鱼油脂肪乳与中长链脂肪乳对胃肠道肿瘤患者肠外营养术后细胞免疫及炎症反应的影响

【目的】探讨鱼油脂肪乳与中长链脂肪乳肠外营养对胃肠道肿瘤患者术后细胞免疫及炎症反应的影响。【方法】选取本院2013年10月至2014年10月收治的胃肠道肿瘤术后行肠外营养患者70例，随机分为对照组和观察组，每组各35例。两组患者均接受等氮、等热量的全肠外营养支持：对照组患者术后24h内、7d补充中长链脂肪乳；观察组患者术后24h内、7d补充中长链脂肪乳联合鱼油脂肪乳。检测两组患者术后d。及d8静脉血中T淋巴细胞亚群（CD3、CD4、CD8细胞）百分比及CD4／CD8比值、单核细胞数目、单核细胞人类白细胞DR抗原（HLA_DR）表达百分比、白细胞介素-1β（IL-1β）、白细胞介素-6（IL-6）以及C反应蛋白（C reactive protein，CRP）含量，并统计两组患者术后并发症的发生情况。【结果】术后d1，两组患者细胞免疫功能指标及炎症反应指标相比较，差异无统计学意义（P〉0.05）；术后d8，观察组患者CD3、CD4细胞百分比、CD4／CD8比值、单核细胞数目和HLA-DR表达百分比显著高于对照组，差异具有统计学意义（P〈0．05）；观察组患者IL-18、IL-6以及CRP含量均显著低于对照组，差异具有统计学意义（P〈0.05）；观察组并发症的发生率显著低于对照组，差异具有统计学意义（P〈0.05）。【结论】胃肠道肿瘤患者术后以鱼油脂肪乳营养支持能够提高患者细胞免疫功能，减轻患者术后的炎症反应，降低术后并发症的发生率，值得临床推广应用。

胃肠道间质瘤22例临床分析

目的探讨胃肠道间质瘤(GIST)的临床表现、病理特点及诊断与治疗。方法回顾性分析22例GIST患者的临床资料和病理资料。结果本组22例均经手术治疗。病理诊断良性2例,潜在恶性9例,恶性11例。免疫组化阳性表达率CD34阳性15例(71.4%),CD117阳性13例(61.9%),SMA阳性9例(42.9%),S-100阳性3例(14.3%)。结论GIST缺乏特异性临床表现,术前确诊非常困难,其确诊主要依靠病理组织学检查及免疫组化染色。完整切除肿瘤为治疗GIST的主要方式。

糖预处理对胃肠道肿瘤手术后胰岛素抵抗及免疫功能的影响

目的 探讨糖预处理对胃肠道肿瘤手术后胰岛素抵抗及免疫功能的影响.方法 选取60例择期胃肠道肿瘤手术患者,按随机数字表法分为治疗组和对照组各30例.治疗组术前给予糖预处理及新的禁食水方法,即麻醉前6h禁食2h禁水,麻醉前2h口服含50 g葡萄糖的碳水化合物300 ml;对照组患者按传统方法进行,术前12 h禁食,术前6h禁水.于术前3h、术后第1、3、7天分别抽取患者外周血,定量监测空腹血糖（FBG）、空腹胰岛素（FINS）,采用稳态模型法计算胰岛素抵抗指数（HOMA-IR）评估患者胰岛素抵抗情况,检测细胞免疫功能指标CD3^＋、CD4^＋、CD8^＋及CD4^＋/CD8^＋比值评估患者免疫功能情况.结果 术后第1天两组HOMA-IR明显高于术前,CD4^＋、CD4^＋/CD8^＋比值均低于术前,差异有统计学意义（P＜0.05）;术后第1、3天治疗组HOMA-IR明显低于对照组,CD4^＋、CD4^＋/CD8^＋比值高于对照组,差异有统计学意义（P＜0.05）;术后第7天治疗组HOMA-IR接近术前,差异无统计学意义（P＞0.05）,而对照组仍高于术前,差异有统计学意义（P＜0.05）.术后第7天两组CD4^＋、CD4^＋/CD8^＋比值水平均接近于术前,差异无统计学意义（P＞0.05）.结论 糖预处理可以缩短胃肠道肿瘤手术后胰岛素抵抗的时间,减轻胰岛素抵抗的强度,改善免疫功能,从而有利于患者的康复.

