营养干预对结直肠癌围手术期营养和免疫状况的影响

Effect of Nutritional Intervention on Nutritional and Immune Status of Colorectal Cancer Patients during Perioperative Period

目的研究营养干预对结直肠癌围手术期营养和免疫状况的影响。方法选取2014年1月1日-2016年12月31日于某院接受治疗的100例CRC患者为研究对象,对照组50例给予常规围术期干预措施,观察组50例在对照组基础上给予营养干预,比较2组术前1天与术后1天、术后4天、术后8天、术后15天营养指标、体液免疫指标及细胞免疫指标,并比较术后并发症发生情况。结果 2组术后1天ALB、PA、HGB、TF水平与术前1天比较有显著差异(P<0.05),2组术后4天ALB、PA、HGB、TF水平与术后1天比较差异有统计学意义(P<0.05),观察组术后15天ALB、PA、HGB、TF水平显著高于对照组(P<0.05);2组术后各时期IgG水平、术后1天、术后4天、术后8天ALB、IgM、IgA水平与术前1天比较有显著差异(P<0.05),观察组术后1天、术后4天、术后8天、术后15天IgG(10.76±1.29、11.61±3.06、12.24±2.95、13.39±0.07)、IgM(0.86±0.11、1.05±0.22、1.11±0.31、1.33±0.23)、IgA(1.96±0.27、2.31±0.43、2.47±0.41、2.55±0.32)水平与对照组比较差异均有统计学意义(P<0.05);两组术后1天体液免疫指标CD3+、CD4+水平显著低于术前1天,CD8+水平显著上升,差异有统计学意义(P<0.05),术后15天CD3+(59.25±5.37)、CD4+(59.25±5.37)水平明显高于对照组,CD8+(19.23±3.34)水平则明显低于对照组,差异有统计学意义(P<0.05);观察组总并发症发生率(10%)显著低于对照组(26%),差异有统计学意义(χ^2=4.336,P<0.05)。结论营养干预对CRC围手术期营养不良状况具有良好改善作用,能增强机体免疫状况功能,降低术后并发症发生率,进而提高手术治疗效果。

Objective To investigate the effect of nutritional intervention on nutritional and immune status of colorectal cancer patients during perioperative period.Methods 100 CRC patients in our hospital from January 2014 to December 2016 were selected,and divided into two groups,each with 50 cases.During perioperative period,control group received the routine intervention,while the observation group received the routine intervention combined with nutritional intervention.Then the nutritional index,humoral immune index,cellular immune index,and postoperative complications were observed and compared between groups.Results The levels of ALB,PA,HGB and TF at postoperative 1 d and 4 d showed significant difference with those at preoperative 1 d(P<0.05).The levels of ALB,PA,HGB and TF at postoperative 15 d were higher in the observation group than in the control group(P<0.05).The levels of postoperative IgG,ALB,IgM,and IgA showed significant difference with those at preoperative 1 d(P<0.05).The levels of IgG(10.76±1.29、11.61±3.06、12.24±2.95、13.39±0.07),IgM(0.86±0.11、1.05±0.22、1.11±0.31、1.33±0.23)and IgA(1.96±0.27、2.31±0.43、2.47±0.41、2.55±0.32)in the observation group were significantly different from those in the control group at postoperative1 d,4 d,4 d and 15 d(P<0.05).Compared with the indicators at preoperative 1 d,CD3+and CD4+were decreased in both groups,meanwhile,the CD8+levels were increased in both groups at the postoperative 1 d(P<0.05).At postoperative 15 d,the observation group had higher levels of CD3+(59.25±5.37)and CD4+(33.49±4.06)as well as lower level of CD8+(19.23±3.34)than those of the control group(P<0.05).The incidence rate of the complication in the observation group was lower than that of the control group(10%vs 26%,χ^2=4.336,P<0.05).Conclusions For CRC patients,application of nutritional intervention could improve perioperative malnutrition,enhance the immune function,and reduce the incidence of postoperative complications.