结肠癌根治术围手术期应用ω-3多不饱和脂肪酸的疗效  

Efficacy of perioperative use of ω-3 polyunsaturated fatty acids in colon cancer radical surgery

作　　者：陈晓昌 马家驰[2] 苏河[2] 李渊[2] 蔡辉[2] 郭庆金 赵晓丹[1] 亓建波 CHEN Xiaochang MA Jiachi SU He LI Yuan CAI Hui GUO Qingjin ZHAO Xiaodan QI Jianbo(Graduate School, Ningxia Medical University, Yinchuan 750000, China Department of General Surgery, Gansu Provincial Hospital Lanzhou 730000, China)

机构地区：[1]宁夏医科大学研究生院,宁夏银川750000 [2]甘肃省人民医院普通外科,甘肃兰州730000

出　　处：《中国普通外科杂志》2016年第12期1785-1791,共7页China Journal of General Surgery

基　　金：国家自然科学基金资助项目(81260325)

摘　　要：目的:探讨结肠癌根治术患者围手术期应用ω-3多不饱和脂肪酸(ω-3 PUFAs)的临床应用价值。方法:选择甘肃省人民医院2014年2月—2015年2月行结肠癌根治术的患者97例,随机分为观察组与对照组,观察组围手术期使用ω-3 PUFAs联合常规静脉营养支持,而对照组仅使用常规静脉营养支持。测定手术前后血清营养学指标和肿瘤标记物水平,以及测定手术后各组血清炎症因子及手术标本中免疫调节分子表达。结果:营养支持前两组术前血清营养学指标包括转铁蛋白、前白蛋白、视黄醇结合蛋白、胰岛素样生长因子1、血红蛋白及营养风险指数,肿瘤标记物CEA、CA19-9、CA125、CA74-2表达水平差异均无统计学意义(均P>0.05),但观察组在术前1 d及术后3 d时,上述营养指标均明显优于对照组,而各肿瘤标记物水平均低于对照组(均P<0.05)。术后3 d时,观察组血清炎症促进因子IL-1、IL-6、IL-8、TNF-α含量均明显低于对照组,而炎症抑制因子TGF-β含量明显高于对照组(均P<0.05);观察组瘤组织中促进瘤细胞转移的免疫分子CD44、CD168、CD133水平明显低于对照组,而抑制瘤细胞侵袭和转移的免疫相关分子CD63明显高于对照组(均P<0.05)。结论:结肠癌根治术围手术期应用ω-3 PUFAs可以有效改善患者术后营养状态,减轻术后炎症反应,调节机体免疫力并增强机体抗肿瘤作用。Objective：To investigate the clinical value of perioperative use ofω-3 polyunsaturated fatty acids （ω-3 PUFAs） in patients undergoing radical surgery for colon cancer. Methods：Ninety-seven patients undergoing radical surgery for colon cancer in Gansu Provincial Hospital from February 2014 to February 2015 were selected and randomly designated to observation group and control group. Patients in observation group receivedω-3 PUFAs combined with conventional intravenous nutritional support and control group received conventional intravenous nutritional support only during perioperative period. In these patients, the serum nutrition indicators and tumor markers were detected before and after surgery, andserum inlfammation indicators as well as immune regulatory molecules in the serum and surgical specimens were determined atfer surgery. Results：hTe levels of serum nutrition indicators that included transferrin, prealbumin, retinol conjugated protein, insulin-like growth factor 1, hemoglobin and nutritional risk index, and the tumor markers that included CEA, CA19-9, CA125 and CA74-2 all showed no significant difference between the two groups （all P〉0.05）, but all the nutrition indicator levels were significantly better in observation group than those in control group on preoperative day 1 and postoperative day 3, and all the tumor marker levels in observation group were signiifcantly lower than those in control group （all P〈0.05）. On postoperative day 3, the serum levels of proinflammatory factors that included IL-1, IL-6, IL-8 and TNF-αwere significantly lower and the level of anti-inflammatory factor TGF-βwas signiifcantly higher in observation group than those in control group （all P〈0.05）;the levels of tumor metastasis promoting immune molecules that included CD44, CD168 and CD133 were signiifcantly lower while the tumor metastasis promoting immune molecule CD63 was signiifcantly higher in the tumor tissue in observation group than those in control group （all P〈0.05）. Con

关 键 词：结肠肿瘤 围手术期 多不饱和脂肪酸酰胺类 营养支持 

分 类 号：R735.3[医药卫生—肿瘤]