早期免疫肠内营养对胃癌患者术后免疫状态及预后影响

发布时间：2018-05-02 12:07

本文选题：早期免疫肠内营养 + 全肠外营养　；参考：《郑州大学》2017年硕士论文

【摘要】：背景由于胃肠道恶性肿瘤本身导致的高消耗,慢性失血及胃肠道功能紊乱等诸多因素,营养不良及恶病质在肿瘤患者中很常见。而营养不良及恶病质又是导致癌症患者死亡的主要原因之一。手术治疗是胃肠道恶性肿瘤早中期主要的治疗方式,但手术引起的创伤、应激等因素,又进一步加重了患者营养不良程度,已有研究已经阐明了术后并发症的发病率与肿瘤患者营养不良发病率呈正相关关系。胃肠癌患者术后常伴有营养不良和免疫功能抑制,免疫抑制可增加术后并发症,减缓患者的康复和诱导肿瘤的复发、转移与恶化。所以不难看出,胃肠道癌症患者的临床预后很大程度上受到营养状况的影响。因此,术后加强营养支持以改善患者的免疫功能具有重要的临床意义。目前术后营养支持主要分为肠内营养与肠外营养,但在二者的选择、开始时间以及成分等方面仍存在着疑问。目的本项目拟以即将行胃癌根治手术患者为研究对象,随机分为早期免疫增强型肠内营养组(EEIN)与全肠外营养(TPN)组,比较两组患者术前与肠道营养8天后营养状态,术后并发症,免疫功能,术后30天营养状态,以及无进展生存期,无长期术后并发症生存期的差别。比较出早期免疫增强型肠内营养与完全肠外营养患者术后营养免疫状态、临床预后及生活质量等方面优劣,对于术后患者营养支持方式的选择具有重要的指导意义,为免疫增强型肠内营养的临床应用和推广提供依据。方法将符合入组条件的70例胃癌患者随机分为早期免疫肠内营养组(EEIN组n=35)与全肠外营养组(TPN组n=35)。在术前第1天、术后第8天抽取外周静脉血,检测免疫细胞比例及其表面标志物表达,血清中IL-2、IFN-g、TNF-a、IL-10的表达水平以及临床相关指标包括血红蛋白、血清白蛋白、前白蛋白含量并观察患者术后恢复情况,电话随访生存期。结果EEIN组患者术后8天多数免疫水平指标显著高于TPN组,且炎症水平指标显著低于TPN组,且差异有显著性统计学意义(P0.05)。EEIN组患者术后体重下降、术后首次排气时间和住院天数明显减少,术后第8天TP、ALB、PA、TG,术后30天BMI指数、ALB、PA以及TG水平显著高于TPN组(P0.05),EEIN可显著延长无并发症生存期及术后无进展生存期。结论EEIN可激活胃癌患者免疫功能,改善术后营养状态,有助于患者术后无进展生存期的延长和生活质量的提高。
[Abstract]:Background malnutrition and cachexia are common in cancer patients due to many factors such as high consumption of gastrointestinal malignant tumors, chronic blood loss and gastrointestinal dysfunction. Malnutrition and cachexia are one of the leading causes of cancer deaths. Surgical treatment is the main treatment for gastrointestinal malignant tumors in the early and middle stages. However, the trauma and stress caused by the operation have further aggravated the degree of malnutrition in the patients. Studies have shown a positive correlation between the incidence of postoperative complications and the incidence of malnutrition in cancer patients. Postoperative gastrointestinal cancer patients are often accompanied by malnutrition and immunosuppression, immunosuppression can increase postoperative complications, slow down the recovery of patients and induce tumor recurrence, metastasis and deterioration. Therefore, it is not difficult to see that the prognosis of gastrointestinal cancer patients is largely affected by nutritional status. Therefore, it is of great clinical significance to strengthen nutritional support to improve the immune function of patients after operation. At present, postoperative nutritional support is mainly divided into enteral nutrition and parenteral nutrition, but there are still some questions about their choice, starting time and composition. Objective to divide the patients undergoing radical gastric cancer operation into two groups: early immune-enhanced enteral nutrition group (EEIN) and total parenteral nutrition (TPN) group. The nutritional status and postoperative complications were compared between the two groups before and after 8 days of enteral nutrition. The difference of immune function, nutritional status 30 days after operation, progression free survival and long term postoperative complications. The nutritional immunity status, clinical prognosis and quality of life of patients with early immune-enhanced enteral nutrition and complete parenteral nutrition were compared. To provide the basis for the clinical application and popularization of immune-enhanced enteral nutrition. Methods 70 patients with gastric cancer were randomly divided into early immunized enteral nutrition group and total parenteral nutrition group. Peripheral venous blood was collected on the first day before operation and on the 8th day after operation to detect the proportion of immune cells and the expression of surface markers, the expression of IL-2 IFN-gtTNF-a IL-10 in serum, and the clinical related indexes including hemoglobin and serum albumin. The prealbumin content and postoperative recovery were observed, and the telephone follow-up survival time was observed. Results on the 8th day after operation, most of the immunological indexes in EEIN group were significantly higher than those in TPN group, and the inflammatory index was significantly lower than that in TPN group, and the difference was statistically significant. The first exhaust time and hospital stay were significantly decreased. On the 8th day after operation, the levels of BMI index and TG were significantly higher than those in TPN group (P 0.05). The survival time without complications and the survival time without progression were significantly prolonged. Conclusion EEIN can activate immune function and improve nutritional status of patients with gastric cancer after operation. It is helpful to prolong the progressive survival and improve the quality of life.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.2

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