谷氨酰胺强化肠内营养对结肠癌患者术后营养指标、免疫及炎性反应的影响

Effect of glutamate-enhanced enteral nutrition on nutrition,immunity and inflammatory response in patients with colon cancer

目的探讨谷氨酰胺强化肠内营养对结肠癌患者术后营养指标、免疫及炎性反应的影响。方法选取2018年7月至2019年7月间中国人民解放军北部战区空军医院收治的行结肠癌根治手术的104例患者,采用随机数字表法分为观察组和对照组,每组52例。观察组患者术后采用谷氨酰胺强化肠内营养治疗,对照组患者采用常规肠内营养治疗,比较两组患者手术前后前清蛋白、清蛋白、CD4^+、CD8^+、CD4^+/CD8^+、瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)和白细胞介素-6(IL-6)水平。结果重复测量方差分析显示,前清蛋白、清蛋白、CD4^+、CD4^+/CD8^+、TNF-α、CRP和IL-6时间因素及时间因素和治疗方法的交互作用均有统计学意义(均P <0.05)。事后多重比较显示,术后1d和术后7d,观察组患者前清蛋白和清蛋白水平均高于对照组,差异均有统计学意义(均P <0.05)。术后7d,两组患者前清蛋白和清蛋白水平均高于术后1d,对照组均低于术前1d,差异均有统计学意义(均P <0.05)。术后1d和术后7d,观察组患者CD4^+水平均高于对照组,差异均有统计学意义(均P <0.05);术后7d,两组患者CD4^+和CD4^+/CD8^+水平均高于术后1d,对照组患者术后7d的CD4^+低于术前1d,差异均有统计学意义(均P <0.05)。术后7d,观察组患者TNF-α、CRP和IL-6水平均低于对照组,两组患者TNF-α、CRP和IL-6水平均低于术前1d和术后1d,差异均有统计学意义(P <0.05)。结论谷氨酰胺强化肠内营养,可较好改善结肠癌患者的术后营养状态,增强免疫功能,降低炎性反应,值得临床推广。

Objective To investigate the effect of glutamine-enhanced enteral nutrition on postoperative nutritional indexes,immunity and inflammatory response in patients with colon cancer. Methods From July 2018 to July 2019,104 patients undergoing radical resection for colon cancer Air Force Hospital,Northern Theater,People’s Liberation Army were selected. They were randomly assigned to an observation group and a control group using the random digital table method with 52 patients in each group. The levels of prealbumin,albumin,CD4^+,CD8^+,CD4^+/CD8^+,tumor necrosis factor( TNF)-α,C-reactive protein( CRP),and interleukin( IL-6) were compared between the two groups. Results Repeated analysis of variance showed that the interactions between prealbumin,albumin,CD4^+,CD4^+/CD8^+,TNF-α,CRP and IL-6 and time factors and treatment methods were statistically significant( all P < 0. 05). Post hoc multiple comparison test showed that the levels of prealbumin and albumin were significantly higher in the observation group than in the control group at 1 d and 7 day after the operation( all P < 0. 05). The levels of prealbumin and albumin were significantly higher in the observation group and the control group at 1 d after the operation than at 7 d after the operation( all P < 0. 05). In the control group,the levels of prealbumin and albumin were significantly lower at 1 d after the operation than 1 d before the operation( all P < 0. 05). The levels of CD4^+were significantly higher in the observation group than in the control group( P < 0. 05). The levels of CD4^+and CD4^+/CD8^+were higher in both groups at 7 d after the operation than at 1 d after the operation. In the control group,the levels of CD4^+were significantly lower at 1 d after the operation than 1 d before the operation( all P < 0. 05). At 7 d after the operation,the levels of TNF-α,CRP and IL-6 were significantly lower in the observation group than in the control group( all P < 0. 05). The levels of TNF-α,CRP and IL-6 were significantly lower in both groups at 7 d after operation than 1 d before the opepration and 1 d after the operation( all P < 0. 05). Conclusion Glutamine-enhanced enteral nutrition can improved postoperative nutrition indexes,enhance immunity and reduce inflammatory response in patients with colon cancer.