精氨酸增强的胃肠外营养在结直肠癌病人中的应用及临床意义

The clinical importance of L-arginine supplemented PN in the patients with colorectal cancer

目的 :探讨精氨酸 (Arg)增强的胃肠外营养 (PN)对结、直肠癌病人术后的免疫功能、蛋白质代谢的影响。方法 :随机选择 4 0例结、直肠癌病人 ,术后分别接受常规PN支持或Arg增强的PN支持 1周 ,观察术前、术后不同时期的免疫功能、氮平衡、并发症及其他指标。 结果 :两组病人入院时均有明显的免疫抑制。TPN +Arg组病人的免疫功能 (CD4 + 、CD4 + /CD8+ 、NK、IL 2R)在术后第 4、7天与TPN组相比有明显改善 (P <0 .0 5 ) ;TPN +Arg组病人在术后第 4天已达到氮平衡 ,与TPN组相比亦有明显差异 (P <0 .0 5 ) ;TPN +Arg组病人术后未出现并发症 ,TPN组 2例病人出现切口并发症。 结论 :精氨酸能改善大肠癌病人术后的免疫功能、蛋白质代谢 ,降低术后并发症的发生率 。

Objectives: To study the effects of L-arginine supplemented PN on the immunofunction and protein metabolism in the patients with colorectal cancer after operation. Methods:Forty patients received either standard PN or PN supplemented with 20 g/d L-arginine for 7 days after colorectal cancer operation.Immunofunction, protein metabolism and complications were observed before and after operation. Results: Two groups had immune suppression before operation. TPN+Arg group had a improved immunofunction with increased CD4 +, CD4 +/CD8 +,NK and IL-2R as compared with standard TPN group at the 4th day and the 7th day after operation(P<0.05). In TPN+Arg group the nitrogen balance become to be positive from the 4th day after operation, while in standard TPN group the nitrogen balance still remained negative. There were no complications in TPN+Arg group after operation, but two in TPN group. Conclusions: Arginine can improve the immunofunction and nitrogen balance,and decrease the incidence of complication in patients with colorectal cancer after operation.