添加精氨酸的TPN对胃肠癌术后营养和免疫方面的影响

Effect of TPN plus Argining on nutrition status and immune function in radical treatment of gastro-intestinal cancer patients

目的 :评价添加精氨酸 (Arg)的全肠外营养 (TPN)对胃肠癌根治术后病人的营养状况、免疫功能及手术并发症的影响。 方法 :将 88例胃肠道癌根治术后的病人随机分为常规TPN组 (常规组 ) 30例、添加ArgTPN组(Arg组 ) 30例及对照组 2 8例。术后第 1天起常规组与Arg组连续给予TPN支持 7天 ;Arg组则在常规组的基础上再加Arg 80～ 1 0 0ml/d ;对照组给予葡萄糖、复方氨基酸及其电解质溶液 ,后逐步过渡到口服饮食。手术前 1天、术后第 1、8天分别检测血清清蛋白、前清蛋白、转铁蛋白等营养和各种免疫指标 ,并观察病人术后并发症的发生情况。 结果 :术后第 8天 ,在营养指标方面 ,常规组和Arg组病人的前清蛋白与转铁蛋白均出现明显改善 ;在免疫指标方面 ,Arg组IgG、IgE、CD3、CD4、及CD4 /CD8自然杀伤细胞活性 (NKCA)和IL 2浓度均明显高于其他两组 (P <0 .0 5 ) ;Arg组术后感染性并发症的发生率也低于其他两组。 结论 :胃肠道癌根治术后添加Arg的TPN ,不仅能预防和纠正营养状况低下 ,而且能刺激免疫细胞 ,增强免疫应答功能 ,维持正常、适度的免疫反应 ,调控细胞因子的产生和释放 。

Objectives: To evaluate the effect of TPN plus argine on nutrition status, immune function and postoperative complications in radical treatment of gastro intestinal cancer patients. Methods: 88 cases undertaking radical treatment were randomized into TPN group (normal group)(30 cases), argine group (plus argine)(30 cases) and control group (28 cases). Since POD+1, the former two groups were given intravenous nutrition support continuously for 7 days and argine 80～100ml/day in argine group.Controlled group was given glucose, amino acid solution and electrolytes first, then transited to normal oral food intake. On AOD-1 and POD+8, albumin, pre albumin, transferrin and immune parameters were analyzed; postoperative complications were observed as well. Results: On POD+8, pre albumin and transferrin were improved in normal and argine group. In argine group, IgG?IgE?CD3?CD4?CD4/CD8?NKC activity and IL 2 concentration were obviously higher than that in other two groups( P <0.05). The occurrence of postoperative complication in argine group was also lower than that in other two groups. Conclusions: In gastro intestinal cancer patients, TPN plus argine can not only prevent and treat malnutrition, but also stimulate immune cell and improve prognostic outcome.