CAJ | 학술논문

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、κ和λ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、κ和λ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]、κ轻链[(2.14±0.46)、(1.78±0.41) g/L和(2.15±0.63)、(1.86±0.62) g/L]和λ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κ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) g/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18 h[(0.24±0.08) g/L]明显低于术前[(0.37±0.36) g/L] (P=0.030),其余各时点与术前比较差异均无统计学意义(均P＞0.05),而EN+ PN组患者手术前后各时点差异均无统计学意义(P＞0.05).两组患者感染相关性并发症发生率和住院时间的差异均无统计学意义(P =0.300,P=0.371).结论 EN和EN+ PN支持方式对食管切除术后体液免疫及结局的影响无差异.两种营养支持方式均不能完全改善术后体液免疫损害,EN方式更经济. 目的探討不同營養支持方式對食管切除術後體液免疫及結跼的影響.方法 46例行Ivor-Lewis食管切除術的食管鱗癌患者按抽籤隨機法分為腸內營養(EN)組和腸內+腸外營養(EN+PN)組,于術前1d、術後第18小時、術後第3、7天檢測血清免疫毬蛋白IgG、IgA、IgM、IgE、κ和λ輕鏈、補體C3、C4的含量.比較兩組圍手術期感染相關性併髮癥及住院時間.結果手術前後各時點兩組患者血清中IgG、IgA、IgM、IgE、κ和λ輕鏈、補體C3、C4的含量差異均無統計學意義(均P＞0.05).術後18h、術後第3天EN和EN+ PN組IgG[(8.90±1.75)、(7.53±1.41) g/L和(8.64±2.44)、(7.48±2.16) g/L]、κ輕鏈[(2.14±0.46)、(1.78±0.41) g/L和(2.15±0.63)、(1.86±0.62) g/L]和λ輕鏈[(1.34±0.45)、(1.11 ±0.31) g/L和(1.20±0.32)、(1.08±0.35) g/L]的含量均較術前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]明顯降低(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組患者中κ輕鏈術後第7天[(2.42±0.69) g/L]仍明顯低于術前[(2.90±0.77) g/L] (P=0.027)外,其他指標均在術後第7天接近術前水平(均P＞0.05)；在手術前後各時點,兩組患者血清中IgA、IgE和C3的含量差異均無統計學意義(均P＞0.05)；EN組患者血清中IgM的含量手術前後各時點差異無統計學意義(P＞0.05),EN+ PN組患者術後第3天[(1.00±0.53) g/L]明顯低于術前[(1.47±0.76) g/L](P =0.031),其餘各時點與術前相比差異無統計學意義(均P＞0.05)；EN組患者血清中C4的含量在術後18 h[(0.24±0.08) g/L]明顯低于術前[(0.37±0.36) g/L] (P=0.030),其餘各時點與術前比較差異均無統計學意義(均P＞0.05),而EN+ PN組患者手術前後各時點差異均無統計學意義(P＞0.05).兩組患者感染相關性併髮癥髮生率和住院時間的差異均無統計學意義(P =0.300,P=0.371).結論 EN和EN+ PN支持方式對食管切除術後體液免疫及結跼的影響無差異.兩種營養支持方式均不能完全改善術後體液免疫損害,EN方式更經濟.
목적 탐토불동영양지지방식대식관절제술후체액면역급결국적영향.방법 46례행Ivor-Lewis식관절제술적식관린암환자안추첨수궤법분위장내영양(EN)조화장내+장외영양(EN+PN)조,우술전1d、술후제18소시、술후제3、7천검측혈청면역구단백IgG、IgA、IgM、IgE、κ화λ경련、보체C3、C4적함량.비교량조위수술기감염상관성병발증급주원시간.결과 수술전후각시점량조환자혈청중IgG、IgA、IgM、IgE、κ화λ경련、보체C3、C4적함량차이균무통계학의의(균P＞0.05).술후18h、술후제3천EN화EN+ PN조IgG[(8.90±1.75)、(7.53±1.41) g/L화(8.64±2.44)、(7.48±2.16) g/L]、κ경련[(2.14±0.46)、(1.78±0.41) g/L화(2.15±0.63)、(1.86±0.62) g/L]화λ경련[(1.34±0.45)、(1.11 ±0.31) g/L화(1.20±0.32)、(1.08±0.35) g/L]적함량균교술전1d[(12.15±2.86)화(11.11±2.96) g/L、(2.90±0.77)화(2.77±0.79) g/L、(1.79±0.57)화(1.56±0.41) g/L]명현강저(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),제EN조환자중κ경련술후제7천[(2.42±0.69) g/L]잉명현저우술전[(2.90±0.77) g/L] (P=0.027)외,기타지표균재술후제7천접근술전수평(균P＞0.05)；재수술전후각시점,량조환자혈청중IgA、IgE화C3적함량차이균무통계학의의(균P＞0.05)；EN조환자혈청중IgM적함량수술전후각시점차이무통계학의의(P＞0.05),EN+ PN조환자술후제3천[(1.00±0.53) g/L]명현저우술전[(1.47±0.76) g/L](P =0.031),기여각시점여술전상비차이무통계학의의(균P＞0.05)；EN조환자혈청중C4적함량재술후18 h[(0.24±0.08) g/L]명현저우술전[(0.37±0.36) g/L] (P=0.030),기여각시점여술전비교차이균무통계학의의(균P＞0.05),이EN+ PN조환자수술전후각시점차이균무통계학의의(P＞0.05).량조환자감염상관성병발증발생솔화주원시간적차이균무통계학의의(P =0.300,P=0.371).결론 EN화EN+ PN지지방식대식관절제술후체액면역급결국적영향무차이.량충영양지지방식균불능완전개선술후체액면역손해,EN방식경경제.
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 enteral 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 comphments (C3/C4) 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 compared between two group s.Results There was no significant difference in all humoral immunity indicators between two groups at the eachpost-operative time point.In both two groups,the levels ofIgG [ (8.90 ± 1.75),(7.53 ±1.41) g/Land (8.64±2.44),(7.48±2.16) g/L],κ [ (2.14±0.46),(1.78±0.41) g/L,and (2.15 ±0.63),( 1.86 ± 0.62) g/L] and λ light chain [ ( 1.34 ± 0.45 ),( 1.11 ± 0.31 ) g/L and ( 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 κ 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 period in EN group (P ＞0.05),and was significantly lower on the 3rd post-operative day [ ( 1.00 ±0.53) g/L] than the pre-operative level [ ( 1.47 ±0.76) g/L] in the EN + PN group (P =0.031 ),and were not significantly different on the other time points (P ＞ 0.05 ).In the EN group,the C4 level was significantly lower at the postoperative 18 hours [ (0.24 ±0.08) g/L] than the pre-operative level [ (0.37 ±0.36) g/L] (P =0.030),and were not significantly different at the other time points ( P ＞ 0.05 ).In the EN + PN group,the C4 level was not significantly different during the perioperative period ( P ＞ 0.05 ).There was no significant difference in the infection-related complications and hospital stay between these two groups ( P =0.300,P =0.371 ).Conclusions The effects of EN or EN + PN on humoral immunity and outcomes after esophagectomy in patients with esophageal carcinoma are not different.Both these two nutritional support modes can not completely alleviate the harm to the humoral immunity.The EN is more cost-effective.