联合营养支持与结直肠癌预后关系的临床研究

Clinical study between combined nutritional support and prognosis of colorectal cancer

摘要:

目的 探讨肠内外联合营养支持与结直肠癌患者预后临床关系。方法 分析肠内外联合营养支持与 结直肠癌患者预后相关营养指标[ 白蛋白（ALB）、转铁蛋白（TF）及前白蛋白（PA）]、临床指标（胃肠功能 恢复时间、平均住院时间、平均治疗费用及术后感染情况与不良反应发生情况）、免疫指标（T 细胞亚群CD3+、 CD4+、CD8+ 及CD4+/CD8+ 比值，血清免疫球蛋白IgA、IgG 及IgM）及疲劳指数的关系。结果 ①肠内营养（EN） + 肠外营养（PN）组营养指标ALB、TF 及PA 值高于EN 组和PN 组（P <0.05）；② EN+PN 组术后住院时 间和术后所需营养费用低于EN 组和PN 组（P <0.05）；EN+PN 组术后第1 次排气时间和第1 次排便时间较 EN 组和PN 组快（P <0.05）；EN+PN 组并发症发生率低于EN 组和PN 组（P <0.05）；③ EN 组、EN+PN 组术后T 细胞亚群CD3+、CD4+ 及CD4+/CD8+ 均高于术前（P <0.05），3 组术后血清免疫球蛋白IgG、IgA 及IgM 水平均高于术前（P <0.05）；④ EN+PN 组疲劳指数较EN 组和PN 组下降（P <0.05）。结论 肠内外 联合营养支持更有利于恢复免疫及肠道功能、减少感染性并发症及改善患者的疲劳指数，值得临床推广应用。

Abstract:

Objective To investigate the clinical efficacy of combined nutrition in colorectal cancer patients undergoing surgery. Methods Patients were divided randomly into enternal nutrition group (EN), parenternal nutrition (PN) group and combination of EN and PN (EN+PN) group. Prognostic indexes including albumin, transferrin, prealbumin, clinical indexes including gastrointestinal functional recovery time, average hospital stay, average cost,immune index including percentage of CD3+, CD4+, CD8+ positive T cells, CD4+/CD8+ ratio, serum immunoglobulin IgA, IgG, IgM, and the fatigue index of the immune system were recorded. Result Patients in EN+PN group had increased levels ofPA, TF and ALB while experienced decreased time of hospital stay, cost, duration of time before first exsufflation and cacation, and incidence of adverse events significantly when compared with EN group or PN group (P < 0.05). Patients in EN+PN group experienced upregulated levels of CD3+, CD4+ and CD4+/CD8+ positive T cells and enhanced serum IgG, IgA and IgM along with decreased fatigue index when compared with that in EN or PN only group (P < 0.05). Conclusions Combination of internal and parenternal nutritional support is beneficial for the restoration of immune and intestinal function, reduces infectious complications and improves the fatigue index of patients.