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

摘要

【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24 h内、7 d补充中长链脂肪乳；观察组患者术后24 h内、7 d补充中长链脂肪乳联合鱼油脂肪乳。检测两组患者术后d1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 ＞00．5）；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 ＜00．5）；观察组患者IL‐1β、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 ＜00．5）；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 ＜00．5）。【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。%[Objective]To explore the effects of parenteral nutrition of fish oil fatty acid and MCT/LCT fat emulsion on cel‐lular immunity and inflammatory reaction in patients with gastrointestinal tumors after operation[.Methods]Seventy periopera‐tive patients underwent gastrointestinal tumor operation and parenteral nutrition from October 2013 to October 2014 in our hospital were chosen and randomly divided into control group (35 cases) and observation group (35 cases) .All of patients were treated with equal nitrogen and calories on total parenteral nutrition support :the control group was supplemented with MCT/LCT fat emulsion 24h ,7D after operation;the observation group was supplied with MCT/LCT fat emulsion combined with fish oil fat emulsion 24 h ,7D after operation .The indicators of T lymphocyte subsets (CD3 ,CD4 ,CD8) percentage ,the CD4/CD8 ratio ,the number of monocytes ,HLA‐DR expression percentage ,and concentration of IL‐1β、IL‐6 and CRP of veinal blood of the two groups were detected at first day and the eighth day after operation .[Results]On the first day after operation , the indexes of cellular immune and inflammatory reaction had no statistical difference between two groups ( P >0 0.5) .On the eighth day after operation ,the percentage of T lymphocyte subsets CD3 ,CD4 ,the CD4/CD8 ratio ,the number of monocytes and HLA‐DR expression percentage of the observation group were significantly higher than those of the control group ( P <0 0.5);The content of IL‐β1 ,IL‐6 and CRP in the observation group were significantly lower than those in the control group , the difference was statistically significant ( P <0 0.5);The incidence of complications in the observation group was significantly lower than that of the control group ,the difference was statistically significant ( P <0 0.5)[.Conclusion] Fish oil fatty acid can improve the cellular immune function of post‐operative patients with gastrointestinal tumors ,control the inflammatory re‐sponse ,and reduce the incidence of complications .It is worthy of clinical popularization and application .