不同营养支持方式对食管切除术后体液免疫及结局的影响  

Effect of different nutritional support modes on humoral immunity and outcomes after esophagectomy

作　　者：谭太昌[1] 叶长宁[1] 方强[2] 任光国[2] 韩泳涛[2] 彭林[2] 

机构地区：[1]四川省医学科学院四川省人民医院检验科免疫室,成都610072 [2]四川省肿瘤医院胸外科,成都610041

出　　处：《中华临床营养杂志》2011年第6期372-376,共5页Chinese Journal of Clinical Nutrition

摘　　要：目的探讨不同营养支持方式对食管切除术后体液免疫及结局的影响。方法46例行Ivor．Lewis食管切除术的食管鳞癌患者按抽签随机法分为肠内营养（EN）组和肠内＋肠外营养（EN＋PN）组，于术前1d、术后第18小时、术后第3、7天检测血清免疫球蛋白IgG、IgA、IgM、IgE、K和入轻链、补体C3、C4的含量。比较两组围手术期感染相关性并发症及住院时间。结果手术前后各时点两组患者血清中IgG、IgA、IgM、IgE、K和入轻链、补体c3、C4的含量差异均无统计学意义（均P〉0．05）。术后18h、术后第3天EN和EN＋PN组IgG[（8．90±1．75）、（7．53±1．41）g／L和（8．64±2．44）、（7．48±2．16）g／L]、K轻链[（2．14±0．46）、（1．78±0．41）g／L和（2．15±0．63）、（1．86±0．62）g／L]和入轻链[（1．34±0．45）、（1．11±0．31）g／L和（1．20±0．32）、（1．08±0．35）g／L]的含量均较术前1d[（12．15±2．86）和（11．11±2．96）g／L、（2．90±0．77）和（2．77±0．79）g／L、（1．79±0．57）和（1．56±0．41）g／L]明显降低（P=0．000，P=0．000；P=0．004，P=0．000；P=0．000，P=0．000；P=0．011，P=0．000；P=0．004，P=0．000；P=0．008，P=0．000），除EN组患者中K轻链术后第7天[（2．42±0．69）g／L]仍明显低于术前[（2．90±0．77）g／L]（P=0．027）外，其他指标均在术后第7天接近术前水平（均P〉0．05）；在手术前后各时点，两组患者血清中IgA、IgE和C3的含量差异均无统计学意义（均P〉0．05）；EN组患者血清中IgM的含量手术前后各时点差异无统计学意义（P〉0．05），EN＋PN组患者术后第3天[（1．00±0．53）g／L]明显低于术前[（1．47±0．76）s／L]（P=0．031），其余各时点与术前相比差异无统计学意义（均P〉0．05）；EN组患者血清中C4的含量在术后18h[（0．24±0．08）g/L]明显低于术前[（0．37±0．36）g／L]（Objective To explore the effect of different nutritional support mdoes on humoral immunity and outcomes after esophagectomy in patients with esophageal carcinoma. Methods Forty-six patients with middle or low thoracic esophageal carcinoma underwent Ivor Lewis esophagectomy. The patients were randomized into en- teral nutrition group （ EN, n = 23 ） and enteral combined parenteral nutrition group （ EN ＋ PN, n = 23 ） based on the nutrition support modes. Serum levels of immunoglobulin （IgG, IgA, IgM, IgE, κ/λ. light chain） and complements （C3/CA） were assayed and compared on the 1st pre-operative day and at 18 hours as well as 3rd and 7th day after operation. The clinical outcomes including infection-related complications and hospital stay were com- pared between two groups. Results There was no significant difference in all humoral immunity indicators between two groups at the each pest-operative time peinL In beth two groups, the levels of IgG [ （ 8.90 ±1.75 ）, （ 7.53 ± 1.41） g/Land （8.64±2.44）, （7.48 ±2. 16） g/L], K [ （2. 14±0.46）, （1.78 ±0.41） g/L, and （2. 15 ±0.63）, （1.86±0.62） g/L] and k light chain [ （1.34±0.45）, （1.11±0.31） g/Land （1.20±0.32）, （ 1.08 ± 0. 35 ） g/L] were significantly lower 18 hours and 3rd day after operation than the pre-operative levels [ （12. 15 ±2.86） and （11.11±2.96） g/L, （2.90 ±0.77） and （2.77 ±0.79） g/L, （1.79 ±0.57） and （1.56±0.41） g/L] （P=0. 000, P=0. 000, and P=0.004, P=0. 000, and P=0. 000, P=0.000, and P= 0. 011, P = 0. 000, and P = 0. 004, P = 0. 000, and P = 0. 008, P = 0. 000 ）, and returned to the preoperative levels by the postoperative 7th day （P〉0. 05）, except for the level of K light chain 7th day after operation in EN group [ （2.42 ±0. 69） g/L] （P =0. 027）. The levels of IgA, IgE, and C3 were not significantly different during the perioperative period （ P 〉 0. 05 ）. The level of IgM was not significantly different during the perioperative

关 键 词：营养支持 食管切除术 体液免疫 结局 

分 类 号：R735.1[医药卫生—肿瘤]