目的 分析结直肠癌围术期营养和免疫状况,为临床应用提供依据.方法 将2014年1月～2016年12月河北北方学院附属第一医院收治的100例直肠癌患者采用随机信封法分为干预组及对照组,每组各50例.对照组采用常规方案干预,干预组采用营养支持方案干预.术前1、7d和术后1、4、8d及15 d检测患者血中分化簇3阳性(CD3+)T细胞、分化簇4阳性(CD4+)T细胞、分化簇8阳性(CD8+)T细胞、免疫球蛋白G(IgG)、免疫球蛋白A(IgA)、免疫球蛋白M(IgM)、血清总蛋白(ALB)、前清蛋白(PA)、血红蛋白(Hb)、转铁蛋白(TF)水平,并统计患者不良反应发生率.结果 与术前1d比较,术后1d两组患者CD3+及CD4+T细胞比例均显著降低,CD8+T细胞比例显著高于术前1d,差异均有统计学意义(P＜ 0.05);术后15 d干预组患者CD3+、CD4+水平显著高于对照组,CD8+显著低于对照组,差异均有统计学意义(P＜0.05).术后1d两组患者血中IgG、IgA及IgM水平均低于术前1d,差异有统计学意义(P＜ 0.05),术后4d两组患者各指标改善程度均明显高于术后1d,差异有统计学意义(P＜0.05),且术后15 d时干预组患者IgG、IgA及IgM水平显著高于对照组,差异有统计学意义(P＜0.05).术后1d时两组患者血中ALB、PA、TF及Hb水平均显著低于术前1 d(P＜ 0.05);术后4d,两组患者各指标明显优于术后1d,差异有统计学意义(P＜0.05),且术后15 d干预组患者血中ALB、PA、TF及Hb水平显著高于对照组,差异有统计学意义(P＜0.05).干预组不良反应总发生率显著低于对照组,差异有统计学意义(P＜0.05).结论 在结直肠癌患者围术期进行营养补充,可有效提高患者营养和免疫状况,降低患者不良反应发生率.%Objective To analyze the perioperative nutritional and immune status of colorectal cancer,and to provide evidence for clinical application.Methods From January 2014 to 2016 December,100 cases of rectal cancer treated in the First Affiliated Hospital of Hebei North University were divided into intervention group and control group with random envelopes,with 50 cases in each group.The control group was treated with routine intervention,and the intervention group was intervened with nutritional support scheme.One d and 7 d before operation,1,4,8 d and 15 d after operation.The levels of CD3+ T cells,CD4+ T cells,CD8+ T cells,IgG,IgA,IgM,ALB,PA,Hb and TF were counted,and the incidence of adverse reactions was statistically analyzed.Results Compared with 1 d before operation,the proportion of CD3+ and CD4+ T cells of the two groups was significantly decreased at 1 d after the operation,and the proportion of CD8+ T cells was significantly higher than that of 1 d before the operation,the differences were statistically significant (P ＜ 0.05).The proportion of CD3+ and CD4+ T cells in the intervention group was significantly higher than those of the control group,and the CD8+ T cells was significantly lower than that of the control group,the differences were statistically significant (P ＜ 0.05).One day after the operation,the levels of IgG,IgA and IgM of the two groups were lower than those 1 d before the operation,and the differences were statistically significant (P ＜ 0.05),4 d after the operation.The level of standard mean improvement of two groups was significantly higher than that of 1 d after operation (P ＜ 0.05),and the level of IgG,IgA and IgM in the blood of the intervention group was significantly higher than that of the control group at 15 d after the operation,and the difference was statistically significant (P ＜ 0.05).The levels of ALB,PA,TF and Hb of the two groups were significantly lower than those of 1 d before the operation,and the difference was significantly lower than the 1 d before the operation,the differences were statistically significant (P ＜ 0.05).Four days after the operation,each index in the two groups were better than 1 d after the operation,the differences were statistically significant (P ＜ 0.05),and the levels of ALB,PA,TF and Hb of the intervention group were significantly higher than those of the control group at 15 d after the operation,and the differences were statistically significant (P ＜ 0.05).The total incidence of reaction was significantly lower than that of the control group,the difference was statistically significant (P ＜ 0.05).Conclusion Nutrition supplementation in the perioperative period of colorectal cancer patients can effectively improve the nutritional and immune status of the patients and reduce the incidence of adverse reactions in patients.
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