摘要
目的 :通过手术后早期应用肠内营养 (EN)支持 ,观察免疫营养对老年消化道肿瘤病人的营养和免疫调节作用 ,探讨肠内免疫营养促进病人康复的机制。 方法 :选择 76例老年消化道肿瘤病人 ,分为对照和实验两组 ,其中实验A组用肠内营养混悬液 (士强 ) ;实验B组用整蛋白纤维型肠内营养混悬液 (能全力 ) ;对照组根据肠功能恢复情况给予普通流质。实验组术后第 2天起 ,给予肠内营养 1 2 5 .5 2kJ/(kg·d) ,连续 7天 ,分别检测各项营养和免疫指标 ;用RT PCR法检测各组病人手术前后外周血单个核细胞 (PBMC)、白细胞介素 1 (IL 1α)、IL 2、IL 6、肿瘤坏死因子 (TNF α)mRNA表达水平变化。 结果 :实验组病人体重 (BW )、肱三头肌皮皱厚度 (TSF)、清蛋白 (Alb)和转铁蛋白 (TRF)等营养指标下降量显著减小。实验A组总蛋白 (TP)、TRF更接近术前水平 ,CD4 + 细胞、IgM、IgA显著上升 ;实验B组CD4 + 细胞、IgM上升。实验组外周血PBMC、IL 6、TNF αmRNA上升水平显著降低 ,实验A组IL 1α、IL 2mRNA上升水平低于实验B组。 结论 :老年消化道肿瘤病人术后早期给予免疫营养支持 ,可提高结构蛋白质合成 ,减少促炎症介质mRNA合成 ,可能减轻术后炎症反应的程度 ,改善免疫功能 。
Objectives: To study the effect of early post operative enteral nutrition on nutritional and immune aspects of senile patients with alimentary tumor and discuss its mechanism of improving the patients' recovery. Methods: ① 76 cases were randomly divided into control and experimental groups(A: Stresson; B: Nutrison). The nutritional and immunological determinations made before and after 7 days' enteral nutrition support of 125.52 kJ/(kg·d). ②IL 1α,IL 2,IL 6,TNF α mRNA in peripheral blood monocytes were measured by RT PCR. Results: Compared to control group, the losses of BW, TSF, Alb and TRF in experimental groups were decreased significantly. CD4 + cells, IgM,IL 6 and TNF α mRNA in peripheral blood monocytes were increased significantly. Conclusions: The early post operative enteral immunonutrition in senile patients with alimentary tumor can increase the synthesis of constructive proteins, decrease pro inflammatory cytokines and improve organic immune function. It aids to prevent and treat the systemic inflammatory reactive syndrome.
出处
《肠外与肠内营养》
CAS
2004年第1期3-7,共5页
Parenteral & Enteral Nutrition
基金
上海市卫生局资助项目 (批准号 :0 0 4L0 3 )
