精氨酸增强的肠外营养对大肠癌患者免疫功能的影响  

Effects of arginine-enriched parenteral nutrition on the immune function of patients with colorectal carcinoma

作　　者：贺健[1] 李晴[1] 葛海燕[1] 

机构地区：[1]同济大学附属第十人民医院普外科,上海200072

出　　处：《上海医学》2006年第6期359-362,共4页Shanghai Medical Journal

摘　　要：目的探讨精氨酸(Arg)增强的肠外营养(PN)对大肠癌患者免疫功能及肠黏膜免疫屏障的作用。方法60例大肠癌患者随机分为PN组(30例)和PN+Arg组(30例),分别接受常规PN和PN+ Arg治疗共5d。检测两组治疗前、后外周血CD3^+、CD4^+、CD8^+、IgG、IgM、IgA和用药第5天肠黏膜固有层CD3^+、CD4^+、CD8^+的变化,并观察用药第5天的小肠黏膜绒毛高度、密度。结果与治疗前比较,PN+Arg组治疗后CD3^+值略增加,PN组略降低,两组间及治疗前、后的差异均无显著性(P值均＞0．05)。治疗后PN+Arg组的CD4^+及CD4^+/CD8^+比值显著高于PN组(P值分别＜0．05、0．01),CD8^+显著低于PN组(P＜0．01),而两组治疗前、后的差异均无显著性(P值均＞0．05)。PN组小肠黏膜固有层常规CD4^+、CD4^+/CD8^+显著降低(P值均＜0．01),CD8^+显著增高(P＜0．05)。PN组小肠黏膜绒毛高度降低,密度变稀疏。结论常规PN可削弱大肠癌患者机体免疫功能和肠黏膜的免疫屏障作用,而Arg可预防常规PN削弱机体免疫的作用,对肠黏膜免疫屏障有保护作用。Objectives To investigate the effects of arginine （Arg）-enriched PN and standard PN on the function of immune system and intestinal barrier of patients with large intestinal carcinoma. Methods Sixty larger intestinal cancer patients were divided into standard PN group （n = 30） and PN＋Arg group （n = 30） receiving standard PN or PN＋ Arg for 5 days, respectively. The phenotypic T-lymphocytes （CD3, CD4, CD8 ） in the peripheral blood and lamina propria of small intestine were assayed by using SABC immunocyte chemistry method. The IgG, IgM, IgA in the peripheral blood and the height and density of small intestinal villi were also determined. Results The standard PN group, compared with the PN＋ Arg group, the CD3^＋ cells decreased with no significant difference （P〉 0.05） whereas the CD8^＋ cells increased and the CD4^＋/CD8^＋ ratio decreased. The levels of IgG, IgM, IgA so produced were low in peripherial blood with no statistical significance. In the lamina propria of small intestinal mucosa the height and density of intestinal villi were all decreased. There were significant difference （P 〈 0.05, 0.01 ） between the two groups. Conclusions Standard PN may weaken the body immune function and intestinal barrier. Addition of arginine may raise the protection of body immune function and intestinal mucosal barria produced by routine PN.

关 键 词：肠外营养 精氨酸 免疫 T细胞亚群 免疫球蛋白 大肠癌 

分 类 号：R735.34[医药卫生—肿瘤]