老年结直肠癌患者术后早期微生态肠内营养对肠道菌群及免疫功能的影响

Effects of early postoperative enteral nutrition in combination of micro-ecological feed preparations on intestinal flora and immune function in elderly colorectal cancer patients after surgery

目的:研究早期微生态肠内营养对老年结直肠癌患者免疫功能的影响。方法:选取2017年11月至2019年8月于我院就诊的88例老年结直肠癌患者作为研究对象,按照随机数字表法分为两组,每组44例,其中观察组给予微生态制剂联合肠内营养、对照组给予常规肠外营养,比较两组患者肠道菌群指标、细胞免疫功能、体液免疫功能和并发症发生率。结果:术前两组患者各肠道菌群指标差异无统计学意义(均P>0.05);对照组术后双歧杆菌和乳酸杆菌较术前减少,大肠杆菌增加,双歧杆菌与大肠杆菌比值(B/E)值降低;观察组双歧杆菌和乳酸杆菌较术前减少、但比对照组多,大肠杆菌增加、比对照组少,B/E值降低、但比对照组增多(均P<0.05)。术前两组血清炎性因子水平比较差异均无统计学意义(均P>0.05);术后两组患者的白细胞介素-6、C-反应蛋白与肿瘤坏死因子-α均较术前明显升高(均P<0.05),其中观察组术后白细胞介素-6、C-反应蛋白与肿瘤坏死因子-α指标较对照组低(t=4.841、7.247、4.231,均P=0.000);观察组IgG、IgM与IgA指标水平(12.53±1.84)g/L、(1.45±0.22)g/L、(2.28±0.24)g/L,较对照组(11.47±1.92)g/L、(1.33±0.17)g/L、(2.13±0.21)g/L高(t=2.644、2.863、3.120,P=0.010、0.005、0.003);观察组CD3+、CD4+、CD8+与CD4+/CD8+指标(52.84±4.12)%、(34.53±3.51)%、(19.09±2.41)%、(1.68±0.22)%,较对照组(50.43±3.91)%、(30.75±3.62)%、(18.24±0.53)%、(1.43±0.15)%高(t=2.814、4.973、2.285、6.228,P=0.006、0.000、0.025、0.000)。结论:早期微生态制剂联合肠内营养能提高结直肠癌老年患者的手术效果与生活质量,促进病情康复且安全性高。

Objective To investigate effects of early postoperative enteral nutrition in combination of micro-ecological feed preparations on intestinal flora and immune function in elderly colorectal cancer patients after surgery.Methods Eighty-eight elderly colorectal cancer patients treated at our hospital from November 2017 to August 2019 were enrolled in the study.They were randomly divided into two groups(n=44,each):the observation group receiving micro-ecological feed preparations and enteral nutrition,and the control group receiving conventional parenteral nutrition.The intestinal flora index,cellular immune function,humoral immune function and complications were compared between the two groups.Results There was no significant difference in the indices of intestinal flora between the two groups before operation(all P>0.05).In the control group,Bifidobacteria and Lactobacillus decreased,E.coli increased,and B/E value decreased after surgery compared with before surgery(P<0.05).In the observation group,Bifidobacteria and Lactobacillus decreased,E.coli increased and B/E value decreased after surgery compared with before surgery(P<0.05).Compared with the control group,the observation group showed that Bifidobacteria and Lactobacillus increased,E.coli decreased and B/E value increased after surgery(P<0.05).Serum inflammatory factors had no statistically significance difference between the two groups before operation(P>0.05).Levels of interleukin-6,C-reactive protein and tumor necrosis factor-αwere increased in the two groups after surgery compared with before surgery(P<0.05),and the indexes were lower in the observation group than in the control group(t=4.841,7.247 and 4.231,all P=0.000).Levels of IgG,IgM,IgA,CD3+,CD4+,CD8+and the ratio of CD4+and CD8+were higher in the observation group than in the control group[(12.53±1.84)g/L vs.(11.47±1.92)g/L,(1.45±0.22)g/L vs.(1.33±0.17)g/L,(2.28±0.24)g/L vs.(2.13±0.12)g/L,(52.84±4.12)%vs.(50.43±3.91)%,(34.53±3.51)%vs.(30.75±3.62)%,(19.09±2.41)%vs.(18.24±0.53)%and(1.68±0.22)%vs.(1.43±0.15)%,t=2.644,2.863,3.120,2.814,4.973,2.285 and 6.228,P=0.010,0.005,0.003,0.006,0.000,0.025 and 0.000].Conclusions Early micro-ecological feed preparation in combination of enteral nutrition can improve the surgical effect and quality of life and promote disease recovery with a safety in patients with colorectal cancer.