蛋白G(IGG)、免疫球蛋白A(IGA)、CD3^+T细胞百分比、CD4^+T细胞百分比、血浆总蛋白(TP)、血浆白蛋白(ALB)及前白蛋白(PAB)比较,差异均有统计学意义,试验组均较高(P<0.05)。2组患者术后7 d内的感染性并发症(切口感染、腹腔感染、肺部感染、泌尿系统感染、血液系统感染和吻合口漏)发生率、非感染性并发症(腹泻、腹胀和腹痛)发生率、术后首次肛门排气时间、住院时间及住院费用比较差异均无统计学意义(P>0.05)。结论早期含ω-3多不饱和脂肪酸肠内营养支持治疗联合静脉补充丙氨酰谷氨酰胺有助于减轻胃癌根治术后患者的炎症反应,增强其免疫功能及改善营养状态。

Objective To investigate the effects of early enteral nutrition containing ω-3 polyunsaturated fatty acids combined with intravenous infusion of alanyl-glutamine on inflammatory response and immune function of postoperative gastric cancer patients. Methods A total of 110 patients, accepting radical operation for gastric cancer in West China Hospital of Sichuan University during October 2017 to December 2018, were prospectively incorporated in the study and were randomly divided into 2 groups equally. Patients in the control group were enterally fed with a formula containing ω-3 polyunsaturated fatty acids for 6 consecutive days after surgery. Patients in the experimental group accepted the same enteral feeding but combined with intravenous infusion of alanyl-glutamine(20 g/d). Both enteral feeding and intravenous infusion started within 24 hours after surgery. Peripheral venous blood was gathered within 3 days before surgery and on the morning of the first, third, and seventh postoperative days to detect inflammatory,immunological, and nutritional indexes. Complications, length of hospital stay, and hospital cost were also taken notes.Results Fifty-two patients in the control group and fifty-two patients in the experimental group respectively finished the study. In both groups, 3 patients withdrew from the study for inadequacy of radical operation. Neutrophilic granulocyte percentage, interleukin-6(IL-6) and tumor necrosis factor-alpha(TNF-α) on the third postoperative day, C-reactive protein(CRP), procalcitonin(PCT), IL-6, and TNF-α on the seventh postoperative day, were significantly lower in the experimental group(P<0.05). Immunological indexes including immunoglobulin G(IGG), immunoglobulin A(IGA),percentage of CD3^+ T cells, and percentage of CD4^+ T cells, nutritional markers including total protein(TP), plasma albumin(ALB), and prealbumin(PAB) were significantly higher in the experimental group on the seventh postoperative day(P<0.05). When the study ended, none significant differences of the rates of both infectious complications(wound infection, intra-abdominal infection, pulmonary infection, urinary system infection, blood system infection, and anastomotic fistula) and noninfectious complications(diarrhea, abdominal distension, and abdominal pain) were observed between the two groups(P>0.05). Time of the first anal discharge, length of hospital stay, and hospitalization cost between the two groups were not significantly different neither(P>0.05). Conclusion Early enteral nutrition containing ω-3 polyunsaturated fatty acids combined with intravenous infusion of alanyl-glutamine contributes to reduce inflammatory response and improve immune function and nutrition status of patients with gastric cancer after surgery.