肠内营养与肠外营养对胃肠道肿瘤患者术后化疗营养状况及细胞免疫功能的影响

目的 研究肠内营养对胃肠道肿瘤患者围化疗期营养状况及细胞免疫功能的影响.方法 选取2013年10月至2015年10月确诊且行化疗患者206例分为观察组和对照组,观察组给予肠内营养支持,对照组给予肠外营养,对比两组患者营养及细胞免疫变化.结果 化疗前两组患者营养指标、细胞免疫功能各指标间差异无统计学意义（P＞0.05）;化疗第2天,两组白蛋白和前白蛋白水平比较差异有统计学意义（P＜0.05）,而血清总蛋白及转铁蛋白水平及BMI值比较差异无统计学意义（P＞0.05）,细胞免疫功能指标中CD3＋、CD4＋、CD8＋、CD4＋/CD8＋水平组间比较差异均无统计学意义（P＞0.05）;化疗第7天,两组患者营养指标及细胞免疫功能较化疗第2天相比有所改善,血清总蛋白、白蛋白、前白蛋白和转铁蛋白水平组间比较差异有统计学意义（P＜0.05）,细胞免疫功能指标中CD4＋、CD8＋、CD4＋/CD8＋水平组间比较差异有统计学意义（P＜0.05）,BMI值及CD3＋水平组间比较差异无统计学意义（P＞0.05）.结论 肠内营养可明显改善胃肠道肿瘤患者围化疗期营养状况及细胞免疫功能.

KIT-negative gastrointestinal stromal tumors with a long term follow-up:A new subgroup does exist

AIM： To investigate the incidence of KIT immunohostochemical staining in （GI） stromal tumors （GISTs）, and to analyze the clinical manifestations of the tumors and prognostic indicators. METHODS： We retrospectively analyzed 50 cases of previously diagnosed GISTs. Tissue samples were assessed with KIT （CDl17 antigen）, CD34, SMA, desmin, S-100, NSE, PCNA, Ki-67, and BCL-2 for immunohistochemical study and pathological characteristics were analyzed for prognostic factors. RESULTS： Fifteen tumors （30%） were negative in KIT staining. A significant association was observed between gender （male patients： 14/15） and KIT-negative staining （P = 0.003）.The patients＇s mean age was 56.6 years. Tumors developed in stomach （n = 8）, small intestine （n = 5）, large intestine （n = 1） and oesophagus （n = 1）. The mean tumor size was 5.72 cm. The mitotic count ranged from 0-29/50 HPF （mean： 3.4） and 73% of tumors showed no necrosis. The majority of the tumors （67%） had dual or epithelioid differentiation. Tumors were classified as very low or low risk （n = 7）, intermediate risk （n = 5）, and high risk （n = 3） groups. Twelve （80%） patients were alive without evidence of residual tumor for an average period of 40.25 mo （12-82 too）; three patients developed metastatic disease to the liver and eventually died within 2-12 mo （median survival： 8.6 too）.CONCLUSION： A small subgroup of GISTs fulfils the clinical and morphological criteria of these tumors, and lacks KIT expression. These tumors predominantly developed in the stomach, being dual or epithelioid in morphology, which are classified as low risk tumors and presented a better survival status than KIT-positive tumors. The ability to diagnose GISTs still depends on immunohistochemical staining but the research should extend in gene mutations.

Clinical characteristics and prognostic analysis of gastroenteropancreatic neuroendocrine neoplasm(GEP-NEN)

Objective： The aim of the study was to analyze the clinicopathologic characteristics of gastroenteropancreatic neuroendocrine neoplasm （GEP-NEN） and to explore the prognostic factors for patients and differences of immunohisto- chemical markers between neuroendocrine tumor （NET） and neuroendocrine carcinoma （NEC）. Methods： Retrospective reviews were conducted for the charts of 119 patients with GEP-NEN at the Affiliated Hospital of Qingdao University （China） from August 2003 to December 2013. Kaplan-Meier method was used to do the overall survivals analysis for the patients at different levels of predictive factors. Meanwhile, Cox proportional hazard model was used to select independent risk factors of surJival. Analysis of variance was used to compare the expression of immunohistochemical markers among different patho- logical grades. Results：Among 119 patients, pancreas （45/119, 37.82%） and rectum （33/119, 27.73%） were mostly involved. The onset age of GEP-NEN in female group was younger than that of the male group. There were 13 deaths （10.92%） during 18.9 （0.1-133.4） months follow-up period. Multivariate analysis indicated that neural invasion, gender and pathological grades of NET and NEC were independent risk factors. In neuroendocrine neoplasm （NEN）, Syn expression in G2 was higher than G1 and G3, while CgA showed no significant difference. All markers showed no significant differences between NET and NEC. Conclusion： GEP-NEN may occur at multiple sites of digestive system and lack specific clinical manifestations. Syn expression detected for the prognosis of G1, G2 and G3 tumors have clinical significance. Neural invasion, sex and patho- logical grades were independent prognostic factors for GEP-NEN patients. No significant difference was found in different pathological grades of NET and NEC.