老年食管癌患者术后早期肠内营养对营养状况及免疫功能的影响

摘要

目的 研究早期肠内营养对老年食管贲门癌患者术后营养状况、肠黏膜通透性及免疫功能的影响.方法 2007年6月至2012年12月在我院行食管癌手术患者96例,术后按随机原则及营养支持方法将96例患者分为肠内营养(EN)组50例和肠外营养(PN)组46例.分别对两组患者术后体质量、排气排便时间、平均住院时间、并发症、病死率和手术前、后的肝功能指标进行监测和分析.分别于术后第1、4、7天,采集两组老年食管癌患者的血液,检测外周血浆二胺氧化酶(DAO)活性及D-乳酸水平来评价肠黏膜通透性.采用动态浊度法测定血浆内毒素含量,评价肠内营养对肠黏膜屏障的保护作用.采用ELISA法测定两组患者术后血液炎性细胞因子、免疫球蛋白等含量.结果 术后EN组患者的排气排便时间、平均住院时间、并发症均少于PN组(P＜0.05),而EN组的白蛋白水平高于PN组(P＜0.05).术后第7天,EN组的DAO活性,D-乳酸水平和内毒素含量均低于PN组(P ＜0.05);EN组的IgA、IgG、IgM、CD4的水平均高于PN组(P＜0.05),而IL-2、IL-6和TNF-α均低于PN组(P＜0.05).结论 早期肠内营养可有效改善老年食管癌患者术后及营养状况,通过减少血浆内毒素,保护肠黏膜屏障,并能有效提高患者术后的免疫功能.%Objective To explore the effect of early enteral nutrition(EN) on postoperative nutritional status,intestinal permeability,and immune function in elderly patients with esophageal cancer.Methods A total of 96 patients with esophageal cancer who underwent surgical treatment in our hospital from June 2007 to December 2012 were enrolled in this study.They were divided into enteral nutrition(EN) group (n =50) and parenteral nutrition (PN) group (n =46) based on the nutrition support modes.The body weight,time to first flatus/defecation,average hospital stay,complications and mortality after the surgery as well as the liver function indicators were recorded and analyzed.Peripheral blood samples were collected on the days 1,4,and 7 after surgery.The plasma diamine oxidase(DAO) activity and D-lactate level were determined to assess the intestinal permeability.The plasma endotoxin levels were determined using dynamic turbid metric assay to assess the protective effect of EN on intestinal mucosal barrier.The postoperative blood levels of inflammatory cytokines and immunoglobulins were determined using enzyme-linked immunosorbent assay(ELISA).Results After the surgery,the time to first flatus/defecation,average hospital stay,and complications were significantly less in the EN group than in the PN group(P ＜0.05),whereas the EN group had significantly higher albumin levels than the PN group(P ＜0.05).On the 7th post-operative day,the DAO activity,D-lactate level and endotoxin contents were significantly lower in the EN group than in the PN group(all P ＜ 0.05).In addition the EN group had significantly higher IgA,IgG,IgM,and CD4 levels than the PN group (P ＜ 0.05) but significantly lower IL-2,IL-6,and TNF-α levels(P ＜ 0.05).Conclusion In elderly patients with esophageal cancer,early EN after surgery can effectively improve the nutritional status,protect intestinal mucosal barrier(by reducing plasma endoxins),and enhance the immune function.