食管癌术后维生素D联合肠内免疫营养对患者免疫功能调节的影响

Effect of vitamin D combined with enteral immune nutrition on immune regulating function in patients with esophageal cancer after operation

目的探讨维生素D联合肠内免疫营养是否能提高食管癌术后患者的免疫功能。方法选择我院普外科2012年11月至2014年11月50例食管癌患者,根据入院顺序进行编号,使用完全随机化分组法将病例分为肠外营养(PN)组(n=12)、维生素D联合肠外营养(Vit D+PN)组(n=13)、肠内免疫+肠外营养(EIN+PN)组(n=12)和维生素D联合肠内免疫,肠外营养(Vit D+EIN+PN)组(n=13)。各组均于术后2 d开始给予肠内免疫营养或全肠外营养,维生素D均在术后马上补充。各组分别在术前1 d、术后4 d及8 d检测血清免疫球蛋白(Ig G、Ig A、Ig M)、外周血T淋巴细胞亚群(CD3+、CD4+、CD8+以及CD4+/CD8+),分析各组是否存在差异。结果 Ig A、CD3+、CD4+、CD8+于术后4 d各组间比较差异均有统计学意义(P<0.01),其中Vit D+EIN+PN组的Ig A、CD3+、CD4+、CD8+分别为(2.48±0.62)g/L、(60.53±4.16)%、(32.89±3.65)%、(30.42±3.71)%,PN组分别为(1.78±0.49)g/L、(55.56±4.73)%、(27.89±2.68)%、(31.72±3.56)%。术后8 d,血清免疫球蛋白及外周血T淋巴细胞亚群各指标各组间比较差异均有显著统计学意义(P<0.01),Vit D+EIN+PN组各免疫指标分别为Ig G:(13.42±3.05)g/L,Ig A:(3.27±0.92)g/L,Ig M:(1.36±0.32)g/L,CD3+:(67.78±6.36)%,CD4+:(37.92±4.50)%,CD8+:(26.86±4.16)%,CD4+/CD8+:(1.48±0.32),在各组中免疫增强效果最为明显。结论维生素D与肠内免疫营养均具有增强免疫之效果,两者联合用于食管癌术后可获得更好效果,减少感染的发生。

Objective To study whether vitamin D combined with enteral immune nutrition could improve the immune function of patients with esophageal cancer after operation. Methods Fifty patients of esophageal cancer in the Department of General Surgery in our hospital from Nov. 2012 to Nov. 2014 were selected as research subjects. The patients were numbered according to the order of admission, and then divided into four groups by completely randomized grouping: parenteral nutrition(PN) group(n=12), vitamin D combined with parenteral nutrition(Vit D + PN) group(n=13), enteral nutrition combined with parenteral nutrition(EIN+PN) group(n=12), vitamin D combined with parenteral and enteral nutrition(Vit D+EIN+PN) group(n=13). Vitamin D was given immediately after the operation, and enteral immune nutrition or parenteral nutrition was applied 2 days after the operation. The immune function related indexes, including serum immunoglobulin(Ig G, Ig A, Ig M) and peripheral blood T lymphocyte subsets(CD3+, CD4+, CD8+and CD4+/CD8+) were detected 4 days and 8 days postoperatively and 1 day preoperatively. Results Ig A, CD3+, CD4+,CD8+on postoperative day 4 showed statistically significant differences between the two groups(P<0.05), with(2.48±0.62) g/L,(60.53±4.16)%,(32.89±3.65)%,(30.42±3.71)% in Vit D+EIN+PN group and(1.78±0.49) g/L,(55.56±4.73)%,(27.89±2.68)%,(31.72±3.56)% in PN group. On postoperative day 8, T lymphocyte subsets and peripheral blood serum immunoglobulin had statistically significant differences between the four groups(P<0.01), with Ig G, Ig A, Ig M, CD3+,CD4+, CD8+, CD4+/CD8+levels of(13.42±3.05) g/L,(3.27±0.92) g/L,(1.36±0.32) g/L,(67.78±6.36)%,(37.92±4.50)%,(26.86±4.16)%,(1.48±0.32) in Vit D+EIN+PN group, which had the most significant enhancing effect of immune function among the four groups. Conclusion Vitamin D and enteral immune nutrition both have enhancing effect on immune function, and the combination of the two can achieve better effects and reduce the incidence of infection after operation in esophageal cancer.