鱼油脂肪乳对直肠癌患者术后免疫功能的影响

Effect of Fish Oil Fat Emulsion on the Immune Function of Patients with Rectal Cancer After the Surgery

目的探讨鱼油脂肪乳在直肠癌患者术后肠外营养支持治疗中的应用价值。方法选取医院2020年4月至7月收治拟行根治手术的直肠癌患者60例,按信封法分为试验组和对照组,各30例。两组患者术后均予短期肠外营养支持治疗,采用常规的营养方案,试验组患者加用10%ω-3鱼油脂肪乳,持续5 d。两组患者术后第1,3,5天凌晨分别抽取肘静脉血,检测细胞免疫功能(外周血淋巴细胞总数,T淋巴细胞亚群CD_3~+,CD_4~+,CD_8~+,CD_4~+/CD_8~+)和体液免疫功能(血清免疫球蛋白Ig A,Ig M,Ig G),以及CD~+_(14)单核细胞表面抗原HLA-DR的表达水平,同时记录患者术后感染性并发症发生情况。结果术后第1天,两组患者细胞及体液免疫功能指标比较,差异无统计学意义(P>0.05);术后第3,5天,两组患者淋巴细胞总数,CD_3~+,CD_4~+水平及CD_4~+/CD_8~+均呈升高趋势,CD_8~+水平呈下降趋势,试验组变化幅度均大于对照组,其组间、时点、组间-时点比较,差异均有统计学意义(P<0.05);连续肠外营养支持治疗5 d后,试验组CD_(14)~+单核细胞表面抗原HLA-DR阳性表达率为(68.10±3.25)%,显著高于对照组的(64.35±3.03)%(P<0.01);试验组术后第5天单核细胞表面抗原HLA-DR阳性表达率相比术后第1天和第3天明显升高(P<0.01),对照组无显著差异(P>0.05);试验组感染性并发症发生率与对照组相当(20.00%比30.00%,χ~2=0.800 0,P=0.371)。结论在直肠癌患者术后的肠外营养方案中合理添加鱼油脂肪乳,有助于改善患者的免疫功能,减少感染性并发症,对预后可能有一定帮助。

Objective To investigate the application value of fish oil fat emulsion in postoperative parenteral nutrition support for patients with rectal cancer.Methods A total of 60 patients with rectal cancer prepared to undergo radical surgery in our hospital from April to July 2020 were selected and divided into the experimental group and the control group according to the envelope method,30cases in each group.The patients in the two groups were treated with short-term parenteral nutrition support after the surgery,and the patients in the control group were given a conventional nutrition scheme,on this basis,the patients in the experimental group were treated with 10%ofω-3 fish oil fat emulsion for 5 d.In the early morning of the first,third and fifth day,the blood samples were collected from the elbow vein of the patients in the two groups to detect the cellular immune function(total number of peripheral blood lymphocytes,T lymphocyte subsets:CD3+,CD4+,CD8+,CD4+/CD8+),humoral immune function(serum immunoglobulin:Ig A,Ig M and Ig G),and the expression level of CD+14monocyte surface antigen-HLA-DR.Meanwhile,the incidence of postoperative infectious complications was recorded.Results On the first day after the surgery,there was no statistically significant difference in the cellular and humoral immune function between the two groups(P>0.05).On the third and fifth day after the surgery,the total lymphocyte count,CD3+,CD4+levels and CD4+/CD8+in the two groups showed an increasing trend,while the CD8+level in the two groups showed a decreasing trend,the change range of the experimental group was more significant than that of the control group,and the differences were statistically significant among groups,time points,and intergroup-time points(P<0.05).After 5 d of parenteral nutrition support,the positive expression rate of CD14+monocyte surface antigen-HLA-DR in the experimental group was(68.10±3.25)%,which was significantly higher than(64.35±3.03)%in the control group(P<0.01).The positive expression rate of monocyte surface antigenHLA-DR in the experimental group on the fifth day after the surgery was significantly higher than that on the first and third day after the surgery(P<0.01),but no difference was found in the control group(P>0.05).The incidence of infectious complications in the experimental group was similar to that in the control group,but the difference was not statistically significant(20.00%vs.30.00%,χ2=0.8000,P=0.371).Conclusion The reasonable addition of fish oil fat emulsion to the postoperative parenteral nutrition program for patients with rectal cancer after the surgery can improve their immune function,reduce infectious complications,and may be helpful to the prognosis.